The COVID-19 pandemic has created a time of uncertainty, anxiety and isolation unmatched in living history. This month’s In Print examines two quite different articles which both highlight areas key to the practice of trauma surgeons in these times: awareness of domestic violence and self-care.
The ANZ Journal of Surgery this month published “Addressing domestic violence: the surgeon’s role” in its Professional Skills for Surgeons series (1). In brief, the paper highlights the prevalence of domestic violence; its potential symptoms and signs; and a checklist to assist in assessing the safety of a patient and likelihood that they are exposed to domestic violence(1). Importantly, it also raises the possibility that Fellows of the College could themselves be experiencing domestic violence(1).
Family or domestic violence escalates during pandemic(2)s. A dramatic increase in teen pregnancy rates during the Ebola crisis in West Africa was hypothesised to be due to higher incidence of rape (3, 4). Domestic violence also increased in South America during the Zika outbreak(2). The Executive Director of UN Women, Phumzile Mlambo-Ngcuka, describes domestic violence as the “shadow pandemic” of COVID-19: the result of a combination of increasing isolation, lockdown measures, over-burdened health systems and lack of capacity at domestic violence shelters(5).
While Australia and New Zealand have been relatively isolated from many of the health impacts of COVID-19, the recent announcement that Australia is officially in recession is a reminder that the wider social and economic impacts of this pandemic stretch worldwide. In the aftermath of the 2008 Global Financial Crisis there was a spike in domestic violence that was particularly evident in low income households(2). The current pandemic is a time of great risk for all people, including those who may not previously have been identified as at risk of domestic violence, and trauma surgeons play a potentially pivotal role in identifying and managing people who are impacted by domestic violence.
In this time the fundamental importance of taking care of oneself- and how this is a necessary and absolute step towards then being able to take care of others- cannot be over-stated. An article in the Harvard Business Review in May 2020 is timely: “How Health Care Workers Can Take Care of Themselves”. It emphasises four areas of emotional intelligence that are key in our work: self-awareness, self-management, social awareness, and relationship management (6). Fessell and Goleman remind us that “… self-attention and self-care are essential so that healthcare workers can continue to help and serve”(6). The article is free to view and includes a simple checklist of the four areas of emotional intelligence; questions to ask ourselves; and what steps we might take to address issues.
2. Davies S, Harman S, True J, Wenham C. Why gender matters in the impact and recovery from COVID-19: The Lowy Institute; 2020 [updated 20th March 2020]. Available from: https://www.lowyinstitute.org/the-interpreter/why-gender-matters-impact-and-recovery-covid-19.
3. Parpia A, Ndeffo-Mbah M, Wenzel A, Galvani A. Effects of response to 2014-2015 Ebola outbreak on deaths from Malaria, HIV/AIDS, and tuberculosis, West Africa. Emerging Infectious Diseases. 2016;22(3):433-41.
4. Yasmin S. The Ebola Rape Epidemic No One’s Talking About: Foreign Policy; 2016 [updated 2nd February 2016]. Available from: https://www.lowyinstitute.org/the-interpreter/why-gender-matters-impact-and-recovery-covid-19.Accessed 24th June 2020.
5. Violence against women and girls: the shadow pandemic [press release]. United Nations, 6th April 2020 2020. Available from: https://www.unwomen.org/en/news/stories/2020/4/statement-ed-phumzile-violence-against-women-during-pandemic
6. Fessell D, Goleman D. How Health Care Workers Can Take Care of Themselves. Harvard Business Review. May 2020. Available from: https://hbr.org/2020/05/how-health-care-workers-can-take-care-of-themselves. Accessed 23rd June 2020.