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Intrafamilial Violence Service in a General Hospital in Argentina

Ignacio Medina Cisterna, Estela Reyes, Marta Guldris & Sysana Garay
Intrafamilial Violence Team of "Cosme Argerich" General Hospital,
Buenos Aires, Argentina

Introduction

Argentina's condition as a member of the U.N., its adhesion to the Rights of Children Convention and the emergence of political democracy back in 1983, provide the political and philosophical background to consider the problem of intrafamilial violence.

The amendment of Argentina's Constitution in 1994 included in its articles the international agreements and conventions on human rights and children's rights. In January 1995 the first law for the prevention of intrafamilial violence was passed by the congress.

In the mid-80s the first governmental groups were formed to work with child abuse and battered women. The group at our hospital began its work by the end of 1989.

Our team began through the initiative of physicians working in pediatrics who found that services were not being adequately provided for cases of child abuse. They began studying on their own and attended courses sponsored by the government on child abuse.

In order to provide a legal and medical background for the team's work, an intrafamilial violence committee was constituted within the hospital's structure. Since 1992 the team has been coordinated by the psychopathology service.

The team is now part of a large network coordinated and organized by the Mental Health Direction of Buenos Aires City Hall, and attends all cases of intrafamilial violence.

The Hospital

Buenos Aires City Hall's health system has 33 hospitals, three of which are children's hospitals that are pioneering efforts in the area of child abuse and neglect. Cosme Argerich General Hospital, where the authors work, is a hospital for acute patients. It has forty specialized services, including neurosurgery and cardiosurgery.

Geographical Area

The hospital is located in the southern area of Buenos Aires City. It covers four great neighbourhoods: San Telmo, the oldest part of the city; La Boca, on the side of Riachuelo (little river into the city), a place where the first immigrants were installed; Downtown Buenos Aires, the political and financial zone of the city (Argentina's government house is in this area; and Barracus, a place with many "emergency villages" with high poverty.

Characteristics of the Population

Families which demand attention at our hospital are residents of the four neighbourhoods described.

La Boca neighbourhood was established at the beginning of this century by the first immigrants from Europe, mainly Italy and Spain. Today the population here originates in neighbouring countries, such as Uruguay, Bolivia and Peru and from other regions inside Argentina.

Most of the people who come to the hospital don't have social security and belong to a low socio-economic level. This includes a high percentage of unemployed or illegal workers with labor and housing instability. However, middle class families, including employees of government and financial sectors, also use the hospital's services.

The education level of the population varies from people with elementary school education to university graduates.

In San Telmo neighbourhood most people live in low category hotels (very cheap), houses for rent-a room, or in very old and abandoned houses, taken over by the poor. Houses in La Boca neighbourhood are made of zinc and wood. Many families are housed together in one unit.

In all of these buildings the sanitary conditions are deficient. Bathrooms are shared by many families, and in most cases only one room is used as bedroom, kitchen, livingroom, etc. All these features contribute to overcrowding and the threat of sexual abuse.

We also receive emergency placements from other villages, where the entire population lives in poverty. Houses of these families are made of wood and cardboard. In these neighbourhoods live many people from Paraguay or from poorer regions within Argentina.

Generally speaking, families that utilize our services are unstable couples or one-parent families. The above description shows the many risk factors faced by this population; others include alcohol and drug abuse.

Theoretical Background

The theoretical background of our team lies on the so-called "ecological model"; we consider intrafamilial violence from a multi-causal perspective which takes into account individual, familial, social and cultural aspects.

We define intrafamilial violence as "all forms of abuse that take place in the relationships between members of a family". We consider abusive relationships as: "...a behaviour which in any way, physical, emotional, verbal or sexual..., whether by action or omission, causes damage or puts in danger other persons, when this violence is periodical and/or chronic, of increasing intensity within a stable affective relationship frame".

From an interdisciplinary viewpoint we cope with intrafamilial violence on women, children and the elderly.

The Team

Our team is comprised of three psychologists, one social worker, one lawyer and a psychiatrist. As it is included within a general hospital's structure we use interconsultation with other services of the hospital in order to make the necessary evaluations for each case.

Goals of the Team

Our aims are: To assist victims of intrafamilial violence. To attend physical, emotional and social pathologies. To stop the violence cycle. To change violent interaction forms. To protect victims. To give legal counselling and advice to victims. To promote in the community the knowledge and comprehension of this problem. To prevent new cases. To train professionals of the team. To train human resources both inside and outside the hospital. To research specific causes of violence in the hospital's surrounding area.

Modality of Work

According to our way of coping with violence against women, children and the elderly, we propose a model which is flexible enough to encompass the singularity of each case, taking into account its origin, whether it is an emergency, and the relative need for intervention when the critical period of violence is over. We have the following steps:

1. Contention of emergency: in order to protect, if necessary, we hospitalize the victim.

2. Risk evaluation: we consider the severity of the incident; consequences for the victim and the family; severity of damage, physical, emotional and social; chronicity of the situation; sources of family stress; and social and familial contention network.

3. Diagnosis:
   - Physical: Medical examinations, X rays, laboratories, etc.
   - Psychological/psychiatric: individual and/or family interviews.
   - Environmental and social: social history, visiting the home and the neighbourhood

4. Legal aspects of the case: According to the new law for the prevention of familial violence, we are obliged to send the cases to the justice system. With these laws we have the chance to remove the perpetrator from the home of the victims.

5. Strategies meeting: All information collected in all areas is put together in order to determine actions and/or treatments.

6. Therapy: individual, family and/or groups.

7. Following the cases through visits to the home and relatives, with other institutions involved such as schools, church, clubs, etc.

Where the Cases Come From

There are two ways in which cases come to our service:

a)	Within the hospital, from different services: pediatrics, gynecology, children's gynecology, traumatology, social services, other teams in the psychopathology service, emergency guard, etc.
b)	Outside the hospital, including schools, justice system, non-governmental organizations, religious institutions, phone networks, etc.

See the table of demands for our services for the last year of operation in which we have percentages.

Demands for Services

	SEX
DEMANDS (%)	MALE	FEMALE	TOTAL
SPONTANEOUS	4.54	6.81	11.35
SCHOOLS	2.27	2.27	4.54
JUSTICE	4.54	2.27	8.81
WITHIN HOSPITAL	18.18	47.72	65.90
OTHERS	9.09	2.27	11.36
TOTAL	38.63	61.36	100.00

Adults, June 1994 - June 1995
N = 77 Cases

TYPE OF ABUSE	SEX		TOTAL
	MALE	FEMALE
PHYSICAL	18.18	11.26	29.52
EMOTIONAL	15.91	15.91	31.81
SEXUAL	11.36	27.27	38.64
TOTAL	45.45	54.55	100.00

Prevention

Our team's activities in the prevention area include:

a)	Within the hospital. Promoting the knowledge of intrafamilial violence problems to all of the hospital's personnel through workshops, use of a theater group to promote discussion of violence issues, presentations, etc.
b)	Outside the hospital. Related to education and community health areas, we are developing projects in order to cope with intrafamilial violence. We work with elementary and high schools, community centers, churches, etc. Sensitization of this problem is accomplished through workshops, reflexion groups, radio programs and papers.

Training

We provide courses for medical doctors, psychologists, social workers and emergency personnel. We have conducted seminars on subjects related to the specific problems associated with violence, including clinical issues, emotional effects on victims, etc.

We also have completed clinical supervision with well-known people who work in this area.

In addition, we provide assistance to congresses and conferences within the country and abroad.

Research

We are conducting research projects, with the main objective being to identify risk factors among the hospital's patient population. We are also conducting research on therapy for intrafamilial violence. Our research today will help us to develop prevention planning.

For further information, please contact:

Ignacio R. Medina Cisterna
Cosme Argerich General Hospital
Pasco 408 5to A
Buenos Aires 1081
ARGENTINA
Ph: (54-1) 941-2229 Fx: (54-1) 954-0247