1 Jūratė Rimkuvienė STATISTICAL DATA ABOUT THE TRAUMAS SUFFERED BY WOMEN: THEIR TREATMENT IN THE MAXILLO FACIAL SURGERY DEPARTMENT During 18 months of a period between 1996 until the first half of the year in 1997, 904 persons were treated for traumas, at the Maxilla Facial Surgery Department of Vilnius University Žalgiris Hospital. Out of this number, 89 had been involved in road accidents. The other 815 were caused by domestic violence, whereby wives, girl- friends and mothers were beaten up by strangers with the aim being robbery or by drunken husbands. 163 of these cases involved women. In 70 of these cases women were seriously abused by a spouse or a boy-friend during a domestic dispute of an unknown cause. During these 18 months period there were 3 cases, whereby sons had beaten up their mothers and one case when a woman was injured by her nephew. The tables presented below details the results of the survey, and examines the circumstances of women who suffered traumas and were treated in the Maxilla Facial surgery department. This includes their age, social status, degree and gravity of the injury, treatment and duration. No clear causes have been established of traumas sustained during domestic disputes. Women themselves are very unwilling to disclose information about the abuse, in particular about the identity of the perpetrator. Sometimes they suppress the circumstances of traumas and refuse totally to explain them (the circumstances of 16 traumas are not clear). There have been cases whereby women say they have suffered due to their own carelessness, although upon examination the doctors had established that the injury could only have been inflicted by another person (Table 1). Table 1 Groups of persons who inflicted bodily injuries Number of cases No. Groups of persons 1st half of 2nd half 1st half of Tota 1996 of 1996 1997 l 1. Strangers who inflicted physical 14 14 15 43 abuse with the aim of robbery 2. Spouses who inflicted physical 23 24 23 70 abuse on another persons during a family conflict 3. Children who inflicted physical 2 1 1 4 abuse during a family conflict 4. Women who suffered injuries 7 5 18 30 due to their own recklessness 5. Reasons not clear 5 3 8 16 2 In most case of domestic violence in the family, the women were usually aged between 26 to 40, the most able-bodied age. Table 2 Women Victims of Domestic Violence, by age groups No. Age groups Women Victims of Women Victims of Violence Domestic Violence by a by Strangers close relative/friend 1. 18 — 20 6 6 2. 21 — 25 8 5 3. 26 — 30 14 4 4. 31 — 35 16 8 5. 36 —40 18 8 6. 41 — ... 12 12 Sometimes face injuries are multiple in nature. There can be fractures and concussions at the same time, or bone fractures and traumas on the brain. One woman who was physically abused during a robbery on the street was treated for the fracture of the upper and the lower jaws, a deep concussion on the face and a brain contusion (Table 3). Table 3 Diagnosis of traumas No. Diagnosis Number of traumas Number of traumas inflicted by a close inflicted by a stranger person 1. One-sided fracture of the 38 14 lower jaw 2. Two-sided fracture of the 11 10 lower jaw 3. Fracture of the cheek-bone 9 8 4. Fracture of the upper jaw 2 5 5. Contusions to the face 6 7 6. Wounds 13 10 7. Injury of the brain 2 4 Other tables contain the data about women who were abused in the family. During interviews of women who are victims of domestic violence, in which their husbands were the main perpetrator it appeared that 44 victims of 70 were of the most able-bodied, although the social status of most of them can be described as that of housewives (Table 4). 3 Table 4 Women suffering domestic violence, by occupation No. Occupation Number of cases 1. Unemployed 44 2. Medical profession (sister, nurse and disinfection attendant) 7 3. Service Trade (hairdresser, dressmaker, barwoman, etc.) 9 4. Worker 4 5. Mothers (raising young children) 3 6. Retired 3 Table 5 Addictive habits of women suffering domestic violence No. Habit Number of cases 1. Smoking 38 2. Moderate use of alcohol 22 3. Frequent use of alcohol 10 In most cases women do not seek medical advice immediately after sustaining a trauma, but a few days later. By then the inflammation is already in process, therefore, apart from surgical treatment, it also requires an expensive antibiotic treatment. In addition, the treatment and recovery takes longer. In the event of fractures of the lower jaw, the acute inflammation may turn into a chronic, recurring one. The treatment itself and its timing affects the woman’s physical and mental state. Splints fixed on both jaws with an inter-jaw fixation changes the woman’s habits, the rhythm of her life and way of taking food for three to four weeks. Not to mention the complications when the victim reports to a medical institution far too late. Suppurative inflammation of the bone and face tissue begins and external incisions become unavoidable. After these traumas, the woman needs both moral and physical rehabilitation (tables 6,7, and 8). Table 6 Treatment No. Treatment Number of cases 1. Splints 40 2. Surgical treatment of the lower jaw 5 3. Surgical treatment of the cheek-bone fracture 9 4. Surgical dressing of wounds 13 5. Surgical interventions in complications 12 6. Medicinal treatment with antibiotics 30 4 Table 7 Duration of in-patient treatment No. Number of days Number of cases 1. 1—5 8 2. 6 — 10 27 3. 11 — 15 24 4. 16 — 20 8 5. 21 — 25 3 Table 8 Degree of gravity of bodily injury No. Degree of gravity Diagnosis of bodily injury Number of of bodily injury cases 1. Light One-sided fracture of the lower jaw Wounds Contusions to the face 57 Fracture of the upper jaw Fracture of the cheek-bone 2. Medium Two-sided fracture of the lower jaw 13 Concussion of the brain CONCLUSIONS 1. 42.9% of domestic violence traumas for which women were treated at Vilnius University Žalgiris Hospital were inflicted during family disputes between spouses, or a mother and a child. 2. Ten women injured by a spouse were in a state of intoxication. We cannot say anything about the state of the women, because they sought medical advise on the next day or even after several days after the injuries. 3. 62.85 % of women who were victims of domestic violence were unemployed. 4. 54 % of victims are smokers, 31% take alcohol moderately and 14.3 % regularly. 5. The lower jaw is the area injured most often. Fractures of the lower jaw comprised 55.7 % of all the traumas. 6. Usually women receive 7 to 14 days in-patient treatment for these traumas, while the longest in-patient treatment lasted 23 days (1 case). 7. In the Maxilla Facial Surgery Department of Vilnius University Žalgiris Hospital, one-day treatment for trauma costs 55 Litas (4Lt = 1USD). On average, one woman is treated for 7 to 14 days. This makes the total costs upto 385 to 770 Litas. During this 18 months period, around 56 thousand Litas was spent on average on the treatment of women who suffered abuse in the family. After in-patient 5 treatment women receive further out-patient treatment for 10 to 14 days. Unfortunately, it is impossible to calculate the costs of sick leave of working women due to their further out-patient treatment.