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Only in the past month has Dr. Maureen ``Mo'' Longworth been able to ask patients if they were being beaten or molested.
After all, these are private topics - perhaps even more private than sex.
``It took me a while to feel comfortable asking, to develop ways to say things without seeming to pry,'' Longworth said Friday afternoon, as Bartlett Regional Hospital formally began its participation in a 10-state domestic violence and sexual assault awareness program.
Longworth, a family practitioner with the Southeast Alaska Regional Health Consortium for seven years, is a member of the hospital's Domestic Violence Task Force. That makes her part of a nationwide awareness initiative that aims to get domestic violence out of the closet and under the microscope of compassion, medicine and law.
When a physician has only 10 or 15 minutes with a patient, it's hard to fit in the old questions - let alone new ones about violence, Longworth said. ``But my goal is 100 percent, and I am sure trying,'' she said. ``And often I find the patient is so willing'' to discuss this topic.
The willingness has made her realize how necessary it is to diagnose patients suffering from violence - that violence, whether physical or psychological, is a component of health. Since she began asking, Longworth has uncovered two or three patients a day who have suffered or are now suffering from domestic violence or sexual assault.
Speakers at Friday's awareness presentation at the hospital alternated with clips from a video called ``The War at Home,'' in which women told their stories. One woman had only two places to fix her gaze while taking a drive with her husband: on the vehicle floor or on his face.
``If I looked at a man out the window, that might be a man I wanted to have sex with,'' she said.
The video also presented statistics that set the audience squirming:
In the United States, a man beats a woman every 12 seconds.
Ninety-nine percent of the victims of domestic violence are women.
A woman is in nine times more danger in her home than on the street.
Caren Robinson, a former AWARE director and state representative, set the tone of Friday's program by quoting Alice Walker's ``The Color Purple'': ``You better not tell nobody but God.''
Lt. Gov. Fran Ulmer appeared by video, noting that Alaska rape rates are 2.2 times greater than the national average and that Alaska has held the unsavory distinction of being fifth in the nation in rapes since 1976.
``Statistics remind us that there are people in our communities that are in pain, in danger and in constant fear,'' Ulmer said.
She also forged a link between domestic violence and difficulties in education: ``If a young boy has huddled in his bed all night listening to the violence in the next room, listening to his father beat up his mother, how can he pay attention to the ABC's?'' she asked rhetorically.
Dr. Peter Nakamura, director of the State Division of Public Health, urged medical workers to look for signs of violence beyond the emergency room.
He noted chronic headache, chronic pain, even bowel disorders could be signs. ``Social disruptive behavior is even more common'' as a signifier, Nakamura said. ``Half of the kids who attempt suicide have been experiencing domestic violence.''
Selina Everson, a member of the executive committee of the Alaska Native Sisterhood, said domestic violence is ``rampant in villages, and that ANS ``would like to make a difference - even to one child.''
Some stories made the audience wince, like the one about the emergency room doctor who told his patient, ``The next time (your husband) takes a swing at you, duck.'' Or the one about the Juneau woman afraid to go to the emergency room because she might encounter friends of her husband, her batterer, who was a volunteer firefighter. And they might tell.
The point, said Tricia Gentle, director of the Council on Domestic Violence and Sexual Assault, is that we need to create ``a broader safety net for victims as a whole.''
The Bartlett task force, said Laura Stats, a registered nurse and task force director, is focusing on a missed opportunity - the ``missed opportunity when a women goes for medical help. We have been missing an opportunity to intervene and help the victim out of the situation which impacts both her mental and her physical health, and the health and well-being of her children, and those effects bleed out into our society.''
The task force plans to create universal screening for all patients over 16, Stats said. Fourteen sites in Alaska have been chosen, and a team from each site began training last April. Those teams are now implementing action in their respective communities.
``We need to remember,'' said Robinson, ``that the ultimate outcome of domestic violence is death.''
Dr. Jim Thompson, a Bartlett emergency room physician, noted that in medical school he never had formal training in domestic violence. He knew about it only because classmates were researching it.
The difference now is Bartlett is implementing a protocol, said Stats: ``All people are entitled to live free from violence or threat of violence from present and past partners.''