A guest blog by Christine Goodall, co-founder of Medics Against Violence
When we founded Medics against Violence (MAV) I remember someone saying to me 'you'll do yourselves out of a job' and I replied 'yes that's the idea' somewhat flippantly but really, that was the idea.
In 2008 I had worked in Maxillofacial Surgery, a speciality dealing with diseases and injuries to the head and neck, for 12 years, had just finished my higher specialist training and got my first consultant job. During those 12 years I saw thousands of facial trauma patients, mostly young men from deprived areas, involved in interpersonal violence, usually while drinking; that's your typical facial trauma patient. Many were quite big characters with colourful language, but some were wee boys, separated from their gang, no longer the big hard man, worried about the wrath of their mother, the prospect of an operation, the involvement of the police, scarred, scared and sore. Being admitted to hospital as an emergency is a great leveller and the 'Badge of Honour' thinge is rarer than you might think. We are really good at patching them up, Scotland has some of the most experienced facial trauma surgeons in the UK, but the trouble is some of them are never the same again because it really is more than just a sore face.
You face is a great thing, the home of all your senses, it is also a fantastic crumple zone, like a series of matchboxes, and the fact that it is, often protects the brain from more serious injury during a fight. But there is something really personal about hitting or slashing someone's face and something really traumatic in more ways than just physical about being on the receiving end.
When I give talks about MAV I always show some photos of patients because no matter whether the audience have inflicted the injury, work in violence prevention or are just interested, most have never really looked at the damage done by violence and many flinch and look away when I show these photos. But this is the reality of life in hospitals and the reality of life for the victims of violence and it's important to see that because these horrific images are what one human being can do to another, and for what? The one thing I can't bring into the room is that smell of blood and alcohol mixed together, it's a really evocative smell and one you never forget if you work in a hospital, the smell of trauma.
Many facial trauma patients require surgery, to fix broken bones most often, and a straightforward operation will cost about £4.5K and take a couple of hours. The other extreme are people who need very extensive surgery and can spend up to eight hours in the operating theatre having all the pieces painstakingly put back together and then often a period of time in intensive care until the swelling goes down, the cost of that, both financial and human, is much more. We fix fractures with titanium plates and screws and even a simple fracture can need two metal plates and up to eight screws, something more complex can require many more.
But that's not the end of it, many facial trauma patients have damage that can't be fully repaired, knife wounds can cut across nerves that work the facial muscles leaving some patients unable to close their eye, smile or move their face normally. Displacement of broken bones can also stretch and sever nerves causing numbness or tingling of parts of the face and lips. Injuries to the eye socket can leave people with double vision or, worse, blindness. Some patients end up with scars across their face that can't be made invisible. The only person who should ever touch someone with a knife is a surgeon; we are the only people who know where to cut in order to leave a hidden scar.
Some of the worst injuries though are psychological. Up to 41% of facial trauma victims will have symptoms of Post Traumatic Stress Disorder (PTSD) six weeks after their injury. Although this improves over time as many as 13% of men and 38% of women still have these symptoms a year after their injury. For many this means they have trouble sleeping, experience flashbacks and are very anxious. The incident that caused their injury and the worry that it might happen again are very real. PTSD stops people functioning normally, it may stop them from working and for some alcohol and drugs are the only way to escape.
Which brings me to women. We don't see female patients that often but when we do they are usually victims of domestic abuse and here's where we fall down - we don't ask often enough, we don't offer reassurance and help because we don't know what to say or do. That's why along with the Violence Reduction Unit we are trying to give as many people as possible the skills to help because we can't let that opportunity slip past. Tackling domestic abuse is everyone's responsibility.
One of my abiding memories is of a female patient I saw while working in Lanarkshire. I never saw her original injury but a year on she had an horrendous scar across her left cheek, the kind of thing you just couldn't miss, still red, wide, something that just looked so out of place on her attractive face. She sat in front of me and sobbed her heart out telling me between her sobs that her partner had held her down and done this to her after a long history of abuse and that she was so ashamed and embarrassed that she never left her house. As far as she was concerned her life was completely ruined and I sat listening, knowing we could never make that scar and the memory of what happened to her completely disappear. I could have cried with her. That is so much more than just a sore face...
Christine Goodall is a Senior Lecturer in Oral Surgery at the University of Glasgow and one of the co-founders of Medics Against Violence, a violence prevention charity established in 2008.
This is where you'll find the latest news and views from the BSC programme and guest blogs from those involved in making Scotland safer and stronger.