My first public health research position years ago involved gathering injury surveillance statistics in the Emergency Department (ED) of a major metropolitan hospital. My role entailed describing the context of a wide range of injuries: sporting, domestic, industrial, vehicular, dog bite, drowning, to name just a few. The fundamental mechanism of most injuries could be condensed into a string of codes entered into a computer for later aggregation and analysis. Ever the nerd, this was a time when I could rapidly translate any injury into numeric “code-speak” referenced from my coding bible: “Fell on netball court fracturing right radius,” or “Forklift truck severed section of right foot.” I tried to clearly establish the circumstances of these injuries, either from family members or from the patients themselves once they were stabilised, treated, and willing to speak with me. I had the good fortune to be working in an emergency service led by a supportive director with public health qualifications who understood the need for data on which to base injury prevention initiatives. Nevertheless the audible groans emanating from busy ED nursing, medical and reception staff contemplating yet another piece of paper in their extraordinarily busy lives, and their palpable relief when assured this task was entirely my responsibility, became a running joke among us for years.

I was in awe of the calm manner of triage nurses faced with a constant stream of patients: the elderly man assaulted during a theft in a car park; the highly anxious mother holding a three year old bitten in the face by the family dog; the woman pacing in psychotic agitation. The range of possible illness, debility and injury seemed inexhaustible. In this setting emergency service nurses educated me about the appalling extent of domestic violence-related injury in (mostly) women who came through our doors. There were women who had presented to the department on multiple occasions with terrible injuries who cynically considered restraining orders worth little more than the proverbial paper they were written on. Their partners habitually contravened these orders, and police, no matter how well meaning, seemed inadequately resourced to ensure their safety. These nurses did their best to provide support, connecting women with hospital social workers and community agencies. The hospital served a multi-ethnic community of lower socio-economic status. We saw white Russian and Asian women, Cambodians, Latvians, Cypriots, a sample of the broader community, many of whom had very little English and were completely unaware of existing supports.

This initial workplace exposure to the emotional and physical trauma associated with domestic violence occurred over two decades ago; many years later it remains a public health issue of enormous national importance. The recently produced Queensland report “Not Now, Not Ever,”1 for example, suggests that in 2013-14, an alarming 66,016 occurrences of domestic and family violence were reported to Queensland Police, making over 180 incidents of domestic and family violence reported daily. Shockingly, there were 17 homicides relating to domestic and family violence in Queensland in 2012-13. The report cites the often quoted, appalling statistic that on average across Australia, one woman is killed by her partner every week. There are 140 recommendations applicable to a broad range of agencies focusing on the functions and responsibilities of the Queensland Government.

There is no doubt that domestic and family violence is commanding the nation's attention. Australian of the Year, Rosie Batty,2 is an extraordinary woman who has used the murder of her son by his father, an unimaginable grief, to work on behalf of all Australians facing the threat of family violence. Commonwealth and state governments are allocating $30 million towards a public awareness campaign, and Victoria is currently conducting a Royal Commission into family violence.3 

As critically important as these government responses are, they need to be underpinned by a powerful and fundamental cultural shift in our appreciation of the sanctity of human life. This lofty ambition may seem unattainable, but the fact is that we are already seeing changes. It’s wonderful, for instance, to see great sporting champions of our nation endorsing the White Ribbon campaign, or to hear of primary schools where anti-bullying programmes are core curriculum, changing behaviour in both classroom and school yard. Every time a parent teaches a small child to respect his or her playmates they are building a platform for positive adult relationships.

As for adults, the keys to behaviour change are many and diverse. I vividly recall a man I interviewed as part of an evaluation of a community programme aimed at families and children at risk. He ran community groups marketed simply as supportive fathers' groups, a space for blokes to hang together and chat about their role as fathers. Some weeks into the programme, having established a relationship of trust, he began sensitively to broach family dynamics. He was struck by how often the “light-bulb moment” came when men learned that even loud arguments4 with their partners could be psychologically damaging to children. Most acknowledged that physical abuse of partners was harmful to kids, but had never considered that other expressions of anger - screaming, shoving fists into walls, or slamming doors - could leave lifelong scars on their children. One father had broken down in tears on hearing this, explaining it had been his long-held ambition not to put his children through the fearful times he'd experienced with his own father. This revelation consolidated his resolve to get counseling for anger management, and to work hard to improve his relationship with his wife.
All of us have a responsibility to commit to the growing momentum in our country to combat the scourge of domestic and family violence. Imagine working in an ED where there was no domestic violence related injury left to treat.  

References:
Not Now, Not Ever. Putting an End to Domestic and Family Violence in Queensland.    
http://www.qld.gov.au/community/documents/getting-support-health-social-issue/dfv-report-vol1.pdf