Domestic Violence

Breaking the Silence with Dr Fernando Pisani

Dr Fernando Pisani and the Forensic Medical Unit (FMU) are bringing domestic violence forensics to light in Western Sydney.  His achievements have been highlighted this month by the Australasian College of Emergency Medicine (ACEM)
Dr Pisani is a FACEM working at Blacktown Hospital in Western Sydney
Domestic violence and sexual assault are constantly making headlines in Australia. The work of Rosie Batty, named Australian of the Year in 2015 for her work as a domestic violence campaigner, has helped bring into the mainstream a problem that for many years has been all too familiar to social workers, police and emergency doctors.

The statistics make for pretty grim reading: between 2012 and 2015 there were over 12,000 female assault victims in NSW alone.
In the midst of what is now being described as an epidemic, Dr Fernando Pisani and his colleagues at the Blacktown Forensic Medical Unit (FMU) strive to provide professionalism and compassion. The FMU provides a more thorough injury documentation service than is generally available either at a GP’s surgery or an emergency department, where time pressure is often intense.

By using tools and procedures specifically designed for domestic violence cases, the FMU wants to give victims a pathway towards justice.

“It’s also about giving them a place to tell their story and be heard,” Dr Pisani said.

Dr Pisani never imagined he would end up working with emergency and forensic medicine. If you had asked him 15 years ago what he would have liked to specialise in, he would have mentioned sports medicine! But as luck or accident would have it, during his internship at a hospital in Malta relief staff were needed in the emergency department. He did one shift and the rest was history.

“When I started working in emergency medicine I realized I loved the variety,” Dr Pisani says, “Having to deal with different cases, not knowing what’s coming through the door next, from trauma, to mental health, to paediatrics, the unpredictability of it got me hooked.”

The treatment of sexual assault in the Nepean/Blacktown area has a fragmented history. Male victims were typically seen by the sexual health department and female victims by obstetrics and gynaecology. At a certain point, Dr Pisani says, all sexual assault cases were being transferred to the Westmead emergency department which was problematic for many reasons, not least because it was in a different local health district. It also placed a considerable burden on an already busy and crowded ED.

In 2008 key players in both Nepean Blue Mountains Local Health District and Sydney West Local Health District collaborated to form the Forensic Medical Unit (FMU) at Blacktown Hospital. It was led by staff specialist Dr Maria Nittis, who still heads the unit today.

In 2010 the FMU was expanded to include victims of domestic violence and became the first ever unit of its kind to specifically focus on DV forensics in NSW and one of only a handful of such units in Australia.

“There is no other unit like this that services victims of domestic violence” Dr Pisani says “Very often police collection of forensic medical evidence in these cases was well intentioned but under-resourced. Photos were often taken with phones and by those untrained in forensic photography.  In a sense, these victims were not being served and they were falling through the cracks.”

Dr Pisani says that the impact of professional forensic photos cannot be underestimated, and that police have found there is now a higher instance of guilty convictions once photographic evidence is presented in court, compared to victims having their injuries documented in the ED or by a GP.

Over the last decade Dr Pisani says he has noticed a change in the way we talk about domestic violence and sexual assault. The definition has expanded to include more than just physical assault but also controlling behaviour or verbal abuse, and there have been nationwide conversations spearheaded by high profile figures such as Rosie Batty and programs such as Hitting Home, a two-part 2015 ABC documentary that Dr Pisani and Maria Nittis both appeared in.

“We have noticed that with female victims there was a fair amount of embarrassment and shame, especially for sexual assault,” Dr Pisani says, “Victims used to be hidden away and wouldn’t want to show their faces or give their names. Now, victims don’t hide themselves as much anymore. These assaults are no longer seen as having been their fault, they’re seen as a victim of abuse much the same way as someone who has been in a car crash is seen as a victim of trauma.”

Dr Pisani noted that male victims of domestic violence are still very much a taboo subject. He would like there to be more education available to male victims to show that there’s no shame in them admitting they’re being abused by their partners of any gender.

Domestic violence and sexual assault are pretty challenging subjects to deal with on a daily basis, and Dr Pisani says his work in emergency medicine helps provide a counter-balance to his forensic work. He extends his gratitude to the heads of the departments he works across: DEM Associate Professor Reza Ali and Dr Maria Nittis from the FMU, for their support and encouragement.

“In the ED we get someone in and patch them up and send them on their way,” Dr Pisani says, “Forensics is on the other end of the scale; you can spend three to four hours with one person. Your job is to empower the victim and reassure them that they’re doing something positive in trying to apprehend the offender.”

“It can be very emotionally challenging, but you have to distance yourself from the emotions and deal with what’s in front of you.”

He would also like to encourage doctors in the ED to remember that domestic violence and sexual assault is much more prevalent than many of us realise. If you see a patient whose injuries don’t quite line up with their story, or who seem to be accompanied by someone who is intimidating them, he suggests taking some time to sit down and ask them some questions.

“Ask them, ‘Are you safe? Are you afraid of someone right now?’” he says.

“Typically those questions can trigger a response within the victim, breaking down barriers and helping them realise there are people who can help them and that they can escape their abusive relationship.”

Just like you would ask about ‘Smoking’ or ‘Drinking’ in your social history, always ask about Domestic Violence, or the threat of it in your history taking.
If you or someone you know is experiencing violence and need help or support, please contact 1800 RESPECT (1800 737 732): 24 hour, National Sexual Assault, Family & Domestic Violence Counselling Line for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.