Sometimes the real injury is one you can’t see

Teaching health-care providers to spot evidence of abuse should be standard curriculum

There is an important and innovative art exhibit at the McMaster Museum of Art running through to March 19. It’s called “Picturing Wellness: From Adversity to Resilience” and it looks at the role of visual literacy in the health sciences. When I talk health sciences, I include every profession that engages in the provision of health services, from social workers to doctors, and especially the front-line care providers working with vulnerable populations. I cast a wide net.

The exhibit has two parts. The first part is comprised of a series of six works by Canadian artists. The pieces are accompanied by a reflection of a health-care provider sharing their engagement with the art. Part two looks at the broader question of museums and social engagement and asks us to consider in a larger context issues related to “trauma, the body, memory, history, medicine and the museum” to quote the museum pamphlet. The artists represented share a history of personal trauma, which is evident in their work.

At the core of the exhibit are the concepts of adversity and resilience within the con- text of child maltreatment, particularly child sexual abuse, the “last taboo,” in the words of co-curator Dr. Christine Wekerle, an associate professor in the department of pediatrics. The exhibit is part of a larger Canadian Institute of Health Research project on boys’ and men’s health, areas of interest underexplored when we consider how gender impacts health.

Often when we view art we have to make sense of something that seemingly hasn’t any. Certainly that’s the case with non-realist forms of artistic expression. What the heck is that supposed to be? You can almost hear people thinking that as they cock their heads in contemplation. It’s not unlike what health-care providers think when they confront a condition that doesn’t make sense or when a story offered to explain bruising or broken bones doesn’t ring true.

Identifying instances of child abuse is a difficult area of practice complicated by uncertainty and emotion and often goes against the wishes of the parents. And yet health-care providers are perfectly positioned to identify cases of child abuse if they know what they’re looking for. According to U.S. statistics, one in six children had a prior disability or chronic illness before a finding of child abuse (one in three from autopsy evidence).

According to the Canadian Incidence Study of Reported Child Abuse and Neglect (2008), 48 per cent of cases had previous investigations; 58 per cent had multiple substantiated incidents within maltreatment type or pattern; 18 per cent had multiple substantiated types of maltreatment and yet only 10 per cent were reported by health-care professionals. That seems low to me and makes me wonder why this might be. So I asked Dr. Wekerle.

In Canada, there is no national evidencebased curriculum that teaches health-care providers about child maltreatment, across all health sciences disciplines. Which isn’t to say there isn’t expert training, but even in the pediatric formal curriculum, issues of child abuse are elective and offered on an informal, as-you’re-interested basis. This should be unacceptable in any society that values children.

Child maltreatment is a huge issue, not only in Canada, but internationally. The ramifications of childhood sexual and physical abuse last a lifetime; its effects are felt on the individual, on the family and in the larger community. Despite the difficulty of looking, health-care professionals have an obligation to not look away, to question — like one would interrogate a piece of art — what they see, or maybe more importantly, what they don’t see. Developing visual literacy skills can help in this regard.

There’s one last bit of information I want to leave with you, a tidbit that for me, hit home viscerally.

I have a beautiful little grandson. He’s just about to turn four. He’s so full of wonder and curiosity. You forget, or rather, I forgot, how long it takes for kids to develop verbal skills as they move from single words to choppy sentences to non-stop talking.

According to U.S. statistics, the average age at which girls are investigated for sexual assault is 14. For boys, it’s four. When I heard that, the laughing f ace of my little buddy flashed through my mind and I imagined how difficult it would be for him to communicate to anyone that something was wrong during the first four years of his life.

They need help, these little kids. Healthcare providers can give them that help, if they know what to look for.

Despite the difficulty of looking, health-care professionals have an obligation to not look away.