Documenting DV

A vital part of supporting the victims of domestic violence is the collection of forensic evidence for use in court. In Australia, there are few experts in the field. Dr Maria Nittis, from Sydney’s western suburbs, is one of them

DOMESTIC violence has never been more prominent on the public agenda than it has been in the past year, thanks largely to the efforts of the 2015 Australian of the Year, Rosie Batty.

While Ms Batty has put a human and relatable face on the issue of family violence, there are other, less visible heroes who have been fighting to improve the lot of victims.

On November 24 and 25 last year the ABC aired a two-part documentary by senior journalist Sarah Ferguson, called Hitting home, which examined how an abusive relationship escalates to violence, and even to murder.1

One part of the documentary highlighted the work of Dr Maria Nittis, a forensic staff specialist working at the Sydney West Area Health Service, documenting the injuries and experiences of the adult victims of sexual assault and domestic violence.

A 1989 graduate from the University of New South Wales, Dr Nittis completed her internship and started practice as a general practitioner in 1992 in Coogee, on Sydney’s eastern beaches.

“I think like a lot of medical graduates I ended up in general practice because I wasn’t really sure what it was a wanted to do”, Dr Nittis tells the MJA.

She moved to Campbelltown on Sydney’s southwestern outskirts and her GP life continued for a decade until one patient changed everything.

“I had a patient who was a sexual assault counsellor, who asked me if I wanted to help out.”

It was in the course of that work that Dr Nittis met the legendary feminist and women’s health activist Dr Patricia Brennan, the first staff specialist in forensic medicine specialising in sexual assault in an emergency department in New South Wales, working at the Royal Prince Alfred Hospital.

“She was incredibly charismatic, and it was then that I realised that there was a potential career for me in this work”, Dr Nittis says.

An opportunity came up to join the Sexual Assault Unit at Liverpool Hospital and she jumped at it.

She also completed a Masters in Forensic Medicine and Legal Medicine, and worked in drug health to help further her knowledge of forensic medicine.

In 2008, she was then offered a job as staff specialist at Sydney West Area Health Service, primarily looking after adult victims of sexual assault. Most of her patients were presenting after hours, which gave her the opportunity to extend the service to help victims of domestic violence, including children.

“This was work that was being done poorly and I saw a real opportunity to make a difference”, Dr Nittis says.

NSW Health has a network of 55 specialist Sexual Assault Services units. Fifty-two of them are run by counsellors, and while some have medical examiners attached to them, none are permanent, full-time positions, with the exception of the two units Dr Nittis runs. Only three are Child Protection Units providing medical and forensic services to victims of sexual and physical abuse and neglect under the age of 18 years and their non-offending family members.

Dr Nittis sees the disfiguring results of violence on women and children every day, but it is not that which can be disheartening for her.

“The patients don’t worry me”, she says. “I approach the patients just as I would any other.

“To be honest, it’s the politics and management systems that run me into the ground sometimes. Domestic violence victims fall through the gaps, and that’s largely because of the way the services are set up in each state.”

There’s no question that more forensic domestic violence units are needed. Doctors and nurses in those units document injuries via photographs and videos, as well as take written notes detailing incidents and timelines. They also provide expert opinion on how those injuries were inflicted, in court cases and hearings.

It’s vital evidence that nobody else has the training to provide.

Dr Nittis is also president of Forensic and Medical Sexual Assault Clinicians Australia.2

Formed in 1998, FAMSACA is the recognised body for those providing medical and nursing sexual assault care (including forensic management) in Australia. It provides professional standards for Australian doctors and nurses providing sexual assault care, particularly in forensic management; and is involved at a political level in the development of sexual assault strategies and policies.

It’s a long, hard, frustrating battle, and Dr Nittis believes there is hope, and more challenges, ahead.

“I certainly think that when the public becomes more aware of domestic violence (and sexual assault) it’s a good thing, and that’s certainly been the case in the last year or so”, she says.

“Getting into the schools is also vital.”

It’s not just about educating boys, however.

“Women are really struggling to know what a healthy relationship looks like”, she says.

“The reality is most people don’t grow up in [happy, conflict-free] households. Yes, we must teach boys about respecting women, but we also need to teach the girls to not accept less than they deserve.

“And that’s not about victim-blaming. It’s about keeping ourselves safe.”

Doctors, Dr Nittis says, are reluctant to ask their patients about domestic violence if they don’t feel they have the resources available to help them.

Campaigns like “Do nothing and you may as well lend a hand” and “Australia says no” may be powerful, but if the infrastructure isn’t there to support women, they are ineffective, she says.3,4

“We have to get those services ready first — document the assaults, provide counselling and the resources so GPs feel confident that when they talk with their patients about domestic violence, the support is there for them”, Dr Nittis says.

“This has to be a multi-agency approach, and it shouldn’t just be left to the Department of Health to finance. The police and the attorney-general’s department should be providing some funding, as well as other departments and agencies.”

Meanwhile, Dr Nittis will continue to do what she does — documenting the injuries and stories of domestic violence in the hopes that what she collects will help put away perpetrators and provide safety to the victims.