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DON’T WAIT UNTIL YOU ARE CERTAIN?

01 Aug

HEADLINES today
Mariusz Krezolek, was found guilty of the “callous and wretched” murder of Daniel Pelka along with Magdelena Luczak.

Sadly another child dies after heinous child abuse and yet again questions are being asked as to where were social services and the school in not reporting suspicious signs.
I am afraid it makes me recall two particular distressing experiences I have had as a doctor and revealing no identity I want to share them in this blog. But if you don’t want to read further please read the next paragraph:-

Would you report something to the local authority or the NSPCC if you noticed something suspicious?

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NSPCC website
http://www.nspcc.org.uk/help-and-advice/enquiries/frequently-asked-questions_wda83770.html#abuse
Local Authority
http://www.ealing.gov.uk/info/200017/children_and_families/169/child_protection_and_safeguarding
It is everyone’s responsibility to bring to attention any suspicions of any form of child abuse be it physical,emotional, sexual abuse or in intentional neglect.
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If as child you need someone to talk to, most children have access to a computer or mobile phone and you will be taken seriously.
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Approximately 50,500 children in the UK are known to be at risk of abuse right now.
One in four young adults (25.3%) were severely maltreated during childhood.
Startlingly, even if a person reports a concern many of these people have waited one month.

When Dr John Caffey, a reputable paediatric radiologist wrote an article pub- lished in 1946 describing six young children with subdural hematomas and fractures of the legs or arms and made a suggestion that these injuries could be a sign of child abuse it was dismissed and ignored. Nobody could comprehend that an adult could intentionally harm a child and he was looked upon scornfully.
However, a stream of physicians drew attention to the abusive origin to some of these injuries but it wasn’t until 1962 that the publication of the blockbuster article “The Battered-Child Syndrome” by pediatrician Henry Kempe and his col- leagues. Kempe played a leading role in bringing child abuse to national attention during the 1960s and 1970s.

When I trained, child abuse was only mentioned and signs of detection were not formally taught. I started as a paediatric junior doctor in 1978/9 and my way of learning was at that time.
Several babies and children were admitted with suspicious injuries but only in one case was court action taken. Onevbaby was admitted at least 3 times and always the parents had some explanation but it did not tie in with the injuries. The baby was investigated for any possible medical reason- these investigations in themselves often not pleasant. I remember the Local authority lawyer turning up to question doctors; he was elderly, vague and dressed like a farmer in contrast to the parent’s lawyer who was young, bright and slickly dressed. We all despaired we didn’t stand a chance of proving the case. Ironically, the baby was admitted again and for some reason the father broke down and admitted exactly what happened.
It was not long after this when the consultant discussed with us child abuse and what to look out for that I was able to involved directly with the worse case I have ever witnessed. This remains indelible of my mind and will rest with me forever.
I was called to A&E to see a child who had ‘fallen downstairs’.
When I entered the cubicle I was in the process of examining a child who was seriously ill, infact dying and as I proceeded to look over her she gasped her last breath. I shall never forget her pale complexion, her soft flaxen hair and the look on her face – a beautiful young child only 3 years of age.
My registrar who was present immediately called the Police surgeon, who I knew well as he was a GP who worked in the practise where I had done my placement. When he realised this was a clear cut case of physical abuse he immediately called the Coroner but in passing told me that although I would be off duty and this would not be a pleasant experience that I should attend the Post-Mortem. It was not long before the Coroner arrived clad in formal evening dinner dress and even wearing a black cloak then he was followed by the the pathologist. There was an eerie silence as the men, who had only a short time ago been laughing and happily merrymaking were now stunned to silence with what lay before their eyes. I was introduced to the Coroner who briefly acknowledged my presence and I sheepishly took my place against the wall to observe the proceedings. These men beavered away carefully examining the small child and recording everything fastidiously. Laurence( the Police Surgeon) whispered asides to let me know the significance of every sign and I remained speechless. I didn’t write anything down as the pictures would be stored in my internal photoshop indefinitely.

Incredibly, this case never reached the Local let alone the National newspapers or the media probably because it was still considered inconceivable and I have no idea whether there was a prosecution I am doubtful. I like many others were part of the denial despite seeing and feeling the evidence. I recall it with great feeling and deep sadness.

When I was a student I helped on a voluntary basis in a local children’s home and remember how I went before the ‘matron’ to air my concerns about potential abuse. She was horrified and dismissed me and told me never to return.This was my experience of being ignored and dismissed out of hand and no comparison to the many thousands of witnesses and victims ignored by those they addressed with worries or claims. I realised how this horrendous problem can be concealed and how people knowingly or unknowingly keep it hidden.

It was in 2006/7 when I was working with the Atos as an EMP(Examining Medical Physician) in Bromyard avenue examing claimants who had been off sick for a prolonged period and were claiming, at that time ‘Sickness Benefit’. A lean gentleman in his late 50’s was the next customer (as they were called) entered and I routinely asked him why he was off sick. He then proceeded to explain that he had been in prison for most of his adult life. Infact, when he entered the army as a young man he had been sent to Military prison for assault but when he had been summoned to his officer to explain himself had tipped the table against him pinning him to the wall. Following this he was dismissed from the army sent to Wormwood Scrubs category B men’s prison. This was the story of his life in and out of prison and hating any form of authority. He was therefore unemployable but now he had a malignant cancer. As I listened I could feel the tangible emotion of despair and frustration and self hate but in no way did I feel threatened or intimidated.
I then asked him ‘what do you enjoy doing most?’ Simply as a way of attempting to complete the medical and understand what he could do. His reply was quite a surprise and tears welled up in my eyes when he replied in a calm genle manner looking up to the ceiling, ‘sitting peacefully alone in the Park watching he birds’ Somehow, I had pressed a button and he then began to tell me his life story totally without punctuation. He related how he was brought up on a farm in Ireland and had been sent away to school (a school run by the infamous Christian Brothers) then relating how they serially physically and sexually abused the boys on entry to the school and persistently afterwards. As he told the story he became that small child again flinching visibly as he described how he was whipped repeatedly. He acted as if it was happening at that moment and then started peering out of the window describing the horrors of physical and sexual abuse he had witnessed those many years ago. He told me how he told his parents and the priest and they had punished him for making such a terrible accusation. As I listened, pen now fallen to the floor as I was too numb to record anything. I acknowledged his need to express how he felt and tell the tale he needed to tell. He then told me of one of the boys who was very intelligent and had vowed to the other boys that he would study hard and become a lawyer and expose these perpetrators and eventually that same boy did qualify as a lawyer and was now in a position to gather evidence and expose these people once and for all. This lawyer had approached this customer to be a witness but sadly he felt with his criminal record his story would have no validity. I had become that person for him to tell and to listen to his evidence. As he took a breath I told him I believed him implicitly and he didn’t need to say more and with that he rose to his feet and took flight and sped rapidly down the road into the abyss as if free at last.
Greatly disturbed by this consultation ,I requested that I could speak to one of my colleagues who listened sensitively and allowed me to debrief. It was a few years later that the full scandal was released in the press. A childhood of abuse, a lifetime of suffering and frustration in not being able to trust anyone especially those in positions of authority or trust. I felt absolutely impotent all I could do was listen and hope whatever time he had left on earth could be peaceful just watching the birds.

These 2 experiences have made a lasting impression but account for why I strongly feel that we should all be responsible safeguarding our children. It is why I always try to show an open door to any new mother even if the reason for the visit is trivial and I like to see them during their pregnancy in order to give them support and khelp if coping is a problem. Having a child is an amazing experience and privilege and with all the will in the World we don’t always get it right and we cannot predict what stresses will prevail.
“life is like a box of chocolates, you never know what you’ll get” forrest gump?
There are provisions in place for support to families who are not coping in any form and contact with them could prevent a Tradegy.

SAFE – Supportive Action for Families in Ealing

Ealing Local authority has a team which is made up of psychologists, therapists, counsellors, pupil/ school workers, family workers and other experts. They also have links with other support groups and services in Ealing to ensure you are given support within your community and the area where you live.
contact the Ealing Children’s Integrated Response Service on 020 8825 8000.
http://www.ealing.gov.uk/info/200017/children_and_families/1187/safe-supportive_action_for_families_in_ealing

Now it is mandatory that all staff working in the surgery attend a Child Protection Training every 3 years. We are CRB checked and even if we work in another setting eg Out of Hours we must have a CRB check. I have made my own children aware from an early age even if they were babysitting in their teens and emphasised to the parents and them how they must call me if the child is not easily pacified. Infact, when my daughter was in the surgery several years ago doing somee light administrative work as a student,she reported a concern she had observed and this was taken up by Social Services and the child was put on the ‘At Risk Register’ and the mother was given support and practical help whilst under great personal stress and the child was able to remain with the mother.

Where I work in Hillingdon Urgent Care Centre whenever a child of under 16 years is seen it is necessary to report who brought the child and you as the doctor satisfied there are no child protection concerns. It is fixed in my mind to do the same every time I see any child. All attendances of children are viewed by the health visitors and followed up if appropriate.

Please familiarise yourself with warning signs as everyone has direct for indirect contact with children and report as suggested or talk to one of us in surgery- it will always be considered highly confidential and dealt with sensitively.
We are ALL responsible for the welfare of children in our midst.

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Posted by on August 1, 2013 in Training and Advice

 

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