Cook Islands - Pacific Prevention of Domestic Violence Programme

Cook Islands
Discussion
I was not able to verify whether alternative forms of support or redress are available to
victims of domestic violence. In either case, this raises the question of where victims can turn
if they cannot seek community help and are unwilling to report to Police. Resolving this
question would best be addressed through victim-focused research.
Overview of nature and extent of systems in place for reporting and sharing information
on medical and death records relating to domestic violence
As far as I could determine, the Ministry of Health has no policy of mandatory reporting of
violence or abuse to Police. They will be informed if a death results from an assault, although
domestic homicides are rare in the Cook Islands. There is no way of marrying hospital and
Police data.
Patient files are forwarded to the Medical Records Unit at Rarotonga Hospital. The
Statistician there said that hospital records contain no specific indicators of domestic violence.
Diseases and health problems are classified using the World Health Organisation’s
International Classification of Diseases (ICD 10), 1 which is probably most useful for
assessing domestic violence at the serious end of the spectrum.
Morbidity data from Rarotonga Hospital showed that in 2005 there were four patients whose
injuries were the result of assault. Two were aged 15-24 and two were 55-64 years of age.
Although ICD 10 coding allows the cause of injury to be recorded as assault, the data did not
specify victim-offender relationships.
Discussion
A number of factors determine whether medical personnel make a link between presenting
injuries and domestic violence. They include:
• the quality of domestic violence screening: medical personnel should be able to tell from
the type and seriousness of an injury whether it resulted from an assault;
• whether victims disclose the real reason for the injury: many victims are reluctant to
disclose partner violence as the cause of injury; and
• the standard of medical record keeping: the patient’s file should indicate whether there is a
history of domestic violence.
This raises the question of whether doctors are willing and have capacity to deal with patients
who are victims of domestic violence. An NGO stakeholder felt that there is likely to be a
shortfall in this area.
Doctors know what domestic violence injuries look like. We need to get them equipped
with counselling skills to deal with the situation.
1 The ICD has become the international standard diagnostic classification for analysing and monitoring the
incidence and prevalence of diseases and other health problems (World Health Organisation,
http://www.who.int/classifications/icd/en/). It has a number of codes (X85-Y09) that can identify external causes
of morbidity and mortality, including assault or intentional injury inflicted by another person.
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