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Beyond the emergency room: seeking solutions to violence

As a trauma surgeon in a public hospital, Cuthbert Simpkins routinely sees the most devastating injuries that humans can inflict on each other. Gunshot wounds. Knife slashes. Bruises and broken bones.

For him, it's not enough to just patch up the wounds.

Simpkins, a UB associate professor of surgery, has initiated a program at Erie County Medical Center to try to help victims of violence on the physical, social and psychological levels. He has also recruited fellow researchers to study violence in the hopes of finding new solutions.

"Operating on these patients just isn't getting to the root of the matter," he says.

Early in his career, Simpkins noticed that certain victims of violence returned to the emergency room again and again. Deeply concerned about the carnage that disproportionately targeted young black men, he was convinced that a scientific study of the problem might begin to provide some answers.

So he completed a study of the victims of interpersonal violence that confirmed his worst suspicions. Within five years, he found, 44 percent of them would return to the hospital after another violent episode‹and even worse, 20 percent would wind up dead.

An intriguing finding was the high correlation between joblessness and violence. In fact, he found, people who started jobs reduced their chances of becoming repeat victims.

ECMC's Violence and Victimization Prevention Program tries to build on this finding by linking victims with job training and other social services.

Before a patient leaves the hospital, Simpkins or social worker Neville Francis will stop by to talk. Often, they say, the fear and pain of the injury will prompt even the toughest drug dealer or the meekest battered wife to consider a change in lifestyle. Francis is available to help with issues ranging from substance abuse to domestic violence to job-hunting. "So far, none of Neville's 55 regular clients has been readmitted to the hospital, and I find that very encouraging," Simpkins says.

The early success of the program has confirmed Simpkins' belief that hard research can suggest ways to prevent violence. He has teamed up with John Wodarski, a professor in UB's School of Social Work, to create the Center for the Study of Antisocial and Violent Behavior, which studies the victims of violence who come through ECMC.

Aided by social work doctoral students, the two are investigating patients' social, psychological and physical characteristics. They have also begun a study of the repercussions of violent events on children who witness them, and of methods of getting unemployed victims back to work.

The center is funded by grants from UB, the New York State Division of Youth and the federal government.

Some of the center's preliminary findings suggest that victims‹not just perpetrators‹tend to have aggressive personalities. The victims also frequently report drinking alcohol before the violence that landed them in the hospital. Counterintuitively, they do not seem to suffer from low self-esteem, Simpkins and Wodarski say.

As one potential solution, the researchers hope to begin a new program that combines substance abuse prevention with training in conflict resolution, job-hunting and work habits. They envision an intensive, 150-hour series of workshops, role-playing games and counseling that will help inner-city victims of violence make the transition to meaningful work.

Such a program would be costly, but Wodarski and Simpkins counter that it has the potential to save money almost immediately. A trauma victim's stay in the hospital can cost $5,000 to $15,000, and could cost even more when long-term repercussions on family, children and community are factored in, Simpkins points out.

But a hospital-based intervention won't cure underlying problems like urban decay and lack of jobs. "If you read the case histories and talk to the patients, it's very understandable how they got there," Simpkins says. He believes that a larger overhaul of society will be necessary to get to the root of the problem of violence.

"I'd like to see the community organize itself. Register people to vote, take their fate in their own hands. Then I think we can enable the community to solve some of its own problems."

He adds, "I don't think we can really solve this problem until our entire country has a different sense of interpersonal relations. I think we need a higher moral and ethical plane."

Jessica Ancker is editor of Buffalo Physician, published quarterly by the UB School of Medicine and Biomedical Sciences.

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