Violence as health problem
Dr. Selwyn O. Rogers Jr.
Violence should be treated as a chronic health problem, according to Rogers, an associate professor of surgery at Harvard Medical School, and the division chief for Trauma, Burns, and Surgical Critical Care at Brigham and Women’s Hospital.
Q. You talk about gunshot and stab wounds as the result of a chronic health problem. What do you mean by that?
A. The current paradigm in city after city in the United States is we wait for spikes to happen of disease - be it murder rates, or assault rates - and retroactively throw more resources at it. But we don’t treat it as disease where we will constantly provide resources to address poverty, hopelessness, lack of educational attainment to prevent these outbreaks of violence. I think fundamentally that that is a glaring weakness of our public policy.
Q. It’s cheaper, then, to get out ahead of the violence with social programs instead of responding with arrests and prison sentences?
A. It’s somewhere around $1 million to keep someone in prison for a year. That’s a lot of money that could be invested in preventive measures.
Q. You say that people who work in hospitals are sometimes part of the problem. What do you mean by that?
A. As someone who is very proud to be a faculty member at Harvard Medical School and at the Brigham and Women’s Hospital, I’ve had occasion to see people who work here downright afraid of the patients they take care of. Nurses, physicians are afraid to walk in someone’s room and treat them as a person.
Q. But the violence prevention program you run has helped change that culture of fear?
A. This program, from its inception to today, has been transformative. We now go on trauma multidisciplinary rounds - there are physicians, nurses, social workers, physicians in training, violence intervention specialists - and all of a sudden, we’re there as a group.
Q. Any recent success stories?
A. A nurse for a patient who had suffered a gunshot wound [asked] ‘What can we do to make sure this doesn’t happen again?’ The first thing we did was make sure the person was in a safe environment, and for this particular individual that meant leaving the state of Massachusetts. We helped with that process. That’s different from what would happen in the past. We used to ‘treat and street.’
Q. So, you see a violent injury as an opportunity to help the patient adopt a new path?
A. Every time someone comes to the hospital with a stab wound, a gunshot wound, an assault, it’s an excellent opportunity to educate them. If we don’t help people understand their disease better, help them with constructive tools to avert further disease, then we really haven’t helped them very much.
Q. You describe this as an issue of justice.
A. It’s not random who gets shot, stabbed, assaulted in America. You’re young, black, poor - you’re going to get stabbed disproportionately more than if you’re rich, white, in the suburbs.
Q. Once someone is deeply entrenched enough in a destructive environment to be stabbed or shot, is it really possible for them to turn their life around?
A. There’s no doubt that we need to catch people earlier. If you learn how to resolve conflict on the playground at 5 years old, that skill will take you through life. [But] we all have a chance to turn it all around. To say that just because someone got stabbed at 28 years old or 58 years old, it’s over, is a fundamental flaw. Those same people can provide unique stories to help someone else turn it all around.