A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India.
A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India.
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DOI：
10.1186/s12905-014-0142-5
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发表时间：
2014-11-30
期刊：
影响因子：
--
通讯作者：
Osrin D
中科院分区：
文献类型：
--
作者：
Daruwalla N;Belur J;Kumar M;Tiwari V;Sarabahi S;Tilley N;Osrin D
大多数烧伤发生在低收入和中等收入国家。在印度，与烧伤相关的死亡在女性中比在男性中更常见，并且发生的背景很复杂，其中原因（意外或非意外、自杀或他杀）往往不清楚。我们的研究旨在了解烧伤的前因和归因问题、女性入院后法医学事件的顺序以及潜在的改进机会。我们对入住两个主要烧伤病房的 33 名女性、她们的家人以及 26 名重要的知情医生、护士和警察进行了半结构化访谈。我们使用框架分析来检查烧伤发生的背景以及入院后采取的法医行动的顺序。受访者描述了事故、自杀未遂和杀人未遂的情况。区分这些是很困难的，因为贫困和文化先例的潜在结合是所有人所共有的，而行动取决于潜在冲突的叙述。空间限制、烹饪设备问题和易燃衣物增加了意外烧伤的风险，但与家庭冲突、性别暴力和酗酒并存。大多数烧伤最初归因于事故。临床医生遵守法医学程序，警方相对较快地执行了调查要求，但两个群体在面对法律程序时都感到脆弱。女性不愿将烧伤描述为非意外，这是可以理解的，陈述的争议性质，她们认为的可变性历史，法医证据的质量和有效性有限，以及客户对复原力的要求，这些都构成了普遍的悲观情绪。事故和意图之间的相似性如此紧密，以至于难以区分，特别是考虑到女性不愿将烧伤描述为非意外，这是可以理解的。法医证据的争议地位和对证词的依赖意味着只有少数案件会被定罪。重点应放在改善记录、服务提供者之间的沟通以及公众对烧伤风险的理解上。
Most burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause – accidental or non-accidental, suicidal or homicidal – is often unclear. Our study aimed to understand the antecedents to burns and the problem of ascribing cause, the sequence of medicolegal events after a woman was admitted to hospital, and potential opportunities for improvement. We conducted semi-structured interviews with 33 women admitted to two major burns units, their families, and 26 key informant doctors, nurses, and police officers. We used framework analysis to examine the context in which burns occurred and the sequence of medicolegal action after admission to hospital. Interviewees described accidents, attempted suicide, and attempted homicide. Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives. Space constraint, problems with cooking equipment, and inflammable clothing increased the risk of accidental burns, but coexisted with household conflict, gender-based violence, and alcohol use. Most burns were initially ascribed to accidents. Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process. Women’s understandable reticence to describe burns as non-accidental, the contested nature of statements, their perceived history of changeability, the limited quality and validity of forensic evidence, and the requirement for resilience on the part of clients underlay a general pessimism. The similarities between accident and intention cluster so tightly as to make them challenging to distinguish, especially given women’s understandable reticence to describe burns as non-accidental. The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction. The emphasis should be on improving documentation, communication between service providers, and public understanding of the risks of burns.
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作者：
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