Health officials estimate that more than 21,000 Jamaicans will have to seek medical treatment this year because of violence-related injuries, 50 per cent more than the numbers for last year.

“If the trend continues it will be over 21,000 patients for the year, compared to 14,000 patients last year,” said Dr Marion Bullock-Ducasse, the senior medical officer and director of emergency medicine and disaster management in the health ministry. She was speaking during a recent workshop to explore the issue of violence in Jamaica.

She estimates that about $600 million of the health sector’s billion-dollar budget is spent on treating patients whose injuries have been violently inflicted. These ever-increasing cases put a strain on the already overburdened health care system.

At the Kingston Public Hospital, for example, 11 per cent of the total trauma budget is spent on violence-related trauma, causing the cancellation of one of three elective surgeries per week, said Dr Bullock-Ducasse.

“The impact of violence on emergency medical services (is that it) increases. workload,” she said.

In addition to cutting into the resources allocated for health care delivery, she added, the violence that is ripping the country apart also compromises the quality of care. As a result, the health sector is unable to achieve its national and international norms and standards.

“(Type ‘C’ hospitals) are fast becoming trauma hospitals,” she said. (For example), approximately 60 per cent of all operations at Spanish Town Hospital are for emergencies.”

With a history of violence that can be traced back to the days of slavery, Jamaicans have progressed, over the years, from the use of the cane field machete to the gun. Violent outbreaks, some sparked by innocuous incidents such as accidentally stepping on someone’s toe, have become par for the course over the years.

Faced with increasingly violent outbreaks in schools, the education and national security ministries came up with the cops in schools programme. Specially trained cops are placed in selected schools where they play the combined role of counsellor and cop, cracking down on hard-core violence as well as lesser offences such as bullying.

Schools are as good a place to start to address the problem. According to Dr Elizabeth Ward, director of Disease Prevention and Control in the Ministry of Health, violence is the fifth leading cause of death in the island’s young adults. Last year, it cost the country $20 million to treat 433 students who were injured while at school.

“Twenty-five per cent of the violence-related injuries occur in young males ages 10 to 19, the majority of which are under age 18,” said Dr Ward.

This data, she explained, was documented in the Jamaica Injury Surveillance System that was set up by the University of the West Indies, Mona, at the Kingston Public Hospital in 1990. The programme has since been expanded to an additional six institutions across the island in May Pen, Montego Bay, Annotto Bay, and Spanish Town.

The surveillance takes into consideration factors such as:

. the method used to inflict injury,

. the circumstances,

. the victim/perpetrator relation,

. the place where the incident occurred, and

. the age of the victims.

The study showed that almost 40 per cent of the time, sharp objects were used to inflict injury while blunt objects were used in 35 per cent of the cases. Gun shots accounted for only four per cent of the injuries.

“A lot of the injuries are due to reprisal,” Dr Ward pointed out. With the number of gangs estimated at somewhere between 80 and 100, feuds are commonplace. Tit-for-tat killings and double murders are not uncommon.

But among the worrying trends this year, Dr Bullock-Ducasse said, was that more than 60 per cent of the patients seen at the island’s hospitals had ruptured wounds – 50 per cent were from stabbings.

The number of intentionally inflicted injuries has increased significantly over the past few years.

“Intentional injuries accounted for four per cent of all that we saw at our accident and emergency department in 2003,” Dr Bullock-Ducasse added. “In 1999, the ratio of intentional injuries to unintentional injuries was one to 1.5”.

The injured are mostly men, who outnumber women by up to seven to one; and patients range in age from 11 to 44.

Startlingly, the study has also shown that victims of violence are being hurt by those closest to them.

Over the last 14 years, 52,333 women were victims of violence. Of that amount 15,700 (30 per cent) were injured by people they know.

Five per cent of the women who fell prey to violence over the last 14 years were injured by a friend, while the attackers of another 12 per cent were relatives. Intimate partners accounted for 16 per cent, while strangers were fewer than two per cent.

“Eighty-one per cent of the circumstances of injury (was) because of a fight or argument between partners,” Dr Ward noted. Women, it appears, are almost just as likely to get hurt inside the home as outside.

Most of the attacks (46 per cent), according to Dr Ward, took place in a public place, another 40 per cent occurred at home and four per cent took place in schools and other institutions.

But in a country faced with severe financial constraints, the roughly $50 million that health officials estimate it will cost to treat trauma cases each year is a hard pill to swallow.

According to Jean Williams-Johnson, the director of the Accident and Emergency department at the University Hospital of the West Indies (UHWI), it cost the hospital roughly $12 million to treat trauma cases between December 2003 and February 2004.