Dr Bharti Khurana: Bringing Intimate Partner Violence Into Focus

Dr Bharti Khurana, MD, a radiologist at Brigham and Women’s Hospital, Harvard Medical School in Boston, is known for her evolving work in the area of intimate partner violence (IPV). 

IPV is defined as physical, sexual or emotional violence between partners or former partners, and now has become a critical public health issue and widely prevalent. With her work, she is creating tools for clinicians to use to identify patients who are experiencing IPV or domestic violence. Dr Khurana is the only Indian and only woman amongst the three finalists in a competition that's welcoming project ideas geared toward solving vexing medical problems.

Born and raised in India, Dr Khurana completed her MBBS from Maulana Azad Medical College in Delhi.

Making the Invisible Visible

This is something, she believes, has been a long time coming. "I've seen these cases for many years now. Sometimes they share their history, sometimes they don't. I remember, two years back, someone raised concerns about domestic violence and how physicians are missing these patients' trauma and injury patterns. Law requires us to not miss a single case of child abuse, we may even lose our licence if we do. However, the law doesn't exist for adults in this regard," she says.

Dr Khurana emphasises on the fact that such patients do not come out with their stories regardless of culture and social economic status. "The silence prevails maybe because of lack of trust, economic dependency etc. We have screening protocols, but they're not effective enough. We need to do more as healthcare providers," she adds.

It's shocking that only when we started screening people that they realised this kind of abuse isn't normal

She says that, as radiologists, they can detect clear patterns of intimate partner violence because of injuries in specific body parts. "If you take a pattern of nose bone fractures, these don't occur easily unless one is constantly smashed into the wall. The patterns are visible even for old healed injuries."

"1/4th of these patients have gone through strangulation, which is extremely sad and unfortunate. Further, these patients go back to the same spouse despite the history because of one reason or another. We need to make them feel believable, extend help, and tell them they're not alone."

While the subject is highly important, it’s equally difficult to take it up with patients or survivors because of the normalised silence bound to it. Dr Khurana believes it's a huge challenge to get people to talk about these matters.

Here's a Q&A with specifics to her research: 

What is the problem that you trying to solve in this regard?

One in four women and one in seven men have reported experiencing severe physical violence from an intimate partner in their lifetime in the US. IPV has both short- and long-term negative health consequences, and even childhood exposure to IPV has been linked to adverse mental and physical health effects in adults. Half of female homicides between 2003 and 2014 have been linked to IPV. Despite how often IPV occurs, many victims think they are alone, and cases can go unreported for decades.

The medical community could play a vital role in detecting IPV early and preventing its perpetuation. But IPV can be a very difficult subject to raise with a patient. Also, IPV happens mostly within the confines of the home and evidence is mostly elusive. Although questionnaires about safety have helped, the proportion of identifiable IPV cases to date only represents the tip of the iceberg. There is more that we as radiologists can do by looking specifically for early signs of IPV and providing opportunity to offer preventive services.

Radiology has access to prior imaging records that can reveal a history of abuse

How are you going to provide solutions for IPV?

We are creating new tools to empower clinicians to identify patients who are experiencing IPV. Our goal is to develop an integrated system that uses patterns derived from expert analysis of historical imaging and clinical data, detects and classifies injuries for their likelihood of being as a result of IPV, and automatically alerts clinicians if a patient’s injuries have low or high-risk probability for IPV.

To do so, we plan to use machine learning, that is teach a computer program to recognise signs of IPV based on radiological and clinical findings from known IPV cases. This will give us a comprehensive picture and help generate a checklist to identify those most at risk. In addition, our multidisciplinary team will design conversational guides and training for social workers and clinicians to approach the patients who are identified as being at high risk for IPV but are not forthcoming.

The idea is to be more specific and develop an alert system

How will your research project benefit people?

Intervening early means preventing adverse physical and mental consequences that result from IPV. With funding from the BRight Futures Prize, we will be able to take the next step towards identifying radiological findings and clinical risk factors in patients with documented IPV.

Our goal is to give clinicians the tools, classification models, statistical evidence and alert systems for greater confidence and robustness in findings, empowering them to open a dialogue with their patients about IPV. We hope that this will have a ripple effect, changing the lives of patients and their families; changing the role of the medical community in identifying IPV; and breaking the silence around IPV in our society.

IPV is a human violation and we're building our work with a hope to change this behaviour in families

IPV and domestic violence are prevalent across the world. How will the research reach out and advance its benefit across, especially in India?

This is something that's prevailing everywhere. I've learnt from social workers how this practice of abuse has been normalised in not only developing countries but also developed ones. This research software is not only limited to the US, we plan on building it further so it can help people across nations. I'm in constant touch with radiologists in India. They're aware of my research and support me in this. The idea is to put the same software everywhere and when it works at one place, it'll be more welcoming at other places as well.

Dr Khurana's efforts to tackle intimate partner violence and domestic violence will not only pave the way for a huge transition but will also shackle the normalised behaviour of abuse among countless families. The competition's winner, to be decided by public voting, hopes to receive the $100,000 BRight Futures Prize, which will be awarded on November 7. This is an effort to make the invisible visible and a vote is going to power the cause further. Here's the voting site: https://goo.gl/AsXwSK

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