Surrey Strangulation Clinic provides specialist care for survivors of domestic abuse

Disclaimer: This story refers to physical and domestic violence.

A clinic in Surrey, British Columbia, which has a long history of serving strangulation victims, has dedicated a clinic to these services.

« We needed a specialty clinic where this could be looked at and people could feel supported, » said nurse practitioner Hannah Varto at Embrace Clinic, which since 2015 has been providing services for strangulation victims.

« It gives me chills just to say it… people who have been strangled, mostly women, by their domestic partner are seven times more likely to be killed by their partner in the future. »

Previously a mobile clinic, Embrace got a permanent location at Surrey Memorial Hospital in 2021 – where last fall it opened the strangulation clinic, which they say is in recognition of the serious health consequences and security of the violent act.

The province told CBC News it was not aware of any other such clinics in British Columbia.

Generally overlooked, strangulation has recently come under greater scrutiny due to consequences such as health problems and domestic homicides, experts say.

It’s the main indicator of escalating violence in the future, according to Winston Sayson, a 30-year-old retired crown attorney.

“When you reach this stage, you are in a very dangerous red zone,” he said, adding throttling is now equivalent assault with a weapon or assault causing bodily harm.

The clinic offers services such as comprehensive head and neck exams to assess injuries, damage to blood vessels, counseling and treatment options after an attack. (Ben Nelms/CBC)

In 2019, the penal code dealing with assault with a weapon or causing bodily harm was amended to include an additional offense that takes into account choking, suffocation or strangulation. If found guilty, an offender could face a prison term of up to 10 years.

Another penal code dealing with sexual assault also had a paragraph added, taking into account a similar offense related to strangulation.

A Fraser Health analysis found that from 2017 to 2022 strangulation occurred 55% of the time among 405 domestic abuse patients at Surrey Memorial Hospital.

A book titled Leaving Abuse sits in front of some plants.
Fraser Health says since forensic nurses started asking specific questions about strangulation in 2014, they’ve heard more reports of the attack, which are often underreported when people have multiple injuries from to domestic violence. (Ben Nelms/CBC)

According to the health authority, the hospital’s forensic nurses – who work closely with the strangulation clinic – have observed more reports of violence since the incidents were documented in 2014, including the strangulation resulting in loss of consciousness and loss of bowel or bladder control.

“It has been eye-opening to consider the number of strangulation incidents – and the physical, emotional, social and safety impacts we may have missed by not specifically asking for and treating strangulation as its own standalone health and safety risk, » said Fraser Health. in an e-mail statement.

Concussion symptoms in strangulation victims

Clinic services include a comprehensive head and neck exam to assess injuries and blood vessel damage, sleep management strategies, counseling, mental health conversations and treatment options after a stroke. .

Varto says many are surprised to learn they could have brain damage from the strangulation or blows to the head.

« What we’re seeing here is that when we follow these patients, they have all the symptoms of a concussion » – including persistent headaches and difficulty concentrating, sleeping and remembering things. things, Varto said.

Last year, of the 480 patients who came to the clinic following recent violence, 60% said they had been strangled, injured in the head or both during their attack, according to Fraser Health.


How assessments are conducted at this strangulation clinic in Surrey, BC

Nurse practitioner Hannah Varto explains some of the ways she assesses patients who have had strangulation.

If the strangulation and concussions become repetitive, the injuries are similar to those seen in retired professional hockey or football players with a history of blows to the head, says health and science professor Paul van Donkelaar. at the University of British Columbia Okanagan and Principal Investigator of SOAR. (Supporting survivors of abuse and brain injury through research).

« They live with these chronic effects, chronic symptoms for months or even years, implying that this will likely lead to longer-term neurodegenerative disorders like dementia and Alzheimer’s disease, » he said. said, adding that more research was needed on brain damage. domestic violence.

Barriers to accessing care

Strangulation victims are often underserved, in part because the violence goes unreported and injuries can be invisible, says SOAR co-founder Karen Mason.

The Department of Health says victims may be treated in emergency departments and not be admitted to an inpatient bed.

Strangulation can also coincide with other attacks that leave injuries such as bruises. When victims don’t disclose the strangulation when seeking care, other injuries can become the focus, Fraser Health explains, adding the lack of blood flow and oxygen to the brain during the strangulation can also lead to memory loss in victims.

Woman's hand on polystyrene head.
Nurse practitioner Hannah Varto says many patients are surprised to learn they could have brain damage due to the strangulation that decreases oxygen supply to the brain. (Ben Nelms/CBC)

Healthcare workers are often unaware of the brain damage caused by strangulation during intimate partner violence, Mason says.

“If these professionals do not understand the nuance and complexity of an abusive relationship, if they are not trained in trauma-informed practice, they will not be able to serve the survivor in the way she wants. need. »

Vancouver’s Battered Women’s Support Services (BWSS) says they help educate medical students about the prevalence of strangulation and assess traumatic brain injury.

Access to services also comes with barriers, says Angela Marie MacDougall, executive director of BWSS, because controlling partners often prevent victims from seeking treatment.

« That doesn’t mean she’s free to just go and seek medical care, » she said, adding that it’s important to work with local organizations, crisis lines and homes for transition to help people safely access medical support.

A woman wearing a leather jacket in front of green plants.
Angela Marie MacDougall of Battered Women’s Support Services says it can be difficult for anyone who is abused to access medical care because of the controlling nature of their abuser. (Radio-Canada News)

« We want to make sure she navigates safely through what could potentially be a very life-threatening situation. »

Anyone 13 and older who has recently suffered a strangulation can book an appointment with the clinic by phone or email, or get a referral from medical clinicians, community service providers or the police.


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