GRIP's HOSPITAL INTERVENTION

Rob Fereira Hospital- Nelspruit

Information gathered from a study done by the World Health Organization (2007), a Sexual Violence Research Initiative done by Janice du Mont and Deborah White combined with practical experiences compiled by Annesta Hofer, CEO of GRIP.

1. Introduction:

Sexual Assault is a common, widespread and insidious problem that has serious physical, psychological, emotional and social consequences. GRIP has established care rooms in hospitals in order to assist and support survivors with the collection of medico legal evidence, often demanded in the law or policy, and to ensure that this procedure is not inconsistent but is undertaken with quality and scope.

The medico-legal evidence (e.g. injuries and semen) can corroborate accounts of sexual assault for court of law. GRIP ensures trained volunteer counselors and adequate facilities for the collection of evidence.

2. Rape Myths:

  • Rape happens only to young, pretty or desirable women.
  • Rape is a crime of lust or passion.
  • Men can have sex freely with women deemed to be of loose morals because these women have nothing to lose.
  • Rape is committed by maniacs or perverts.
  • Rape only happens in poorly lit or secluded places.
  • Sexy clothes incite men to rape.
  • When a woman's chastity is threatened, she violently resists, attempts to escape or screams for help.
  • Women seeking to extort money often fabricate rape charges.
  • A real rape involves a strange, physical force and physical injury.

3. Magnitude of the problem:

Although underreported, sexual assault is known to be a problem that affects the lives of millions of women worldwide, regardless of age, race, appearances, marital status, sexual orientation, ability or health status.

The negative short and long term physical, psychological and social effects of sexual assault can be considerable and they may include:

  • Ano-genital and extra genital injuries
  • Sexually transmitted infections
  • HIV infection
  • Unwanted pregnancy/unsafe abortions
  • Depression
  • Anxiety/phobias
  • Post traumatic stress disorder
  • Sleep disturbance
  • Suicide attempts/ substance abuse/ eating disorders.
  • Difficulties at work and school.

4. Medico Legal Evidence:

4.1 The purpose of medico-legal evidence:
Medico legal evidence is collected from a survivor's body in order to prove her account of a sexual assault for a court of law. It is forensic evidence to prove a physical connection between individuals and objects or places and will determine the occurrence of recent sexual activity, identifying the assailant, establishing the use of force or resistance, and indicating an inability to consent due to the influence of alcohol, drugs or mental state.

4.2 Definition of medico-legal evidence:
Medico legal evidence refers to documented extra-and-ano genital injuries and emotional state, as well as to those samples and specimens' that are taken (from the survivor's body and clothing) solely for legal purposes. Such evidence includes salvia, seminal fluid, head hair, pubic hair, blood, urine, fibre, debris and soil.

4.3 Settings at the Hospitals:
GRIP has established care rooms in hospitals where around the clock collection of medico-legal evidence, medical care, HIV testing and counseling, and PEP (Post exposure prophylaxis) medication is given, as well as emotional support, counseling and referrals to other services are offered. Private Victim Friendly facilities have been established and furnished in order to provide a comfortable, friendly and private facility where a GRIP volunteer s are on duty 24 hours , 7 days a week. A medical doctor or forensic nurse from the Department of Health will collect the medical evidence and conduct the HIV testing, while the volunteer of GRIP will ensure support, assistance, counseling and follow up visits to the survivor.

4.4 Medico-legal findings:
The clothing worn by the survivor at the time of the sexual assault is often collected if available. The survivor's hair may be combed or cut to capture any foreign hairs or materials. She may also be asked to provide a urine or blood sample to test for drugs and alcohol. A physical examination follows, in which both extra-genital and genital injuries or marks such as abrasions, lacerations, swellings, bites and scratches are documented. Injuries to the ano-genital areas are also documented. The skin is examined for secretions such as semen and salvia and body cavities are swabbed for seminal fluid. The survivor's emotional state will also be observed and recorded (e.g. whether she is crying or appears depressed, calm or composed

4.5 Collection of medico-legal evidence


5. Forensic Examinations:

The examination needs to be carried out within 72 hours of a sexual assault.

5.1 Consent:
Written consent is generally required from the survivor of sexual assault prior to medical forensic examinations. She may stop the examination at any point, and is asked to consent to the release of evidence.

5.2 Medical History:
This is done to assess the survivor's state of health and identify existing health problems that might be relevant to her care.

5.3 Sexual Assault History:
The survivor is usually asked to recount the relevant details of the assault, including the date, time and location and details about the perpetrator. She may also be asked what activities she may have engaged in since the assault (e.g. whether she has bathed, douched, urinated, defecated and changed her clothes).

5.4 Treatment guidelines:
The survivor is offered pre-exposure-prophylaxis (PEP) medication for reducing the risk of pregnancy, hepatitis B, sexually transmitted infections and HIV infections. She will also receive counseling from the GRIP Volunteer counselor and will receive information on medication and available GRIP and Social Services, and she will be visited at her home in order to ensure follow- up care.

6. Processing of Medico-legal evidence:

6.1 Police:
The evidence is handed over to a law enforcement official who may either take it directly to a forensic laboratory or store it at the Police Station until it is to be analyzed.

6.2 Forensic Laboratories:
Once submitted to a forensic laboratory, the medico legal evidence is to be analyzed and a report provided. Tests for drugs and alcohol may be run and foreign matter examined for particular characteristics. Other analyses involve identifying the specimen, and its source. DNA testing is also done.

6.3 Courts:
Any health care worker who has examined and collected evidence from a survivor may testify to it in court.

7. The impact that GRIP has regarding Hospital Care Rooms:
GRIP ensures friendly and comfortable care rooms in Government Hospitals, and ensures that protocols are followed regarding medico-legal evidence. GRIP ensures better negotiation with the criminal justice systems and to see that perpetrators are convicted. Medico-legal-evidence is crucial to the successful prosecution of perpetrators and GRIP lobby's for the correct, and prompt reaction of forensic nurses, police officials and legal officers to ensure that this evidence are available for court cases.

GRIP also:

  • Reduces waiting and assessment times for examinations
  • Increased the number of sexual assault kits completed
  • Improve the chain of evidence of custody.
  • Aided law enforcement officials in collecting information and laying/filing charges.
  • Enhanced the likelihood of prosecution and conviction.
  • GRIP avails suitable facilities with appropriate supplies and victim friendly equipment and also increases integrity during the medico-legal examination.
  • To ensure that sexual assault kits are available.

8. Relationship to legal outcome of non-medico-legal factors:
Certain survivors can be received to be at the wrong end and will be least likely to see her perpetrator convicted and these disadvantaged survivors can include:

  • An older or poorer person
  • Sexually promiscuous person or a sex worker
  • A person with a psychiatric history or a criminal record.
  • Drug or alcohol abuser
  • A Person who was engaged in risk-taking behaviors such as walking alone late at night or hitchhiking.
  • A person who did not verbally or physically resisted the perpetrator or reports the assault promptly to the police.
  • Sometimes being acquitted with the assailant can be negatively associated with the legal outcome, but others have found the opposite to be true.

Certain characteristics of offences are positively associated with convictions, for instance:

  • Multiple charges
  • Penetration or physical force
  • Weapons

9. Socio cultural Conditions of the use of medico-legal evidence:

Male dominance and gender inequality can foster false notions about rape and raped women which in turn, may have a bearing upon the collection and processing of medico legal evidence. Survivors are often blamed on the basis of character and behavior, and many harmful reactions may surface when a woman reports having been sexually assaulted to friends, family and authorities. The survivor may experience stigmatization and be told to stay silent. In some circumstances a rape may be interpreted as damaging to the reputation and honor of the survivor's male relatives and family. The survivor telling about the rape can have consequences that include adultery, banishment, forced marriage to the perpetrator, femicide and in some countries there is frequently support for family members to do whatever is necessary - including murder- to alleviate the shame associated with a rape. GRIP provides survivors of rape with care characterized with facilities, supplies, equipment, well trained defusers/counselors, appropriate facilities and intersectional coordination. GRIP brings together medical, legal and law professionals and officials and through well trained and counseled survivors, GRIP brings more perpetrators to justice, on the basis of better standards of forensic evidence.

10. Protocols:

Protocols provide examiners with precise instructions, documentation forms and implements that allow for the collection of evidence in a constant manner. The evidence created through such tools, however frequently fails to reflect the full range of the survivors experiences of sexual assault. Some survivors do have emotional control and appears calm, detached and rational. This does not mean that they have not been sexually assaulted. Forced intercourse is a requirement for the legal determination of rape. Sperm and semen can be lost or the quantity significantly diminished as a result of delays in examinations. A survivor having bathed, douched, urinated, and or defecated after being assaulted, and a perpetrator having used a condom, ejaculated away from the body of a survivor, not ejaculated, undergone a vasectomy or penetrated the woman with an object rather than his penis, can all have influences on the outcome of the evidence.

In contrast to the specific guidelines in medico-legal-protocol, physicians routinely comment on the age, virginity and character of a woman to demonstrate that she is sexually experienced, old enough, or promiscuous enough to consent to sexual relations, thereby raising doubts about the commission of rape.

The police represent a critical point in the post-sexual assault evidentiary process and in this regard, can become a barrier to evidence being collected or processed. In RSA survivors have a difficult time getting the police and prosecutors to believe that they have been violated, and lost files are a common problem. In some circumstances medico-legal evidence does not reach the trial stage, as cases may be plea-bargained or informally settled out of court.

Barberton Hospital.

11. CONCLUSION:

The sexual assault of children, adolescents, and adults is a common, widespread problem that has serious physical, psychological, emotional and social consequences. Anti-women attitudes and rape myths have fuelled its prevalence and shaped the ways in which survivors have been treated by health, legal and police services. GRIP's intention is to provide suitable facilities, volunteers, counselors, protocols, staff and technologies for collecting and processing viable medico-legal- evidence, to aid in the conviction of rapists.

GRIP focuses on well trained staff, positive behaviors of the professionals involved with rape survivors. GRIP ensures collaborative networks and effective communications across the health care, law enforcement and legal sectors and also between involved NGO's.

Resource:
World Health Organization : 2007, Sexual Violence Research Initiative.
Jamice du Mont and Deborah White.

Compiled by Annesta Hofer- CEO of GRIP.

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