Implementation of protocols to deal with sexual assault

1
Implementation of protocols to deal with sexual
assault experiences from field

• Sangeeta Rege
• Sana Contractor
• Centre for Enquiry into Health and Allied Themes
  (CEHAT)

2
SAFE KIT

• Development of a model for examination and
  collection in cases of sexual assault/Rape,
  called Sexual Assault and Forensic evidence kit
  (SAFE KIT) in 1998.
• This kit is based on the Ontario Police Force kit
  used in Canada. Extensive feedback was sought
  from several forensic experts, gynecologists,
  public health experts and womens rights groups.
  

3
Safe Kit Contents

• Manual for Safe kit usage
• Protocol
• Equipments required for collecting evidence.

4
Contents of the Protocol

• Medical history , sexual assault history , nature
  of evidence collected and treatment provided
• Body maps to record injuries(for both male and
  female bodies)
• Tables for Tanner Staging for boys and girls are
  provided for age estimation
•  

5
implementation of the safe kit

• Negotiation with the Hospital Authorities to
  implement SAFE KIT in 2 Public Hospitals in April
  2008. These were
• Rajawadi - a 500-bed, well equipped hospital
• Oshiwara Maternity home - an extension centre of
  the Cooper hospital.
• Agreement over conducting periodical training on
  understanding sexual violence, provision of
  crisis intervention by CEHAT team and
  documentation of the experience of using the kit.
  

6
Training Health Care Providers

• Trainings conducted for
• Defining sexual violence.
• Addressing Myths and Facts related to sexual
  violence.
• Use of Case studies to facilitate the use of the
  SAFE KIT

7
Procedural issues arising post safe kit
implementation

• Mandatory Admission
• Mandatory Police case.
• Patients shuttled from major tertiary hospital to
  maternity home for examination.
• Discharge date prolonged till evidence is sent to
  Forensic laboratory.
• X-rays/ USG/ and procedures conducted rampantly
• Option of partial evidence collection not given
  to women

8
Attitudinal issues amongst HCPSS

• Lack of confidentiality, privacy
• Lack of belief in the woman's story
• Precedence of forensic role over clinical role.
• Multiple players in the chain of custody.

9
issues for discussion

• Review and change obsolete procedures related to
  management and care of victims of Rape
• Clarify ambiguity between forensic and clinical
  role of Doctors
• Evolve a multidisciplinary team to respond to
  various needs of the victims

10
Defining Comprehensive health care for Rape

• Obtaining consent of survivor before collecting
  evidence and explaining the importance of such
  evidence
• Collection and documentation of evidence
• A clear and fool proof chain of custody that
  preserves evidence collected
• Providing medical care
• Providing psychological support
• Referral and follow up for further care