The management of survivors of sexual violence and abuse

The Management of Survivors of Sexual Violence and Abuse

These principles apply to any type of violent incident

No-one may be turned away
A survivor of violence must not be turned away and referred to another health care institution. If is irrelevant form which geographic area the survivor originates

Reporting to the police
Health care practitioners must establish whether the matter was reported to the police or not:

If the patient wishes to report the incident, contract the police station in the area in which the incident occurred. The health care practitioner must ask the police to come to the health care institution to take a statement from the patient.
If not, discuss the advantages and disadvantages of reporting the incident.
If an adult survivor declines to report the matter to the police, the health care practitioner should still perform a full forensic examination of the patient and record the findings, in case the patient changes her/his mind

Medical assessment
A patient who has sustained injuries must be assessed and treated at the nearest casualty/trauma unit. Once stabilized the Casualty Officer may refer the patient to the CCC for the forensic examination.
Under NO circumstances must an injured survivor be referred back to the referring institution for forensic assessment or medical management

Timing of the medico-legal examination
The medico-legal examination of the patient must be done after the medical assessment has been completed and ideally within two hours of the patient presenting to the institution. Where a patient is admitted, the medico-legal examination is conducted in the ward.

Venue
The health care practitioner must respect the dignity of the patient and all survivors must be interviewed in a private room or Crisis Care Centre.

Emotional Support
Patients suffer mental trauma that may or may not be obvious. The health care practitioner must be caring and supportive

Consent
Consent for the medical examination, treatment, collection of specimens for medical and forensic purposes, disclosure of medical information and the HIV test must be voluntary and informed and must be obtained in writing on the prescribed form or recorded in the patient records.
Any patient over the age of 14 years can consent to the medical examination

Presence of third person
It is important for a third person (with whom the survivor is comfortable), to be present during the examination of a patient.

Post-medical examination procedures

Forensic Specimens And Exhibits:
These must be sealed, labelled and kept under lock and key in a special cupboard or refrigerator, until sent to the laboratory.

Medical Treatment:
Physical injuries must be treated appropriately.
In the case of sexual assault, there is need to treat and counsel regarding:

Prevention of pregnancy
Treatment of sexually transmitted diseases

Referral for Counselling
If the patient is suicidal or has suffered sever emotional trauma, she or he must be referred for immediate counselling and management, or e admitted t the ward.
The patient must be advised of the options regarding post-trauma counselling. The patient may be referred to the hospital social worker, mental health services, or to a NGO support group.

Recording the findings
The report should be comprehensive and all necessary information must be recorded in the patient's file during or after each consultation or examination. The results of the forensic examination must be recorded on the prescribed form (J88). A copy must be retained for the hospital records and the original J88 form handed to the investigating officer.

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