Best interests of the child survivor
The best interests of the child survivor are
always a priority and each case must be dealt with on its own
merits. the future treatment and rehabilitation of the child
will depend on how the trauma is treated at the time of crisis.
Relationship between
professionals
The health care practitioner is part of the
multidisciplinary team, including medical, police and justice
personnel. It is essential that a close working relationship
and liaison is maintained at all times between the professionals
and the community.
No one may be turned away
A child survivor must not be turned sway or referred to
another health care institution.
All child survivors of abuse, whether male or female. must be
medically examined.
Consent for minors
Informed consent (for examination, treatment, collection of
specimens for medical and forensic purposes, disclosure of
medical information and the HIV test) must be obtained from the
parent/legal guardian on the prescribed form or recorded in the
patient record.
Any patient over the age of 14 years can consent to the medical
examination.
Interviewing the child survivor
A social worker or the sister in charge must interview the
child survivor and accompanying parent/legal guardian with
sensitivity in a private room a the health care facility , It
is not necessary for a Police Officer to be present at the
medical examination of the child survivor.
Medical Assessment
If the child has sustained serious physical injuries, these
must be assessed and treated a the nearest Casualty/Trauma
unit. The Casualty Officer may there-after refer the patient to
the CCC or admit the patient.
Under NO circumstances must an injured victim be referred back
to the referring institution for the forensic assessment.
Timing of the Medico-Legal
Examination
The medico-legal examination must be done after the medical
assessment has been completed and ideally within two hours of
the patient presenting at the institution, especially if the
patient was sexually abused. |
Second Opinion
When the examining health care practitioner is unsure of the
medical finding, a second opinion may be sought from another
health care practitioner or paediatrician.
It is the responsibility of the doctor who first examined the
child to complete the J88, after consulting with the second
doctor/specialist. Consider admitting the child survivor to the
ward in order to
- remove the child from the traumatic environment
- obtain a second/specialist opinion
Making a statement to the Police
It must be established whether the matter was reported to,
and a statement taken by, the Police. If not, the social worker
or sister must make the necessary arrangements with the Police
to come to the health care facility to take the statement
Record keeping and notification of abuse
The report must be
comprehensive and all the information must be recorded in the
patient's file immediately.
The results of the forensic examination must be recorded on the
prescribed form (J88). The original J88 form must be handed to
the Police and a copy/photocopy of the J88 retained in the
patient's file.
The health care practitioner is required in terms of the Child
Care Act 1983 to notify all child abuse cases to the relevant
regional welfare authority. The clinic or hospital is
responsible for ensuring that the notification reaches the
relevant authority.
Post Trauma Counselling and
Support
The child survivor
should be referred for trauma counselling and support of if
necessary to a psychologist or psychiatrist
Medical Management and Follow-up
The health care practitioner
must routinely take ano-genital swab(s), urine and blood
samples. The health care practitioner must prescribe medication
for the prevention of STD's and pregnancy.
Follow-up
All cases require follow up within 48 hours, but the giving
of further medication is dependent on the circumstances of each
case and must be assessed accordingly.
In the majority of cases follow up investigation are at 3 and 6
month intervals, and my include:
- Blood
HIV - 3 and 6 months VDRL - 3 and 6 months
- Vaginal swab - if indicated
- Urine - if indicated
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HEALTH KWAZULU-NATAL