Many obstacles to healthcare for rape survivors
Teenage girls who are raped are often scolded or branded liars by healthworkers attending to them, while men, gays and lesbians and sex workers who have been raped are also discriminated against.
Other problems facing rape survivors include the denial of healthcare to those who have not reported the rape to police, the lack of privacy for examinations and staff ignorance of basic treatment procedures.
This is according to the National Working Group on Sexual Offences, a group of 25 organisations including Childline, the Teddy Bear Clinic, People Opposing Women Abuse and the Tshwaranang Legal Advocacy Centre.
The group this week sent a detailed submission to the SA Human Rights Commission on the experiences of rape survivors of the health services.
The SAHRC is convening public hearings next month on the ‘availability, accessibility, acceptability and quality’ of health services to South Africans.
Almost a third of health practitioners said they did not consider rape to be a serious medical condition, according to a survey carried out at 31 health national facilities that treat rape survivors.
Healthworkers at 26 Gauteng medico-legal services were often ‘unsympathetic, judgemental and impatient attitude’ towards the rape survivors.
One teen rape survivor reported that she was screamed at by the nurse: ‘While she was busy doing the blood test she kept asking me questions like what happened’¦and she was like shouting. So I had to tell her what happened. That’s when she told me that ‘As a 17 year-old girl what you were thinking? You deserve things like that’.’
Another teenage girl was lectured on the shortness of her skirt, with the nurse stating that fewer rapes had occurred in her day because longer skirts had been worn.
‘Both healthcare providers and members of the criminal justice system are prone to believing that girls are likely to lie about being raped in order to cover up illicit sexual activity,’ according to the group.
Gays and lesbians also faced discrimination when reporting rape, with a small proportion actually being denied healthcare altogether because of their sexual orientation.
The Teddy Bear Clinic and Resources Aimed at the Prevention of Child Abuse and Neglect (RAPCAN) note that homophobia and ignorance about male-on-male rape affect men and boys’ access to healthcare.
Health workers sometimes viewed male rape victims as ‘failed men’ or gay, while they sometimes did not believe that gay men had been raped.
A broad assumption that sex workers have given up their right to withhold consent to other sexual advances so cannot be raped affected this group’s access to services.
Many rape services are in the casualty section of hospitals.
‘But these are precisely the departments most unsuited to dealing with rape patients, being noisy, busy, chaotic, bloody, frightening and conflictual ‘ hardly the ideal environment for someone in a state of shock,’ according to the group.
‘Further, unless rape survivors have suffered serious physical injury they will be bypassed in order to treat those patients whose conditions are seen as more life-threatening.’
Rape survivors often have to wait long periods to be treated, particularly as rapes are most likely at night and over weekends when the fewest services are available.
Many women depend on the police to transport them to healthcare facilities, and often wait for sometime at police stations before being taken to these facilities.
Long waits impact negatively upon women’s right to emergency medical treatment in the form of antiretroviral drugs taken as post-exposure prophylaxis (PEP) to prevent HIV infection. These should be taken as soon as possible after the rape and no more than 72 hours later.
Victims who do not report the rape to the police are also frequently denied healthcare, although this is contrary to policy. Staff members often refuse to give PEP to those who had not reported their rape as a means of distinguishing the ‘real’ rape survivors from the ‘liars’ who merely wanted medication.
Of the 31 health facilities surveyed, less than half (47.4%) had a private room available for the examination of rape survivors and these rooms were often kept locked after hours.
Although most rape survivors desperately want to wash after their attack, none of the healthcare facilities in Gauteng, Limpopo, North West or Free State had access to showers or baths and few had access to basins. In contrast, all Western Cape facilities had basins while over half (56.8%) had showers or baths.
There were often shortages of forensic kits necessary for collecting evidence.
Although only medical personnel should be present while the rape survivor is being examined, police officers and other unauthorised people were sometimes present in the examination room.
Less than a third (30.3%) of the healthcare practitioners surveyed had received training on caring for rape survivors. The best trained and most committed staff was on duty during the day yet the majority of rapes are reported at night and over weekends.
There was a lot of ignorance about how to treat child victims in particular. Western Cape children’s organisation Molo Songololo recently dealt with the case of a five-year old boy who was forced to give oral sex to a man.
Although the matter was reported to the police in Atlantis, the child was not taken to hospital. When the child’s mother decided to take her child to hospital, he was given an HIV test, but no antiretroviral drugs or counseling.
The emotional needs of rape survivors are generally not addressed, with the majority not being referred for counseling.
Where counseling existed, it was generally focused on preparation for an HIV test and the PEP drugs, ‘with less thought and time being spent on the emotional needs of the survivor’.
However, survivors rated the PEP service and a sensitive health care provider who could provide counseling as the two most important health services.
‘The collection of medico-legal evidence has too often been seen as the main role of the healthcare worker in relation to rape. This has meant that rape survivors’ health needs have been subordinated to the demands of a criminal investigation,’ reports the group.
In some cases, doctors’ reluctance to testify in court undermined the legal process.
In 2003, a seven-year-old girl was raped in QwaQwa, Free State. The child’s mother sought help from Thusanang Advice Centre in November 2006 after the case had come to a complete standstill as the doctor who had originally examined the child could not be located and it was very likely that the matter would be struck off the roll.
Thusanang eventually located the doctor in Heidelberg in January 2007. However, he refused to appear in court and when subpoenaed to do so, refused to accept the subpoena.
The doctor had to be arrested and brought to court on 28 March 2007, where he gave evidence confirming that his examination had found proof of rape.
The group has asked the SAHRC to invite the Department of Health to testify about what practical steps it is taking to implement its policies on sexual assault treatment and care, as well as targets and budget for the next three years.
In 2005/06, 54 926 rapes were reported to police. Of this, approximately 42.7% of rapes were of children.
As rape is defined as an act perpetrated by a man (or boy) against a woman (or girl), police rape statistics do not include the rape of men and boys.
These cases are amongst the statistics for indecent assault which the police do not disaggregate by gender. There were 9 805 indecent assaults for the same period.
However, rape is hugely under-reported. StatsSA found in 2000 that only half of rape survivors reported being raped to the police, while the Medical Research Council found in 2002 that one in nine women reported being raped.
Sexual violence can have profound physical, emotional, relational and behavioural consequences. Many survivors live for years with the after-effects of sexual violence, and although often outwardly able to cope with the demands of daily living, the effects can be so pervasive that they permeate all aspects of life, sense of self, intimate relationships, sexuality, parenting, studies or employment, and the ability to cope.
The consequences of childhood sexual coercion and violence are particularly pernicious, with South African research finding that girls sexually assaulted as children are at increased risk of being victimised again as adults.
Women who experienced sexual assault were also more likely to attempt or commit suicide. Other mental health problems associated with sexual violence include depression, generalised anxiety, reduced self esteem, panic phobias and post-traumatic stress disorder (PTSD).
Rape survivors are six times more likely to develop PTSD at some point in their lives and also constitute the single largest group suffering from PTSD.
All of these reactions can be further exacerbated by the ill-informed and judgmental treatment of rape victims by their families and communities, health care workers and criminal justice system personnel.
(extract from National Working Group on Sexual Offences submission to the South African Human Rights Commission (SAHRC)
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