'Women should not go out'

Negative attitudes toward sexual assault survivors hamper specialised treatment.

Models of care for sexual assault survivors who access the public health system will feature prominently in public hearings on gender-based violence and the health sector in Parliament on June 11 and 12.

The hearings are being co-convened by the national portfolio committee on health and the South African Gender-based Violence and Health Sector Initiative, in the interests of developing clear and effective policies and guidelines for a public-health response to survivors of sexual assault and other forms of domestic violence.

Put yourself in the shoes of the average survivor of sexual violence in South Africa and you may not see the inside of a public health facility, let alone the corridors of the justice system.
Many women remain silent about the violations they suffer at the hands of perpetrators and do not approach police, the courts or health-care workers for help.

Health services to survivors of gender-based violence are delivered under the Health Act of 1977 and as such have a medico-legal focus. Primary to the service is the collection of evidence, yet according to a survey commissioned by the initiative on health services for rape survivors in North West, in many facilities health-care workers lack specialist training and resource-poor facilities do not have the equipment for specialised examinations.

Issues of privacy and collection of evidence are also integral to acceptable and effective service delivery. According to the initiative’s survey, only five of 20 hospitals observed in North West had a private room with walls and a door for rape examinations and in cases where a private room was available it was not always used. Only 15% of the 40 health facilities observed had the J88 forms officially required to document rape cases and only 5% stocked the evidence envelopes critical for the storage of clothes for DNA testing. In 80% of rape examinations clothes are not sent for forensic testing and there are documented cases of nurses placing clothes in plastic bags, which prevents DNA analysis.

In 30% of facilities, a locked cupboard for storage of rape kits and evidence envelopes was observed, but in facilities with no locked cupboard, completed rape kits were kept on nurses’ desks awaiting collection by police, allowing for possible tampering with evidence.

The report also documents the attitudes of health-care workers toward rape and survivors presenting at provincial facilities as critical barriers to access and effective service delivery: “Many women who report that they have been raped are drunk,” claims one nursing sister. “If a woman is not bleeding excessively then she can wait in the queue like everyone else,” says another. “Women should not get themselves into trouble”; “They should not go out on New Year’s Eve”; “Some women who come here have not really been raped.”

These responses highlight the gender bias and often insensitive attitudes of some professional health-care workers.

Authors of the report, Naomi Webster and Makhurwane Malala, found “health workers perceive that most rape survivors go to the police before hospital and they prefer women to do this”. This was observed to the extent that “55,1% of health workers would send women who come directly to health facilities to police before examination”.

However, as disclosure and counselling services are not protocol in police services survivors who decide to seek help probably look to the public health service first. Sadly, elusive protocols in the health-care facilities provide health-care workers with little direction for responding to survivors of sexual assault. The survey suggests that less than three-quarters of health-care workers surveyed in the North West have any knowledge of protocols for rape examinations.

The lack of protocols and policy guidelines presents great challenges to the public health service, and not least to rape survivors.

Tina Sideris, a psychologist working with the Masisukumeni Women’s Crisis Centre in rural Mpumalanga, believes a service model for sexual assault survivors must include protocols for effective delivery.

Sideris says the Masisukumeni Crisis Centre has had great success in assisting survivors of sexual violence over the past eight years, primarily because it employs well-trained sexual assault counsellors rather than relying on overstretched hospital and clinic staff.

Sideris says including the training of specialised sexual-assault counsellors in a future policy framework would add great value to the health services for survivors of sexual violence.

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