Tintswalo Hospital in Acornhoek, Mpumalanga, is somewhat run down and in need of a coat of paint. From the outside there is little to suggest the 450-bed government hospital is home to an innovative research project exploring the provision of quality post-rape medical care in under-resourced, rural settings.
The hospital’s Refentse (meaning resilience in the face of adversity) project began in March 2003. Initial research showed a parlous state of affairs: few doctors and nurses had training in post-rape management; rape survivors waited long periods before receiving treatment and saw up to 10 healthcare workers during the first, traumatic visit; and women were afforded little privacy, being examined and treated in curtained cubicles in the casualty section.
Of particular concern was that only 44% of doctors and 15% of nurses knew that post-exposure prophylaxis (PEP) had to be administered within 72 hours of the rape. About half of the women who arrived in time to receive PEP did not get it because they could not access counselling and HIV-testing.
Rape survivors were routinely offered a three-day starter pack and told to return to the hospital for the rest of the medication (a 28-day course of treatment is recommended). Many did not return because they could not afford the cost of transport or they were too traumatised to undertake the journey. Only 16% of women who should have received PEP treatment received a full course of medication.
This was the situation at Tintswalo Hospital before lead researcher Dr Julia Kim introduced a simple, but effective intervention.
Kim established a committee of key stakeholders from the hospital, local police station and community. The committee was persuaded that a holistic approach to the health needs of rape survivors was necessary and was instrumental in developing the new service.
The hospital developed a rape-management policy in line with the National Sexual Assault Policy, but which was responsive to the complexities of the rural environment. It also allowed Kim and her team to train healthcare workers and other services providers in the key issues in post-rape care.
The hospital set aside a private room where the medico-legal examination could take place and where rape survivors could wait to see a doctor or nurse. A supply of medication was kept here. This centralised post-rape care.
The research component of the Refentse project ended in April this year. The results are encouraging, with the most significant improvement seen in relation to PEP. Almost all women eligible for treatment were able to access it and there was a reduction in the time between the rape and the start of PEP.
The service was more efficient and patient-centred and improvements were noted in the provision of pregnancy testing, emergency contraception, STI treatment, voluntary counselling and testing, as well as on follow-ups and referrals.
Although the research has ended, the provision of services to rape survivors has continued at Tintswalo Hospital, which has further demonstrated its commitment to providing this care by recently employing a qualified forensic nurse.
Liesl Gerntholtz is the director of the Tshwaranang Legal Advocacy Centre, a multidisciplinary centre that promotes the right of women to live lives free of violence. The centre is managing the next phase of the Refentse project