Examination of rape survivors: sensitivity still missing

The two-finger test, so called for its use of the doctor’s index and middle fingers to check for the presence and status of the survivor’s hymen, was banned in 2018 for being pseudo-science, as well as traumatic and humiliating for survivors.  

But the physical examination carried out in hospitals is still not trauma-sensitive, as evidenced in survivors’ accounts.

Remember the 13-year-old girl from Kamrangirchar, who was raped for a year by her father’s employer because her dad owed him Tk 6,000? According to her testimony, her physical examination was done at the gynecological emergency ward of Dhaka Medical College Hospital without any semblance of privacy.

“I was taken to a ward on the second floor where there were a lot of women lying on beds,” the girl told this correspondent.

“I was taken to a bed, asked to remove my clothes, lie down, and close my eyes. I asked them to pull the curtains, but they told me that there are two police aunties present and that I have nothing to be afraid of.”

Asked whether she was, in fact, afraid, the girl suddenly went quiet. She hung her head, looked down at her hands, and refused to say anything. Up until then, she had been making eye-contact and articulating very clearly what had happened.

She was speaking to The Daily Star in the privacy of her home, supervised by her aunt.

“Did you feel bad?” this correspondent asked. She gave a nod, her gaze still buried deep in her lap.

“Did they tell you what they were going to do to you?” she was asked. This time she answered. “No. They just asked me to close my eyes.”

In this correspondent’s previous experience interviewing survivors, children in particular were found to have a harder time articulating feelings of trauma. They tended to keep quiet when asked questions such as “Were you scared?” or “How did you feel?”

Just because the 13-year-old did not utter damning words decrying the physical examination, does not mean that the ordeal wasn’t traumatising.

Rape survivors are examined at two stages at the DMCH -- upon admission, the survivor is led to the gynecological emergency ward where doctors administer primary treatment and collect swabs. The next stop is the OCC.

“All rape survivors are first taken to the gynecological emergency ward,” stated Dr Bilkis Begum, coordinator of the One-Stop Crisis Centre (OCC) at DMCH, who was previously head of the gynecological department.

“The OCC can provide primary medical care but it is still necessary to take the survivor to the emergency ward first to make sure she is not in any immediate danger.

“We need to see if they are in trauma or they are bleeding or if they need to be taken to the operating theatre, which the OCC does not have.”

Later, they are taken to the reassuring privacy of the OCC, where DNA evidence is collected. “We call the OCC the Bailey Bridge -- it is an uphill battle getting here, but once you are here, it is a safe place,” Dr Bilkis added.

“It all goes downhill again, once you leave the OCC.”

The OCC is designed to be trauma-sensitive in many ways. The gynecological emergency ward is not. The OCC lies across a collapsible gate, and is only opened from inside to certain people. The centre is equipped with a separate enclosure for physical and forensic examinations.

For rape survivors, a hospital is the first safe space they are taken to, making it imperative that the physical examination be more sensitive after what they went through. 

The 13-year-old, for example, was raped for a year under the direct patronage of her father and grandmother, making trauma an ingrained part of her life.

“When he came into the house, I used to be taken to the balcony. My father had bought a quilt and that used to be spread on the floor,” the girl described, “When it was done, my father would come back, fix my clothes, and carry me back to my grandmother’s bed.”

“This happened every day.”

The survivor has asked her uncle to buy her a head-to-toe burkha, that covers everything except her eyes. Her uncle complied, buying a royal blue burkha for her. He showed a photo of the new acquisition.

“This is what she is going to be wearing when going out, from now on,” he said.

The difference between the initial physical examination at the gynecological emergency ward and the one done by the OCC doctors was articulated by an eight-year-old survivor from Tantibazar to this correspondent recently.

The Daily Star spoke to her at the balcony of the Women and Children’s Repression Tribunal 1, where she was awaiting her turn in the courtroom.

“There were six people watching me in the ward on the second floor.My mother was not there. They asked me to take off my pants and then they took three sticks from a thin bottle and did something,” she described, each sentence punctuated by a long pause.

Remembering the ordeal was difficult for her -- she refused eye contact the entire time, clutched at her father, and fiddled around with the drawstring of her pants. When asked whether she was scared, she nodded and whispered a barely inaudible “yes”.

“The next day the doctor saw me again. This time it was in a room on the ground floor. Only one doctor. My mother was there.”

“Were you scared?”, she was asked again. “No,” she said, definitively, and vocally.

An adult in her early 20s, who was raped on October 16, 2018, was vocal in her criticism of the physical examination done at the emergency ward.

“Not one single person offered me any sympathy. Instead, the duty doctor who was collecting evidence from my genitals, said to me that I got raped because of what I was wearing,” she said.

“This was at a time when I was lying completely exposed in front of her. I felt like leaving the hospital and regretted my decision to even come seek help.” 

She pointed out several things about the emergency ward that made her feel uncomfortable -- how little the curtains covered, how ward boys walked in and out and how she was afraid they would take a peek, how a policewoman and a medical intern stared at her private parts during the examination, and how two people held her legs down while the doctor collected evidence from areas of abuse.  

 “Their behaviour was very rough. If I knew all of this was going to happen, I would have never gone to the hospital,” she stated.

WHY CAN’T SERVICES BE CONSOLIDATED?

The doctors at the emergency ward deal with more patients than they can handle, making it difficult to provide trauma-sensitive treatment, according to Dr Bilkis.

Brig Gen AKM Nasir Uddin, director of the DMCH, said, “Maybe it is time to consider setting up an operation theatre in the OCC.

“I will make sure that rape survivors are given privacy and special care.”

In countries like the United States and the United Kingdom, it has long been standard practice for medical evidence to be collected using a “rape kit”. The kit contains tools for collecting all evidence in one sitting, so that survivors are not subjected to repeated examinations.

The home ministry in India supplied over 3,000 rape kits across hospitals last year, in an effort to streamline the process and increase conviction rates.