Yvonne McCalla Sobers | Rape survivors and system roadblocks
Rape is a crime that is often not reported. According to police data, reported rape cases declined from 863 in 2013 to 442 in 2017. However, rape survivor silence raises questions about the data, especially where in an estimated seven out of ten cases, the survivor knows the perpetrator.
It is accepted that rape survivors may be men and boys, but they are mostly women and girls. Rape perpetrators may be female, but they are mostly male. Recovery from trauma often depends on the way rape survivors are treated when they seek help. A treatment protocol for rape survivors has, therefore, been developed by the World Health Organisation (WHO).
Rape survivor's fears
Like many rape survivors, Ann (not her real name) did not want to make a police report. She believed the perpetrator when he said that he would kill her or have her killed if she informed on him. Determined to stay alive, she intended to confide in her best friend only. Her best friend, therefore, had to work hard to persuade her that she needed at least to see a doctor for immediate medical treatment whether or not she chose to press rape charges.
Confronting Survivor's Reality
Ann's best friend wanted to ensure that Ann saw a doctor before she bathed or changed her clothes. According to WHO guidelines, a medical professional needed to see Ann as soon as possible after the rape to ensure that:
- injuries were documented and treated.
- forensic evidence was collected.
- sexually transmitted infections (STIs), in particular HIV, were prevented.
- risk of pregnancy was evaluated and prevented.
- psychosocial support and counselling were offered.
- follow-up services were arranged to monitor her mental and physical-health status.
Ann didn't want to place herself under scrutiny. She feared condemnation for being alone with the perpetrator in his apartment even if she considered him to be a colleague with whom she was working on a project. She was not going to answer any questions about her sex life or say why she didn't run or scream. She felt ashamed that there were no signs of struggle - no injuries and no torn clothing - because she made a conscious decision not to resist.
Locating Rape Survivors' Drugs
Treatment protocol required that Ann begin the HIV Post exposure prophylaxis (PEP) regimen immediately on exposure to HIV infection. There was a maximum window of 72 hours after exposure, with risk increasing all the time.
Treatment needed to take place in an environment Ann could trust, with healthcare providers to provide her with compassionate, high-quality medical care centering on her needs as a survivor. She knew, however, that access to medical treatment could be challenging on the approaching holiday weekend when drugs and health care providers could be difficult to access.
Ann initially resisted going to Centre of Investigation of Sexual Offences and Child Abuse (CISOCA) but agreed to see a private doctor available outside of regular clinic hours. The doctor sent Ann away with a single drug. A pharmacist later told her that she should have been given the PEP three-drug cocktail. Further, the doctor should also have administered a rape kit to collect forensic evidence such as blood, sperm, and hair and measure bruises and lacerations. In addition, sedatives and antibiotics could have been made available if warranted by Ann's condition. Instead, the doctor directed Ann to CISOCA.
CISOCA and a Narrowing Timeline
Ann's best friend sought help to overcome her reluctance to visit CISOCA. She told Ann that part of CISOCA's mission was to arrange for rape survivors to be medically examined, provided with medication, and exhibits taken to the Forensic Government Laboratory. In addition, CISOCA could assist with Ann's rehabilitation by assisting that to receive counselling and therapy and by referring her to the Victim Support Unit.
However, Ann refused to answer questions or divulge information to CISOCA. The CISOCA representative told her the agency could not help her unless she gave them details to support the rape allegation. Like many rape victims in the aftermath of the violation, Ann felt too psychologically damaged to be interviewed, have her complaint assessed, and have her statement recorded.
The window for PEP was narrowing. Ann's best friend found out that pharmacies in public hospitals stocked the drug cocktail. However, after a six-hour wait at the nearest public hospital, Ann once again went away empty-handed. The hospital nurses were as supportive as they could be, but the doctor on duty was dismissive. She said that she knew nothing about PEP or about the treatment protocol for rape survivors coming to Accident and Emergency.
The doctor sent Ann back to CISOCA.
Personal Influence to the Rescue
With hours to go before time ran out, Ann's best friend reached out to some NGOs with a gender-violence focus. Could they, perhaps, point her to a doctor who knew the protocol well enough to write the PEP drug cocktail and help Ann to obtain the drugs in the few hours now remaining? Her inquiries to NGOs yielded further advice to return to CISOCA.
Almost down to the wire, Ann's best friend worked the phones and drew on her contacts in the medical community. She ultimately got the PEP from another public hospital. She had help from a consultant relative of a friend who was familiar with the WHO protocol for treating rape survivors. However, this public hospital was not able to provide a rape kit unless on CISOCA's request. In any event, during the almost three days since the rape, Ann had bathed and changed her clothes. The forensic evidence was lost.
Contacted by phone with respect to Ann's case, staff at CISOCA seemed empathetic but stuck in a procedure requiring survivors to provide statements before receiving treatment. Ann declined CISOCA's invitation to return to give a statement that could be acted on later if she changed her mind about bringing charges against the rapist.
Government's Role in Developing and Enforcing Protocols
CISOCA was set up to provide rape survivors with support and, hopefully, a route to justice. However, if survivor testimonies are not recorded, rape cases go unreported.
Perpetrators remain free to repeat the sexual offence, and the survivors retreat into dark spaces where they may have the illusion of safety.
The State needs to see rape as primarily a health crisis. The Ministry of Health would, therefore, need to ensure that all medical personnel are briefed on a protocol based on WHO guidelines and structured around the needs of rape survivors in a Jamaican context. This protocol would need to enable survivors to:
1. quickly find 24/7 hotline help (inclusive of public holidays).
2. be assigned an intervenor who believes and supports the survivor, especially when the survivor is most fragile and has no trusted confidante.
3. understand that violation took place even if the rape did not involve physical force - not fighting does not mean consent.
4. receive medical, psychological, and legal help according to the survivor's needs and timetable.
5. receive attention from medical personnel who are all equipped with the knowledge and resources to provide care in accordance with given protocols.
6. feel protected from distress and in control during interviews.
7. receive referrals to appropriate help agencies (State or NGO) informed about and committed to observing the protocol, for example, a rape survivor may need counselling and therapy to prepare them for providing police investigators with statements.
8. access long-term physical and mental healthcare, For example, decades after the event took place, survivors may suffer mentally (guilt, shame, anxiety, confusion, depression, nightmares, inability to trust, or post-traumatic stress disorder) and physically (burning, infection, insomnia, unexplained pain, or fertility problems).
Ann's difficulty in accessing care shows gaps that can further traumatise rape survivors. Procedures need to be well known to the support network for rape survivors. Healthcare and security personnel need to have the knowledge and resources to treat rape survivors with regard for timeliness as well as rights and dignity of the individual. Overall, Jamaica's rape survivor protocols need to be based on available drugs and resources, national policies and procedures, local culture, and global best practices.