CHENNAI: Enna? Orama azhugama wait pannu!” (What? Stand in the corner and stop crying) The rebuke, from a government hospital staff, was directed at Priya*, a 15-year-old rape survivor while she was awaiting treatment at the hospital.
The social worker who was with the child’s family at the time recounted the incident to draw attention to the way child survivors of sexual assault are treated at hospitals.
Survivors of sexual assault go to the hospital for treatment of injuries or ailments related to the assault or for medical examination after reporting the assault. Under both circumstances, survivors’ families, activists and others note that they are subjected to insensitive questioning and are handled harshly, causing further trauma to the already traumatised children.
“The survivors and their families, when they go to hospitals, often hear questions like ‘why did you leave the child alone? Now there is no use crying?’ which are highly insensitive, causing them to feel guilty and regret having sought help,” Sherin Bosko of Nakshatra Rape Crisis Centre said.
Priya was raped by a neighbour who had stalked her for over six months. He raped her a second time by claiming to have videotaped the first assault and impregnated her. Priya’s mother has severe mental illness and her father supports the family by working as a security guard.
When she was taken to the Institute of Child Health at Egmore, every person she encountered — from the sanitary worker to the doctor — shamed the child and her brother, at every chance they got.Worse, she was forced to tell her account of the assault again and again. “She was made to wait for hours in the corridor for the doctor, for the tests, for the test results and she had to recount the entire incident to members of the entire medical team, from different departments,” Sherin said.
As word spread, that she was a sexual assault survivor, the looks and stares from the staff increased. Everyone felt it their duty to ‘advice’ the girl on how to ‘protect’ herself from such men. “Finally, she underwent the abortion and in the little time she was conscious during the procedure, she could hear whispers and murmurs in the room blaming her,” added Sherin.
“After the procedure, the foetus which is meant to be preserved as evidence in such cases was left unattended for almost three hours. I had to wait in the same room with the patient and the foetus to make sure the evidence was not tampered with,” she recalled.
Between the assault and the experience at the hospital, the child was traumatised and refused to return to school. She eventually discontinued her studies. Pooja*, mother of a four-year-old boy, who was sexually assaulted by a school van attender on the school bus, said that the child who was already traumatised by the assault was further traumatised by his experience at the hospital where he went for treatment and medical examination.
“He is traumatised to the extent that even after six months, he fears going to the hospital,” said Pooja. First, he had to wait for an hour to see the doctor. “As soon, as I entered the doctor’s room, the first question the doctor asked him was ‘Enna? Enna pakara? (What? What are you looking at?). He then, ran a couple of tests and sent us back. In the whole time, he said not one soothing word to the child,” she recalled.
The next day, they received a report which claimed there were no signs of sexual assault. “We were shocked as I could see certain marks near my son’s private parts. I insisted on a re-examination,” she said.
“The doctor examined the child and was said he needed to be admitted for three days. Children tend to wonder why they are being admitted at a hospital, despite not being sick or hurt. They start thinking something is wrong. On the second day, after a psychiatric check up, the child was found to have undergone trauma and on the third day, we were asked to go to the Institute Of Child Health for examination. The reports were later handed over to the magistrate,” she said, adding that this entire ordeal has traumatised the child more than the assault had.
Banned methods
If not properly examining the child is one problem, using outdated and banned methods to examine the child is another. Child activists pointed out that despite the 2013 Supreme Court ruling banning the two-finger test, doctors in Tamil Nadu’s government hospitals continue to administer it. The antiquated test involved inserting two fingers into the survivor’s vagina to check the laxity of vaginal walls, thereby establishing if the survivor is “habituated to sexual intercourse”. The SC had ruled that this invasive procedure violated a survivor’s right to privacy.
Nonetheless it is administered on even child survivors of sexual assault in Tamil Nadu.“Even the court accepts it. The doctors submit the report to the court, clearing mentioning the two finger test was conducted and nothing is said against it. This is clearly a lack of ignorance,” said a child rights’ activist.
A senior doctor from a government hospital admitted that the test was being conducted and attributed it to a lack of awareness. “The instructions and directions have not reached the doctors. There has always been a disconnect in such issues and the proforma also doesn’t have any such instructions,” the doctor added.
Unaware of guidelines
Most doctors are also unaware of existing guidelines of Union Health Ministry on the Protection of Children from Sexual Offences Act. For instance, under Rule 5 of the Act emergency medical care is to be provided by any medical facility, private or public. No magisterial requisition or other document is to be demanded as a precondition to providing emergency medical care. However, private hospitals have been known to direct survivors to government hospitals and both private and public facilities have been known to demand an FIR and other documentation before providing care.
A doctor working at a private hospital said that when such cases came to them, they informed the police and provided basic treatment before referring the child to government hospitals. “Even in the court, only records from government hospitals are valid,” the doctor added. This is not strictly true. POCSO says that medical examination may be conducted by a registered medical practitioner (RMP) at a private hospital in the absence of a government hospital RMP.
Further, there is little awareness of the importance of consent before the medical examination (from the child’s guardian or parent) and the right of the child, if over age 12, to refuse medical examinations, which are often done as a matter of routine on the grounds that it aids the prosecution.
K Selva Priya, special public prospector of Mahila Court, Cuddalore noted that survivor’s statement alone could be taken as evidence. However, she believed the medical examination should be done. “There will definitely be some kind of injury marks on the victims which will considered as evidence. Most of these tests are done in government hospitals as in case of emergency, when they approach a private hospital, an explanation is expected. In some districts, certain hospitals may not have all the facilities to treat grievous injuries and so they are referred to the government hospitals. Ultimately, the goal is to convict the right person,” she said.
Still, senior officials in the health department claimed that training was being provided to doctors on how to treat child survivors of sexual assault. In December 2018, for instance, a workshop was conducted with professors from 22 government colleges across the state. Dr R Selvakumar, professor and head of the forensic department, Kilpauk Medical College, said that since 2016, awareness programmes on the matter are being frequently held.
“But given their workload, there is little change in their attitude. We are also urging the government to set up a centre that will treat only such cases. This will speed up the medical treatment as well as the legal procedure,” he said. Indeed, Tamil Nadu has only one Sakhi One Stop Centre, which is envisaged to support survivors of gender-based violence.
(*-names changed)