Choose Words that are Gentle and Soothing A victim is often in a heightened state of awareness and very emotional after an assault due to circulating stress hormones. Many survivors of sexual assault have described the kindness of the treating personnel as being beneficial to their recovery. For this reason, health workers must choose their words with great care when dealing with sexual assault patients. Sources:FUND (1998): Improvingthehealthcareresponsetodomesticviolence – a trainer’smanualforhealthcareproviders, Manual. WHO (2003): Guidelinesformedico-legal care of victims of sexual violence, Manual, Geneva.
Why health care providers should document violence against women: • For good clinical care: documentation provides records of the effects of a pattern over time; increases communication among multiple providers • For the practitioner’s legal issues: such as standards of care, mandatory reporting requirements, etc. • For the patient’s legal issues: documentation is useful as evidence to get a no contest order in criminal proceedings, to file for child custody, etc.
Strategies for documentation: • Use body maps and/or pictures to identify injuries: When using photos, get consent and review photography procedures. • Types of notes to put in chart: Describe specifics about abusive incidents: who inflicted the violence, the perpetrator’s abusive conduct, health impact on survivor (injuries and other medical issues), if the perpetrator uses alcohol/drugs and/or weapons. -> For an example see also: Handout „Documentation of GBV“
Photography • Consider the Patient • Identification • Scales • Orientation • Chain of Custody • Security • Sensitivity
Examination and Documentation of Sexual Violence Sexual Violence Examination shall ideally be conducted by gynecologists or forensic experts especially trained on GBV. If it´s not guaranteed that the survivor will have access to a sensitized gynecologist or forensic expert general health care providers have to document the injuries.
General Principles • Note the patient’s general appearance, demeanor and mental functioning • Note the patient’s vital signs • Examine the patient from head-to-toe, concluding with the genito-anal area • Note and describe in detail any physical injuries, even if forensic evidence is not being collected. Use body maps to indicate location and size of injury • Photograph any injuries, if possible • Order diagnostic tests (e.g. X-rays, CT scan, ultrasound) • Draw blood samples for testing for HIV (informed consent must be obtained for HIV testing), hepatitis B, syphilis and other STIs -> See also: Handout 1 “WHO documentation template” and Handout 2 “Guidelines for documentation”
Universal Precautions should be Observed at all Times during the Examination: • Wear gloves whenever in contact with blood or other body fluids • Change gloves between patients; it may sometimes be necessary to change gloves during the examination in order to prevent contamination • Wash hands with soap and water after any exposure to body fluids or blood, between clients, and after removing gloves • Wear protective eye-wear, masks or face shields if there is a possibility of splashing blood or body fluids into your eyes, face or mouth • Do not recap used needles; • Do not bend or break needles after use; • Dispose of used needles in special impermeable sharps containers immediately after use