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Rape victim examination . Dr. Sharda Jain Lifecare Centre


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Rape victim examination . Dr. Sharda Jain Lifecare Centre

  1. 1. “UNIFORM Examination of Rape Victim by all Lady Doctors : is Need of Hour in India” Dr. Sharda Jain Director :- Sec General : Delhi Gynae Forum
  2. 2. DEDICATED to NIRBHAYA 16/12/12 & Women of India
  3. 3. Sexual assault and rape cases are increasing at an alarming rate in India h 6t & can Happen c1 De to anyone shattering her life completely (She can be your Daughter, Sister, Friend & Even Mother !!)
  4. 4. Rape Needs to STOP
  5. 5. Victims Need to Speak Up rst Fi AK PE S Up -
  6. 6. nd co Se How Society Views Rape Victims Need to change
  7. 7. ird Th Rapist Should Not Go Scot Free
  8. 8. Lousy Fourth Medical Care/ Exam. Of Rape Victim has to change !!
  9. 9. Every Lady Doctor Has to Get Trained in Rape Victim Exam & Care - WHY ???
  10. 10. Delhi High Court – Judgement 2011 • Directing uniform examination protocol • Use a standard kit • Protocol of treatment Film & Kit
  11. 11. Delhi High Court - Judgment 2013 Following Judgment of division bench of DELHI HIGH COURT comprising of chief justice sh. D Murgeshan and justice sh.V.K. Jain stating that the government must issue direction to all hospital including those in Private sector - not to deny emergency treatment to rape victims - free of cost. Dept of Health and Family welfare NCT of Delhi has directed nursing homes and private hospital not to refuse emergency treatment to rape Victims / give care Failing which - face punishment.
  12. 12. Lets Know the LAW New Definition Of RAPE (According to 2013 amendment) •Penetration of penis, to any extent, into the vagina, mouth, urethra or anus of a women or makes her to do so with him or any other person; or •Insert, to any extent, any object or a part of the body, not being the penis, into the vagina, the urethra or anus of a women or makes her to do so with him or any other person;
  13. 13. Lets Know the LAW Cond. New Definition Of RAPE (According to 2013 amendment) •Manipulation of any part of the body of a women so as to cause penetration into the vagina, urethra, anus or any part of body of such women or makes her to do so with him or any other person Or •Applies his mouth to the vagina, anus urethra of a women or makes her to do so with him or any other person, under the circumstances falling under any of the following seven descriptions:
  14. 14. Lets Know the LAW Cond. New Definition Of RAPE (According to 2013 amendment) FIRST – Against her will SECONDLY – without her consent THIRDLY – with her consent, when her consent has been obtained by putting her or any person in women she is interested in fear of death or of hurt. FOURTH – with her consent, when the man knows that he is not her husband and that her consent is given because she believes that he is another man to whom she is or believes herself to be lawfully married.
  15. 15. Lets Know the LAW Cond. New Definition Of RAPE (According to 2013 amendment) FIFTHLY – with her consent when, at the time of giving such consent, by reason of unsoundness of mind or intoxication or the administration by hem personally or through another of any stupefying or unwholesome substance, she is unable to understand the nature and consequences of that to which she gives consent. SIXTHLY – with or without her consent, when she is under eighteen years of age SEVENTHLY – when she is unable to commutate consent 2.INJURIES ON VICTIMS BODY HAS NO RELEVANCE
  16. 16. Appeal 3 things are important 1st Rape victim of sexual assault or rape is received by sympathetic and sensitive doctor, 2nd appropriate medical Exam./care & treatment , 3rd clinical evidence saved.
  17. 17. 3 Most Important Things Needed •Trained Doctor & her team • Special kit for examination • Protocol of Treatment to prevent STD/ Pregnancy is crucial
  18. 18. What You Can do Before Reaching Hospital ? As soon as one comes across a victim Of Sexual assault, the first step is to ensure SAFETY • Take her to safe and secure place call the police if danger from the assailant is still there. • Call a close friend or relative- someone who will offer unconditional support.
  19. 19. INSTRUCTIONS TO THE VICTIM What You Can Do Before Reaching Hospital ? • One must take care not to clean up before taking them to hospital. The victim should not bath, go to the bathroom, comb hair, change clothes or brush teeth before undergoing a medical examination. • This will help to preserve all the evidence.
  20. 20. Principle of Emergency Care The doctor’s job at the emergency room is not to determine if the rape has happened or not. Rape is a legal term – a crime – and whether this crime has been committed or not will be decided by the Honorable court.
  21. 21. Principle of Emergency Care • The attitude of the medical staff should be compassionate and not judgmental • Life threatening emergency, if present needs urgent attention
  22. 22. Guidelines for Medical Examination As per new law 2013 • Victim : the first aid medical treatment to the victim of rape and vitriolage shall be provided promptly and FREE OF COST by all hospital public or private • Medical examination of a female victim shall be conducted by a FEMALE REGISTERED MEDICAL PRACTITIONER, in absence there of , in presence of a female registered medical practitioner
  23. 23. Guidelines for Medical Examination As per new law 2013 POLICE REQUISITION /FIR is not mandatory for seeking medical care and treatment of the victim.
  24. 24. The Principal Features of the Examination are:1. 2. 3. 4. 5. 6. Informed consent Preliminary data The statement of the victim and others separately Collection of clothes of victim Signs of struggle on clothes and body Examination of the genitals for:• Local signs of violation • Genital injuries • Presence of spermatozoa and other micro organisms Any evidence of STD 5. Collection of laboratory specimens 6. Inference 7. Advice on follow-up
  25. 25. INFORMED CONSENT of the victim should be taken in writing in presence of a witness if she above the age of 12 years (In India) if she is under the age of 12 years or a mentally subnormal person, the written consent of the parents
  27. 27. The statement of the victim in her words must be written down as much as possible “WORD FOR WORD”. The amount of violence used, the position of the assailant, and the mode of attack should be elicited. It is necessary to inquire if vaginal, oral, or rectal contact occurred. Her statement should be noted with reference to:•Pain •Haemorrhage •Sensation as to penetration and emission and •The appearance of discharge •If she cried for help, or was too terrified to do so, or she fainted Enquiry should be made of the events after the all eged assault, e. g, if she has changed her clothing, bathed or passed urine. Any delay in making complain to the authorities should have a proper explanation. A record should be made of the statement of others who accompany her. The degree of agreement of the various statements is important.
  29. 29. Collection of Clothes of victim including under linen
  30. 30. Guidelines for Injuries As per new law 2013 • Sign of Struggle on Clothes & Body are IRRELEVANT According to New Low • Injuries are seen in only one third cases. • Common sites of extra genital trauma are mouth, throat, wrists, arms, breast and thighs. It is essential to do a careful recording of the findings if there presents.
  31. 31. The women usually scratches the assailant during the struggle and this may result in injury to her nail which should be recorded. The debris under nail should be removed and examined for the presence of tags of epithelium, blood, fibers, etc, of the assailant Nails Scrapping
  32. 32. Guidelines for Medical Examination As per new law 2013 • Two finger admissibility test on a women victim shall not be performed and • Recording of “victim is habituated to sexual inter course or not” shall not form a part of report at all.
  33. 33. Menstruation is not a bar for Examination “MENSTRUATION IS NOT BAR TO ILLEGAL SEXUAL INTERCOURSE”.
  34. 34. Soon after act, the torn marging are sharp and red, and bleed on touch. Even when examined after 3 to 4 days of offence, the edges of laceration are congested and swollen. The surrounding tissues are tissues are also swollen and tender.
  35. 35. Collection of Forensic Sample Followings samples are required to be collected in sexual abuse cases • Microscopic examination of vaginal slides (motile and immotile sperm) • Vaginal swab (vulva , low vaginal, high vaginal) to stress here that it should be made a routine • Nail scrubbing (to look for epithelium of the assailant) • Hairs from mons pubis (to look for seminal stain, foreign hair) • Seminal stain (blood grouping) • Ultraviolet test for detection of seminal and saliva stains (optional) • Blood (blood grouping, Bhcg , STDs , testing drug intoxication) • Urine (to test for suspected pregnancy, drug testing)
  36. 36. Motility of Sperm – Prepare a hanging drop Preparation Motile sperms can visualized up to four – five hours The smears are fixed with drop of alcohol
  37. 37. Swabs and Smears Vagina • Vaginal swab (vulva , low vaginal, high vaginal) to stress here that it should be made a routine • Dry or Saline
  38. 38. Swabs and Smears • Mouth Swab from under the tongue and buccal area near molars. Take one swab from each area and prepare the smear • Rectum Take one sample from the external orifice and another from the 2-5 cm area around external orifice
  39. 39. Essential for preparing smearing – instruction used to obtain a smear: • Clean microscopic glass slides of good quality, preferably with frosted ends (0.96-1.06 mm. thickness). • Suitable glass marking pencil or a diamond marker for identification of slides. • Paper clips to separate the slides. • Fixative 95% ethy alcohol or 100% methy alcohol • Laboratory from with clear identification of the patients and history
  40. 40. In Sexual Abuse Victims Screening Recommended • Pregnancy test • HIV, STD TEST • Blood and urine for addiction or substance abuse such as: heroin , opium, benzodiazepine and alcohol
  41. 41. Collection of Evidence • Even if the victim is NOT SURE, whether she wants to report the attack, it is still important to collect and preserve evidence so it can be accessed at a later date, if necessary. • Evidence if not collect within 48 to 72 hours of the incident is often unrecoverable or invalid.
  42. 42. Optional in Virgins & Children
  43. 43. PUNISHMENT FOR NON COMPLIANCE for we doctors – Exam/ Care/ Evidence collection Whoever, being in charge of a hospital , public or private , whether run by the central Government, local bodies or any other person, contravenes the provisions of sections 357c of the code of criminal procedure , 1973(2 of 1974), shall be punished with imprisonment for a term which may extend to one year or with fine (166B – IPC)
  44. 44. Rape is a Rape !!
  45. 45. Hard to disprove
  46. 46. Treatment AIM • Pregnancy prevention • Sexually Transmitted Disease Prevention • Emotional Support
  47. 47. Prevention of pregnancy Emergency Pill : levonorgestrel 0.75 mg one pill orally every 12 hours for two doses UPT : to be repeated at 1,2 weeks & MTP : if need be
  48. 48. Sexually transmitted diseases Incubation period of common infections • • • • • • • Gonorrhea Trichomonas Chlamydia Warts Herpes Herpes vaginosis Syphilis 3-4 days 1-4 weeks 7-14 days several months 2-14 days 2-14 days 3 months
  49. 49. Universal STD Prophylaxis Metrogyl 2gm orally - single dose Azithromycin 1g - orally single dose Ceftriaxone 250 mg I/M single dose
  50. 50. Optional • Hepatitis B vaccination • Oral HIV pep (Post exposure Prophylaxis) for 4 weeks
  51. 51. Emotional Support Sexual assault victim need unconditional emotional support as they may be struggling with emotions of Anger, Fear, Guilt, Shame and anxiety
  52. 52. Emotional Support The Victim May Suffer From • Sleep disturbances • Lack of appetite • Depression and nightmare • Physical pain
  53. 53. Counseling Most victims find counseling helpful in the process of recovering and moving on with their life. The care a patients initially receives influences her recovery from the trauma suffered due to rape Follow up is must
  54. 54. Please Remember Girls can not stop rape just by changing their own behavior violent people never stop unless they are Punished Please join hands with Delhi Gynaecologists forum’s campaign to do great medical examination & care
  55. 55. FILM On Medical Examination of Rape Victim Prepared by MOWCD/ IMA Youtube
  56. 56. Girls must learn self defense self defense self defense
  57. 57. Thank You