Was the kid lost in science books at school, practically lived in the science labs at high school but that love affair diverted to mass media studies during graduation. When you have a combination like that, there plops a health journalist. And after 6 years of work now, she still feels she hasn't talked enough about YOUR health - all that you want to know & need to know on pandemics, major public health concerns (tobacco products must be banned!), new miracle medicines & treatments on the horizon to drugs that should banned here & now…And more importantly, about the people behind these stories. The real reasons, real inspirations.
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The brutal gangrape and death of a 23-year-old paramedics student in New Delhi has left India enraged and shocked and a dialogue on reforms in rape laws has set in. But a crucial need for reform also lies within the medical community, an onus waiting to be taken up.
For most of us, rape is unimaginable. We cringe at the idea of it. Off and on, when newspapers report of it, we feel sad, enraged, helpless, not necessarily in that particular order. We discuss it with colleagues and friends, over lunch or coffee, recount our 'scary' moments from the past, that feeling of being stalked, and then we move on. Away.
But unfortunately, for a victim of rape, there is no moving on from it. There is no wishing it away. I am afraid, never.
In India, more than 23,000 rape cases were registered in 2011, but finally only 5,470 persons were convicted under rape, according to the National Crime Records Bureau.
Justice is either delayed or denied in a large number of cases. The police, to begin with, are infamous for turning away the victims or convincing them against filing a complaint. In some cases, victims have been raped inside the police stations again. The media is also full of first hand accounts of mental torture at the police stations. Victims are questioned insensitively about the gory details. The interview for filing a rape complaint often becomes the test of the victim's own moral character. Even little kids, 4 or 6 year old rape victims, have not been spared. The main reason for such insensitivity is often the social and cultural background of the police personnel themselves, even in their understanding of the crime. Often the thought process is that victim must have provoked the rapist, by wearing skimpy clothes or being 'modern'. Worse, that she may have even deserved it. Not a very different mindset than the rapist himself. Sadly, the police in this country are ill-trained.
And this is why, to my mind, there is a bigger responsibility lying with the medical community in the country, one that often goes unrealised.
There is a set protocol under Section 164A of Code of Criminal Procedure in India, which gives provisions for medical examination of a rape victim. To begin with, no hospital, whether public or private, can turn away a victim of rape. But in reality, a rape victim often goes to a police station first, not knowing that she could directly go to a hospital and that it's her right to get all possible help there. All rape cases are to be treated as medico-legal cases. It is the hospital's duty to inform the police and a formal complaint will be registered, with the consent of the victim. It is also the onus of the hospital to get the medical examination done, evidence collected and prepare the medical report within a time frame, thereafter. Once the medical report is out, there is no turning away from the case.
Maybe, if women knew their rights, if only the hospitals did their duty and follow the required course of action, it would deter the police from brushing these cases under the carpet. If only the doctors on duty and the hospital staff, collected the required medical evidence, providing irrefutable evidence that is crucial in the course of conviction of the rapists - justice would indeed be provided to victims.
But that's one obvious fact that the medical community in India seems to be missing. Medico legal cases are always taken up on priority in hospitals, but there have been cases of rape victims left unattended and uncared for, even taken advantage of, in such a vulnerable state. Medical personnel often don't seem to realise that it is their role - medical, psychological, and unbiased evidence collection - that will decide the victim's fate. They also don't seem to realise that the hospital is often the first place, where a victim can be made to feel 'safe' again, unwind from the shock and trauma, and get counseling, which will help not only to fight the ensuing legal battle, but eventually manage her own life.
But the medical community largely, seems to be untrained and in some cases, even unreceptive to all this. Despite set laws, like only female doctors are allowed to do examine a rape victim. If unavailable, a female attendant must be present at the time of examination, otherwise a male doctor can be charged with indecent assault under law. A doctor is allowed to collect information about the victim's sexual past only after the victim is explained the purpose of such questions. Despite such rules, most rape victims are not informed of such rights. There are many variables and degrees in which the said rules are broken, each time. Even the two-finger test, that turned obsolete only last year in our law books, is still said to be performed in far flung areas.
The problem is that the treatment that is meted out at both the police stations and hospitals is not victim or patient-centric. The need of the hour, clearly, is training at both these levels. While, the police reforms have been much talked about, the medical reforms are yet to be raised.
Our doctors need to be trained, how to conduct a medical interview of a victim of rape, how to ask the right questions at the right time. The All India Institute of Medical Sciences in New Delhi, conducts trainings for its resident doctors, but the practice is not prevalent throughout the country. We require certified courses in technical training for nurses, like in the US, on how to collect and manage forensic samples. And both need to take the doctor-patient confidentiality a notch higher in such cases.. And one trained doctor or one trained nurse per hospital is not enough. There needs to be someone in each shift that the hospital runs, who is trained for all requirements. There should be a separate room where a rape victim should be examined, and not made a show of in front of the whole ward.
And the need for immediate counseling cannot be stressed enough. Any medico, who examines or attends to the victim, must also be trained for sensitive behaviour. Rape is one of the most inhumane crimes, and if the victims are not provided with psychological support in time, quite often, they tend to become suicidal.
Doctors must remember their basic oath to do no harm. Insensitive treatment often hurts the rape victim more than the physical injuries and haunts them longer. Doctors must also remember their oath to not discriminate and to help one and all.
Enough said with that, dear doctors. There is a lot of work to be done.