Medico-legal documentation of rape or sexual assault: are community-service doctors equipped for the task?

Epidemiological pattern of rape cases managed at a regional hospital in South Africa

Background

South Africa has one of the highest incidences of rape globally. Understanding the epidemiological pattern of rape is needed to inform the design of effective intervention programmes for rape prevention and management of alleged rape cases.

Aims

To investigate important epidemiological patterns associated with rape in Kimberly, Northern Cape Province, South Africa.

Setting

The Robert Mangaliso Sobukwe Hospital (RMSH) forensic unit.

Methods

A descriptive, retrospective cross-sectional clinical audit of rape cases.

Results

The majority (93.3%) of the alleged rape victims were women, with a mean age (SD) of 21.6 years (11.3); the male population made up 6.7% of the cases, with a mean age (SD) of 10.5 years (6.9). The highest incidence of alleged rape in the male population was seen in the age group ≤ 16 years (81.8%) and for women 17-30 years (50.3%). Most of the incidents occurred at the perpetrators' homes (42.7%); on the days Fridays (14.6%), Saturdays (29.9%) and Sundays (23.2%); at night up to midnight 20:00-23:59 (32.9%) (p = 0.01) and involved threats of violence (55.5%). The majority (56.0%) of the perpetrators were known to the victims.

Conclusion

Important information about the victims and circumstances in which rape occurs as reported herein can be used to inform the design of effective intervention programmes for sexual crime prevention and management in Kimberly, South Africa.

Contribution

This study helped to advance knowledge and understanding of the epidemiological pattern associated with rape in Kimberley, Northern Cape Province of South Africa.

Medico-legal history taking from the victims of sexual assaults: the role of nurse examiners

Background

Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause re-victimization and hamper the medico-legal evidence collection.

Main text

This article aims to orient the novice examiner and nurses to the prerequisites of medico-legal history collection, techniques of building trust, establishing rapport, ensuring privacy and confidentiality, taking consent, communicating effectively with the victims of sexual assault, and components of medico-legal history collection.

Conclusions

Novice examiners and nurses need to be trained in collecting medico-legal history and evidence. The examiners who conduct the examination should be dedicated to delivering compassionate and high-quality care to individuals who have disclosed sexual assault.

To confront sexual violence, we must train non-forensic experts to perform medico-legal evaluations

Sexual violence is a global crisis. Forensic evaluations are critical for obtaining evidence and increasing the likelihood of accessing justice, as many cases fail due to lack of evidence or poor evidence. In some countries, only board-certified forensic specialists are authorized to conduct forensic evaluations. However, the high number of sexual violence cases coupled with the shortage of forensic physicians make that restriction a fundamental impediment to a rights-based response to sexual violence crimes. Governments and regulatory bodies should expand the pool of those capable of conducting forensic sexual violence evaluations by partnering with clinicians of different specialties and facilitating their training.