Another rape, another time. while laws and guidelines are in place to give succor to these victims, caregivers are often clueless about how to deal with them
By Shobha John
It’s happened yet again. Exactly two years after the horrific rape of Nirbhaya in Delhi on December 16, 2012, it was the turn of another Delhi woman to be raped, this time in an Uber cab. While she survived and is trying to get on with her life, the fact is that sexually-abused victims are India’s shame and growing by the numbers. But after Nirbhaya, the way society deals with rape victims has changed.
Figures pertaining to sexual violence in India are shocking, to say the least. According to the Ministry of Health and Family Welfare, one in three women in India is likely to face sexual and physical violence in her lifetime. That’s 33 percent of the total population—far too high for any complacency.
The latest UN report says that 42 percent of girls in India are physically and sexually abused before the age of 19. The study, conducted between 2005 and 2013, says that the majority of girls had reported that the perpetrators of this violence were persons known to them. Many of these cases go unreported.
In an effort to give these victims proper counseling and legal aid, the Ministry of Health and Family Welfare came out with a detailed and comprehensive 74-page document in March 2014 called, “Guidelines & Protocols: Medico-legal care for survivors and victims of sexual violence” (see box). It says categorically: “Sexual assault victims cannot be denied treatment in either government or private hospitals when they approach them…. As is known, the rape law has been made more stringent with zero tolerance for offenders.”
But shockingly, there is general ignorance among private medical practitioners about these guidelines as they haven’t been disseminated properly. Few know that Section 357 C of the CrPC (Criminal Law Amendment Act 2013) says that both private and public health professionals are obligated to provide treatment to sexual assault victims. Denial of treatment is punishable under Section 166B of the IPC with imprisonment for a term which may extend to one year or with a fine or both.
In an effort to remove this ignorance, the Federation of Obstetric and Gynaecological Societies of India (FOGSI) in collaboration with Women’s Empowerment Foundation (WEF) organized a workshop in October in Mumbai called, “Managing Sexual Abuse – Training the Trainers.” This was meant to create awareness about various legal and administration procedures every doctor should follow in handling these victims.
While government doctors are well-versed with these procedures as most of these cases come to them, private ones are often ignorant about them. Hopefully, this workshop will ensure that such victims are not deprived of
justice because of poor documentation and lack of evidence.
The workshop had 40 participants from all over India, many of them private gynaecologists, legal experts, NGOs, such as RAHAT, which help sexual-abuse victims, and representatives from the police. The role of doctors in obtaining the history of victims, record-keeping and evidence collection for documentation and delivery of justice, along with lawyers and police, cannot be over-emphasized. Booklets of the health ministry’s guidelines were distributed to these doctors for better dissemination.
IGNORANCE NOT BLISS
Dr Duru Shah, managing trustee, WEF, who trained these doctors at the workshop, said many did not know the proper protocols. Whatever training they had in this sphere was during their undergraduate studies, a long time back. “But private doctors have to be trained to handle these victims. For example, they have to be given medicines for sexually transmitted diseases (in case the rapist has it), emergency contraception (in case he has impregnated the victim) and antibiotics,” says Shah. “This is something most general practitioners also don’t know,” he says.
In addition, she says, injuries (bleeding, tears in the private region) have to be treated and physical evidence collected from the mouth, vagina and anal region of the victim. “This standardized protocol will aid the victim in getting faster justice. In fact, 90 percent of sexual abuse cases reported don’t get justice due to lack of medical evidence and correct documentation,” she specifies.
Doctors are also being given courtroom training on how to withstand cross-examination in front of defense lawyers. They are encouraged to open up in court about the case details rather than say just a “yes” or a “no”. They are also told to keep a record of their medico-legal cases so that if they have to appear in court years later, they don’t forget the details and contradict themselves.
Few private medical practitioners know that Section 357 of CrPC says that all health professionals must provide treatment to sexual-assault victims.
HANDHOLDING THE VICTIM
The new protocol is also a far departure from the shabby treatment given to these victims earlier. They were mainly treated in government hospitals, where the doctors were so overworked and stressed that beyond giving them immediate aid, there was no time to empathize with them. Now, victims will be hand-held to reduce the trauma and the humiliation of an assault. “Also,” says Shah, “the two-finger test given to find out if a victim has been raped has, thankfully, been done away with. This was akin to a second rape as it was humiliating as well as degrading.”
The gynaecologists thus trained, called, “Master Trainers”, will then conduct similar workshops in their own states and train 20 more to enable better management of sexual abuse victims. At least, that is what is hoped.
Though these steps are welcome, more needs to be done. For example, the medical curriculum needs to be changed to keep up with the changing social milieu. Shah advises that all medical examinations for graduates and postgraduates in obstetrics and gynaecology should have at least one question on sexual abuse. “This will help them in future,” she says.
Dr Ranjit Roychaudhury, who was adviser to Dr Harsh Vardhan, former union minister of health and family welfare, adds that the course dealing with medical jurisprudence in medical colleges should be upgraded. “There are various regulations in medicine, such as surrogacy, in-vitro fertilization, organ donation, etc, which doctors need to know. When I was in the Medical Council of India (MCI), we had made changes in the curriculum in 2010 and submitted it to the then government. But before anything could be gone, the governing body was changed. The present government will have to see what can be done, though this is really for the MCI to do.”
Despite the need to help victims of sexual abuse, the workshop could not come to a consensus on two issues. The new laws—357C of the CrPC and Section 19 Amendment of the Protection of Children from Sexual Offences (POCSO) Act—make it mandatory for doctors to report such abuse cases to the police.
The first issue for doctors is that under the Hippocratic Oath, they can’t break the confidentiality of a patient. Secondly, the POSCO Act clearly says that doctors have to report any Medical Termination of Pregnancy (MTP) case to the police. Shah says: “Often, sexually active youngsters between 16-18 years come to us for MTP. If we report them, where will they go? The girl will go to a quack and could have a botched abortion, while the boy will end up in jail. This is hardly the right solution.”
KMM Prasanna, deputy commissioner of police, Mumbai, said that while doctors had certain apprehensions with regard to how sexually abused victims are treated, this workshop was an attempt to ensure better coordination with the police. “The workshop helped bridge the trust deficit. After all, we aren’t working against each other, we are part of the same system,” he said.
However, ignorance of the law cannot be a justification for going against the law, he said. The moral dilemmas of doctors (like going against the Hippocratic Oath), said Prasanna, would have to be worked within the law of the land. He suggested that doctors could form an interest group and send whatever changes they wanted in the present law concerning abused victims to the concerned ministry.
Nonetheless, there have been legal strides to make sexual abuse victims feel a little safer. For example, the Criminal Law Amendment Act 2013 says that even if there are no injuries on a sexual abuse victim, her sole testimony is enough to convict the accused.
This, says Persis Sidhva—program manager RAHAT—is a very important change in the law. “One-third of sexual abuse cases are within families itself. These are often cases of continuous victimization and it is not necessary that there will be injuries,” she suggests.
WHERE’S THE SENSITIVITY?
While laws have been put in place, implementation is often a problem, says Sidhva. Take infrastructure problems. While the law says that during deposition, an abused child should be separated from the abuser by a screen, this often doesn’t happen, she says. “And though the law disallows any reference to past sexual practices of the survivor, often, an aggressive defense lawyer can question her and it is for a strong judge to control that,” says Sidhva.
Meanwhile, FOGSI will disseminate Shah’s information to 225 societies under it, and they will, in turn, spread the message to over 29,310 members. Dr Indrani Ganguly, vice-president of FOGSI, says: “The workshop was very informative for private doctors, most of whom don’t know the stringent laws pertaining to sexual assaults. Even with good intentions, we can sometimes go wrong.” As for the duality between law and doctors’ own code of ethics, she advised that the law should take into consideration the realities of Indian society and increasing permissiveness among youngsters.
The police too needs to be trained to be sensitive and do thorough investigations leading to justice for such victims. RAHAT trained some 750 Mumbai policemen between December 2013 and April 2014 on the amendments to rape laws and case studies where acquittals took place due to shoddy investigation.
“This has led to some change in attitude. Whereas earlier the police were reluctant to file FIRs saying the case did not fall under the jurisdiction of a particular police station, now most do so in Mumbai,” says Sidhva. “The police are also softer in their approach to these victims. Society needs to give recognition to those officers who do a good job in assisting them.”
It helped, that in Delhi, the father of the victim in the Uber rape case praised the efforts of the police in arresting the accused, Shiv Kumar Yadav, within 24 hours. “It has changed my perception of the police….I am thankful to them for having given my daughter justice,” he told The Indian Express.
Meanwhile, Prasanna said that RAHAT’s initiative with Mumbai police had helped lead to greater sensitivity, urgency and awareness among the po-lice. “Women officers and constables have been selectively picked up and given training to handle victims. The information is also being disseminated among male officers so that it makes a difference,” he said.
Will all these measures help to make society a safer and more just place for the sexually abused victims?
Persis Sidhva, program manager, RAHAT, believes that while sexual abuse laws are in place, implementation is often a problem
Dr Ranjit Roychaudhury, adviser to Dr Harsh Vardhan, former minister of health and family welfare, wants medical jurisprudence course upgraded in colleges
Dr Duru Shah, managing trustee, Women’s Empowerment Foundation, feels private doctors need to be trained to handle sexually abused victims