Through a nurse’s eyes: Caring for sexual assault victims

By Natalie Feulner, Special to the BDN
Posted April 23, 2013, at 1:10 p.m.

Last week, my class of Rape Response Services’ advocates-in-training spent our three-hour training session at St. Joseph’s Hospital with Sexual Assault Forensic Examiner and Registered Nurse Michelle Markie. Markie is one of two certified SAFE nurses employed at St. Joseph’s, a certification requiring a 40-hour class, hours of observation, ongoing education and practice administering rape kits.

The kits contain equipment nurses can use to collect DNA evidence, take photos of injuries and perform overall health exams of sexual assault patients. Information obtained can be used in court cases to corroborate a victim’s story.

We were there to learn about the various components of rape kits and about the overall treatment of sexual assault victims. I also walked away from the class confident that the hospital doesn’t have to be a frightening place for victims, so long as he or she remains in control, is supported by an advocate and feels believed by members of law enforcement.

Markie explained that when a sexual assault victim is brought to or arrives at the hospital, that person is treated as a trauma patient and immediately taken to a private room. Shortly after, nurses will notify Rape Response Services, which will send someone to support the victim through the next few hours and beyond.

The advocate is there to fill an emotional role, Markie said, while nurses are there to treat medical needs. Law enforcement is present, if the victim wishes, to take a report and investigate the crime.

“It’s a team approach — a nurse, the advocate and police,” she said.

The exam takes anywhere from three to six hours to complete, and once the kit is opened, SAFE nurses are unable to leave it for any reason — to maintain what’s called “chain of custody” of the evidence. That means other tasks, such as getting water for the victim or talking to family, falls to the advocate. Kits are free for the victim, as they are paid for through the legislatively mandated Victims’ Compensation Program.

Markie estimated that about 90 percent of the women she treats after a sexual assault have no injuries, and close to 98 percent of children do not have injuries. It’s a fact she attributes to the anatomy of the female body. Some people may think that if victims don’t show signs of physical injury, the incident wasn’t severe, but that’s not true.

Nurses gives victims complete control when it comes to declining or accepting portions of the rape kit. If someone doesn’t want their nails clipped for evidence collection, for example, they can have them swabbed. If another person is OK with everything but an internal exam, that’s OK, too.

It’s a way for the victim to feel even the smallest amount of control after experiencing such a loss of power during a sexual crime.

Markie added that she does not give speculum exams to women or teens who have never undergone one for routine health purposes. She believes such an exam would only traumatize the victim more and cause her to be reminded that the first time she received such an exam was the night she came to the hospital because she was raped.

Once the kit is completed to the victim’s satisfaction, it is sealed with red evidence tape and taken one of two places. If a report was made, the police station where the incident occurred will take the kit from the hospital and send it to Augusta for evidence testing. If it is not being submitted right away, the kit stays at the Bangor Police Station for 90 days or until the victim comes forward with a report.

That 90-day waiting period is crucial for people to know about, Markie said. That’s because more victims would probably come forward if they knew they didn’t have to make a report or knew they had time to think about doing so.

The fear of reporting to law enforcement is evident in many cases. Some victims feel they won’t be believed by officers, while others are afraid their information will become public knowledge somehow. Some work with law enforcement for a while and then decide they don’t want to pursue charges any longer.

Still, more people are arriving at the hospital year after year to seek treatment and request kits. According to Markie, 35 victims were treated at St. Joseph’s last year, an increase from 2005 when she started and there were fewer than 10.

However, the increase in exams doesn’t necessarily match the number of nurses in Maine who are certified to administer rape kits. The state has a shortage of SAFE nurses, less than 30, Markie estimates, many of whom are clustered around the state’s service centers. It’s a problem Markie hopes takes a shift in the near future, but she said she also recognizes that the role is not for everyone.

Even just hearing a few stories of victims she treated had my stomach churning. But I had to remind myself that those feelings of anger and empathy are exactly why I and everyone in our community should take time to learn about sexual violence and what can be and is being done to prevent and treat it.

Natalie Feulner of Bangor is the BDN newsroom administrator.

 

http://bangordailynews.com/2013/04/23/opinion/contributors/through-a-nurses-eyes-caring-for-sexual-assault-victims/ printed on April 21, 2014