Miss Shirani a 20 year old factory worker gets admitted at 9 pm with a history of having been raped on her way to the boarding house.
She is very scared and thoroughly agitated. She has some bleeding and is also in pain. She is in a dilemma as to what should be done
Role player
Doctor this happened a little while ago.
An unknown man who was wearing a mask dragged me away from the road and had sexual intercourse.
I am sure my hymen was damaged as I felt severe pain and I have bleeding.
After about half an hour he left me on the ground and ran away. I did not know what to do. I came to hospital because I am in pain and I am bleeding. Doctor what can be done?
Candidate 10 marks
Allow her to settle down.
I am Dr. — the registrar
Don’t worry Miss Shirani ,we will do the needful and prevent further harm happening to you.
Shall we go to my room where there will be more privacy.
I will get you some biscuits and a cup of tea.
That will help you to settle down.
First of all I must examine you very superficially to exclude any injuries which can cause severe bleeding.
I will be very gentle and will not hurt you.
I am sorry there is no female staff member to examine you but there will be a nurse with you.
After examining her:- 10 marks
There seems to be a tear in your hymen and few other injuries but bleeding is settling.
A more detailed examination will be done later by the JMO.
Please avoid washing the area or passing urine till you are seen by the JMO.
He will come soon.
We have to inform the police because you are claiming that you have been forcefully handled and raped.
Role player
Doctor I am scared.
Will there be a threat to my life?
Will people get to know.
Candidate- 10 marks
Don’t be scared.
There is law and order in the country.
You should not walk alone at night.
Try to get some transport at least from the office or someone from home to accompany you.
If you are willing we can inform your manager regarding the incident.
We will maintain absolute confidentiality.
You should inform a friend or a relation you can trust, who will be helpful after you settle down and the JMO has seen you.
Role player
Doctor can I become pregnant?
Candidate 10 marks
It depends on your menstrual cycle
Role player
I started menstruating one week ago
Candidate
The risk is less because you are less likely to have an egg at least for another 5
days but sperms can remain for a few days.
Therefore we will give you a tablet
immediately for emergency contraception to prevent pregnancy.
Role player
Can I get sexual diseases?
Candidate 20 marks
Immediately after you are seen by the JMO we will take blood and vaginal
discharge to examine for STD.
We will commence treatment once reports are
available and a complete cure can be obtained.
However there could be a window
period to develop infections and the tests should be repeated in one month. All
these are treatable.
Have you been vaccinated for covid 19 and hepatitis B
Role player
Yes both were given to all the factory workers.
Candidate
I am happy as that reduces some of the immediate and major risks.
However we will give you some tablets to start treatment for HIV because it is
dangerous and should be treated early before the reports are available and
during the window period.
We will treat chlamydia, gonorrhoea and syphilis once the reports are available
as these can be cured easily.
Role player
Doctor I am very worried about the hymenal tear. I will not be able to marry
because of the stigma.
Candidate 10 marks
Don’t worry we can repair it surgically once the wound has healed.
Role player
Will the police and the JMO and my parents believe my story
Candidate 5 marks
Don’t worry because there are a few injuries which indicate force. These will be documented by the JMO.
Role player
Doctor I am very upset. I cannot control my emotions. I want to cry out aloud.
Candidate 10 marks
We will refer you to a psychiatrist tomorrow. We will give some medicine to
calm you down and help you to sleep tonight and you will also be appropriately
counselled tomorrow.
You can contact them whenever you feel anxious.
We will attend to correct every harm which has been caused to you – such as
the possibility of pregnancy and STD and repair of the hymen
Role player
I am worried about legal proceedings.
Can I refuse to file a case.
Candidate 5 marks
I think it can be done. However you can get accurate information from the JMO
and the police. However the culprit should be found to file a case.
Role player
If I wish to file a case I am worried about retaining a lawyer
Candidates 10 mark
We will be referring you to Mithuru Piyasa which is a governmental organisation
to help people like you before you leave the hospital for further follow up and
help. There is a branch at our hospital.
They will help you in many ways and
follow you up .
They will arrange for a lawyer through government organisations
if you need one.
Theory
| type of assault | forensic time frame |
| Penile Penetration oral | 2days |
| anal | 3days |
| vaginal | 7days |
| digital penetration of any orifice | 2days |
| skin swap | 2 days / upto 7days if not washed |
| Blood | 3days |
| Urine | 14days |
if woman wishes to have forensic evidence collected , advise her not to have
wash, wipe
eat/drink
pass urine and contact the police / a sexual assault referral centre
swaps are taken to recover body fluids and DNA and
are sent to the police forensic science laboratory .
buccal scrape from the inside of the cheek is taken as a reference sample for DNA Profiling.
Toxicology screen will be sent from blood and urine within allocated time frame.
About the Author
