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close this bookClinical Management of Survivors of Rape - A Guide to the Development of Protocols for Use in Refugee and Internally Displaced Person Situations (United Nations High Commissioner for Refugees (UNHCR) / Alto Comisionado de Naciones Unidas para los Refugiados (ACNUR) - WHO - OMS, 2001, 46 p.)
View the document(introduction...)
View the documentPreface
View the documentAcknowledgements
View the documentAbbreviations and acronyms used in this guide
View the documentIntroduction
View the documentSTEP 1 - Making preparations to offer medical care to rape survivors
View the documentSTEP 2 - Preparing the survivor for the examination
View the documentSTEP 3 - Taking the history
View the documentSTEP 4 - Collecting forensic evidence
View the documentSTEP 5 - Performing the physical and genital examination
View the documentSTEP 6 - Prescribing treatments
View the documentSTEP 7 - Counselling the survivor
View the documentSTEP 8 - Follow-up care of the survivor
View the documentAnnex 1 · Information needed to develop a local protocol
View the documentAnnex 2 · Sample consent form
View the documentAnnex 3 · Sample history and examination form
View the documentAnnex 4 · Pictograms
View the documentAnnex 5 · Protocols for treatment of STIs
View the documentAnnex 6 · Protocols for post-exposure prophylaxis of HIV infection
View the documentAnnex 7 · Protocols for emergency contraception
View the documentAnnex 8 · Minimum care for rape survivors in low-resource settings
View the documentAnnex 9 · Additional resource materials

STEP 3 - Taking the history

General guidelines

- If the interview is conducted in the treatment room, cover the medical instruments until use.

- Before taking the history, review any documents or paperwork brought by the survivor to the health centre.

- Let the survivor tell her story the way she wants to.

- Questioning should be done gently and at the survivor's own pace.

- Sufficient time should be allotted to collect all needed information without rushing.

- Do not ask questions that have already been asked and documented by other people involved in the case.

- Avoid any distraction or interruption during history-taking.

- Explain what you are going to do.

- Try to create a climate of trust.

A sample history and examination form is included in Annex 3. The main elements of the relevant history are described below.

General information

- Name, address, sex, date of birth (or age in years).

- Note the date and time of the examination and the names of any staff or support person (someone the survivor may request) present during the interview and examination.

Description of the incident

- Ask the survivor to describe what happened. Allow the survivor to speak at her own pace. Do not interrupt to ask for details; follow up with clarification questions after she finishes telling her story. Explain that she does not have to tell you anything she does not feel comfortable with.

- It is important that the health worker understands the details of exactly what happened in order to check for possible injuries. Explain this to the survivor, and reassure her of confidentiality if she is reluctant to give detailed information. The form in Annex 3 specifies the details needed.

History

- If the incident occurred recently, determine whether the survivor has bathed, urinated, vomited, etc. since the incident. This may affect the collection of forensic evidence.

- Information on existing health problems, allergies, use of medication, and vaccination and HIV status will help you to determine the best treatment to provide, counselling needed, and follow-up health care.

- Evaluate for possible pregnancy, ask for details of contraceptive use, last menstrual period, etc.

In developed country settings, some 2% of survivors of rape have been found to be pregnant at the time of the rape.1 Some were not aware of their pregnancy. Explore the possibility of a pre-existing pregnancy in women of reproductive age by a pregnancy test or by history and examination. The following guide may be useful if you do not have access to pregnancy tests.

1 Sexual assault nurse examiner (SANE) development and operation guide. Washington, DC, United States Department of Justice, Office of Justice Programs, Office for Victims of Crime (www.sane-sart.com/SaneGuide/toc.asp).


A guide for confirming pre existing pregnancy (adapted from an FHI protocol2)

2 Checklist for ruling out pregnancy among family-planning clients in primary care. Lancet, 1999, 354(9178).