Experiencing a sexual assault is without a doubt intrusive, disempowering and traumatic. For survivors of this abhorrent crime, the ordeal is often exacerbated by indifference or the mismanagement they experience when trying to access care and support after the fact. In South Africa, the prevalence of HIV/Aids and the fear of possibly becoming infected as a result of the violation add significant stress to survivors.
Prior to Netcare’s pioneering establishment of sexual assault centres, victims of rape needed to be medically examined by a district surgeon for forensic evidence. As a mechanical, evidence-focused process, this often required the traumatised victim to wait for many hours in an impersonal, public facility before being attended to.
This was brought to public attention in 1998 when journalist Charlene Smith was raped, and experienced unsatisfactory treatment by authorities and at two Netcare hospitals. Netcare’s CEO, Richard Friedland, responded by personally engaging with Charlene and subsequently developing sexual assault centres at Netcare hospitals. Netcare is now the leading hospital group for dealing with sexual violence and trauma, running 37 in-hospital centres across the country.
Preserving the dignity of rape survivors
The treatment is a multifaceted approach covering emotional, psychological, medical, physical and sanitary care. On arrival at any of the 37 equipped Netcare emergency departments, victims (women, men and children) are taken to a private, self-contained room with an en-suite bathroom facility and given a ‘dignity pack’ tailored to their needs, which may include toiletries, underwear and clothing. They are treated as Priority 1 patients and are forensically assessed immediately, thereafter being able to shower and dress. Medical treatment is provided to patients with physical injuries, and for all patients, advice and counselling is given about possible conditions that may arise as a result of the sexual assault, including HIV testing, counselling and provision of a course of antiretroviral (ARV) medication if necessary.
Psychological counselling is offered to patients and their loved ones by partner NPOs, with a focus on facilitating the mind shift from being a victim to being a survivor. In the case of children, Netcare works closely with organisations such as The Teddy Bear and Rainbow clinics. By law, medical staff must report any sexual assault of minors to the South African Police Service (SAPS).
All survivors are encouraged to report the crime to SAPS and press charges – in this way Netcare aims to reduce the level of sexual assault in South Africa and they currently claim a 77.5% report rate.
Netcare staff work closely with the SAPS by undertaking the forensic examination with evidence preservation. Meticulous adherence to the necessary protocols in gathering forensic evidence, together with accurate record keeping and safe storage of records by Netcare, has contributed to a reduction in the number of cases dismissed as a result of evidence being lost during the judicial process. In such cases, Netcare is able to speedily track and again provide certified copies of patient records with forensic evidence to the prosecuting authorities, while continuing to safely store the originals. The expert testimony by the treating doctors in support of the survivors during trial is significant in achieving convictions.
Reducing the HIV burden on the State
Netcare was the first private service provider in South Africa to routinely supply survivors with prophylactic medication to prevent them contracting HIV as a result of their violation. Blood tests are performed to obtain a baseline HIV status to determine further management of the patient. If the results are negative, the patient is provided with a full 28-day prophylactic ARV course. The “morning-after” pill to prevent possible pregnancy is also given as well as a course of prophylactic antibiotics prevent possible STDs. HIV blood test monitoring of patients who were HIV negative before the assault, continues for a full year after exposure.
The protocols developed and introduced by Netcare to prevent transmission of HIV infection, STDs and unwanted pregnancy by means of appropriate prophylactic medication are hugely significant:
● It relieves the added burden of fear of these risks that survivors had to face
● It saves on future medical burdens as a consequence of survivors contracting infections
● It’s effective. Since Netcare commenced statistical monitoring of patients receiving care in 2001, only one patient has contracted HIV as a result of the sexual assault and that was because the person sought assistance for the first time after the 72-hour treatment window period.
Replicating values, influencing policy
Although the intention of the project was never competitive, Netcare has realised long-term reputational benefits from it. The initiative assists in reinforcing the Netcare Way – values of care, dignity, participation, truth and passion among staff and towards its patients.
It has strengthened Netcare’s relationship with SAPS and its family violence, child protection and sexual offences unit. Netcare also shares best practice on the management of sexual assault survivors with State healthcare workers, enhancing collaboration between the private and public sectors. Through its work in this field, Netcare has been able to influence government policy by participating in the development of an anti-rape strategy during the Sexual Offences Indaba held in 2008.
Doctors and nursing staff providing services to survivors have received specialised training with regard to the requirements for the collection of forensic evidence and soft skills training in engaging with survivors holistically.
Netcare has also trained public healthcare workers in these skills, which has demonstrated to government the company’s willingness and readiness to collaborate with government in initiatives to provide quality healthcare, particularly for people in difficult circumstances who cannot afford private care.
Through education initiatives targeted at communities and organisations, Netcare continues to raise awareness on sexual assault including providing information on what to do in the case of an assault so that evidence is not damaged.
Pioneers making a difference
Netcare remains the only private healthcare provider in South Africa to deliver this crucial service on a national and sustainable basis, 24 hours a day, 365 days a year. Through this programme, Netcare is setting an example for other healthcare institutions to become involved. The company received an award for excellence from the Hospital Association of South Africa (HASA) for this project in 2006.
In 2012/13, the Netcare Sexual Assault Centres assisted 949 survivors at a total cost of R1.9 million. The programme’s outcomes include preventing infections associated with sexual assault through immediate preventive care, including HIV/Aids. Netcare’s prophylactic treatment and unwanted pregnancy protocols have also influenced a change in government’s and other organisations’ management of sexual assault survivors.