Sexual assault can occur in any community, but when it happens in a rural community, there can be challenges for the survivor to get adequate and timely help.
That’s why East Texas Medical Center–Gilmer implemented its Sexual Assault Nurse Examiner, or SANE, program this month.
Four of their nurses were trained to ensure people who have been sexually assaulted not only get a proper medical examination, but also guidance with legal, emotional, mental and health issues following the attack.
“Our sexual assault program is extremely important in this rural community,” said Greta Parks, SANE medical director. “We have seen countless patients have to be transported to larger facilities for injuries sustained during sexual assault.”
Training for the nurses involved more than 240 hours of coursework and clinicals.
As the emergency department’s director, Teri Curington is in charge of analyzing which modalities appear most often through their doors.
“The number of physical violent acts was showing up over a period of two years,” she said. “It started escalating as far as assaults were concerned. It bothered me to the point that I did not feel comfortable not being able to provide a service that I saw was becoming a desperate need in our community.”
There were 197 reports of sexual assault in 2013 in Wood, Upshur, Titus and Camp counties. That number was up from 182 the previous year, and 165 in 2011.
Those are just the reported cases. According to the U.S. Justice Department, only 26 percent of sexual assaults are reported.
“The reason why we have so little reporting of it in our nation is because of the taboos attached to it,” Ms. Curington said. “They somehow feel responsible.”
Ms. Curington spearheaded a sexual assault response team in October in advance of the SANE Program. A 27-person committee comprises law enforcement agencies, district attorneys, child protective services workers and advocates.
She said there are not enough advocates, especially in Upshur County.
“Advocates are so necessary to help the healing process once the trauma is over as far as the assault and the evidence collection,” Ms. Curington said.
Advocates are available around the clock to help patients through the initial exam and to get them counseling and reimbursement for any medical costs.
More hospitals are implementing SANE programs and others are being encouraged to develop some kind of sexual assault response program. Last year, Texas legislators passed Senate Bill 1191, which requires all hospitals to have doctors and nurses trained in forensic evidence collection.
In Texas, the SANE program is run by the Attorney General’s office. There are more than 300 SANE nurses in the state, including three at ETMC in Tyler and one at UT Health Northeast. Mother Frances Hospital has four certified SANE nurses and two in training.
TREATING, PROVIDING COMFORT
When a person has been sexually assaulted, the way hospital staff responds is critical, as the collection of evidence and the telling of the victim’s story could affect the outcome of a criminal case.
Once the survivor alerts someone in admissions they’ve been a victim of a sexual assault, they are immediately escorted to a triage nurse and told to withhold information until they see a sexual assault nurse examiner.
There is no touching or physically comforting the person, as not to contaminate their clothing or body with their DNA.
From triage, they get checked for any physical trauma or wounds. All articles of clothing are kept to collect and preserve evidence.
Photos are taken and nurses look for visible tears or bruises. However, the absence of bruising or physical trauma is common with many victims.
“A lot of times, patients won’t fight back because they’re in fear for their lives,” said Brandy May, a SANE nurse. “They go into survival mode, so a lot of times there won’t be any bruising. There won’t be any scratches.”
Officials said evidence should be collected within four days.
“Once the patient is medically cleared, the actual sexual assault exam begins,” Ms. Curington said. “With a stroke, you’ve got that critical hour, or trauma, you’ve got that critical hour. It’s the same for evidence collection. The longer that you wait to collect the evidence, it increases the risk of no longer being viable.”
An exam could last at least four hours. Evidence is locked away in a quad-lock system, which only five people have access to. Adult sexual abuse survivors do not have to report the crime, but evidence is still collected and stored for two years, in case the person changes their mind.
The nurses say they are natural nurturers, but for some, sexual assault hits close to home.
“I have family that have been affected by sexual assault,” Ms. May said. “I have friends that have been affected by sexual assault. It’s also a big need around here, especially in the local area. There’s nobody to help with this type of thing.”
SEXUAL ASSAULT AND HEALTH
Sexual assault survivors may cope with emotional, mental and physical problems long after the attack.
Ms. Curington said women who have been affected by a sexual assault are at risk for health problems, primarily because they may change their lifestyle. This includes smoking or using drugs or alcohol.
“Statistically speaking, women who have been sexually assaulted are 80 percent more likely to suffer a stroke they’re 75 percent more likely to have cardiovascular disease,” Ms. Curington said. “They’re 85 percent more likely to have drug and alcohol abuse problems. So, you see, by not addressing it and not identifying it and not getting treated for it is going to open up a whole host of other issues.”
With swift action and the guidance of advocates and local agencies, the nurses say the survivors of sexual assault can move forward with their lives.
“They had something stolen from them,” Ms. May said. “This is the first step in getting back what they had stolen, and that was their say-so, their rights and their independence.”