Launch of ‘Medical responses
to adults who have experienced sexual assault: an interactive educational
module for Doctors’
Speech by Pru Goward, Sex Discrimination Commissioner, RANZCOG College House,
East Melbourne, 31 March 2005
Acknowledgements.
Thank you for inviting me to launch this module today.
Congratulations on the leadership role the College has taken. It is important for reputable senior professional groups to demonstrate commitment to this issue. It reinforces the legitimacy of sexual assault as a concern for all of us.
It is impossible I know to capture the hours and hours of voluntary effort, sweat and tears that have gone into the development of this marvellous module.
Months of work and careful negotiation, days and nights spent agonising over a word or a sentence, getting the tone right, making sure the pictures are not too confronting but confronting enough.
But it is of course, confronting. The nature of the issues it deals with see to that.
Its intended readership is broad- gps and specialists, in public and private hospitals, in private practice.
Its purpose is straightforward, to assist medical practitioners to respond to patients who have been sexually assaulted. The complexity of the issues, moral, social and psychological ensure that this is no easy task.
There is a lot to say about it.
First, the problem is not insignificant.
As the College"s fact
sheet establishes, one in four women and one in eight men experience sexual
assault during their life time. One in three women and one in six men experience
sexual assault in their child hoods.
This audience does not
need reminding that early intervention is more successful in preventing long
term medical problems but that the intervention has to be right. If it is
wrong, it can compound the victim"s psychological trauma and compromise
long term health outcomes.
So for the module to be worth doing, we have to get it right first up.
It is significant that this is focussed on adults. While there have long been protocols and training in place for responding to and working with child victims of sexual assault, adults have often been left to deal with it alone.
Yet assault is also confronting, terrifying, degrading and morally repugnant to adults.
Like child sex offenders, most adult sex offenders are known to their victims, suggesting a complex web of social and moral dilemmas in which lies many a trap for victims and those who try to help them.
Reading through the module, I was reminded again how similar the issues are for victims of sexual assault and domestic violence, perhaps because intimate relationships are always involved in domestic violence and almost always in sexual assault cases.
Victims frequently believe that they have caused it, and are too ashamed to discuss it or report it. Others believe they will not be taken seriously and that a long process of semi public humiliation in court will be their reward for speaking up.
Many of those who counsel
victims, advertently or inadvertently, confirm the victim"s belief in their
own guilt. Questions which to an outsider can appear to be the sort of questions
investigators need to ask to check or confirm a detail, appear to the victim
to challenge their account and undermine them.
Once, we might have shrugged our shoulders and dismissed this problem as insoluble. The questions must be asked, and victims need to be able to deal with this or not report.
But no longer. This module means there are no excuses.
At the heart of this module is language. Getting the language right.
Although the module does not go quite as far as providing scripts, it certainly challenges the practitioner to choose their words carefully and understand the assumptions behind their questions.
As the module demonstrates, one false step can derail a discussion while minor changes can encourage an open and frank discussion with the patient- or the victim- about the assault, their symptoms, their fears and their options.
In sensitive matters such as these, tone is everything.
Take the example of Michelle, the young woman who was date raped at her school formal. Michelle had presented asking for contraception after her school formal, no mention of rape. The discussion had begun innocuously enough thought the doctor, with an enquiry about contraception.
But somehow, Michelle had closed down and the consultation had been unsatisfactory. Fortunately Michelle came back a day or so later and the doctor was then able to establish what had really happened.
By reviewing the script,
and the doctor"s assumptions, it is possible to see why the consultation
was derailed and how easily this could have been avoided.
Michelle, you see, had asked for emergency contraception, observing in passing that quote, she thought he used a condom but just in case she would like to use the MAP.
You express puzzlement that Michelle did not know whether a condom had been used or not but Michelle would not discuss the matter further.
She becomes increasingly irritated by the questions, gentle as they are, and accuses you of being a sticky beak. She just wants the emergency pill thanks.
What was the assumption
in this exchange that threw Michelle? The assumption that she would know
whether or not he had used a condom. That it had been unprotected consensual
sex. She didn"t know, because she was raped. It was down hill from there
with the good doctor.
Of course some assumptions we make are less innocent than this; for this reason the first part of the module is an information exercise, providing doctors with statistical information about the nature and incidence of assault, legal procedures and medical assistance as well as the complexities entailed in dealing with with people who have been shockingly betrayed by people they know and even like.
The self awareness is kept up throughout the module; participants are frequently asked to examine their assumptions and to check against the information in the first section. The role of the doctor, after all, is the role of the scientist. It is not to judge, dismiss or decide, that is the task of others.
But I have not come here to review the module, other than to declare my delight in the thoughtful thoroughness of the thinking behind it. There can be no one in this room who is after all not familiar with its contents.
There are two aspects of the module however that I would particularly like to commend the College upon and which are central to the challenges of gender equity.
First the module demands a degree of humility and gender understanding from medical practitioners which is commendable and which would be nice to see replicated for barristers, police prosecutors and judges.
The module is based on
an assumption of ignorance. Sadly there are many in the criminal justice
system just as ignorant, so ignorant they don"t know how much they don"t
know, and with no module to help them. Ignorance is not sex linked of course.
As I have found, to my cost and to my sorrow during my engagements with men over the past few months on the issue of men, women, work and family- make that housework- language is everything, tone is everything and so often I failed to connect with them because my assumptions and their assumptions, my meanings and their meanings, were different.
The second point I would make in launching this module is that training materials such as this must be rights-based. Fortunately this one is.
A rights-based approach
to sexual assault, or domestic violence, or trafficking, requires that the
responses are premised on the assumption that women and men are equal, equal
in their rights to live in safety, to live free of sexual exploitation against
our will, to live without coercion, to exercise our choices freely. These
are default positions, not "nice to haves". They are the assumptions on
which people congregate together, live together, love together.
From this assumption,
what follows is not a series of questions suggesting the patient"s recollections
are faulty or deliberately misleading, what follows is care for the patient
as one who has had their fundamental rights violated, who requires comfort,
affirmation of those rights and restoration. It is for others to find if
the victim is in fact the predator, not the doctor.
The great achievement of this module is that it is clearly based on this approach and reinforces it at every turn.
Congratulations to all who were involved in the development of this interesting, thorough, challenging and informative module. It was humbling to read and I trust to learn from.
If I have one disappointment, it was in the gender of those on the working party. Only two out of the thirteen members were male. What a shame.
What does this say- that
male doctors and forensic specialists and counsellors felt they had nothing
to say, that this was women"s business, nothing male doctors would or should have to deal with. Does the composition of the expert working party mean that only female doctors will read it, that male doctors at the practitioner level will also feel this is women"s
business? I hope not.
It is clearly the remaining challenge for this distinguished royal college to ensure this is not the case.
For so long as sexual
assault training remains women"s business, for so long as other men collude
in the invisibility of the perpetrator and fail to affirm the rights of women
to live in safety by not contributing to projects of this kind, we will continue
to have our country polluted by sexual assault, domestic violence and trafficking
for sexual exploitation.
It will remain a matter of deep cultural shame. It must change. This College must now ensure it does change.
Sex Discrimination
