Health
services for rape survivors:
an exploration
Thirty women attended a path-breaking seminar on health services for women recovering from rape organised by Black Women's Rape Action Project and Women Against Rape, which took place at Crossroads Women's Centre on 11th April 2001.
Rape survivors of different races and nationalities and their advocates opened the dialogue with professional health providers, including clinical psychologists, nurses, health advisors, therapists and counsellors. The seminar set out to explore and evaluate how professionals respond to women survivors of sexual abuse and other violence, and whether women get the treatments they need from the NHS, including information about affordable "alternative" treatments. It asked what can be done to promote awareness among professionals of women’s particular needs and to ensure that these needs are met.
The seminar was divided into two parts: survivors gave personal testimonies of health services then practitioners responded, relating what was said to their own experiences at work.
Several survivors described racist discrimination they had experienced; for example a young Asian woman said she had been ridiculed by a forensic examiner at a police Rape Suite, "She told me l was abnormal because l was a virgin at 18, but that's normal in my culture". She also suffered with several sexually transmitted diseases which were left untreated for many months, despite her having sought medical help at the sexual health clinics of two London hospitals soon after the rape. Several years later, she is still suffering significant ill health.
An African woman seeking asylum after fleeing rape, reported that her GP had not seen her in two years. Each time she visited the surgery she was put to the end of the queue and after waiting three hours was sent away without being seen. When she was finally seen, the GP blamed her for not having come to him sooner; the lack of medical treatment had contributed to her ill-health. She commented that the GP claimed an NHS fee for every visit she made, whether or not she got what she needed, and she resented being used in that way, particularly since asylum seekers are scapegoated as a drain on public funds.
Several women with physical disabilities spoke of examinations which made no allowances for constraints on their physical mobility. They said practitioners should be more flexible and routinely ask patients what was possible and comfortable before beginning examinations.
Several testimonies, including from a mental health worker, conveyed that women who have experienced rape or domestic violence are commonly given anti-depressants, sleeping pills or pain killers by GPs, sometimes resulting in drug dependency, or illness due to toxicity. They said these drugs did not solve the problems they had presented, and some were told by the GP who prescribed the drug that such medication was not an adequate response to the effects of violence so they referred the woman for counselling. Women diagnosed as HIV+ or with AIDS had been given extremely toxic drugs, and the children of immigrant women had been used as guinea pigs in drugs trials.
Several women reported negative experiences of counselling. One survivor reported having been classified as "mentally disturbed", one had been put on a long waiting list to see a counsellor or clinical psychologist, while several others did not even get a referral because of some clerical "error". Of those who were seen, women reported ignorance or lack of sympathy for what they had been through from professional counsellors, some counsellors even implied the patient was to blame for the violence inflicted on her. Women reported inappropriate comments and judgments passed on their lifestyle or appearance, including comments on having been a stripper, a lesbian, and about wearing jewellery. They said the problems they sought help with were distorted or overshadowed by these prejudices. A number of Black women commented that white psychologists were prejudiced about race and violence. The power relationship with the sometimes patronising professional was described as a major barrier to speaking freely about painful and intimate experiences.
Summing up, the chair from WAR said sexism, racism, ignorance and lack of compassion had clearly translated into brutality in physical and mental treatments, or denial of treatment altogether.
Responding to womens’ frank testimonies, professionals said they were taken aback by the injustices described. In evaluating their workplace practices and policies, they emphasised that not all services and health workers operate in the same manner and that respectful effective healthcare is available. Sexual health clinics, based in hospitals and elsewhere, offer free treatments on a self-referral basis, and emergency cases can usually be seen on the same day. Some commented that effective treatment is easier if they knew in advance that the patient's injuries resulted from sexual violence, for example they might question the patient more sensitively, drawing on their written policies.
A number of nurses reported that they had actively opposed sexism and racism from colleagues, sometimes collectively organising against individual perpetrators. They said patients’ complaints are taken more seriously than workers complaining about colleagues. But non-professionals responded that in practice, complainants can be treated with hostility and may even suffer further discrimatory treatment as a result. Everyone agreed that complaints from whatever source improve services.
Responding to a reported experience from a Kenyan asylum seeker, who claimed she had been refused help from a charity because she was told rape did not constitute torture, a counsellor present from that charity assured the meeting that its policy was indeed to recognise rape as torture, but that they could only assist where the rape had occurred in detention. She also said that she could not vouch for how her co-workers might interpret the policy. She was challenged on this, but unfortunately had to leave the event at this point. In the discussion that followed, one psychologist expressed disapproval that the charity had been criticised, because they are "on the same side". In response, another woman said that this was not an isolated complaint, that every worker had a responsibility to challenge their colleagues if they were contravening policy and that this meeting had provided a rare and valuable occasion to air such a discussion.
A number of nurses then continued with their reports and evaluations. Several health professionals said they would encourage colleagues and other health centres to invite speakers from BWRAP and WAR. They said their colleagues needed to hear directly from the experts, on all the issues raised at this forum.
The seminar was a breakthrough in beginning to uncover the sources of ineffective treatments, discrimination and hostility confronting rape survivors and what can be done about it. Compassion, patience, immediate help and access to alternative treatments were clearly women’s main demands. It was reported that homeopathy is available on the NHS; many GPs’ surgeries now offer homeopathy on site or can refer patients for homeopathy elsewhere on the NHS, such as to the Royal London Homeopathic Hospital.
Free services and medicines are also needed. As one woman put it, "We already bear the costs physically and financially after rape. Why shouldn’t the State pay for the medications prescribed to us?"