Interview With Dr. Sebastian Van As
Cape Town trauma surgeon Dr. Sebastian Van As talks about the social ills behind South Africa's high rape statistics and what it will take to properly addresss the problem.
Links and Resources
More on ANC leader Jacob Zuma's rape trial and the "virgin rape" myth; plus links to organizations working to protect women and children against sexual violence.
Sister Fazielah Bartlett is a forensic nurse who sees the majority of rape cases that come through Thuthuzela Rape Clinic at GF Jooste Trauma Hospital in Cape Town. In this interview, Bartlett describes how the clinic treats each case and her own coping mechanism as a staunch Muslim in dealing with the daily cycle of abuse.
Sister Fazielah Bartlett
Elena Ghanotakis: Can you tell me the process a rape survivor goes through once they come to Thuthuzela?
Sister Fazielah Bartlett: We have at Thuthuzela what we call a "one-stop shop." Once a patient walks through the door, she will get holistic care. First, she will see a counselor for an initial debriefing session. This is to calm her down, tell her what is going to happen to her here, who she is going to see, talk a little about HIV testing, and find out if there is something that needs to be done urgently. Maybe she's got a family or a child. Then she will see a nurse who will make sure she doesn't have major injuries that need to be treated by trauma first. After that, she will come to see me. I am the sexual assault forensic examiner. She will get a medical examination from me, and I will collect the forensic evidence for the police.
When you have a patient who walks in, most of the time we find that she will tell you everything that happened that day: when she had breakfast, what she ate, where she went, when she returned -- the whole day's events, up until when the actual rape happened. She will say something like, "Then it happened" or "Then he raped me, and when he was done, I went back home" or "I went to the police station." And that's it. So you know all the events of the day, but you know nothing of the rape.
So how do you get around that?
This is where our nice protocol comes in. We have a 15-page document, called "the protocol," which we use in the Department of Health. It gives us guidelines on the kinds of questions to [ask] a rape survivor. "When did it happen? Where did it happen? Where did he penetrate you? Did he kiss you? Did he ejaculate? How many perpetrators were there?" It actually gives you the opportunity to probe a little. At the same time, it gives the patient the opportunity to express her feelings and say what happened, which is part of the healing process. It actually empowers her to say, "It is not so bad to tell someone what happened to me because now I feel much better."
Can you discuss what happens during the forensic examination?
For the forensic examination, we have a box, called the Sexual Assault Forensic Crime Kit. There are multiple packets inside the box used, [depending on] the story that the patient is telling. As you interview the survivor, you find out how it happened, what he did, all those things. And you collect evidence according to the story. Once you are done, that box is sealed again. It will be given back to the policeman who brought the survivor into the center. The crime kit has to be signed over to the policeman, and he, in return, will have to sign for it to say, "Yes, I have received this box." That is to maintain the chain of evidence. If that box hasn't been signed over, the chain of evidence has been broken and will not stand up in court.
Sometimes the patient is unsure if they want to make a case. Because of the trauma, because of the stress, because of the uncertainty, we say, "Let us collect all the evidence that we can find on your body; let us keep it for you; and you can go home and think about it." If she decides to go ahead, we [have] the evidence in a locked place. We can then say to the police, "We have a crime kit here. The patient has been seen, and the documents have been filled in. This patient wants to open a case now."
In your experience, do the survivors usually press charges?
Initially survivors will lay a charge, but at a later stage, they will withdraw the case. There are various reasons why people withdraw a case. First of all, it could be that the perpetrator is the breadwinner or the person who sustains that family. Secondly, it could be that the rape was gang-related. If the gang member finds out that a charge has been laid, he could threaten the victim or the family and say, "If you are going to continue with this case, I am going to kill you or hurt your family."
Who are usually the perpetrators in the cases you see at Thuthuzela?
There's a variety, but most commonly the perpetrator is someone the victim knows. It could be the boyfriend, the ex-boyfriend, the father. It is seldom somebody who is not known to them.
Can you tell me what it was like for you when you first started working at Thuthuzela?
I come from a staunch Muslim background, where we were not exposed to drinking, drugs and those kinds of things. When I walked in here, it was like, "Where do they come from?" These were young adults, teenagers, who were indulging in sex, drugs, alcohol; for me, it was very strange. At first, I had to deal with my prejudice and put my feelings and beliefs aside to effectively give them the care they needed.
How do you deal with working in an environment where you see a lot of rape cases?
At the beginning, it was quite traumatic. The only way I could actually deal with it was to sit down after each case and write. I would write the scenario, and I would look at what I had offered that client and my reaction toward the client or the story. I would come to a conclusion that maybe I should have acted [a different] way to make it a little better. Maybe I should have offered her something different or changed my body language, my behavior or my expression. That is how I dealt with it.
When do most of the cases come in to Thuthuzela?
Cases come day and night. We have a 24-hour service. We don't have a problem with clients coming in the middle of the night. Overall, we see between 90 and 150 cases a month. I am here during the day, every day of the week. Once I leave, we have a doctor who is on call. If a client walks in at 2 a.m., we pick up the phone and say, "Doctor you have a client, please come in and see this patient."
We see an increase of patients reporting rape during weekends. And there are situations where we have an increase in patients at the end of the month or at the beginning of the new month. I think most of the time month-end means that they got a bit of money and they want to relax and drink. Maybe there is a party going on -- that is where it happens.
What are the biggest challenges you face?
My biggest challenge is prevention. We need to change our focus slightly. We've been offering a lot of care, a lot of solutions, but we haven't looked at preparing the person physically, emotionally. We haven't looked at educating our children, and now we have a major increase in children coming in to the center. I think that prevention is the word that needs to be on everybody's lips now.
Why do you think there is so much rape in these communities?
If I look at the past few months, there has been a major increase in children coming through the center. Our children are much more advanced than they used to be. They explore more than they use to. And I think our television, magazines and DVDs all have a major effect on our children. They are watching soap operas during the day. They are watching movies during the night that are explicitly showing sex; they are experimenting with these things that they have seen on television. But the danger with this is that our children have not been educated. They might see it on TV, but they are not able to handle it. And I think that is where the prevention comes in. We need to target schools and homes and teach our children about sex, sexuality and their own body, about violence and how to protect themselves.