– Dr. Anuruddhi Edirisinghe, Consultant Forensic Pathologist
First ever medico-legal guidelines for the examination, reporting and management of sexually abused survivors in Sri Lanka.
Research suggests that 1 out of 4 women in Sri Lanka are sexually abused by the time they reach age 18.With such high prevalence of sexual violence, the medico- legal system of the country holds great responsibility in bringing justice to the survivors, legally, socially as well as medically; ensuring lifelong medical, psychological and social wellbeing.
“Research suggests that 1 out of 4 women in Sri Lanka are sexually abused by the time they reach age 18 years”
Find out how these guidelines will help to improve this situation.
A medical examination is conducted by a doctor to determine reasons for illness with the aim of curing the illness. A medico-legal examination is conducted on the request of the criminal justice system (police/ court) with the consent of the examinee to assist the judiciary to give justice. In earlier situation,the patient seeks the doctor’s advice voluntarily.
The main motive was to improve the quality of the medico-legal services delivered, i.e. from medico-legal examination, report writing to the medical care of the individual. The examinations were mainly from a judicial centered perspective. Due to lack of facilities as well as training, the services delivered varied from person to person and institution to institution. Thus, Sri Lanka needed a guide where all the stake-holders are compelled to give a uniformed service to all survivors of sexual violence minimizing personal, technical and institutional differences in the medical and legal procedures while providing the services.
The primary challenge is how to heal this individual and bring back to normality within the health and social care system of Sri Lanka. The second is to bring justice in the context of an adversarial system of Sri Lanka. Sri Lankan society lacks awareness about the 24 hour facilities provided by the government for individuals subjected to sexual violence. This lack of awareness has led to issues in gathering scientific evidence to prove allegations of sexual violence against the perpetrators. People delay to report abuse sometimes taking weeks to months, making medical examinations a tedious task.
These guidelines set a standard that is feasible in Sri Lanka. Setting standards is the first step of improving the quality of the system. Next, is raising awareness among medico-legal professionals on the guidelines. There are only 45 forensic specialists for 20 million people in this country. Therefore, it is very important that the next generation of doctors are made aware and educated about these guidelines through undergraduate and postgraduate education. Third is implementation. Implementation should go hand in hand with improving resources. We have to conduct resource assessments and audits on what we have done and then bring changes where necessary.Therefore, I would say it has only filled a part of the vacuum; there is lot more to do.
The main difference I see is that it makes life easy for a JMO, because there is a uniformed format presented and he just has to follow it. Earlier we have to think each detail and see whether it is there or not. For me, the best of the guide is its comprehensive details on the evidence collection in early presentations.
Well, as I said earlier the best of this document is the comprehensive guide to evidence collection.Guide will not solve this issue alone. We have to do teaching and training as well as supply necessary kits for collection. They have to reach the labs and finally the reports to courts. It is a process. We have to strengthen each step.
Yes this can be used by the defense lawyers against a JMO especially pointing fingers at deficiencies.We took up this challenge and addressed it in the Guide. We have given three grades of recommended practices depending on the facilities available. First of all we have to understand the health care facilities in all hospitals in Sri Lanka are not similar, with the limited budgetary allocations improvements are slow to come. That is a main reason we incorporated clauses which enables a doctor to deviate, but basics have to do. I think a doctor who goes to courts has enough training to explain such situation, because at the end of the day what we do is the best for the individual to the best of that each one’s ability.