Rape has reached epidemic proportions in Nigeria. We would be going through certain aspects in this discussion. What role should you play?
4 weeks ago. We handled a case of defilement in a 12-year-old and a 15-year-old. Should you be concerned? Definitely
Enugu is not left out. Notice that even the elderly is not excluded
A recent survey in Nigeria showed 31.4 and 5.7% of sexually active adolescent females and males, respectively, reported forced sex (rape) at sexual initiation.

• Why the sudden increase? Could it be due to COVID👹
  Rape as we all know has to be against the will of the victim without his/her consent
  – With her consent following threatening
  – With her consent under false pretense
  – With her consent under intoxication
  – With or without consent under valid legal age (Under 18 years)
  Think of it as 1 in every 3 females have been raped, Meaning rape is under reported because guardians do not know what to do, sounds far-fetched but the statistic is alarming.The other alarming detail is Less than one in five (18.1%) of 10,000 respondents who have been raped in Nigeria report the offence to the police.

So what should a guardian do on suspicion of rape or defilement
The first point is everybody should be suspect. Particularly in this holiday season.
A study showed that half of rapists are people familiar to the victim and the family of the victim
They lurk nearby and study your environment. From the Mai ruwa to the brother in faith
They are not strangers.

Observe your wards for any abnormal or strange behaviour
They come in various shades
Have a high index of suspicion
A lot of parents have been treating “toilet infection” in their children but they have not bothered wondering if the toilet is a human toilet
Frequent urinary tract infection in child, adolescent should warrant proper clinical infection
Breast pain or boil on the breast of a girl child should equally arouse suspicion
Vaginal discharge in the same should warrant clinical examination
Vaginal itching in a girl or adolescent should raise suspicion
Abnormal gait changes. Way of walking should raise suspicion
For actual cases of rape like the one we handled 4 weeks back. What should you do?
Similarly has my child become moody of recent. Especially when uncle Fidelis comes into the house
Many of this prehospital signs should be sought for. Not every case of rape is obvious. Some have been secretly happening but it takes a sensitive guardian to pick them
Painful as it is. The first thing is to remain as calm as possible.
The first port of call should be the hospital but before then. The scene should be combed for any evidence that could prove
What are you looking for?
Used tissue (blood stained, seminal fluid – look like liquid starch)
We had a hard time calming the mother I must confess. She tossed me up and down like a 25kg rice
Condom
Used or discarded underwear

What must you not do?

Change the clothing. Please do not do this. The clothing is also evidence abeg
Wash the vagina to remove sperm or “yamayama”
This again removes vital evidence
This is important. Most times in a bid to get to the hospital. Vital evidence is left behind. Sometimes it may require bringing our wonderful police to the scene before Is tampered with
Bath the individual
This removes vital evidence
The person should be brought to the hospital in the state in which he or she is found
The hospital should be the first point of call
If you are still awake please I respectfully bring my hand to chop knuckle👊
Need I say that a tertiary government hospital is better than a private hospital in this regard
Be careful to protect identity of the victim
Rape is legal term and evidence of the health care provider stands supreme. The evidence collected by the guardian in the presence of the police at such times would prove invaluable
There are certain peculiarities that must be mentioned of Nigerian hospitals
Washing vagina includes douching please
It is your right. Do not discuss rape cases in the emergency with everyone listening like BBNaija
Seek for privacy
A medical officer statutorily is assigned to rape cases and other criminal related cases. The victim would have to see this medical officer
It is not right for the victim please
Do not be judgmental and caution anyone including the doctor from judgmental tone
Be careful of healthcare workers that are only interested in the latest gist. Ah!! Madam wetin happen commonly reveals them
Protect the identity of the victim
The victim should never be blamed even if she was in her boyfriend’s house.
Seriously noted
The examination should not be done with phone torch. A well lit environment with a female matron
The victim must be ready and agree to the examination and evaluation. This must be patiently done. If the doctor is in a hurry. Let him be done with the other events
A hurried examination is equivalent to no examination
Remember you are dealing with a psychologically traumatized individual

We examine the gait of the patient as the patient walks in. Is she in pains? Walking with legs wide apart
What did the patient do since the episode?
– Change of clothes
– Bathing
– Douching
– Urinating
Delay and reasons for the delay are noted
– The time of the incident
– The number of assailants
– The relationship with the assailant
– The location/ venue of the attack
Any violence and how the struggle ensued
What is the examination usually like?
After the preliminaries of obtaining the history
This would include the external clothing and the under garments
Examination is done of the clothing
Ideally the outer clothing is examined and packed in a separate bag for later evaluation. Signs of struggle on the cloth are checked as well as stains (seminal, blood, saliva)
The inner undergarments are also examined and kept in a separate bag.
All this has to be done by the clinician
How is her clothing
This is evidence and kept away.
The victim is usually restrained and forceful violated in this region
Cheeks, lips and neck as well as wrists are common sites of injury
For example, if her blouse is torn in front. I would check to be sure she has no marks on her breast upper chest region
Torn clothes direct us to corresponding areas of injury on the body and we commonly seek this out
Examination of the vulva and vagina is next
We examine to ensure there are no cuts, bleeding or swelling. Rape is usually forceful against an unwilling victim so some level of injury would be seen
We examine the pubic hair to check for matted hair which would suggest discharge
3 categories of people
For the virgin.
Tears are common with bleeding
The outer lip of the vagina would be noted to be swollen and cuts may be noticed on the vaginal wall
In other words, the tear may extend close to the anus
The hymen if present is usually cut in a ragged manner with tears extending to the fossa naviculars and fourchette in the first picture
Sperm may be seen in the vagina up to 12hours after the incident
For children. Presence of hymen does not mean the child is not being violated
Or has not been violated
For sexually active women. It becomes pretty difficult as hymen is no more. Cuts, bruises, bleeding and sperm nails the rapist
Non motile sperm can be seen up to 12 hours. Some have reported seeing dead spermatozoa up to 48 hours
The anus is also examined as we are in strange times.
The rapist may be content with “playing” outside the vagina with his device
Especially when he considers size disparity
Sperm has been sampled from the anus as well
Some are content with using their finger
Having done all this we must treat the patient
Sadly enough, most of our facilities cannot carry DNA test. So sperm is what we follow and unexplained injuries as well as cuts
Other areas as mentioned before include the breasts, finger nails and back of the victim for bruises
Just as we have had reports of sperm from the mouth of some rape victims. These are still rare instances. But this has been noticed as well
And give post exposure prophylaxis for HIV
We commonly give prophylaxis for Tetanus toxoid
For females, emergency contraceptive is important
We prefer to do baseline investigations before treating. None of the infections would manifest in hours. So any patient who has a positive test result for any of the infection had it before the incident
Some benefit from group therapy
We treat for gonorrhea, syphilis, chlamydia and give vaccine for Hepatitis
Lastly the victim must undergo or be enrolled with the psychologist so as not to suffer depression and suicide
This however comes after reporting to the police. Remember the doctor only collects evidence. The court determines if guilty or not.