The sea of pregnant women wilting and moaning in the Vellore sun overwhelmed me. As a young intern and unmarried woman, I had the image of a doting husband and two kids -- one boy, one girl -- and a dog or two. Looking at their discomfort, I mentally scratched off the kids: I would settle for the dude and the dogs.
The senior lady doctor I was with went through dozens of cases with clinical precision while I helped with the examination.
That’s when I saw the duo. The young girl and her huge belly walking in with her mother. But she was different from the others. Her coarse skin, hair in pigtails, incongruous constant giggle, social awkwardness and inability to answer simple questions suggested a level of subnormal intelligence.
The mother confirmed my suspicion when she blurted out apologetically: “She is mentally retarded. My only child. Sorry...so sorry. We didn’t deserve this. Maybe we sinned in a previous life?”
I wondered why the lady doctor didn’t examine her straight away, as she did the others. She let her ramble on and then asked: “what is your daughter’s ailment?”
“Oh, nothing much really, she just has a headache,” she said.
I waited. No exchange between the two.
C’mon ladies! I wanted to scream out loud. What about her abdomen and the baby that could pop out any second.
The senior doctor casually examined her throat, her sclera (white part of the eye), palpated for lymph nodes and put her stethoscope on her chest.
She then looked at the mother and said: “can we examine her inside?”
Surprisingly, the girl lay at ease on the bed with no coaxing necessary. While the doctor started palpating her abdomen, the 16-year-old twirled her pigtails, licked the ends, stuck out her tongue and laughed incongruously. The irritated mother wiped the constant drool near the sides of her mouth.
I watched as the doctor did the per vaginum examination. Every woman prior to the girl showed discomfort and winced, at least a little, no matter how reassuring the physician swords were. The girl showed no signs of any discomfort at all.
Her comfort and ease made me cringe. I went through the stages of anger, horror and a sense of profound sadness. I cannot hide my expressions well and the mother sensed this.
She whispered: “I have come here for an abortion for my daughter.” I marvelled at the senior doctor’s calm demeanour as she walked her through the options of abortion.
She continued to hold onto her mother, who wept, narrating the countless times that her daughter had been brutally raped by her maternal uncle and cousins. I fought back my tears as I listened.
I watched the duo walk away. The mother with her tear-soaked pallu and the 9-month pregnant girl skipping alongside, laughing, her pigtails sashaying in the wind until they were mere dots in the horizon.
I’ve often thought of them and I wonder where the three of them are.
In my heart, I hope and pray that the teenager, now woman, is safe from harm and danger, unexploited and free in a society which has helped protect her child. I recalled the words of Desmond Tutu, the South African human rights activist: “Hope is being able to see that there is light despite all of the darkness”.
Every 20 minutes a woman is raped in India, and only 10% of these crimes are reported. An overwhelming majority of the perpetrators are people known to the victim and may include a family member, a spouse, a school teacher, a coach or a religious leader.
Home, educational institute, workplace, public transportation and places of worship are common areas where rapes occur. At least 20,000 cases of rape against children are reported every year in India. It has been estimated that 2.2% of the Indian Population (or 26.8 million) who have a disability face an additional risk of sexual violence and rape. These figures may be hugely under-represented as many cases go unreported in India. The incidence of multiple and repeated acts of rape are unclear in India, where the rate of conviction of rapists is estimated at only 25.5%.
Survivors of rape bear psychological scars and mental health issues that include depression, anxiety, post-traumatic stress disorders (PTSD), substance abuse disorder, alcoholism, drug addiction, chronic fatigue, social withdrawal, sleeping disorder, anorexia, bulimia and borderline personality disorders. The rates of suicide and attempted suicide are higher among rape survivors as is the inability to have meaningful healthy relationships. The #MeToo movement has highlighted the effects of PTSD even 50-70 years following rape.
Both men and women experience sexual dysfunction following rape. Half the women have non-genital or genital injuries during rape. Women may have dyspareunia or pain during intercourse, chronic pelvic pain or menstrual irregularities. Repeated sexual violence leads to unwanted pregnancies and takes a toll on the physical and mental health of the girl child or woman resulting in unhealthy babies, and chronic anaemia. Increased incidences of high blood pressure and urinary tract infections have been reported in both men and women after sexual violence.
Sexually transmitted diseases are common following rape. Gonorrhoea, Chlamydia, Trichomoniasis, Pediculosis Pubis (pubic louse), genital warts and Syphilis are treatable conditions that need to be investigated and diagnosed when a rape is reported. It is important to provide post-exposure prophylaxis to prevent HIV infection after a rape has occurred and to follow it up to ensure that rape survivors complete their medication. Hepatitis B is 50-100 times more infectious than HIV and is commonly transmitted via exchange of body fluids such as blood, semen and vaginal fluid and hence must be investigated for post-sexual violence.
(Dr Samuel, MD is a former Professor of Pathology, Christian Medical College, Vellore.)