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As COVID-19 empties hospitals, rape kit nurses lose 'right hand man' in patient advocates

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SANE-sexual assault nurse examiners

Catherine Kaiser, BSN, RN (foreground) and Brooke Bae, ADN, RN pack up a sexual assault collection kit. Both are MUSC SANE (sexual assault nurse examiners) nurses. Wearing masks at all times as protocol during COVID-19 measures Sarah Pack/MUSC/Provided

In the months since the Medical University of South Carolina began treating COVID-19 patients, hospital officials have limited guests to keep the virus from spreading. Patients undergoing everything from traumatic injury treatments to routine surgeries stay there alone — and so do physically uninjured sexual assault survivors who visit the hospital for sexual assault exams.

The exams fulfill several needs for recent survivors, from collecting evidence in case they want to file a police report to scanning for physical injuries that warrant immediate treatment. But nurses, social workers, advocates and activists throughout the tri-county have also ensured that MUSC's program offers victims connections to services they may need down the road, from legal help to counseling.

But when keeping patients safe meant that sexual assault survivors would have to sit through the exam without additional support, nurses and advocates found a novel way to continue their work: video chatting with patients on tablets.

A unique solution

Volunteer coordinator Laura Coates' turning point came in late April, when a nurse called her from the exam room and passed the phone to a patient.

Coates listened for the sounds she remembered from the exams she'd attended in person: a bottlecap twisting, a hospital gown rustling, medical supplies scraping against each other.

Miles away from the woman on the other end of the line, it was the only way Coates could tell what was happening in MUSC's sexual assault exam room. With no friends or family to comfort her, the survivor had asked Coates to stay on the phone with her through the process.

Normally, Coates would have met the patient at the emergency room and asked if she wanted company during the exam. There, she'd do whatever was needed to get the victim comfortable: make small talk, sit with her quietly, answer questions about services or provide food and music.

Coates did what she could over the phone, but realized a visual of the patient, even without physical presence, could help her better understand how the exam was progressing. Weeks of teleconferences with her colleagues, who began working from home in mid-March, sparked an idea: sending the organization's stock of electronic tablets to the hospital so nurses could call an on-duty representative when a patient arrived.

Even among medical professionals, sexual assault nurse examiners are thoroughly trained, said Karen Hughes, an examiner at MUSC,  In addition to health care education, they learn about forensics and legal concerns and train with live models. About 15 trained nurses cover the calendar, though MUSC furloughs affected at least one trainee. 

But with the focus required to treat wounds and document evidence, nurses rely on the organization's advocates to help comfort patients during an inherently difficult examination process.

"The advocates are our right-hand man," Hughes said. "Human contact is the most important thing, and that never changes. ... It gives them one more person to connect to."

Coronavirus' impact

For a while, nurses saw fewer patients overall. Closed bars may have led to fewer sex assaults, Hughes said, while some survivors may have avoided hospitals at the pandemic's onset. But many of those who came had survived violent attacks, and needed physical care as well as recovery services.

"Personally, I believe every sex assault survivor should come in and be taken care of; every single one is an emergency," Hughes said.

For a few weeks, program leaders tried to continue as normal. But few patients wanted to do phone calls, Coates said, and it was difficult to tell over a phone call what they needed. Nurses kept seeing patients in the private room reserved for sex assault kits, but disinfected religiously and kept patients' masks on except for a few seconds for oral swabs.

They operated for weeks before realizing as area cases rose they'd need a contingency plan for a patient with the virus, Hughes said. Patients who may have been exposed are examined in a separate room, which is still private but lacks the shower, rocking chair and comforting lighting of the dedicated room. Hughes has seen a couple presumed-positive patients in the alternate room, she said, and another COVID-19 patient was examined in her regular hospital bed.

Those precautions aren't much of a bother, especially as patients are still dealing with a much greater trauma.

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SANE-sexual assault nurse examiners

Sexual Assault Evidence Collection Kit MUSC SANE program — sexual assault nurse examiners protocol during COVID-19.  Sarah Pack/MUSC/Provided

The exam process

Each session varies, but the goal is always the same: to ease the trauma of an inherently invasive exam that's most effective in the hours after an assault. How that works changes with each survivor. Some want a distracting conversation, others silent comfort. Coates watches their faces and body language to predict what they need, monitoring winces so she can ask the nurse on the other side of the partition to give the survivor a break.

The exam process varies depending on the patient and assault. Hughes emphasizes to each patient that they can refuse any part of the exam — many, she said, just want medications to prevent pregnancy and infection and to forgo the physical examination or evidence collection.

Nurses first attend to any serious physical injuries. Then they interview the patient about her health history and the assault to decide how to plan swabbing for evidence and documentation.

If the patient agrees, nurses conduct a head-to-toe examination, taking photographs or samples of any evidence that could identify the attacker and document the survivor's injuries.

From there, patients with some potentially serious wounds, like head trauma or strangulation injuries, might be guided to a doctor equipped for treatment. 

With that, the nurse's job is done. Hospital staff and social workers connect victims with services, but they aren't billed or sent any follow-ups that could identify them as a survivor.

"It's almost like they weren't there," Hughes said.

But it's just the beginning for the group's staff and volunteers.

"(Nurses') focus is on their immediate well-being," Brockington said. "And our focus is on our victim's safety mentally, and understanding they just endured something horrific. ... To let them know that there is someone in your corner who is going to stay with you as long as you want through this process."

Sustained support

People Against Rape's services range from connecting victims with financial help to counseling and support groups. It is open to anyone who needs these services, but it's especially important for survivors to know their options as they begin to heal, Interim Executive Director Djuanna Brockington said.

The most popular service for survivors who have provided a rape kit is help and assistance as victims report the attack to law enforcement. That process still happens in person, with barriers and masks to mitigate risk as officers take down information for the report and begin their investigation.

While calls to the organization's hotline and participation in online programs has risen since the pandemic began, Brockington said the initial face-to-face connection is key to providing survivors with help as early as possible.

"You don't know what you've got until it's gone," Brockington said. "But if you've had this traumatic experience, you did it by yourself. ... Our presence is a way to give victims their power back. They get to say, 'Yes, I want you with me.'"

The organization's resources are available to any survivor or loved one who needs them. To connect with a representative, call the hotline at 843-745-0144 or email

SANE-sexual assault nurse examiners

Sexual Assault Evidence Collection Kit. Sarah Pack/MUSC/Provided

Reach Sara Coello at 843-937-5705 and follow her on Twitter @smlcoello.

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