Posted on: Thursday, May 29, 2003

ISLAND VOICES
Compassion after sex assault

By Adriana Ramelli
Director of the Sex Abuse Treatment Center at Kapi'olani Medical Center

The use of the word "force" when talking about requiring hospitals to provide emergency contraception (Honolulu Advertiser, May 10) bears no comparison to the use of the word "force" when talking about the crime of sexual assault.

Officials at St. Francis Medical Center do not want to be "forced" to operate counter to their religious beliefs. As someone who has worked with sexual assault victims for over 20 years, I can appreciate the thought of not wanting to be forced to engage in any activity against one's will. However, it is the very nature of being forced into something that has created this problem to begin with.

Rape and sexual abuse are about force — control, power and anger. The crimes themselves often involve force, which comes in many forms: direct physical force, threat of force, use of a weapon, emotional manipulation, bribery and coercion. It is the aftermath of a sexual assault, however, that sheds true light on the meaning of the word "force."

Once the sexual attack is over and the victim has survived, the road to healing is about control, strength, energy and desire—a forceful will to live. Victims of rape and sexual abuse talk about having to cope — or forcing themselves to cope — with the flood of physical and emotional trauma. Each day after the assault, they are forced to face the unwanted feelings and thoughts of this horrible crime and the person who committed the harm.

If the crime is reported to the police, victims are forced to muster the energy to describe the attack to the beat officer who takes the initial report and the detective who investigates the case. When victims choose to have a forensic examination, they are pushing themselves through this procedure because they want to be safe, they want evidence for court, and they want preventative treatment to reduce risks of disease and complications.

When they come through the doors of the Sex Abuse Treatment Center for counseling, I witness the determination and drive to recover from the assault — the forceful will to live.

St. Francis Hospital does not want to be "forced" to practice medicine that runs counter to religious belief and sees the current system as working. It does work when the victim wants the comprehensive forensic examination offered through the Sex Abuse Treatment Center. However, not all victims choose this method of care and may be concerned only about a pregnancy from the assault.

If this is the case, the system works when a victim can walk into any emergency room, be evaluated for the risk of pregnancy, and offered the choice of the emergency contraception.

Offering emergency contraception is also a time-sensitive issue. The medication needs to be administered within 72 hours of the sexual attack to be effective. It is not uncommon for victims to delay seeking immediate medical care because the realities of a sexual assault are often too painful to face.

Thus, the victim may be asking for the medication with only a small window of time available. An unwanted pregnancy should not be added to an already exhaustive list of concerns for a sexual assault victim.

Like victims of sexual assault who have been forced to struggle with their crisis and create positive outcomes, many religious-based institutions across the country have struggled with this issue and opted to support sexual assault victims. Over 200 Catholic emergency rooms nationwide routinely provide emergency contraception to sexual assault victims, according to a study released by the Catholics for a Free Choice.

Eugene Tiwanak, chief foundation officer of St. Francis Healthcare System, indicated in the article that the hospital follows the rules of the Honolulu Diocese, which is opposed to contraceptives. Perhaps the time has come for the Honolulu Diocese and officials from St. Francis to understand that any crisis can create an opportunity for positive change. Sometimes we just have to force ourselves to challenge our principles.

The issue is really about compassion — the bill before the governor is necessary, because the current system does not work. More importantly, it does not demonstrate compassion for victims of sexual assault.