The patient was a 4-year-old girl – malnourished, unhygienic, active little child. Her presenting complaint was per-vaginal (PV) bleeding for the past ten days. The mother was reprimanded for not being proactive in bringing her daughter for evaluation as early as possible, especially regarding a complaint like that. She was asked to take her daughter behind the screen immediately and remove her trousers for examination.
With children this small, the examination is never easy. They are scared and anxious. The mother is usually asked to keep the child in her lap during the examination so that the child won’t be afraid and would let the doctor examine them. The parents also prefer the child to be examined in front of them rather than hearing the child thrash around from behind the screen. So, when the mother came out from behind the screen, leaving her daughter there alone, and sat down casually on the sofa, the attending doctor was mildly surprised. She didn’t explain the correct ethics, though – being short on time and full-on pending OPD appointments.
Behind the screen, she started talking to the little girl to build a rapport and distract her during an examination. But the girl didn’t require distraction. She got examined without a single protest or hesitation. Upon examination, it was evident that she was sexually abused – multiple times. The attending doctor asked her senior to step in and have a look in case she was misdiagnosing. By the time she returned with her senior behind the curtains, the child had already gotten up from the bed. She was asked to lie down again. Her mother was also called in as they assumed that she would not readily get examined for a second time now. The assumption proved to be wrong. The little girl smiled at the new doctor, climbed at the bed, and got into the lithotomy position quite cheerfully. The mother didn’t come in either.
The readiness with which she assumed the position had both the doctors were raising their eyebrows. It didn’t take the senior doctor more than 2 minutes to confirm the diagnosis. The OPD room was cleared, the mother was asked to sit down with her daughter and was told about the diagnosis and apprehensions of the doctors. Denial, anger, bargaining, depression, and acceptance, the attending doctor prepared herself to guide the patient (‘s mother) through each stage. The denial came immediately. Check. But she was not followed by anger. Hm, strange. The absolute denial was followed by amusement and laughter. The mother shyly looked at the daughter, back at the doctors, and laughed meekly as her daughter’s trauma was something to be bashful about.
The remissive reaction of the mother made the attending doctor speechless. But the senior was not fazed. Instead, she pressed on. Explaining to her what their findings were and what they were consistent with. The relaxed demeanour of the mother was astounding as it was infuriating. Over the next half an hour, amidst the lengthy counselling of sexual abuse to the inattentive and in-denial mother, it was not until the doctor mentioned police that the mother became alert.
She outrightly rejected the idea of involving the police in their domestic affair. Even after comprehensive guidance, the mother failed to see the reason. Finally, the senior doctor – exasperated – proceeded to call the police without the mother’s consent. By this time, the mother realized that her daughter’s medical evaluation was inevitably becoming a medicolegal case, at which she scooped up her daughter and ran out the door. The guard was informed promptly to keep her from exiting the building. But the senility of the guard was unable to catch up with her youthful, hasty sprint. In a frenzy, she didn’t even bother taking the prescription slip.
The police were called and informed, nevertheless. The OPD resumed its natural order. And it just became another piece of gossip in another overworked day. But let’s not let it become just that. Let’s dissect episode one happening at a time:
The Mother’s Response
The mother was not literate. It was evident from her communication, her clothing, her outlook, and her response. When told about the horrific episode(s) that her daughter was undergoing for the past God-knows-how-much time, she was pretty heedless and irresponsible about the whole matter. But it begs the question: sure, the correct medicolegal procedure to follow in cases like these can only be determined by education/literacy, but being disgusted or horrified at the prospect of your daughter being abused, does that demand literacy as well? That ought to come naturally.
The History of the Presenting Complaint
One can assume that the entire matter was no news to the mother as the senior doctor did. Her carelessness can only be explained if she was already fully aware of the gory details of her daughter’s trauma. She was aware that her daughter was being violated, but whether she or her daughter had the right to protest that violation, she was unaware. She was not perturbed or panicked. She was not seeking help. Maybe because she never knew that she had the option to do so. She did what she was taught to do so: conceal the trauma and dismiss the effects.
On examination, it was evident that the episodes of the said crime were plural. How far back they go was challenging to determine due to lack of proper history. Even this case would not be reported if the patient had not been bleeding persistently. Her mother waited for 10 – 12 days before bringing her in for evaluation. She had hoped that the bleeding would cease on its own – like it’s some viral flu. Even when she left in haste due to the police alarm, she didn’t take the prescription slip – which means that despite the visit to the hospital, the complaint will remain unaddressed, and the patient would stay untreated. Apprised of the police angle, it is doubtful that the mother would take another evaluation to any hospital. The best-case scenario for non-resolution of bleeding would be a visit to some unqualified quack or untrained midwife.
The Examination of the Patient
The lack of hesitancy during the examination of the patient shows how normal this is for the 4-year-old child. She doesn’t know good touch from bad. She doesn’t know and isn’t taught any better. The abuse is normal. At an age, when any stranger – be it a doctor – touching/examining her should make her awkward, uneasy, or spiral into a hysteria, her no-fuss-attitude/no-outcry during PV examination and readily assuming the position as she proceeded to lie down indicates the inadequate and hazardous parenting the girl is being subjected to. Her childhood and innocence are being exploited dangerously and consistently, with her abjectly uninformed consent. One cannot begin to imagine the disastrous impact it will have on her once she grows up to be sensible of the abuse.
The Reporting of the Complaint
Here was this mother who was not ready to acknowledge the problem in the first place. What measures would she take to prevent the abuse from happening again: none whatsoever. The pseudo-singularity of the case wakes one up to the reality of numerous children who are being violated but are going unreported. This is just one case that surfaced because of the presenting complaint not resolving. If the patient had suffered some minor injury, she would not have consulted the medical staff at all. Only God knows how many such cases are there.
The police took the prescription slip and registered the case immediately. But the Sub Inspector was not optimistic. From their investigation within the first 2 – 4 hours of registration (if the 2 – 4-hour narrow window of prompt response is lost, the probability of finding the required person drops to as low as 20% – stats as stated by the police), the police found the address of the woman, on the prescription slip to be fake. The CCTV cameras of the office and the waiting area – although functional – were turned off. Only 2 CCTV camera footage from the corridors could be retrieved, but the picture quality was so poor that the faces of both the mother and daughter were undetectable.
In short, no clue could be gathered as to who they were and where they went. Upon further probing the matter with the officer-in-charge of the case, he said that cases like these never ‘pan out’ because of a) lack of evidence, b) severe under-staffing of the medicolegal center of the hospital, and c) surfeit of cases which can culminate hence and adequately, demand more attention. His experience suggested that this case would just get lost amidst the sea of others, so he advised for the hopes to be taken down a few notches.
Yet another day, yet another tale of horror. Unfortunately, the society we live in tells a woman that her abuse, her suffering, and her exploitation is her own chagrin. She is not allowed to raise her voice and demand justice. Seeking justice is crassly pretentious and God-forbid if she ever does. She must be shamed and blamed for it herself. That has been the case in prehistoric times. That is the case today.
Actually, it would be unfair if this is restricted to women only. It applies to anyone who lies on the lighter side of the power equilibrium in our society. Be it (regardless of gender) students, junior employees, domestic help, the children on the street, the orphans in the shelters, anyone upon whom the abuser can exert his/her control. Abuse operates on the power dynamic. Those with power abuse – sexually, emotionally, physically, psychologically, financially. Those without receive. That has been the case in prehistoric times. That is the case today.
Karl Marx said that
the proletariat would revolt against the bourgeoisie, by the have-nots against the haves, by the oppressed against the oppressor, which would uproot the entirety of the system, and utopia would be established.
I always agreed with the revolution but never with utopia. But by the looks of it, both of us are in the wrong: there is not going to be a utopia any time soon, evidently; but if prehistoric times can change into globalized today of 2021 with the subjugation of the weak, only changing forms and never getting truly eradicated, then it seems there is not going to be a revolution either.