Helping sexual assault survivors in her community

When care increases stigma

“They’d sit there so awkwardly, in full view of everyone, sometimes accompanied by a policeman with a rape survivor’s kit, mostly female and between the ages of 13 and 35. Occasionally we’d see outliers, younger than 12 years old, or grannies, often with horrific internal genital injuries – those ones still affect me the most.”

Dr Yandiswa Mnyanda, Chief Medical Officer in the Accident and Emergency Department at Cecilia Makiwane Hospital outside East London, describes her encounter with survivors of sexual assault in the Eastern Cape that prompted her Discovery Foundation Award-winning research.

Very little in her university medical curriculum prepared Dr Mnyanda for this almost overwhelming experience. So, she attended a gender-based-violence course in East London. She learned what to look for physically, how to describe and report on injuries, and how to work with police, social workers and the rest of the survivor support team. “That was huge – it gave me so many new insights,” she says.

Dr Mnyanda was instrumental in helping set up the Thuthuzela Care Centre for sexual-assault survivors at the hospital in 2012 – one of only nine such facilities in the Eastern Cape. The centre has made a quantum difference in the integrated quality of care for sexual violence survivors, reducing not only secondary victimisation, but also improving conviction rates and enhancing physical and emotional care.

Making a difference in her community

The daughter of a domestic worker and single mother from Mdantsane urban township in the Eastern Cape, Dr Mnyanda’s teachers noticed her in Grade 10 when she consistently came out top of her class.

They secured a scholarship for her to All Saints College in Bisho, a multi-racial private school, where she continued to work hard and excel, qualifying upon matriculation for a government bursary to study medicine. In 1999, she received her MBChB from Nelson Mandela University in Port Elizabeth and has been in her post at Cecilia Makiwane since 2010.

Today a mother of a 14-year-old daughter and a 22-year-old son who is studying emergency care, Dr Mnyanda has become intimately acquainted with her working environment, having completed both her internship and community service there.

Why sexual violence survivors report so late for care

The late presentation of so many of her patients troubled her deeply, increasing as it does the chances of sexually transmitted disease, unwanted pregnancy and the collection of valid forensic evidence for use by police and the courts.

“There are so many reasons why people report late, from being unable to afford or find transport, stigma, and alcohol or drugs to even straight ignorance of the all-round advantages of reporting for treatment within 72 hours,” she says. While men are among the minority of sexual abuse survivors, they are also among the most hesitant to report for care.

Dr Mnyanda decided to identify what factors cause sexual violence survivors to report so late for care, and to quantify these as part of her ongoing study towards an MPhil degree. Her Discovery Rural Individual Fellowship will enable her to do a retrospective study of 1 300 files of sexual violence survivors at her unit between January 2017 and June 2018.

“We should at least get an idea of where these delayed presentations are coming from, the prevalence and what causes the delays, and share this with the National Prosecuting Authorities, the hospital management and police. From there we can do outreach programmes at schools and community halls, talk to children about sexual assault and gender-based violence and promote the advantages of early presentation for medical care,” she says.

Research to influence local and national policy makers

One excellent platform for this will be Mdantsane FM radio, a popular local source of news and entertainment, but television and other media are also in her sights. Her findings stand to influence local and national policy makers.

According to Stats SA, in 2018, the greater East London area was rated the third worst region in the Eastern Cape for sexual assaults – 19 reported cases – with the highest overall crime rate figure of 13 812 cases. Asked how this compares with her experience, Dr Mnyanda responds, “That’s quite important data as it reflects on what we’re doing. People aren’t reporting nearly enough. If we compare our reported cases with local and national figures, we’ll be able to see if we are going in the right direction in terms of holistic management.”

Given her existing estimation of the numbers of sexual violence survivors presenting at her unit, that is a humble and very scientific way of illustrating just how important her research findings stand to become.