(Adapted from the Crisis Management Handbook: A Guide for Overseas Staff, Peace Corps Volunteer Safety Council)

A) PURPOSE

To provide guidance in meeting the emotional needs of students who have been sexually assaulted. The vast majority of sexual assaults are assaults on women, and for the purposes of this guideline it is assumed that the victim is a women. The same principles should be used when responding to a sexual assault on a man.

B) BACKGROUND

"Management of Sexual Assault", provides background information concerning sexual assaults and describes the medical and legal procedures appropriate in managing reported assaults. This guideline provides more specific information on the emotional support of victims of sexual assaults.

C) PREVENTION AND PLANNING

The medical doctor has a responsibility to the student to assist them in preventing sexual assaults by including the following topics in Pre-departure orientations and on-site orientations.

• Students should be informed about when and where sexual assault is more likely to occur. The institution could consider keeping information on these types of incidents on a database.
• When threatened with sexual assault, the initial response is an individual decision and may include verbal tactics such as conversation, joking, or screaming; and physical actions such as struggling, biting, or kicking.
• A review of cultural do's and don'ts can help students understand what might make them targets for attack. The review may include discussions on behavior in the street, manner of dress, and areas to avoid (for men and women.)
• Students can learn from watching host country women handle various forms of harassment such as unsolicited verbal comments, facial expressions, gestures, touching, and fondling. For some students, attitudes and behaviors will need to change significantly to avoid and/or cope with harassment.

The medical doctor should identify local physicians and trained counselors available for managing cases of sexual assault. Staff members should agree on how medical confidentiality should be preserved and student privacy respected.

D) INITIAL RESPONSE TO A SEXUAL ASSAULT

After a sexual assault, the student may seek out someone she trusts and from whom she expects to receive support. All staff should be trained to fulfill this role. Students who report a rape or other serious assault should not be left unaccompanied.

The emotional and physical needs of the victim should be attended to immediately. For serious assaults, the designated medical doctor should:

• Assure the student of her physical safety.
• Provide psychological support through a warm, non-judgmental approach.
• Help the student identify people and things that she would find supportive and comforting.
• Offer calm acceptance of the student's range of feelings, and reassure her that these are normal reactions to trauma.
• After obtaining consent, record the medical history, perform a physical examination and evaluate the student's psychological condition. Refer to "Management of Sexual Assault." Medevac is generally recommended, but may not be immediately accepted by the Student (see below.)
• Suggest a warm bath or shower and a change of clothes (after the appropriate physical evaluation has been completed.)

Assault Reporting

Students who are sexually assaulted may be reluctant or unwilling to report the assault. Reasons for this reluctance include guilt, denial, shame, distrust of staff, and concerns about confidentiality. Reporting is more likely to occur if the assailant is a stranger or if the student is injured as a result of the assault. Assault reporting is important both to provide care and support for the victim and to assist other students through the in-country safety program.

E) RECOVERY FROM SEXUAL ASSAULT

The recovery from sexual assault may be long and complicated. To assist, the designated medical doctor should:

• Continue to help the student work through the experience by offering emotional support. Suggest professional counseling as appropriate.
• Offer medical evacuation for counseling, recuperation, consideration of withdrawing from the program or preparation to return to country. This brief return to one's own culture greatly facilitates the healing and emotional reorganization. Medical evacuation should be encouraged.
• Assist her in making her own decisions. She needs to regain control of her life, starting with the small decisions, such as what to take home with her.
• Gradually begin to discuss options with her.

Does she want to go home for additional medical or psychological support?
Does she want her family or friends notified?
Is there another student in the program able to provide companionship and support who should be notified?
Are there any concerns about returning to her program?

• Offer support to the students who may be experiencing guilt, anger, or anxiety.
• Recognize that the sense of belonging to the program can be therapeutic.
• Be aware that there is the potential for an anniversary reaction the following year.

F) PSYCHOLOGICAL COUNSELING

The psychological condition of the student should be evaluated at all visits. Encourage the student to talk. Listen carefully and notice how she acts. Her body language will give clues as to how she feels. Following are suggestions for helping the student talk about her experience.

• Encourage her to tell you what happened. Start with general questions and gradually move to more specific ones. These might include questions about the circumstances before, during and after the assault, the assailant, any conversation that took place, the sexual details, physical and verbal threats, whether there was a struggle, alcohol or drug use (by assailant or student) and her reactions. Find out about her social network and whether she has been supported or not.
• Empathize and do not blame. Blaming and judgmental attitudes greatly interfere with the helping process. She needs and deserves confirmation that she has been assaulted. Support the fact that she was victimized.
• Share her pain. Let her know she's no longer alone. It will emotionally strengthen her.
• Encourage her to keep talking. Through it she will gain perspective and help herself. If she is not verbal and her style of expression is hard to understand, try to avoid getting frustrated-silence communicates, too. Allow periods of silence.
• Let her cry if she needs to. This is a grieving process. She's been hurt and has lost a sense of safety and security and thus a way of life. That is a severe loss.
• She will need to hear that it wasn't her fault. Assure her that she can get through this. If she took risks, assure her that she can avoid risks in the future.
• Encourage her to express all feelings regarding the assault, the assailant, and the situation. Assist her in clarifying and defining these feelings which may be overwhelming. Assure her that her feelings are the understandable reaction to such as trauma.
• Recognize her fear and respect it. She needs it, especially if threatened. It is real.
• Recognize her rage and help her to identify and respect it. Rage at being important and helpless should be directed toward the assailant and not toward herself (i.e. self-blame and recrimination.) It may be slow incoming because it is usually constricted. To assist, you may need to help her express anger at the assailant.
• Know that it will take time for her to get over this, but that she can learn to live with it. Tell her this.
• Recognize and support her strength every step of the way (e.g., her coping mechanisms during the assault, her getting help.)

G) LONG-TERM EMOTIONAL REACTIONS

Reactions to sexual assault vary. However, there are several common ones that may recur for weeks or even months after the attack. These include:

• Fear of remaining in the same residence or site.
• A need for continuous support from family or close friends.
• Difficulty in sleeping, recurrent nightmares, intrusive thoughts about the event.
• Fear that the assailant will return.
• Fear of crowds but also fear of being alone.
• Fear of being either indoors or outdoors, depending on where the rape occurred.
• Fear of sex or lack of sexual desire.
• Periods of depression or anger.
• Feelings of guilt.
• Feelings of being damaged or unclean.
• Feelings of paranoia that other people are talking about her or laughing at her.
• Feelings that she can't trust anyone, particularly men.

The student should be assured that her feelings are normal. She should be encouraged to regain control of her life. As she does so she should begin to experience a lessening of her fears and begin to accept that the rape has occurred and that it can be placed in perspective along with other bad things that occurred in her life.

Many students are worried about what to say and how to handle the reactions of people who know about their experience. The utmost care must be taken in observing medical confidentiality requirements.

The designated medical doctor should be aware of his or her own response to the student who has been sexually assaulted:

• One common response is denial, downplaying the trauma, and telling the student that things really aren't so bad.
• Another common response to a student is to focus on what went wrong, what she might have done differently or what mistakes she made. Explain to the student that people who respond in such a way probably do not mean to judge as much as they need to deal with their own anxiety about the event.
• Some may respond with criticism or judgment of the student. In particular, some men may be dealing with their own anxiety about the aggressive use of sexuality by members of their own sex. Men who are able to respond with sensitivity and understanding may have particularly helpful effect in providing support.

(Adapted from the Crisis Management Handbook: A Guide for Overseas Staff, Peace Corps Volunteer Safety Council)