Kiruhura murders: Medical examination of the rape victim

Saturday April 11 2020

 

By Dr Sylvester Onzivua

On the night of August 16, 2013, when a prominent farmer in Kiruhura District was killed together with five of his workers, his granddaughter, NM, a student, was also sexually assaulted. The girl, then 17 years old, told court that the assailant threatened to kill her as he ordered her into the back of her grand-father’s car and had sex with her for 10 minutes.

She reported this incidence to her stepmother and her aunt soon after it happened in the morning. She was taken to the nearby police station on August 18, 2013, and the police officer in charge of Kiruhura Police Station, issued her the Police Form 3A. This special form is issued to victims of sexual assault and used to collect and document the necessary forensic evidence.

On August 21, 2013, five days after the sexual assault, a clinical officer examined NM. The clinical officer had obtained a Diploma in Clinical Medicine a year earlier and had working experience of about six months. The officer, under cross examination, confessed that he had not examined many victims of sexual assault.

It is not clear from the court records what clinical history was taken by the clinical officer when he examined the victim. However, what is certain is that he did not document any sexual history of the victim. To the examiner, this was not important.

He was further asked if a virgin and a woman who is sexually active would sustain the same types of injury when sexually assaulted and he told court that these two victims would sustain different injuries. This line of questioning was, unfortunately, not pursued further.

The clinical officer determined the victim’s age to be about 17 years, based on her physical appearance, date of menarche and date of birth. The clinical officer recorded the mental status of the victim as normal. He told court that he carried out an abdominal examination and then a digital vaginal examination.

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He was evasive when asked if he used a speculum to examine the victim. What was clear was that the health unit where the examination was undertaken, did not have a colposcope, an advanced and modern instrument for examining, among other things, vaginal injuries.

The main abnormal findings, according to the clinical officer, during the examination, were pain in the lower abdomen, described as mild tenderness and blood at the vulva and vagina. The officer later told court that the vulva is the external part of a woman’s reproductive organ.
The clinical officer noted that the victim could not even accommodate his two fingers when he examined her as she felt pain during the examination. During the cross examination, he, however, reported that he even examined the cervix of the victim and found it painful.

He therefore, attributed the pain in the lower abdomen to that radiating from the cervix and concluded that the cause of the pain and injuries was rough sex in the course of rape. He was not asked, and did not tell court what, to him, constituted rough sex.

The officer was asked whether the young lady had an intact or ruptured hymen to which he replied, “the hymen was not there” as he was able to examine the cervix of the victim without any undue resistance.

In the course of the cross examination, the defense lawyers pointed out that the clinical officer did not mention the pain in the vaginal canal in his forensic report; the pain he could remember off head two years down the road and narrate to court. To the clinical officer, the lower abdominal pain he had documented included all pain in the reproductive organs.

The officer was to admit before court that the victim had stated that she had started her monthly menstrual period. One of the lawyers put it to the clinical officer that blood from a vaginal injury and that from menstruation would flow through the same opening and under the circumstances it would be impossible to differentiate between menstrual blood and blood coming out of any possible injury.

The clinical officer was then tasked to explain the source of the bleeding that he reported, and specifically whether it was “normal blood” or menstrual blood. To the clinical officer it was fresh blood and not menstrual blood. He defined fresh blood as that “which is coming out of an injury such as a fresh wound, and which is not coagulated and is in its normal colour”.

To the officer, there were injuries in the vaginal canal and these injuries were responsible for the pain and the bleeding. He was not asked and therefore did not elaborate on the type of injuries or wounds
The clinical officer was asked to explain the fresh bleeding when the sexual assault had taken place four days earlier. To the examiner, the victim kept cleaning herself and was not on medication and these factors were responsible for the fresh blood.

Although the medical examiner did not indicate in his report the presence of blood in the vaginal canal, to him it was obvious as he had inserted his fingers in the vaginal canal and there was blood on the examining finger.

It was also pointed out to the clinical officer that in some women the menstrual period is associated with pain, sometimes so severe that they are even admitted to hospital or given strong pain killers. Another cause of abdominal pain in women, according to one of the lawyers, is infection which, in this case, the clinical officer had not excluded.

There was no record whatsoever that any samples or specimens were removed from the victim, apart from blood for an HIV test, during this very important medical examination.

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