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The Role of a SANE (Sexual Assault Nurse Examiner) by Kellie Cajas, RN-BSN

Hello and good day! My name is Kellie Cajas and I currently work as a Sexual Assault Nurse Examiner at St. Vincent Hospital Indianapolis. For the last two years it has been my honor and privilege to work with an amazing team of nurses, doctors, social workers, technicians, advocates, law enforcement officers, and lawyers to help serve men, women, and children in the state of Indiana who have experienced sexual assault and abuse. April is a time each year that we work to bring awareness to sexual assault as a community issue, and attempt to help the community understand resources available. Today as a SANE, my goal is to help our community understand the medical and forensic services available to anyone and everyone who has experienced sexual assault, as well as dispel any myths or half-truths that keep people from seeking out the services within their community.

So first, let’s define sexual assault. As a community we understand ‘sexual assault’ as any unwanted sexual contact by another person. Many people feel that the word “assault” implies violence, but sometimes the violence is not seen or perceived as violence. Violence can look like manipulation, coercion, threat of danger, or intimidation. After any incident of sexual assault – no matter the type of forced activity – medical and forensic services are available, regardless of a person’s decision to report the assault to law enforcement.

For anyone over the age of 18, the choice to report the assault remains with the person who has been victimized. For anyone under the age of 18, a report to authorities is mandated by the State of Indiana. However, no matter the status of a report, the person has the right to medical and forensic services that help ensure their health and safety following a sexual assault. The state of Indiana even has a special fund of money set aside to help afford these examinations to persons in need immediately following a sexual assault. As a SANE, I help my patient fill out these applications at the start of the exam, and submit the application on their behalf. Most often this fund of money will cover parts or the entirety of the exam. The fund can also assist with follow-up services such as doctor’s visits, counseling, or job-loss assistance.

 

Upon arrival to the hospital following an assault, many people do not know what to expect. The first thing I recommend when coming to the emergency department after an assault to bring a trusted person to help make the process feel safer – a family member, a friend, or a mentor who can help talk through decisions is ideal. There will be a lot of scary questions upon arrival: Why are you here today? When did it happen? What happened? The staff at our emergency department work their hardest to be gentle and kind, but these questions can often feel intrusive or scary following a sexual assault. As the SANE, emergency department staff contact me as soon as someone in need of sexual assault services arrives. I come and meet with the patient briefly, explain who I am, and that I offer special services to anyone who has been sexually assaulted. If the patient would like to use some or all of these services, we proceed to a special exam room used only for these types of examinations. It is quieter, more comfortable, and has a private bathroom used for parts of the exam and for the patient to shower afterwards.

The most important thing to know is that every part of the examination we offer is just that – an offer. In no way is someone forced to use any of our medical or forensic services. We offer a lot of different services and often it can feel like an all-or-nothing situation. A patient is allowed to choose any combination of services that they feel would be most helpful. We first talk through what the patient would like to do regarding reporting the assault to law enforcement. If reporting, law enforcement is contacted and will often come to the hospital to take an initial report. If not reporting, contact information for law enforcement is provided in the event that there is a desire to report after the exam. The primary focus of the examination is a head-to-toe physical assessment to ensure the patient is healthy. If there are injuries, these can be documented and forensically photographed. If there are health concerns, the patient is able to see a doctor to address any specific needs. Following a health assessment, the patient has the option to have forensic evidence collection completed. Evidence collection can include cotton swabs of body areas, nail scrapings or clippings, hair combings, clothing collection, and a variety of techniques to attempt to collect DNA evidence of the assailant. A blue light will also be used to look on the skin for any body fluids or stains left on the body from the assault. At the end of the examination, medications for prevention of specific sexually-transmitted diseases, pregnancy, HIV, as well as different vaccines will be offered according to each patient’s specific situation. If the patient would like further support or resources within the community, we offer to contact an advocate that can help the patient ask questions, make decisions, and seek out follow-up services after the initial examination. Sometimes an advocate can arrive to the hospital to provide support throughout the exam, or they can arrange to meet at a later time. We also provide contact information for community resources available if the preference is to seek out services at a later time.

Immediately following the exam, evidence is logged into the statewide tracking system and secured for pick-up by law enforcement. With the statewide tracking system, anyone who has had evidence collected now has the ability to watch their sexual assault kit move through the process from collection to pick-up to processing to results. Following report of the assault, documentation from the examination is shared with the investigating detective. If not reporting, the documentation is stored in the medical record and available should a report be filed. The purpose of our collection and examination is to build accurate and unbiased documentation of the history of assault, physical findings, and medical interventions required.

As a SANE, my goal in working with each and every patient I meet is to begin to lay the foundation for healing. Some days that looks like letting a patient take breaks as we make our way through a long exam. Some days it means turning the exam room into a stand-up comedy show to help everyone cope with the stress of a traumatic event. Sometimes it means helping a teen talk to her parents about what she needs to begin to heal. Some days it means assuring a patient that their body is healthy and normal, even though it feels like everything has changed. Every day my work as a SANE looks a little bit different, but the goal is always the same: lay a solid foundation for future healing.

 

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