In the aftermath of a sexual assault, victims need medical attention and possibly help from the police.
But the process of treatment and evidence collection can be a second trauma on top of the assault itself. Questions about sexual history and details of the attack can leave a patient exhausted and feeling violated all over again.
“These poor people have to tell me, and an officer, and maybe a detective, and maybe a doctor, if they have other injuries that require a doctor,” said Caroline Fisher, a registered nurse with Franciscan St. Francis Health. “Imagine the amount of bravery that it takes, the courage it takes, and you see that in these people.”
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Minimizing that trauma and giving some semblance of control is the mission of the Center of Hope, the sexual assault treatment program Fisher helped establish at Franciscan St. Francis Health.
Victims are provided with a private examination room and work with nurses trained specifically to deal with the physical, mental and emotional issues surrounding such violent attacks.
The work is difficult and wearing, but those who do it find strength in helping people at their most vulnerable and needy.
“I have never come in and not been glad that I was the nurse in that night. There is some connection that you make every time that is so rewarding,” Fisher said.
Tucked in the emergency wing of Franciscan St. Francis Health’s southside hospital, the Center of Hope is designed as an oasis in a chaotic time.
Patients are taken to a private examination room, where specially trained nurses tend to their physical, emotional and mental wounds.
Crosses decorate the walls, near the words, “Healing Begins Here” stenciled on the walls. Teddy bears and flowers are arranged to provide small comfort.
“These victims are amazing. It’s hard to come in here and do this, which is why it means so much to help them,” Fisher said.
According to a U.S. Department of Justice report, the care of the patient who has experienced sexual assault is unique and requires both victim-centered and comprehensive health care, as well as the preservation of evidence for the justice system.
Victims who seek care at facilities without this particular training frequently become victims again, the report says. Their immediate and long-term health care needs fail to be met.
That was the rationale behind starting the Center of Hope program at Franciscan St. Francis Health.
Similar centers have been founded throughout Indianapolis, such as at Community Hospital East and IU Health Methodist.
St. Vincent Hospital in Indianapolis was the first area hospital to feature a Center of Hope. The hospital now sees about 30 sexual assault cases each month from both adults and children, as well as victims of domestic abuse and other trauma.
A team of nurses works full-time at the Center of Hope, which means they are specially trained and can put in the extra steps needed for these sensitive cases.
“Every patient we see for sexual assault has four or five hours of work. It doesn’t just stop with the exam. There’s the calling, the following up, making sure all of the policies are up to date and the steps have been followed,” said Megan Brown, clinical supervisor of the Center of Hope at St. Vincent Hospital 86th Street location.
The Franciscan St. Francis Health branch is the only one on the southside.
Fisher, who has been a nurse for more than 30 years, founded that program in 1997. She had become frustrated with the response she received from physicians following sexual assaults.
She worked with her supervisor for two years to develop a protocol.
“I didn’t know why patients were behaving the way they were. I didn’t have the words to help them, because I’d never been sexually assaulted,” she said.
At the time, training for sexual assault medical programs was difficult to find. She worked with law enforcement agents and other medical staff in Indianapolis and Fort Wayne to learn how to best help patients.
The training also helped her create a system to best preserve evidence for prosecution.
Fisher now teaches that system — nearly 80 hours of classroom and hands-on clinical instruction — twice yearly in Marion County. The International Association of Forensic nurses provides guidelines on what the minimum amount of training is needed.
Fisher responds to every call that comes into the center. She is its only full-time employee, though a roster of nurses working in other departments also provide assistance as a secondary responsibility.
“They sign up for call, and there may or may not be a patient. So the nurses who do this are very passionate about this work, and have to care about these women, or they wouldn’t do this,” she said.
When a patient who has suffered sexual assault comes to Franciscan St. Francis, they are automatically transferred to the Center of Hope, unless their injuries are severe enough to warrant more immediate care.
The nurses explain how they’ll collect rape evidence, offer patients options as far as the treatment they want, and find out if the patient wants to involve the police or not.
A medical screening and complete head-to-toe assessment determines the extent of the injuries. Fisher goes over the victim’s entire body, looking for bruising or tenderness. Depending on what the patient has told them about the attack, nurses may collect or swab the mouth, skin or genitals.
A forensic light is used to look over their wounds and their clothing for additional evidence, such as blood, saliva or bruises that haven’t yet formed on the body.
Fisher will take a full forensic medical history from the patient, as well.
“I need to learn enough about what happened to them to deliver good nursing care,” she said.
Patients can take a shower and clean up in a private shower in the facility. If they want medication to protect against diseases such as syphilis, gonorrhea, hepatitis or tetanus, as well as unwanted pregnancy, it is provided.
“We don’t give them anything they don’t want. One of our primary goals is to give them control back, because that’s what was taken away,” Fisher said.
Before a patient leaves, the Center of Hope team also provides information on counseling, either at Franciscan St. Francis Health behavioral health services, or at domestic violence services Turning Point or Legacy House.
“That’s what is going to give them the skills to make changes to their lives, so they don’t end up having these negative consequences associated with violence,” Fisher said.
Violence has consequences that can extend far into a person’s life and beyond.
Health concerns, such as fibromyalgia, back pain, headaches, gastrointestinal disturbances, go along with the emotional trauma that violent attacks cause.
Children of victims can also suffer repercussions and negative effects.
“We know that there is the likelihood of violence perpetuating through generations, so it’s important that we treat these victims in a way that is reflective of their dignity, gives them control back, (someone) loves on them,” Fisher said. “It’s a health issue, and people don’t always realize that.”
About Center for Hope
What: A special treatment area for victims of sexual assault and rape, where specially trained nurses, law enforcement officers, victim advocates and counselors work together with the patient.
Where: Franciscan St. Francis Health, Indianapolis
When: Founded in 1997
Who: Executive director and registered nurse Caroline Fisher
Other Centers of Hope in the area
- St. Vincent Hospital
- Wishard Hospital and Health Services
- Riley Hospital for Children
- Community Hospital East
- IU Health Methodist