Warning – this post contains material of a sexual nature.
This young lady is an actor, who has played the role of an abused girl.
Despite the fact that most girls start having sex before they have reached the age of consent, this counts as statutory rape in Swaziland. The law says that girls under the age of 18 are not able to consent to sex. This is confusing, because traditional Swazi custom allows girls to be married at age 12. Occasionally the police send a girl to the clinic with an official request to find out if she has had “carnal knowledge”.
Previous MSF doctors in my role have refused to do virginity testing on principle. They felt it was not their job, it was not in the best interest of their patient and it put them at risk of prosecution. If doctors are aware that rape has occurred, the law states that they are obliged to report it to the police. If they don’t, they could be arrested and charged, although I have never heard of this happening since I have been working here. (In the UK, although the age of consent is 16, no legal action is taken if children aged 14 or 15 are having consensual sex with a similar-aged partner. However, if the child is 13 or under and having sex, reporting is mandatory. And it would also be an offence not to inform the authorities.)
“That’s different,” say the police. “What we want to stamp out is exploitation of young girls by much older sugar daddies. The girls are naive, they believe that rich, older men really love them. Having a sexual relationship with a sugar daddy seems like their way out of poverty, until they are tossed aside and discarded.”
This blanket refusal had angered the police and soured the relationship between police and MSF. As usual, I take a different view. But I still put the interests of the child first. I interview the girls and make a clinical decision regarding their competency to consent to sex. According to section 33(1) of the Children Protection and Welfare Act (2012):
“If a medical officer believes on reasonable grounds that the child he is examining or treating is physically, psychologically or emotionally injured as a result of being ill-treated, neglected, or sexually abused, he shall immediately inform a police officer or social worker.”
However, it is challenging when I am confronted with angry parents waving an official police form requesting I examine their daughter. “We want to know if she has been raped!” they say. Their daughter usually sits quietly between them, head bowed, avoiding all eye contact. A lamb to the slaughter. Sometimes, they won’t even speak. I interpret this passivity as an “ostrich head in the sand” strategy. “If I don’t acknowledge or participate in what’s happening around me, perhaps it will all just go away.”
A typical scenario is when a sixteen year old girl has stayed out overnight, without her parents’ consent. The parents jump to the conclusion that she has been seeing a boy, and has been sexually active. She is underage, so this is rape, and the boy must be punished.
The first thing I do is to try to defuse the situation. I let the parents have their say, allow them to express their concern and what (ideally) they would like to happen. I take them seriously and don’t argue or challenge them. Then I ask if I can speak to the girl by myself, with my nurse or interpreter. Doctors have such high status in Swaziland that no parents have ever objected to this or insisted on being present when I talk to their daughter.
Using all the consulting skills I can muster, I try to break through the ice and get the girl to trust me. I explain about the limits to confidentiality. We talk about hypothetical situations, so she can avoid telling me outright what has happened. While we are talking, I am assessing her competence, knowledge and understanding. When I am satisfied she can give informed consent, I ask permission to examine her and usually she agrees.
If she refuses to be examined, and I feel she fully understands the possible consequences of that decision, I comply with her wishes. I tell the parents that I consider it would be an assault if I went ahead. This has only happened once. I was told that the police would have to get a court order requesting an examination by a gynaecologist at a government hospital.
However, refusing to co-operate in the investigation of a possible crime is an offence in Swaziland. The police are prepared to prosecute. On one occasion, the police threatened a girl (who refused to be examined) with being sent to a detention centre for young offenders.
If she agrees to be examined, I ask if she would allow her mother to come into the room during the examination. I explain exactly what I am going to do and talk through the stages. I explicitly state that although I will be touching her, I am not going to put anything inside her. Of course, we routinely offer tests for HIV infection and pregnancy, followed by appropriate preventive treatment.
Following consensual, occasional, gentle sex, it is uncommon to see certain signs of penetration. Even the damage following rough sex can heal quite rapidly, showing no definite signs after a few weeks. My report might typically contain the bald statement, “On genital examination, I found no signs of sexual penetration”.*
If there are signs of penetration, I am obliged to include this in my report.
As well as handwriting the police report, I type out my conclusions on a more detailed MSF confidential form, and hand this over to the family. This is what tends to be used in court, if the case gets that far.
Then my real work begins – counselling the family. Together with a psychosocial counsellor, I talk to the family about how difficult adolescence can be for both parents and children. I tell them that I know, I have experience in this matter; my wife and I brought up three daughters.
I say things like, “Your parents would not have brought you here if they didn’t love you.”
And “You are becoming a woman, you want to take decisions for yourself, but with independence there comes responsibility.”
Or even, “Sometimes when you insist that your daughter obeys you, she reacts against it. Being too controlling can have the opposite effect.”
Traditionally, Swazi parents expect blind obedience from their children, and the idea of compromise can be new to them. Doctors don’t spend a lot of time talking to patients here, especially about non-clinical matters. So my attempt at family counselling can come as a surprise.
You may regard my attempts to build bridges between controlling parent and wayward daughter as patronising, but the psychosocial counsellor has said to me, “You are talking as though you really mean it, like you really care. The girl and her parents appreciated what you said.”
This little girl got a present of a cuddly toy for allowing me to examine her. Sometimes bribery is necessary! I like the way her finger is pointing to her head, showing that she is deep in thought whilst making her choice.
There are other ways of assessing virginity. You could take your daughter to a sangoma (traditional healer) who would give you an answer by going into a trance, or throwing some bones into the dust. Or you could ask a gogo. Grannies know things because of their decades of experience.
One mother told me, “I suspected that she was not a virgin because she did not pass urine like a girl.”
What on earth was she talking about?
“She was passing urine like a grandmother,” she said.
And how does a gogo pass urine, as opposed to a maiden?
“Well, when a virgin girl passes urine it is quiet and sounds like piiisssss. But when a gogo passes urine, it is loud and strong, shuusssshhh, and often accompanied by a fart, prrfffttt at the end.”
I discussed this method with the psychosocial counsellors in the office and they all fell about, laughing. They told me that to test for virginity, some gogos make a pile of sand and ask the girl to crouch over it and pass urine. If the stream is single, making one hole in the sand, she is a virgin. If it sprays everywhere, she is not a virgin. “And what does it mean if she farts when passing urine?” I asked. “Oh, Doctor Ian!”
You learn something new every day in this job.
*When someone has been sexually assaulted, but the genital examination is normal, in my report I use the phrase, “There were no signs of sexual penetration, but this does NOT mean that a sexual assault did not occur.” This is a triple negative, I know, but the courts understand this terminology.