| Self medication can be harmful, consult a doctor when your child is sick
We perceive India as a safe, tradition bound country that honours women and loves children. Yet, our cities are becoming famous, even internationally, for molestation and rape. The number of cases reported has increased 700 per cent since Independence. And this is probably only the tip of the iceberg.
Shame, family pressures, social stigma, economic vulnerability and lack of knowledge of legal procedures coerce a victim into silence. To make things worse, the victim is often regarded by our inadequately educated, underpaid and insensitive police personnel as the one at fault.
Rape is traditionally considered a crime against women. But times are changing. Horror stories abound about homosexual sexual predators targeting, kidnapping and victimising young boys. The victims range from six-month-olds to 80-year-olds. The perpetuators of rape, however, are almost always male.
Around 80 per cent of the crime is committed by someone known to the victim. Often, the abuser is a member of the victims family or belongs to his or her circle of acquaintances. In such cases, the crime is perpetuated in a known place, in either of their homes or that of a friend, relative or neighbour.
Today, children of both sexes are in danger, in exclusive neighbourhoods as well as the slums. Their lack of knowledge, inexperience and trusting nature make them ideal victims. Many of these attacks are not random but well planned by a predator known to the victim.
Police complaints are often followed by unwelcome media publicity. There are no special victim units in the police force yet, that may be trained to handle such cases with discretion and empathy. The guidelines provided deal mostly with the rape of women. The concept of male or child rape is new and the level of expertise in dealing with this is low.
Despite this, if a parent or the victim wishes to prosecute the assailant, a physical medical examination, documentation of the evidence and registration of an FIR (First Information Report) must be done.
Even otherwise, a thorough medical examination must be undertaken as soon as possible to treat and record lacerations and injuries, both external and internal.
The greatest fear about sexual assault is that of acquiring STDs. The number infected varies between 5 and 10 per cent. Infection depends upon several factors, such as the type of sexual contact, number of assailants, and whether or not they had an STD at the time of the assault.
The risk of contracting STDs can be reduced by taking medication as a preventive measure. Immediate and effective treatment options are available for some STDs such as hepatitis B, gonorrhea, syphilis, herpes, chlamydia and trichomonas vaginalis.
The regimen recommended is a single injection of ceftriaxone, plus an oral dose of azithromycin, plus either secnidazole, tinidazole or metronidazole. Herpes can be tackled with a five or seven-day course of acyclovir.
The risk of acquiring HIV infection is less than 1 per cent. However, it is important for medico-legal reasons to document the HIV status immediately. The test should be repeated after six months and then a year. A 28-day regimen of zidovudine and lamivudine provides post-exposure prophylaxis for HIV and should be started as soon as possible, preferably within 72 hours.
Injuries and lacerations require a single booster dose of tetanus toxoid. Hepatitis B can be sexually transmitted. Most children today have received three doses of the vaccine as part of their immunisation schedule and are thus protected against the infection. In that case, only a booster dose needs to be given. If the victim has not been immunised in childhood, immunoglobulin needs to be given. In addition, three doses of the vaccine must be given — immediately after the incident, after a month and after six months.
Prophylactic treatment against syphilis is not advised. Instead, a blood test can be done after three months to ascertain if infection has occurred.
Counselling, psychiatric evaluation and support are necessary for the victim as well as his or her family to overcome the trauma.
To protect children —
• Make them learn addresses and phone numbers by heart
• Teach them certain body parts are not to be touched
• Discourage them from talking to strangers
• Do not send them anywhere alone, especially after dark
• Escort them to and from school bus stops
• Encourage physical fitness and teach them martial arts
• Teach them to trust their survival instincts and, if needed, run in the opposite direction as fast as they can, shouting all the way.
For adults, the best bet is —
To have peepholes in the front door
Avoid dark and deserted areas
Be physically fit and able to run fast.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org