One Stop Crisis Center

By : Nathan Raja

Supervisor : Dr. Anisah

History of OSCC
1986 - First OSCC established in the University Hospital (UMMC) by womens organizations 1993 - second was created in Hospital Kuala Lumpur (HKL) 1996 - Ministry of Health Malaysia directed all state hospitals to set up the OSCC for victims of domestic violence 1997 - OSCC was established in 90% of government hospitals nationwide

OSCC
survivor of domestic violence requires medical attention, protection, safe accommodation, support, counseling and legal assistance OSCC designed to make all these services available in one place for all violence survivors who seek help enable multidisciplinary management of the victims problems all in one place instead of having to send them to different units

OSCC
Is a place where victim (including rape, sexual assault, domestic violence, child abuse and sodomy) Can seek treatment Can obtain other form of necessary help Basically, it is PATIENT CENTERED MANAGEMENT place because officers from all relevant agencies will come to provide assistance once they are called

Cases in OSCC
Rape Sexual abuse Statutory rape Domestic violence (Gender-based Violence, Violence Against Women) Child abuse (mental, physical,negligence, sexual, etc) Geriatric abuse

Rape Cases

Definition of Rape
Sexual intercourse obtained through force or threat of force without the victims consent. There must be some penetration, however slight Ejaculation is not necessary (Section 375 Penal Code)
Section 376 of the Penal Code states that whoever commits rape shall be punished with imprisonment for a minimum term of 5 years and a maximum term of twenty years, and shall be liable to whipping

Limitation Of Current Definition of Rape

Excludes other violent acts such as penile penetration of the victims mouth or anus, or insertion of fingers and other objects into the survivors vagina, and Excludes the possibility of men being raped when in reality men and boys are also subjected to acts of sexual violence, degradation, and violations of their body too

Limitation Of Current Definition of Rape

Exludes the possibility that wives can be raped by their husbands, thereby treating married women as the property of their husbands and to be used by them as they please

Definition of Sexual Assault

Sexual assault : Non-consented kissing and fondling of the breast or womens private part (but without penetration) Sexual assault also includes forced anal sex, and the insertion of objects into vagina, mouth or anus

Marital Rape in Malaysia

Marital Rape is not legally recognised but the new Section 375A states any husband causing fear of death or hurt to his wife in order to have sex shall be punished for term which may extend to five years

Statutory Rape
The offence of statutory rape in Malaysia is dealt under Section 375 of the Malaysian Penal Code: Statutory rape : Any sexual intercourse with a girl under 16 years of age is considered rape irrespective of whether victims consent was obtained

Sample Collection
Sample from vulva/ vagina/ cervix/ rectum Wet smear from introitus Wet smear from fornix for spermatozoa Smear from post fornix and endofornix for micro and bacteriology Swab from vagina pool Rectal swab

Sample collection
Scraping from nail Pubic hair Scalp hair Clothing for blood/ semen Blood : ABO/Rh, VDRL,Alcohol, Drugs, Anti HIV, Hep B

Advice That Can be Given To A Rape Victim

Do not wash yourself or change your clothes, even if you really want to it will destroy important evidence of the rape, such as semen, blood, saliva, hairs, and fibers Go for a medical examination at the ETD Dept (OSCC) of a government hospital immediately

Advice That Can be Given To A Rape Victim

Make a police report as soon as possible ( if in hospital (OSCC), hospital staff will notify the police for report

Sodomy / Carnal Intercourse

Sodomy / carnal intercourse is charged under Penal Code Section 377 Section 377A defines that a carnal intercourse means Section 377B describes offences in consensual carnal intercourse Section 377C describes offenses in nonconsensual carnal intercourse (against the will)

Sodomy / Carnal Intercourse

Penal Code, Section 377A
Any person who has sexual connection with another person by the introduction of the penis into the anus or mouth of the other person is said to commit carnal intercourse against the order of nature

Sodomy / Carnal Intercourse

Penal Code, Section 377B
Whoever voluntarily commits carnal intercourse against the order of nature shall be punished with imprisonment for a term which may extend twenty years, and shall also be liable to whipping

Sodomy / Carnal Intercourse

Penal Code, Section 377C
Whoever voluntarily commits carnal intercourse against the order of nature on another person without the consent, or against the will, of the other person, or by putting the other person in fear of death or hurt to the person or any other person, shall be punished with imprisonment for a term of not less than five years and not more than twenty years, and shall also be liable to whipping

Domestic Violence

Domestic violence in Malaysia

In a national research study conducted by WAO, it was estimated that in 1989, 1.8 million or 39% of women over the age 15 were beaten by their husbands or boyfriends Only 909 women actually reported violence to the police

Common Erroneous Attitudes Towards Domestic Violence

The women is to be blamed for instigating violence in some way The role of a wife is to accommodate her husbands demands and behaviour The belief that violence domestic disputes should be worked out privately between husband and wife

Malaysian Domestic Violence Act 1994

With the passing of the Domestic Violence Act (DVA) in 1994, domestic violence was no longer a private matter but a societal concern. It is a crime under the penal code

Domestic Violence (DVA 1994)

Means the commission of any of the following acts :
Will fully or knowingly placing, or attempting to place, the victim in fear of physical injury Causing physical injury to the victim by such act which is known or ought to have been known would result in physical injury Compelling the victim by force or threat to engage in any conduct or act, sexual or otherwise, from which the victim has right to abstain

Domestic Violence (DVA 1994)

Means the commission of any of the following acts :
Confining or detaining the victim against the victims will or Causing mischief or destruction or damage to property with intent to cause or knowing that it is likely to cause distress or annoyance to the victim

Who Can Commit Domestic Violence?

Domestic violence can be committed by a person against:
His or her spouse His or her former spouse A child An incapacitated adult or Any other member of the family

Types of Violence
Physical Abuse
Holding or keeping her from leaving Slapping or biting her Kicking, choking, hitting, or punching her Threatening or hurting her with a weapon

Sexual Abuse
Forcing a woman to strip when she does not want to Forcing

Types of Violence
Sexual Abuse
Forcing a woman to strip when she does not want to Forcing a woman to have unwanted sex with others or forcing her to watch others having sex Forcing sex after a beating Forcing sex when she is sick or when it endangers her health Forcing sex for the purpose of hurting her with objects or weapons

Types of Violence
Emotional Abuse
Ignoring a womans feeling Continually criticising her, calling her names, shouting at her Humiliating her in public or privately

Isolation
Stopping a woman from going to visit her relatives and friends Confining her to the house Stopping her from socialising with others

Types of Violence
Isolation
Stopping a woman from going to visit her relatives and friends Confining her to the house Stopping her from socialising with others

Interim Protection Order

The court may, during the pendency of investigations relating to the commission of an offence involving, issue an interim protection order prohibiting the person against whom the order is made from using domestic violence against his or her spouse or former spouse or a child or an incapacitated adult or any other member of the family, as the case may be, as specified in the order (Domestic Violence Act 1994)

Protection Order (DVA 1994)

The court may, in proceedings involving a complaint of domestic violence, issue any one or more of the following protection orders:
A protection order restraining the person against whom the order is made from using domestic violence against the
Complainant Child or Incapacitated adult

Issues and Challenges

No active screening (just presented cases) Disclosure often happens when provider talking to client Women often seeking medical report but do not want to make a police report Overall proportion of women attending ETD because of DV is not known

Typical Protocol of DV in OSCC

Woman registering at the counter Triage according to the severity of injury Severe injuries treated immediately Less severe injuries seen after, if other emergency case ongoing (low priority) Disclosure about DV often happens when provider is talking to client Record of DV case made in OSCC registry

Typical Protocol of DV in OSCC

Woman examined (OSCC room or main ETD room) Internal referrals (x-ray, etc) Process may take some time before the patient is examined and referred Admission, if severe injury, or temporary shelter (safety) Internal referral to medical social welfare mainly for admitted cases

Typical Protocol of DV in OSCC

Discharged and maybe external referrals to support services (social welfare, NGOs, religious office)

Child Abuse

Child Act 2001

Also Akta Kanak-kanak 2001 Definition :
Means every human being under 18 years of age (Section 2, The Child Act 2001) Also similarly defined in The (UN) Convention on the rights of the Child 1989 (Article 1)

Minimum Age for Marriage

Legal Provision The Law Reform (Marriage and Divorce) Act for non-Muslims The Syariah Family Law Act for Muslims Description Minimum age for non-Muslims to marry is 18 years for both females and males Minimum age for Muslims is 18 for males and 16 for females

However, non-Muslim girls between the ages of 16 and 18 may marry with the permission of the chief minister or Federal Territories minister, and Muslim girls under 16 years may marry with the consent of the Syariah Court

Determining the Age of a Bruise By Its Color

Color of Bruise Age of Bruise

Red (swollen,tender)
Blue purple Green Yellow Brown No further evidence of bruising

0 2 days
2 5 days 5 7 days 7 10 days 10 14 days 2 4 weeks

Child Abuse
Non accidental injury (NAI) = multiple ages of bruises at the body and not correlate with history from parents or guardian Delayed in seeking treatment Malaysian Police statistics for year 2006 shows that 89% of the child sexual abuse perpetrators are people known to the victims In this 89% of the perpetrators, 53% of them are parents

Clues To Possible Abuse

Accidental vs. Non-Accidental Bruises

Evaluation Of The Potentially Abused Child

Suspected Child Abuse and Neglect (S.C.A.N) Team

Established since 1985 at the National Paediatric Institute of Hospital Kuala Lumpur (HKL) to provide medical care, treatment and services to children who have been physically or sexually abused The team comprise of paediatricians, gynecologists, child psychiatrists, medical officers, medical social worker and nurses in the hospital, as well as social workers from the Welfare Department, Police and NGOs

Take Home Message

Care of survivors Clinical Management of survivors (Fast Track) Counselling Emotional support Temporary Shelter Ensure existence of support for the survivors from all relevant section and agencies through good networking and collaboration with various related interagency Social welfare, Shelter, Legal Aid Assistance, Court Procedure, Police Service