Module 3 Answers

The primary purpose of a medical evaluation of torture and ill treatment is to assess the degree to which physical and psychological findings correlate with the individual allegations of abuse and to communicate effectively the clinician’s medical findings and interpretations to the judiciary or other appropriate authorities.

Clinicians must have the capacity to create a climate of trust in which disclosure of crucial, though perhaps very painful or shameful, facts can occur. All of the considerations listed will aid clinicians in earning the trust of survivors of torture.

Medical evaluations, whether for physical or psychological evidence, usually require considerable time, about 2 to 4 hours. If more time is required, it is advisable to schedule a second interview. Interviews lasting 6 hours or more may be particularly difficult for the individual being interviewed.

Forensic medical services should be under judicial or an independent authority and not under the same governmental authority as the police or prison system.

Physical and psychological examinations by their very nature may re-traumatise an individual by provoking and/or exacerbating psychological distress and symptoms by eliciting painful memories. The interview must be structured to minimise the risk of re-traumatisation by balancing the need to obtain detailed accurate account of events and the importance of respecting the needs of the person being interviewed.

The preferred gender of the examining clinician should not be presumed. Ideally, an investigation team should contain specialists of both genders, permitting the alleged torture victim to choose the gender of the investigator and, where necessary, the interpreter.

All of the statements about the use of interpreters are accurate with the exception of C. The age of the interpreter may be relevant. A young male individual may be able to discuss sexual torture with an older woman to whom he may relate as to an aunt, but not to a woman of his own age. Similarly, a young female individual may find an older man easier to talk to than one who is of a similar age to her torturer.

Transference refers to the feelings a survivor has towards the clinician that relate to past experiences but which are misunderstood as directed towards the clinician personally. Fear and mistrust may be particularly strong in cases where physicians or other health workers were participants in the torture.

All of the emotional reactions listed are common counter-transference reactions that an interviewer is likely experience while listening to the interview with Sr. Diana Ortiz.

The interviewer did not attempt to relocate the interview to a more comfortable and private location; Sr. Diana suggested that they move out of the cold weather into a nearby hotel. While the interviewer was empathetic to some extent, he maintained a somewhat detached demeanor and did not acknowledge the difficulty of recounting highly traumatic experiences.

Before beginning any medical evaluation, forensic clinicians must explain their role to the individual and make clear any limits on medical confidentiality.

All of the strategies listed may help to manage and limit secondary trauma with the exception of B. Discussing your emotional reactions with the survivor/alleged victim would be inappropriate and likely harmful to the individual.

Inquiries should be structured to elicit an open-ended, chronological account of events experienced during detention with minimal interruptions. Closed questions are often used to add clarity to a narrative account or to carefully redirect the interview if the individual wanders off the subject. Leading questions are avoided wherever possible, because individuals may answer with what they think the health professional wants to hear.

All of the techniques listed may help to improve the accuracy of information obtained in a medical evaluation.

Inconsistencies may result from a number of factors that may be directly related to the torture and ill treatment or to the psychological and/or neurological symptoms that result from torture and ill treatment. Interview conditions and cross cultural factors may be significant as well. Clinicians should be familiar with such factors to effectively explain any inconsistencies observed.

All of the steps listed may help clinicians to assess inconsistencies that may be identified in the course of a medical evaluation of torture and ill treatment.

Inquiries into prior political activities and beliefs and opinions are relevant insofar as they help to explain why the person was detained and/or tortured, but such inquiries are best made indirectly by asking the person what accusations were made, or why they think they were detained and tortured. The psychosocial history is particularly important in understanding the meaning that individuals assign to traumatic experiences.

Correlations between specific allegations of abuse and subsequent physical evidence require clinicians to obtain detailed information for each form of abuse alleged as stated in the question.

A medico-legal report should not be falsified under any circumstance. The ethical obligation of beneficence demands uncompromising accuracy and impartiality in order to establish and maintain professional credibility which, in turn, benefits survivors of torture. A medico-legal report should not be falsified under any circumstance.

Wherever possible, examinations to document torture for medico-legal purposes should be combined with an assessment for other needs, whether referral to specialist physicians, psychologists, physiotherapists or those who can offer social advice and support. Investigators should be aware of local rehabilitation and support services. Those who appear to be in need of further medical or psychological care should be referred to the appropriate services.