Systemic silencing: No incentive to cry "rape!"

My investigative project for my masters class has been published in Manila Standard Today, VERA Files and its media partner

Inside this room are hundreds of rape kits that would likely find their way to the hospital's medical waste a few years from now.

The storage room is overflowing with these white boxes containing specimens from someone’s ordeal.

Even the decrepit storage room is not enough. "Live" rape kits are stored inside the office of the women's desk, where people come and go.

A small, dark, musty room with broken windows at the bottom of one of the ground-floor stairs of the Philippine General Hospital is a treasure trove of stories. Locked up here are hundreds of white boxes – rape kits full of specimen from victims – stretching from floor to ceiling, wall to wall.

But the boxes lie idle, subjected to heat and exposed to bugs and rats, their contents ignored and later disposed of without accomplishing their purpose.

Ward assistant Rizza Pamintuan who is detailed at the PGH’s Women’s Desk says that in her ten years at the PGH, she has never seen a rape kit being used to convict anybody. “In only two instances did the NBI and the PNP get the boxes. We have no way of tracking what has happened to them.”

The PGH situation speaks volumes about how difficult it is to be a victim of rape in this country. A lack of coordination among medical and law enforcement personnel and ignorance and laziness of policemen and prosecutors results in crucial rape evidence rotting away in store rooms like the one in PGH. Meanwhile, rapists get away scot-free, their victims – especially those who muster the courage to come forward despite the stigma and cultural factors – denied justice.

Pamintuan receives victims of rape and other forms of violence, hears their stories and accompanies them as they weave their way through the various departments of the hospital. Sometimes the victims are referred to the PGH by the police or barangay (village) officials. Some are brought by NGO workers. Some are called “walk-in”, i.e., they come out of their own accord, straight from their harrowing experience.

Once at the women’s desk, the women are interviewed by social workers and referred to the OB department for an intensive physical examination. The rape kit is particularly useful if the rape occurred less than 72 hours prior to the hospital visit. If the victims are sent to the hospital by the police, PGH issues a standard doctor’s report – not the analysis of the rape kit’s contents -- that would be brought back to the PNP station.

The contents of the kit sound comprehensive. There are oral, vaginal and anal swabs and smears. The victim’s clothes and debris from her body and surroundings. Saliva, head hair and pubic hair samples. Fingernail scrapings. These samples sound as though they could help in pinning down the assailant. If the victim is too distraught, confused, weak, or scared to stand up in court and point to her accuser, DNA that is found in the hair, nails, and body fluids will provide conclusive proof of who did the crime, and justice will be served. But no one ever uses the evidence. It can only be used if there is DNA sample from suspects to compare the collected specimen with. Alas, investigations hardly ever reach this stage.

The PGH women’s desk supposedly serves as its women and children protection unit (WCPU), a feature that should be present in all government hospitals. The establishment of these units were mandated by the Rape Victims Assistance and Protection Law that was passed in 1998, just a year after the Anti-Rape Law amended pertinent provisions in the Revised Penal Code.

Under these laws, rape has become a crime against persons, and not only a crime against chastity. The Anti-Rape Law also expanded the definition of rape to include several other acts that may not necessarily be considered sexual intercourse but are nonetheless performed against the will of the victim.

The Department of Health also issued Administrative Order 1B outlining the requirements for setting up WCPUs in all government hospitals.

PGH is lucky. Other hospitals don’t even have fully-functioning WCPUs, much less use a rape kit or perform a thorough physical examination on victims of rape and violence. This even as a Department of Health document on the WCPC claimed that “there are 38 working WCPUs in 25 provinces of the country as of 2011.

The laws also do not specify the use of rape kits. The Women’s Desk of the PGH uses them out of its own initiative.

At the Rizal Medical Center in Pasig, a DOH-administered hospital, the women and children protection unit is built into the Medical Social Services Unit. The office is busy the whole day with charity cases: If a rape victim strolls in and seeks help, she would have to tell her story to the social worker within earshot of everybody in the room.

“It was not always this way,” says social worker Luningning Banocia, unit supervisor. “Years ago, we were sponsored by the Rotary Club of Pasig.” In those better times, the WCPU had a room of its own in the hospital premises, painted in pastel colors. But the funding ran out and the hospital underwent a renovation. It has been two years and nothing has been the same.

In fact, senior OB resident Ria Rachelle Almoneda admits they only see rape victims for medical purposes. Last year, for instance, a 16-year-old lesbian was raped and had gotten pregnant as a result of the incident. She tried to abort the baby. When complications arose, it was only then that she was treated at the hospital. Almoneda has no idea what has happened to the victim.

Storage is not a problem here. This is because no rape kits are even used – patients are “referred” to the PNP hospital in Camp Crame if they want themselves examined for purposes other than medical treatment.

“Referral” is a big word even among the staff of the Women and Children Protection Center of the Philippine National Police. Civilian social workers Nora Gibote and Rowena Mateo Gatus say that they normally advise victims to go to the police stations in their respective districts. The police stations then tell the victims to have themselves examined in government hospitals nearest them.

Private hospitals will have none of the trouble of having their doctors go to various courts to testify on their findings.

At the PNP Crime Laboratory’s medico legal division, physical and genital examinations are performed on rape victims. Gibote and Gatus however say that these procedures are merely to test for trauma depending on the lacerations on the victims’ vagina. Taking DNA samples for the victim would entail “a different request” altogether.

But the chief of the operations management division of the Crime Lab, Police Senior Superintendent Elimer Catabay, says their team gathers everything from latent prints, fingernail scrapings, hair samples and sperm specimens from victims. Catabay however provides no specifics as to how the gathering of samples is conducted.

When asked whether the evidence is stored properly, he pointed to an ongoing construction site at the PNP compund – the DNA building that will be operational in June this year.

In the meantime, where and how are the evidence stored? This is why we are building a new structure that will have proper storage,” he said.

Banocia says only four rape victims were assisted in 2011.

At the National Center for Mental Health in Mandaluyong City, the pastel colored walls, the spacious room and the inviting chairs are there. But this WCPU specializes in psychological trauma to victims of violence such that physical examination is also referred to the Camp Crame facilities.

“Of course, our aim is to have our own people here in the WCPU who will do everything so that the patients do not have to go from one place to the next,” says Dr. Beverly Azucena, WCPU head of the hospital. “That will happen soon.”

If the Department of Health were to be asked, it would confine itself to what the ideal situation is. Dr. Honorata Catibog, head of the family health services unit of the DOH, says her office is concerned about policy – what the units should do, how they could upgrade their standards. Catibog’s team has in fact collaborated with the Philippine Commission on Women (formerly the National Commission for the Role of Filipino Women) in drafting a performance assessment tool for all WCPUs in government hospitals all over the country. The tool acts as benchmark: it is supposed to guide the operations of WCPUs for it to meet objectives as envisioned by the law.

The DOH’s administrative order outlined the requirements for setting up WCPUs.

The Philippine National Police guidelines are also clear in the step-by-step process in assisting victims of sexual assault. The process flowchart is specific to the steps taken for various types of histopathological examination, the office and person responsible and the expected processing time for each step: Submission of letter-request, processing of payments, relaying to the victim of the procedure, actual examination, evaluation of results and release of results.

These steps however do not include the extraction of DNA specimen from the victim, any form of psychological counseling or legal advice.

In October 2007, the Supreme Court laid down the Rules for the use of DNA evidence in court cases. The issuance was a landmark move, signifying the court’s recognition of the probative value of DNA evidence in criminal proceedings. If the samples are collected and stored properly, they could hold the key to identifying the perpetrator without exclusively relying on testimonial evidence. Then again, for these samples to be of use, they need to compare the profile with that of possible suspects – if they could be found, much less made to submit their own DNA profile..

According to Dr. Maria Corazon de Ungria, head of the DNA Analysis Laboratory at the UP-National Science Research Institute, there are at least four entities that can now perform DNA analysis in the Philippines: UP, the National Bureau of Investigation, the Philippine National Police, and the St. Luke’s Medical Center.

Despite the technology, DNA analysis cannot be performed if samples from the crime scene are not available.

Norma Escobido, family health officer of the Department of Health, has been with the agency for 35 years but has only been working with the WCPUs for two years. This has been her toughest assignment. She goes around the country, visiting WCPUs in DOH-administered hospitals.

She talks to rape victims and tells them about their option to pursue their attackers in court. “Only roughly 10 percent of them file cases.” These few women find that government agencies are unable to use the evidence they have collected.

Instead of encouraging victims of violence to submit themselves to the criminal justice system, state agencies do the opposite – they frustrate the victims and confirm that it is so much easier to leave the matter to fate and divine retribution.

Atty. Ricardo Sunga III, coordinator for the National Capital Region of the Free Legal Assistance Group (FLAG) and a law reform specialist at the UP Law Center, says there are two road blocks to the use of DNA evidence to prosecute guilty parties, and even to defend those accused who insist they are innocent.

First, not all trial courts are open to the use of such evidence. Older judges are specifically hesitant to use physical evidence that can be processed by high-tech equipment.

Second, not all lawyers are willing, or even aware, that physical evidence can be used to bolster their cases. This is true especially for those in the provinces whose only recourse is the testimony of the victims.

Dr. Raquel Fortun, forensic pathologist from the UP College of Medicine, has an even stronger opinion. “We need an overhaul of the entire criminal investigation system.” “Shallow” is the word she uses to describe police efforts to deal with crime scenes, much less DNA evidence. “We cannot even solve cases that are piling up every day. How can we even begin to look into cold cases?”

Fortun has been lending her expertise to the government, working with the police and the NBI, from as far back as the Ozone Disco fire in 1996, and from as recently as the Sendong flooding which hit Northern Mindanao in December 2011. “You would think much has changed. But nothing has. They still only go for the obvious.”

Pamintuan keeps telling the rape victims to tell their prosecutors that the kits are available and can be used for the case. Why the prosecutors do not have that initiative in the first place is mind-boggling.

A culture of deference

The WCPUs, especially in the provinces, exposes the employees to the hazards of going against powerful politicians, soldiers or policemen, or tribe elders who want to protect their erring members. They would go to great lengths to stop the victims from haling them to court.

More than dangerous, the job is frustrating. “Many times, the victims of violence decide not to file cases even though we have advised them that this is what they should do. Some of them appear ready to file cases. Then, almost always, they change their minds,” Escobido says.

She adds that this is because the aggressors are the husbands, fathers, uncles and grandfathers who beg the victims to just forgive them. “We Filipinos place so much value on keeping the family honor and avoiding shame. We also feel powerless when faced against influential people. Rape is deeply personal and shameful. It is in our culture to keep the shame within the family.”

In the absence of anything solid on which to pin their case against their attackers, the victims almost always choose to forgive, and “move on.”

Banocia, who has been a social worker with the Rizal Medical Center since 1982, says that the law is good but the implementation is poor. For instance, they face a dilemma when they send the victims back home when the aggressor is a family member, living in the same home. “We do not have a shelter here for women who do not want to return to their houses.”

Sometimes, the attackers themselves bring the victims to the hospital and lurk around the corridors as if to make sure their victims will not bring them to the police.

Crucial to the decision are the mothers in the family, Banocia adds. Unfortunately, they are “much too in love with the fathers, or they worry about who will bring home the money. They do not want to be talked about by the neighbors. So they would rather stay silent and keep it to themselves.”

This is why the cases of abuse, despite the laws that seek to prevent them from happening, is still underreported, Escobido says.

Indeed, Fortun says many Filipinos are fond of saying “ipagpasa-Diyos na lang natin ang lahat.” This results in no cases being pursued when the aggrieved party decides not to fight, when in fact it should be the state that files a case against the perpetrator – regardless of how forgiving the victim is.

Funding problems

Economics seems to be another root of the problem. WCPUs, according to Escobido, fall within the gender development budget of the Department of Health. But they compete with other units of the hospital for these funds, such that most of the WCPUs cannot even afford a regular complement of social workers, obstetricians, psychiatrists and administrative staff. The more active WCPUs – in East Avenue Medical Center, in Baguio Medical Center and the Vicente Sotto Medical Center in Cebu are all backed by international NGOs.

The WCPU of the Rizal Medical Center had to be augmented by a local rotary club to be functional. When the assistance stopped, the unit’s operations had to be merged with the social services unit of the entire hospital. Banocia has sought meetings with the hospital administrators, asking them to assign at least a small room to the WCPU. She has not been successful.

The women’s desk at the PGH is not wholly funded by the UP-PGH system, either. The hospital has provided the room and pays Pamintuan's Salary Grade 7 wages. Everything else comes from donations – international NGOs and advocate-senators who prop the office up through office supplies and other operational needs. Then again, these forms of assistance are not regular, their sustainability uncertain.

At least the PGH makes use of rape kits, the improvised version of which costs P150 per box. The original idea was to collect 15 different samples and store them in Zip-lock containers. But these containers are expensive. PGH decided to do away with blood samples and use bond papers and glass slides that would be contained in small manila envelopes instead. The white boxes contain 12 of these envelopes.

But testing these specimens for prosecutorial purposes is another issue altogether. In UP, it costs P8,00 for a DNA analysis of a single sample. If the kit contains 12 samples, this translates to P96,000 per patient. In the event that the victim decides to use her kit to go after her rapist, all the way to court, she may just have to find a way to shoulder the costs.

Filling the gaps

Pamintuan believes that the use of the rape kits, as well as handling and storage, should be included in the amendments to the rape law. Who should have custody of them? What are the conditions under which they must be stored? Who decides whether they should be used in court?

But the women’s desk has bigger, more immediate problems. The room where the hundreds of rape kits are stored is not even assigned to it. It is assigned to the surgery department, which has repeatedly hinted at wanting to use the room for itself.

There are just too many boxes. Even though the prescription period for rape is 10 years, Pamintuan has had to throw boxes away as medical waste once they hit the five-year mark. Even then, the space is not enough. She has recently resorted to putting some of the boxes at the top of her office shelves.

When the next victim walks into the door, Pamintuan, as she has been doing for the past ten years, will assist her as best as she could. The ward assistant will continue to accompany her to the OB department to have her samples collected.

But the process will continue to be frustrating until these government agencies make it easier for victims submit themselves to the criminal justice system instead of just walking away in exasperation – a violation, all over again.