The response I receive after being asked what I do is usually a grimace and “That must be hard.”
A little over a year ago, I was hired as a sexual assault nurse examiner (SANE) in Boston — a few months before the Harvey Weinstein story broke, around the time Bill O’Reilly was fired and just months after the inauguration of President Donald Trump and the Women’s March. In the subsequent months, the Me Too movement started to gain traction; survivors came forward and spurred waves of headlines in the media reporting pervasive sexual assault across all industries.
While focus on sexual assault this past year has increased, dialogue about what happens in the aftermath of an assault has not. SANEs (sometimes referred to as sexual assault forensic examiners) are post-sexual-assault care experts. We assess patients for injuries, offer medications to reduce the risk of sexually transmitted infections and collect forensic evidence that may match an assailant to the crime. We also screen for sex trafficking and safety, all while ensuring the survivor is empowered and cared for throughout the exam.
One value of SANE lies in the fact that we are independently contracted through the state. Since we are not employees of the hospital, we have only one patient at a time, and thus our full attention is given to that survivor. In Massachusetts, where SANE coverage is provided 24/7/365, we must have at least three years of nursing experience before undergoing rigorous training; this prepares us to provide trauma-informed, holistic nursing care.
While focus on sexual assault this past year has increased, dialogue about what happens in the aftermath of an assault has not.
Sexual assault forensic programs are not nationally standardized, though; they are state regulated, and it is up to individual states to fund them. We are fortunate in Massachusetts to have a comprehensive and committed program, but that is not the case everywhere. Not every hospital is SANE-affiliated, although survivors will be provided care wherever they go, and kits should be available.
There are up to 17 components to the evidence collection kit, from hair combings to photography, though survivors may determine what parts of the kit they want completed. Several of these must be completed within a small window after the assault. Showering, changing clothing or brushing teeth may affect evidence collection, and I have had survivors comment that they wish they hadn’t taken a shower if they had known it might affect evidence collection or that they would have gone to a hospital sooner if they had known the forensic exam was time sensitive. After the evidence is collected, the kit is stored for up to 15 years in Massachusetts, but the time varies across the country. If the assault is reported to police, the kit will be opened and processed in a crime lab. After the exam, SANEs do not have contact with a survivor but may be called, even years later, to testify in court to the care they provided.
I entered this field because I saw the lasting trauma of sexual assault while working with adolescent girls in a residential facility. Their harrowing stories fueled my curiosity about post-assault care and evidence collection in the U.S.
These first 12 months in the job have shown me that we still have a long way to go in addressing this crisis. I learned that a lack of funding means that SANEs are not available in every state, let alone in every hospital. Because of this, survivors often feel ignored, and evidence collection is incomplete. Even when evidence collection is done properly, there is a glaring national rape kit backlog crisis. Because of a lack of funding, resources and adequate policies, hundreds of thousands of kits nationally have sat for years without being examined. This not only causes distrust in the system but also provides yet another reason for survivors to not come forward.
Shortly after the Oscars aired in March, one survivor told me that the Times Up buttons she saw worn by some of her favorite celebrities had given her the courage to seek care. Others have mentioned how their strength to participate in the forensic exam came from knowing their actions may help others who are assaulted. Not only are the hashtags resonating with survivors; they’re also creating a tribe. Add the recent arrest of and rape charges against Harvey Weinstein and the guilty verdict in the Bill Cosby retrial and it is clear that, despite the existing challenges, my first year as a SANE has come amid a powerful paradigm shift.
In the past few months, “Silence breakers” were named Time’s people of the year, The New Yorker and The New York Times were awarded Pulitzer Prizes for their reports of entertainment moguls’ sexual harassment and assault allegations, and HBO released a documentary titled “I Am Evidence” concerning the rape kit backlog.
As this national movement continues, prompting more survivors to go for care and report these crimes, we must solve the national rape kit backlog crisis. Federal funding for SANE needs to be prioritized, as well as increasing access to SANE in rural communities. Standardizing post-assault care nationally would improve rates of evidence collection and might encourage survivors to come forward. Committing to creating space for post-assault care dialogue by making the process more widely understood by survivors and the public alike would reduce anxiety and further trauma.
The hard part of my job, despite what one might think, is not working in post-assault care. It’s knowing that there need to be systemic-level changes to improve the process but not having adequate funding to do so. My hope is that someday when I tell people what I do, the response is not a grimace, as this is the most inspirational work I have ever been part of. Giving the space for survivors to reclaim control and collecting evidence that may help convict the assailant, all while often being the first to acknowledge that the assault was not their fault — that is a privilege.
Kate McNair is a sexual assault nurse examiner and women’s health nurse practitioner in the Boston area and a doctoral fellow at Boston College.