HCP also have a duty to not just perform clerical duties of unthinkingly documenting and treating isolated symptoms.
For instance, if a patient with diabetes is found to have signs of kidney disease or uncontrollable sugar, it is also important to assess if medicines are available regularly and also being given at the right time rather than just increase the dosage.
Also if a patient has body lice and poor personal hygiene, part of the management should include recommendations to improve the overall sanitation of the prison. if a person(s) comes with multiple painful caries, then the recommendation should also include regular dental visits/checks as well as advice on offering better nutrition/oral hygiene facilities.
The doctor should take informed consent before performing any personal examination or doing a procedure. If the person is of the opposite gender as the doctor, having a chaperone of the same gender as the person is good practice. If the person identifies as LGBTQI, then the doctor should give them a choice of doctor’s gender. If no other doctor is available, then a chaperone of the gender of persons choice should be present.
Doctor should keep informed on what procedures, tests, investigations are out-dated or out-lawed. Examining a person to document if they are sexually active or not is not warranted. There is a thin line between being clinical, and being voyeristic/prejudiced/judgemental/moralistic. If a person has been raped and the doctor’s notes say ‘this person is habituated to sex’ it implies that a person who has had consensual intercourse cannot be sexually abused. These are pitfalls in clinical work that doctors should be wary of.
Make sure the person is comfortable physically and psychologically as much as possible. If a person whose genital or perineal area has been injured is not able to sit during consultation, offer a painkiller and ask him or her to lie down if that is more comfortable. Similarly if a person is fearful or angry, the HCP needs to understand that this is not a reaction to him or her, but is an expected outcome of torture. Sometimes if a person is in acute health related distress, it is ok to take a quick history, treat and then take a more detailed history a little later and once the acute situation has been managed. HCP should also remember that some kinds of torture leaves little physical traces so symptomatic management is also equally important.
Sometimes it is good to give the victim/survivor an idea of possible sequelae, long term effects, progression of the torture signs and symptoms. THis also includes advising them about the best treatment option or preventing the symptoms from worsening. This includes precautions the person must take. For eg. regarding driving or riding a vehicle, alcohol consumption, gait, sleep, scar formation etc.
If there is some form of torture that the HCP is unable to recognise and manage, effort should be made to consult with someone who may have more experience or expertise either nationally or internationally.
If the person is unable to communicate in the language of the doctor, there should be facility for a trained interpreter who is mandated to confidentiality.
The HCP should not use this situation to judge a person or lecture them about what they are doing wrong or worse, how they are responsible for their own torture because of their behaviour/attitude/negligence/dishonesty etc. Nothing justifies torture and the HCP should not go along that path all even inadvertently.
The HCP should look at non verbal cues from person and corroborate with clinical findings. A person who is jittery, easily scared, overwhelmed by authority, submissive sends the message to the HCP that all is not well in custody.
The HCP should not make sweeping promises that cannot be fulfilled. Building a trusting relationship and rapport with the affected person can happen only the HCP is reliable, makes efforts to keep assurances and is honest and open. Building false rapport as a way to exploit, get a person to withdraw a statement against police brutality, to extract information that can be used against the person goes against medical ethics.
If HCP is experiencing issues with his or her own mental health, there should be mechanisms to identify these and systems in place to address them. Poor mental health of the HCP can lead to inability to address the victim’s issues, react in inappropriate ways or violate medical ethics.
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