Warning: This text consists of particulars about sexual abuse that some readers could discover disturbing.
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The toys on the desk are “ice-breakers” for the youngsters, the physician tells me. A beaded bracelet, a small toy cranium, chalky white dental moulds, a glass formed like a lightbulb with a inexperienced candy-striped straw.
When her son and daughter have been youthful and would eat McDonalds’ Pleased Meals, Dr Summaiya Syed would save the toys from them and produce them to work so as to add to the stash.
She would purchase dolls and hand them to a toddler sitting throughout from her within the hospital room and play a sport. The doll has been damage. “Are you able to present me the place it’s hurting?” she would ask. “Did somebody contact the doll?”
If the kid confirmed her the place it damage, the place the doll had felt an undesirable grasp, Dr Summaiya would ask, “Who did this to the doll?” There aren’t any dolls right here at the moment. The youngsters hold them once they go away the hospital.
Dr Summaiya has been a girl medico-legal officer (WMLO) for 23 years. The bespectacled 50-year-old physician seems to be like a kindly however agency instructor. She has a heat smile and she or he patiently solutions questions, however when a customer asks her to tweak the foundations just a bit for some paperwork he wants, she adamantly refuses.
On the day we meet, her hair is pulled again in a bun and she or he is sporting an informal orange and black kameez with black denims and sandals. Dupattas solely get in the best way, she says.
The door to her workplace doesn’t stay closed for lengthy, with workers popping in to run a call by her or give updates on a case. A few of them name her ‘Sir’. She solutions their queries and picks up the thread of our dialog with out pause.
If I’m ready for a lull to start asking my questions, I’ll be right here some time.
“We don’t cease for anybody,” she says.
‘The bowels of society’
In 1999, Dr Summaiya, recent out of medical faculty, was posted on the police surgeon’s workplace at Karachi’s Civil Hospital, the place it was her job to look at feminine victims of violence together with rapes, assaults and unnatural deaths, corresponding to suicides, homicides or accidents.
At the moment, she says, they didn’t even use the phrases “home violence”; it was simply referred to as “bodily assault”.
“I had no thought what I used to be in for,” she recollects.
In medical faculty, whereas her friends have been thinking about profitable specialisations, she advised a pal she want to be a coroner. And so it felt like a stroke of luck to her that she was a 27-year-old with a steady authorities job at a public hospital that paid 6,000 Pakistani rupees ($34) a month, tasked with figuring out the circumstances underneath which somebody had misplaced their life or been injured.
Not everybody thought that. It is a job the place you get your arms soiled.
“The MLO sits within the bowels of society,” Dr Summaiya explains. “I’ve seen our bodies with heroin capsules of their stomach, I’ve handled new-born youngsters thrown on garbage dumps, battered ladies, we go to graveyards for exhumations, you must cope with the police and go to courtroom to current your findings…” She trails off.
Many of the medical doctors who had been inducted together with her, particularly the ladies, requested transfers. In a metropolis of roughly 10 million folks on the time, there have been solely 4 WMLOs and, so far as she will keep in mind, 20 male MLOs.
Within the first month of her new job, Dr Summaiya handled the case of a lady who had been raped by her sports activities instructor. She was summoned to courtroom – her first time there – to current her proof.
Even in any case this time, she nonetheless remembers the decide’s title and the courtroom room quantity. “Jaffrey sahib in courtroom room primary.”
When she was grilled in cross-examination about why the lady’s hymen appeared to have escaped harm, she quoted from the MLO’s “holy e book”, Parikh’s Simplified Textbook of Medical Jurisprudence and Toxicology to clarify why she couldn’t conclusively say that it had, as she was unable to see the hymen clearly to examine for accidents. “I knew that with youngsters underneath the age of 10, the hymen can’t be simply visualised, and I knew precisely which web page it mentioned so within the textbook,” she says.
The decide turned to her and mentioned, “You’re in the proper subject.” The perpetrator was sentenced to 14 years. It was Dr Summaiya’s first conviction. She hasn’t regarded again since. “I thrive on this work,” she says.
Every case is a puzzle
An MLO is accountable for conducting an entire bodily examination of a sufferer, gathering proof for testing, offering therapy (corresponding to emergency contraception within the case of rape), referring the case to the police and testifying in courtroom if essential. An MLO can cope with victims of incidents corresponding to bombings, firearm accidents, bodily assault, murder, suicide, rape and sexual assault. The MLO writes a report based mostly on their examination and information statements from residing victims. Each are submitted to the police.
“I attempted my hand at paediatrics, however I used to be too emotional with my sufferers to be of any use to them,” says Dr Summaiya. Even now, she is enormously troubled when she has to look at the our bodies of kids or pregnant ladies who’ve suffered violence.
“I can think about the agony they have been in of their final moments,” she says. “It’s a curse. I needed to study to compartmentalise and never lose my objectivity.”
Dr Summaiya is motivated by the prospect of an investigation. “I can’t sit nonetheless till a case is solved.”
Every case, she says, is sort of a puzzle, one which requires not only a shut examine of the textbooks, however good instincts. In a single case, as an illustration, a lady was introduced in by her father as he mentioned she had been raped by their neighbour. “I felt suspicious about why the mom was not with the kid at this traumatic time,” Dr Summaiya explains. She requested for the daddy’s blood pattern.
The cells from the lady’s vaginal swabs matched with the daddy’s blood pattern. He had lied concerning the neighbour to cowl up for sexually assaulting his little one. “These puzzles don’t carry me down, they wake me up,” she says.
After I ask the place she developed a style for thriller, she laughs. “Who is aware of! Agatha Christie books? A hearty dose of Well-known 5? Possibly Nancy Drew or jasoosi (spy) novels.”
‘Not an everyday mother’
There is no such thing as a satisfaction, nevertheless, in some instances. In Could 2020, when a airplane crashed in a residential neighbourhood in Karachi, killing 97 passengers, Dr Summaiya did 34 autopsies in someday.
And on this metropolis, the place everybody has a narrative a couple of mugging gone awry or can inform you precisely the place they have been when a riot broke out, it didn’t take lengthy for a well-recognized face to reach on a gurney in her examination room. In a single case, the physique of a 16-year-old lady who had been stabbed by a house intruder was introduced in. She was a pal’s daughter. “I misplaced depend of the injuries,” Dr Summaiya recollects quietly.
Three years into her first job, Dr Summaiya’s son was born. When he was not even a 12 months previous, she would carry him in to work together with her when she was on evening responsibility. “You’re on name 12 hours a day, with no days off for Eid, no sick go away, no days off for a demise within the household,” she says.
Her son was studying to stroll, nonetheless wobbly on his legs, as she would sit at her desk and write her notes from examinations. The violence she witnessed indelibly seeped into her expertise as a mom. By the point her daughter was born in 2004, she says, “I used to be a traumatised mother, not an everyday mother.”
Whereas her youngsters, now 18 and 20, joke that they’re ‘prisoners’ due to her guidelines (curfews, no driving motorbikes, all buddies should be launched to her), she explains, “Right here’s what I knew even earlier than they have been born: at even six months, a toddler may be raped. At 10, they are often kidnapped.”
When her son went to a live performance on Valentine’s Day this 12 months, she referred to as him near his 10pm curfew. He didn’t reply the cellphone. The live performance was in a basement venue and he had no cell reception there. “For an hour, I used to be going loopy with fear,” she says. “I ended wanting calling the police in that neighbourhood’s jurisdiction to raid the venue.”
Altering the system
In November 2020, she began a brand new position, turning into the primary girl to carry the submit of Further Police Surgeon, Karachi, at Jinnah Postgraduate Medical Centre (JPMC), one of many metropolis’s busiest public hospitals. “I used to be posted right here by some individuals who thought I might carry a couple of change within the system,” she explains. “My colleagues and I wished to make this hospital the face of medico-legal requirements within the nation.”
Among the many reforms on her agenda: the necessity for higher dialogue on ‘object rape’, introducing customary working procedures for the gathering of samples for proof, and no MLO working underneath her could be allowed to make use of the ‘two-finger take a look at’ on rape victims.
Dr Summaiya describes the latter, whereby a physician inserts two fingers into the vagina to detect if the hymen is current and the way “habituated” a girl is to intercourse, as “akin to raping a survivor once more”. Many MLOs, she says, persist in utilizing the take a look at relatively than be aware bruising or accidents or talking with the survivor to find out what has occurred as they really feel it’s “faster and simpler”, and sometimes don’t hassle to take vaginal swabs or different samples as soon as they’ve carried out the take a look at.
In 2021, the Lahore Excessive Court docket banned the take a look at in Punjab province, saying it was “unlawful and towards the Structure of Pakistan”; Dr Summaiya and a senior physician, Dr Farhat Hussain Mirza, have been tasked by the well being division with supporting a petition calling for the take a look at’s abolition in Sindh province, and the courtroom dominated of their favour in September 2021.
“We now have been working at nighttime ages for therefore lengthy, and that’s the reason our judicial system is the best way that it’s,” Dr Summaiya says. She attracts a triangle for me on a chunk of paper. She writes at every level: MLO, prosecution, investigating officer. Within the centre of the triangle, “decide”.
Every level must work collectively on a case for a profitable conviction, she explains. Within the case of sexual assault, a cursory take a look at the numbers tells you that this isn’t occurring: greater than 14,000 ladies have reportedly been raped in Pakistan within the final 4 years, and fewer than three p.c of rapists in these instances have been convicted.
Proof for a watertight case
In her nook of the triangle, one of many modifications that Dr Summaiya has been engaged on since 2016 is an overhaul of the best way that proof of sexual assault is documented.
She arms me a type with a couple of sections to be crammed in. When she first began working, that is the sort of type she could be required to make use of to assemble proof. With expertise, an MLO would study that this way incorporates a fraction of the knowledge wanted for a watertight case. “A physician would fill this way based mostly on their experience,” she explains. “An excellent deal was left to likelihood as a physician with a day’s expertise will report proof very otherwise to a physician who has 20 years of expertise.”
That piece of paper is an important report. In 2002, in some of the well-known instances of rape in Pakistan, 14 males within the village of Meerwala in Muzaffargarh district, Punjab, have been accused of raping a girl named Mukhtara Mai as revenge for her 13-year-old brother’s alleged relationship with a girl from one other tribe. She was then paraded bare by the village. Solely six of the 14 males have been convicted and sentenced to demise. They appealed and 5 have been acquitted. In 2005, the Supreme Court docket upheld this judgement by the Lahore Excessive Court docket, citing a scarcity of proof.
Dr Summaiya doesn’t need something to slide by the cracks. She locations a second type on the desk. It’s way more detailed, with three sections documenting a bodily examination, the physician’s notes and opinion. “Take a look at this one,” she instructs. “Even when it was your first day on the job, the shape guides you. With this, we don’t have to depend on a physician’s expertise to examine for sure issues.”
As an example: Has the sufferer bathed, subsequently eliminating potential proof? Does the sufferer have youngsters and in that case, what was the mode of supply? “A girl who has had 4 youngsters will current otherwise in contrast with a 14-year-old,” Dr Summaiya explains. “If she has fewer accidents, that doesn’t imply she wasn’t subjected to rape.”
The brand new type asks the medical doctors to say the sufferer’s gait. If a girl has been gang-raped, her gait is affected. A physician should be aware down the dates of the incident, the sufferer’s restoration and the date and time they have been examined. With the passing of every day, an MLO’s findings will change as proof – traces of semen, blood, or marks of violence – may be misplaced.
“With all the extra info, I’m giving the police and prosecution proof to construct a case, to corroborate what the sufferer tells them,” Dr Summaiya says. The brand new type has two instances the area to notice down “marks of violence”, so a physician may be as thorough as doable.
Resistance in her stride
A kitten mewls from underneath her chair. Dr Summaiya has forgotten to feed the litter of strays exterior her workplace. “Come on, child,” she says, getting up. One other kitten darts out from a nook. “The cats we deal with do have names however it is a new bunch, so for now their names are billi (cat) #1, 2, 3, 4 and 5.”
When she returns, one among her clerks brings in a plate and she or he beams. Masala-covered French fries. He thought she may be getting hungry. She continues to clarify the small print on the brand new varieties to me whereas nibbling on the fries. However then one other member of her workers walks in and scolds her. “Your blood strain goes to be excessive in case you eat these.”
She ignores him and continues. “After I first began working, we didn’t must report the sufferer’s consent to be examined,” she says. “If you happen to forcefully examined somebody who has been raped, what’s the distinction between you and the rapist?”
The varieties have been submitted for approval to the prosecutor normal they usually have been in use at JPMC for a 12 months. Dr Summaiya describes them as an evolving doc and she or he hopes that they may finally be used throughout Sindh. She asks her MLOs – 4 ladies and three males – for suggestions and plans to tweak them additional, with the addition of sections corresponding to pictograms to totally doc marks of violence on the physique.
However the change has not come simply.
To the left of her desk is a small whiteboard mounted on the wall with the next directions: “Cease anticipating honesty from individuals who deceive themselves. Save your explanations for individuals who perceive you. Give your silence to those that are decided to misconceive you.”
Dr Summaiya has glanced at this whiteboard typically previously 12 months. She retains a yellow and inexperienced rubber snake on her desk, to remind her of her enemies, she says, solely half-joking.
There was resistance to the brand new varieties. Whereas some MLOs mentioned it was not their job to assemble further knowledge and it took an excessive amount of further time, others knew that it hampered their possibilities of fudging knowledge, misreporting it or leaving out info in change for a bribe from the perpetrators.
The shape reveals poor therapy: as an illustration, an MLO is now required to notice the time a sufferer was introduced in and the time they have been examined. “If there’s a hole of a number of hours, the MLO will get caught, you see, they usually’re not blissful about it,” Dr Summaiya says. The quantities slipped underneath the desk can considerably complement a meagre authorities wage. In a single case, Dr Summaiya says she was supplied – and refused – 2.5 million Pakistani rupees ($14,000) to report a murder as an accident.
She has realized to take the resistance in her stride. The hurdles should not new.
‘Stepchildren of the medical system’
The workplace allotted to her is positioned within the hospital’s previous surgical wing. Light indicators for the thyroid clinic and examination rooms stay on the doorways. Recordsdata are laden on stretchers and three clerks have devised a system to maintain them organised. Exterior the workplace doorways, males experience their motorbikes by the hall and paan stains partitions plastered with notices to respect the hospital area and hold it clear. The workplace we sit in has no air conditioner, no giant home windows for air flow. It could be brutal in the summertime heatwaves.
Dr Summaiya has been on this room for six months, as her final workplace, simply throughout the hall, grew to become unusable when a part of the ceiling crumbled and caved in. It’s now stuffed with sacks of previous information destroyed by water injury or termites. A few of these baggage could include stories wanted in courtroom, as instances can take six months to 4 years to go to trial. The final time Dr Summaiya was in courtroom this 12 months, it was for a case she documented in 2016.
Each day, folks arrive right here on one of many worst days of their life and they’re on the mercy of a system that appears designed to fail. There is no such thing as a finances for the varieties that doc the violence they’ve endured – each month, the MLOs contribute Rs1,000 ($5.60) every to pay for the printing of varieties, and Dr Summaiya makes up the deficit.
This 12 months, the Authorized Assist Society, a not-for-profit organisation providing help and illustration, supplied the funds. The victims will likely be examined in a room with blinds that Dr Summaiya paid for to make sure their privateness, with bilingual posters she had printed to tell them of their rights. A sufferer depends on the MLO to gather as a lot proof as doable, however what they could not know is that the MLO could also be required to purchase swabs, jars, or sterile casings for samples out of their very own pocket if provides fall quick. “If you happen to don’t tackle the fee, you’re weakening the case,” Dr Summaiya explains. “In courtroom, it’s not ok to say that you just didn’t do your job correctly since you didn’t have what you wanted.”
Ambulance drivers share clear sheets from their provides to cowl our bodies, E.R. workers present sanitiser, PPE or gloves. As soon as samples are collected, a police officer will transport them to the lab, typically travelling on a bike. In a single occasion, an officer carrying glass vials of samples in plastic baggage acquired into an accident. All proof was destroyed. “We’re the stepchildren of the medical system,” Dr Summaiya says with a smile. “Nobody is prepared to simply accept us or present for us.”
There’s little curiosity, she says, in how essential their work is. Most medical doctors dismiss the MLOs as a corrupt bunch. “Our fame precedes us, and the few who aren’t dishonest are tarred with the identical brush,” Dr Summaiya explains. “In any case, you don’t eat the complete deg (pot) to guage the biryani, do you? You base your opinion on one chew.”
After I ask her if she ever thinks of quitting, she laughs. “Each day! Each day I inform my husband, ‘That’s it, I’m achieved, I’m not entering into tomorrow.’ And he jogs my memory, ‘That’s what you mentioned yesterday.’”
She pulls the rubber snake on her desk nearer and strokes its webbed sample. “It is a struggle that continues, and if I stop, I’ve misplaced. I’m not a quitter.”
In Pakistan, the hotlines for gender-based harassment or violence are 1043 (toll-free; Punjab Fee on the Standing of Ladies; 1098 (toll-free), 0311-6641098 or e mail madadgaar@cyber.internet.pk (Madadgaar); or 0800-13518 (toll-free; Sahil).