In the early days, because nobody had ever directly responded to rape survivors, the understanding was that if a hospital receives a rape survivor, a CEHAT (Mumbai) team member will go to that hospital. It could be any day of the week, any time of the day. That is what we did for the first 20-odd rape survivors, so as to really get a pulse and a sense of how the health system responds to it and in what circumstances is a survivor brought to the hospital. So I would say that these elements were crucial for us to design the helpline intervention at that point in time.
Once some of us had worked in this area, we were quite seasoned with dealing with several issues, including legal and medical. For example, a police personnel has brought in a 13-year-old, who was found on the road, to the hospital, and the doctor on night duty calls us and asks, “Do I do a rape examination?” He has no clue what to do. So the adviser gets the doctor to communicate with the child and ask further questions: Is the child a pavement dweller? Why is he or she alone? Is the child lost? Based on the conversation, the doctor has to gauge whether there is a possibility of rape and therefore a need for an examination. Now, it may seem like common sense, but that is not how the health systems work. There is a very mechanical manner in which they operate. Because we are trained and have the knowledge and experience, we are able to tell them what to do. And most important, the ones answering the calls must be very well-read. One must know the circumstances in which people are brought in, know the laws and the procedures thoroughly, and also know what is the role of a health care provider vis-a-vis the criminal law.
But one thing was sure that vis-a-vis doctors, we would never give solutions or recommendations because doctors are ultimately accountable to the court. So the doctor has to be convinced of whatever he or she is going to do as his or her next step. So the content of the communication from the helpline would be to enable them to take some kind of a decision.
It was during Covid-19 that we realised that women facing violence were not able to visit DILASA centres inside hospitals because it was also a site of infection. And that is when we had to immediately change our methodology. So I would say it was really 2020 that kind of pushed us to conduct a training of DILASA counsellors as well as the CEHAT team. Because earlier they were used to doing in-person counselling for one hour, and following up on the phone to see what was happening. But as a first contact to provide telephonic counselling is quite different. I would say that is when we said that we cannot shy away from having a helpline for survivors, though initially it was mostly for health care providers.
And that meant that we had to be completely equipped. The team had to take turns. The kind of questions asked to us initially were very challenging. Young girls said that they were suicidal, that they were unable to get out of their homes. And when you are actually in the midst of intervention, they will just cut the phone call. But then there is no way to get them back on the call. And that does leave counsellors a bit high and dry. So that is a very uneasy feeling. And then we had to look up a lot of other evidence to understand the scope of a helpline. A helpline is a temporary relief. It is not a permanent solution.
And one expects that people will call you in crisis and kind of follow up with an in-person meeting at some point. But then you come to know that these young callers are calling specifically because it is a helpline, so there is no disclosure of age. Issues like POCSO loom large―what are you going to do as far as mandatory reporting is concerned? If a 17-year-old says, ‘I have had consensual sex and I am pregnant, what do I do?’ She cannot disclose it to her parents. So our entire intervention is around the fact that unfortunately a medical termination of pregnancy cannot be accessed by you on your own in this country. So you will have to confide in at least one adult that you trust, otherwise there is no way you will even get pills. Those are very, very difficult cases. And on a helpline typically you do not start following up. That is not the procedure. So you end your call by saying, ‘would you like me to call you back?’ And some of them will say they don't want to be identified. It comes with its own set of limitations.
As told to Pooja Biraia
Rege is former director of CEHAT, which runs a 24x7 helpline for women and girls facing violence.