'Limited by lack of funding': Kentville doc calls for sexual assault examiner program in western Nova Scotia

Wendy Elliott welliott@kingscountynews.ca
Published on February 23, 2016

Women in western Nova Scotia are still waiting for the expansion of the Sexual Assault Nurse Examiner program.

©Wendy Elliott

KENTVILLE - A Kentville physician is spearheading a drive to bring a Sexual Assault Nurse Examiner  program to the Valley.

Last April when the provincial budget was released, the government promised $700,000 in funding to expand the province's Sexual Assault Nurse Examiner (SANE) program to two more areas.

Earlier this month, a meeting was held at Valley Regional Hospital about the lack of a SANE program in the Valley.

Family physician Christa Mindrum said she was thrilled with the diversity and enthusiasm of those who attended. 

“There is great interest in creating community-based, survivor-centred, trauma-informed sexual assault services in our area,” she said.  

Several emergency room  and community nurses expressed interest in becoming Sexual Assault Nurse Examiners, Mindrum said, and “efforts are already being made to create new ER protocols for those presenting with sexual assault.”

A representative from the RCMP was present, she added.

“(The RCMP is) motivated to improve our response to sexual assaults. There were professionals from mental health services and other interested community organizations at the table,” Mindrum said. 

The goal is to make Valley Regional Hospital a safe place in which sexual assault victims can expect timely, comprehensive, and competent care, she explained.

"The enthusiasm of our health care professionals and community organizations gives me great hope for the future of sexual assault services in the Annapolis Valley," Mindrum said. "We are primed to create a great service, yet limited by lack of funding.” 

The meeting, said health authority spokeswoman Leslie Mulcahy, was designed to bring together healthcare providers and community partners to discuss response and support for sexual assault victims.

Team members from Valley Regional Hospital, who are connected with services throughout the Valley area, will be participating in future conversations, which have a focus on looking at how we can contribute to the coordination and enhancement of services for victims/survivors of sexual violence. Mulcahy said.

“The opportunities and benefits of the SANE program will be one of the items examined during these discussions. These are initial stages and the NSHA team is happy to be a part of these important conversations,” she said.

“We can confirm that information has been gathered to help inform the discussion about potential expansion of SANE to the eastern and western areas of the province. It has been provided to the provincial SANE working group, which is being chaired by Department of Health and Wellness and includes NSHA staff.”

But, there are no set plans in place, she said.

“At this time, we do not have any definite information regarding specific plans nor recommendations in place.”

Mindrum believes Kings County - and other under-served areas of the province - need backing now, not later.

"Someone will present to one of our emergency rooms this week having been traumatized by assault and will not receive adequate care,” she said.  

“They will receive disjointed, non-survivor-centred care by well-meaning medical staff. The forensic examination performed will be outdated, inadequate and decrease the already low probability that they would secure a conviction in court. They will not have adequate control over the release of their evidence, follow-up or support in the community. This is a crisis. Now.” 


Not the same standard of care

Last fall, Mindrum said, local female family physicians were asked by hospital authorities to create a call rota for sexual assaults because the current standard of practice is for ER staff to randomly call female family physicians - often in the middle of the night - until they find one available to come to the hospital to perform a forensic examination. 

Many physicians were willing, but felt more training in the execution of the forensic examination was needed, she said.

In response to this concern, a Sexual Assault Nurse Examiner from the Avalon Centre in Halifax provided a three-hour training session for physicians. 

While the training was meant to reduce physician anxiety and increase confidence, it resulted in increased angst and even anger. 

“We learned that the RCMP forensic kit is grossly outdated and elements of the examination are completely unnecessary and traumatizing to an already traumatized patient,” Mindrum says. 

Many physicians shared their experience of following the kit to the letter for fear of jeopardizing the evidence, yet feeling it was causing harm to the patient.

“We learned that victims in areas with SANE programs have access to faster care with less fragmentation, higher-quality forensic examination techniques and equipment, and the ability to anonymously store evidence for months to years," Mindrum said. "I, and many of my colleagues, felt that the discrepancy in standards of care for sexual assault victims from one area of the province to another was unacceptable and intolerable.”


Tories speak out


The provincial government had promised funds to the western area of the province for improvements to sexual assault services as part of the province's sexual violence strategy.  

In a recent media release, Progressive Conservative Health critic Chris d’Entremont questioned why the Liberal government is making sexual assault survivors wait for the promised service in southwest Nova Scotia. 

In the release, he said, "survivors should not be further traumatized by long waits for appropriate services or being forced to travel to centres where services are available."  

Mindrum said she applauds any public official who gives voice to the vulnerable and supports quality sexual assault services.  She is baffled why communities and allies are being placed in a position to compete for services. 

“It is my opinion that access to timely and competent sexual assault services should be a basic standard of care for all Nova Scotians. At this time, there are pockets of our province with top-notch services and others, such as the Annapolis Valley, that have services well below an acceptable standard,” she says. 

Angela Johnston, who is the sexual violence prevention 

co-ordinator with the Red Door in Kentville, said she understood new programs related to the strategy were going to be rolled out last year.

If a SANE program is added, it has to be administered properly, she says.

“It has to be done right,” Johnston says.

She adds that the Tories were right to stir up the issue again.

Pam Rubin, the author of the 2008 text Suffering in Silence, set out the provincial needs assessment for sexual assault services that support victims.

“In the absence of a comprehensive response, sexual violence will continue to generate high psychological, social and financial costs to communities and survivors,” Rubin wrote.

Statisically, fewer that 10 per cent of women who are sexually assaulted will report their injuries, Johnston said.

As part of the broader sexual violence strategy led by the Department of Community Services, a department of health spokesperson said Feb. 17,

that the government has committed $700,000 to offer new SANE services in western and eastern Nova Scotia.

Meetings with the Nova Scotia Health Authority and IWK are underway to discuss program delivery and the model that will best serve the needs of each community.

The Nova Scotia Health Authority is tasked with determining the program’s development and implementation. The authority was formed on April 1, 2015.


The recent history


Last June, Premier Stephen McNeil spoke at the Nova Scotia Community College Kingstec campus at the launch for Breaking the Silence: A Co-ordinated Response to Sexual Violence in Nova Scotia.

McNeil spoke about better co-ordinating supports for victims and stated, "sexual violence is a traumatic and pervasive problem in all of society and our province is no exception."

One of the actions the province has planned over the next two years included an expansion of SANE program to Sydney and western Nova Scotia.

Halifax has a SANE team of 15 registered nurses. It responds to all metro hospitals within one hour of a victim reporting to triage. Another SANE team is based in Antigonish, serving six hospitals in the outlying areas. Both programs are funded by the Department of Health.


Yarmouth is prepared

Tri-County Women’s Centre co-ordinator Bernadette MacDonald hopes that, given the community-based research and groundwork that began in 2009, Yarmouth will become the base for the SANE program in western Nova Scotia.

She said Feb. 18 that there is a hospital-based program in Bridgewater/ Lunenburg, which is contrary to the community-based model utilized at the Avalon Centre in Halifax and the Antigonish Women’s Resource Centre and Sexual Assault Services Association in Antigonish.

She would like to see the SANE program consistently operated across the province and believes Yarmouth nurses “could cover both sides of western Nova Scotia.”  

The Tri-County Women’s Health Coalition, in partnership with the Tri-County Women’s Centre, has been advocating for a model that conforms to the highest level of SANE training based on the International Association of Forensic Nurses Standards. 

“That way victims will feel safer to come forward. The training is excellent,” MacDonald said.

But, there's no way to move forward yet.

"We’ve had no clear commitment from the department or the minister. We would welcome some response,” she said.