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SANE: Four letters, one awe-inspiring calling

Rrecruits at a YWCA SANE training in July. Left to right: Molly Palmer, RN, SANE trainer (in red), Kari Wheeling, APRN, Sunny Chen, RN

YWCA’s Sexual Assault Support Services program is our island’s main source of crisis intervention, care, advocacy and healing for victims and survivors of sexual assault. It is Hawaii County’s only dedicated 24-7 crisis line and safety net for all victims of sexual assault regardless of age or gender. SASS even extends it services to others affected, such as victims’ parents or significant others.

One of the most crucial elements of Sexual Assault Support Services is our SANE program. SANE stands for Sexual Assault Nurse Examiner. YWCA recruits, trains and manages the island’s only team of SANE nurses doing this critical work.

These highly specialized registered nurses have dedicated 80 hours of their own time to participate in classes, clinical trainings and meetings, enabling them to conduct sexual assault medical forensic examinations on both adults and children. The job is not full-time but it is intense, and can take 2-6 hours per incident.

In July we sat in on a SANE training at YWCA headquarters, where a seasoned SANE nurse trainer walked three new recruits through the elements of a comprehensive medical forensic exam:

  • Obtaining the medical forensic history
  • Conducting the physical assessment
  • Providing support and crisis intervention
  • Assessing pregnancy risk
  • Documenting of examination findings
  • Collecting, preserving and ensuring safe delivery of evidence to police
  • Interpreting examination findings
  • Offering treatment options
  • Providing follow-up referrals for medical and emotional needs
  • Presenting expert witness testimony in the courtroom if case goes to trial

The trainer explained the Secure Digital Forensic Imaging (SDFI) system, an $18,000 piece of camera equipment that encrypts images into unalterable files and can even detect bruising beneath the skin, not visible to the naked eye. This is particularly important in identifying evidence of strangulation, which elevates the assault to a life-and-death situation and affects prosecution.

In plain terms, the trainer covered aspects of a pediatric SANE exam. Parents generally are not in the room at the time of the exam (though a SASS advocate is always present). SANE nurses help the child victim stay calm and regain a sense of control by, for instance, letting them initiate their own photos by pushing the button on the camera’s remote shutter. Internal genitalia is not examined or photographed in pre-menstrual girls.

On the west side of the island, exams are conducted in a dedicated room at the Kona Community Hospital. On the east side, Hilo Medical Center lacks space for a dedicated room, so a mobile SANE cart is wheeled to whatever space is available at the time of the exam. Documentation is meticulous, including full body photos as well as images of external and internal genitalia. Suspects are also examined, either at the holding cell in Kona or at the detention center in Hilo.

SANE nurses must stay impartial, so they cannot tell victims or family what they find. They must ensure an unbroken chain of custody for all evidence, and be ready to testify in court as to their findings.

It’s a monumental task. But the need is great, and those who answer the call possess a rare level of dedication and compassion. Sunny Chen, an RN with the Healthy Mothers Healthy Babies Coalition who took part in the July training, said simply, “We are the gap-fillers for our community.” Sexual assault is a difficult reality, one that many would prefer to pretend did not exist in our community. The system is held together by sheer will, and these women are nothing short of amazing.

Do you have what it takes to be a SANE nurse? We need you!

Contact: Lisa Williams
SASS/SANE Program Director
YWCA of Hawaii Island
145 Ululani St., Hilo, HI 96720
Phone: 808-854-0322

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