Newsletter: Summer 2005: Singapore Visit by St. Vincent’s Social Worker

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In early 2005, I was able to take advantage of an exciting opportunity to spend two weeks providing consultation and training on rape and childhood sexual abuse to social work, medical, and criminal justice staff in Singapore. The Singapore Health Ministry funds “Visiting Experts” to provide medical training in Singapore. This was the first time that a medical social worker was funded by this program.

The background and training of social work and other staff in Singapore is different than in the US. Anyone with an undergraduate degree in social work or psychology is called a social worker or psychologist. Some hospital social workers had graduate degrees, but most did not. As far as I could tell, post-graduate institutes or advanced training in psychotherapy does not exist. Family centers provide counseling and psychotherapy, with most providers receiving their professional training on-the-job.

Child protective services are also organized differently than in the States. Hospital social workers who suspect child abuse must conduct the investigation themselves. It is only when this social worker determines abuse has occurred that the child protective authorities are called. Social workers complained that, particularly in child sexual abuse cases, they too often had referrals turned down. This led to situations in which the child was sent back to the home and sexually abused once again. Then and only then did child protection finally accept the case.

Evidence collection kits, while available, are usually utilized only by request from the police. Without a police report, it costs about $650 U.S. dollars to open one. The kits are turned over immediately to the crime lab with no provision for storing them, or for the victim to decide about reporting. I had two very strong suggestions. First, open and do the kit on all cases, since it is what happens in the crime lab (i.e. DNA processing), and not the swabs and slides that are costly. Second, hold the kits while maintaining chain of custody, and allow the victim to decide whether to make a police report. It seemed likely that these changes would be made.

There are other complications in the criminal justice system regarding access to evidence kits for rape victims. Unlike the U.S. where possession, not ingestion, of drugs is the crime, it is a crime to have ingested illegal drugs in Singapore. Testing for drugs is a routine part of the evidence collection kit—potentially, reporting could lead to arrest of rape victims who took drugs or were drugged. There are no jury trials in Singapore—judges hear all cases. It appeared that plea-bargaining was not used as option. Victims of crime do not seem to have any particular status in the system. There were no criminal justice based crime victim programs and no crime victim’s compensation. Crime statistics are very low and those convicted of crime are very harshly treated—including capital punishment for drug dealing.

In a related matter, statutory rape cases are treated somewhat differently in Singapore. In the U.S. the age difference is considered. In Singapore, if two under-age youth have consensual sex, both can be arrested and prosecuted. Young women sexually assaulted by peers could therefore be at risk for arrest themselves, should they report.

The evidence kit was also used for what could be called “virginity checks.” As it in the U.S., virginity is highly valued in some of the cultural groups in Singapore. When a parent brought a teenage girl to the ER to see if the girl’s hymen was intact, she could be forced to have the exam. Needless to say, I strongly advocated that no child be forced to have a vaginal exam, since this is a sexual assault. I also suggested that requests for virginity checks routinely be referred to a social worker for an assessment of the situation. There may be a number of reasons why a girl’s hymen is not intact and virginity checks may lead to physical or psychological danger for the child.

It is worth noting that, while class differences in health care are evident in the US, in Singapore they are more blatant and pronounced. These differences were clearly seen at one of the hospitals I visited. There are both private (full pay) and public hospitals. Individuals who cannot pay their full health care costs can apply for subsidies at the public hospitals. There are separate hospital floors for the full-pay and subsidized patients. On the maternity ward, full-pay new mothers and babies get private, plush, air-conditioned rooms. Partially subsidized new moms and babies get semi-private, non-air conditioned rooms. Highly subsidized patients are on huge, open wards with no air conditioning—Singapore has a tropical, hot and humid climate all year long. The children’s floors also were different according to subsidy or not—but this was not quite as obvious.

In relation to women’s rights issues, one Singaporean woman put it this way: “Singapore is usually 10 years behind the U.S. and 5 years behind Australia when it comes to women’s services.” There is no rape crisis program in Singapore, and, although there is a vocal women’s advocacy group, the issue of sexual violence has gotten little attention. Research has consistently indicated that there is a correlation between cultures with very ‘traditional’ gender specific roles and a higher acceptance of rape myths. This seemed very true in Singapore as rape myths seemed widely accepted. I definitely got the impression that rape is grossly under-reported in Singapore, and that victims who do report are re-victimized by the system. Thankfully, the staff I trained recognized this and attended the training programs because they were committed to making changes in the treatment of victims in Singapore.

In the training programs that I conducted, I tried a slightly different approach than usual. Rather than starting with a focus on survivors, I started with videos and information on rapists and child molesters. The rapists, not the victims, cause rape and sexual abuse, and talking first about why men rape seemed to be a way to really stress this point. NYS Coalition Against Sexual Assault has a number of videos of interviews that I used. This seemed to work well: in small group discussions, participants seemed to understand that rape was not really about sex.

I also wanted to integrate information about the neurobiology of trauma. Having read and reviewed my materials countless times, I still got confused between the hippocampus and amygdala. About a month before I left for Singapore I was mailed a copy of a DVD, “Understanding Sexual Violence.” Produced to educate judges about sexual violence, there is an excellent 30-minute segment on the neurobiology of trauma. (The DVD can be obtained at www.njep.org, National Judicial Education Program.) Great timing!

I also tried a slightly different approach to understanding victim blaming. Many educators use the rape scene from the movie “The Accused,” starting with the bar scene in which the victim, played by Jodi Foster, flirts very suggestively with the men in a bar. The scene goes on to show her brutal and graphic gang rape. In this case, I started with the rape scene, stopped the tape and discussed the audience’s visceral reaction, and their empathy for the victim. I asked if anyone could think of a justification for what happened—could the victim have done anything to ‘deserve it?’ I then showed the scenes leading up to the rape. It led to a lively discussion.

It was fascinating to see the differences—and similarities—between our culture(s) and Singapore’s. It was exciting, as a social worker, to get to know other workers and to have some input, hopefully, into social change.

[Singapore is a City-State located on an island at the bottom of the Malaysian peninsula in Southeast Asia. Singapore has 4 official languages: English, Mandarin Chinese, Malay and Tamil. Of the approximately 4 million Singaporeans, most (77%) are of Chinese ancestry with 14% Malay, 8% Indian, and 1% European. Singapore is one of the 20 smallest countries and the second most densely populated in the world.]

Rape Crisis Program Manager, SVCMC St. Vincent’s Manhattan, Department of Community Medicine [[3] more]

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[1]: http://www.nycagainstrape.org/home/nycaasa/stage.nycagainstrape.org/newsletter_author_114.html
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[3]: http://www.nycagainstrape.org/home/nycaasa/stage.nycagainstrape.org/newsletter_author_114.html
[4]: http://www.nycagainstrape.org/home/nycaasa/stage.nycagainstrape.org/newsletter_article_207.html

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