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Posts tagged as “health”

The life cycle of a sexual assault evidence kit

It starts when the emergency room door opens.

A victim walks in. She may have been sexually assaulted an hour ago or a day ago, but now, she’s decided to see a doctor. She might walk in with a friend or a parent, or she might sit alone and wait for the sexual assault nurse examiner to arrive.

“I just introduce myself at the beginning,” says Molly Chadbourne, a former sexual assault nurse examiner in Durham who currently trains other nurses. “I explain who I am and why I’m there to talk with them. Then, I ask them what they want. Do they want a kit?”

This is where a sexual assault kit begins. Its life cycle may last months, or even years.

The nurse ushers the victim into a small hospital room where they have privacy. Chadbourne likes to start with the easier questions: “What’s your medical history? What types of medicine do you take?” Then, she’ll ask the harder question. “Can you tell me what happened to you?”

The nurse listens, letting the victim take breaks and reminding her that it’s okay to tell her story imperfectly.

“We know that some people aren’t going to remember everything right away, and they might not remember it linearly,” Chadbourne says. “We have to give people permission to start talking about whatever they can, even if it’s not at the beginning.”

Then, the nurse starts to assemble the kit, a small white cardboard box with “Sexual Assault Evidence Collection Kit” printed on the front. 

The nurse starts collecting “known” samples, or the victim’s DNA. She’ll gently swab around the victim’s cheeks, gums, and lips. She’ll ask the victim to take off her underwear and seal it in a bag labeled “Underpants”. She’ll pluck exactly 50 hairs out of the victim’s head and then comb through her pubic hair, securing any hairs that fall off into a small envelope. 

Then the nurse collects “unknown” samples, which could include the assailant’s DNA. The nurse will swab any place on the body where the victim says she was assaulted. “It’s anywhere that was licked, bit, or touched by the assailant,” Chadbourne says.

She says “anything that’s on their body might be relevant”. Victims and nurses alike understand that the victim’s body is a crime scene.

The nurse takes photos of the woman, documenting any cuts, scrapes, or bruises. “I offer to let people look at the pictures,” Chadbourne says. “I try to give them as much control over the process as possible.” At any point, she notes, a victim can stop the kit collection.

After two hours, the nurse has packed away dozens of cotton swabs, photographs of injuries, and envelopes of hair into the sexual assault kit. She closes the lid of the white cardboard box and places it in storage, where the kit waits for law enforcement to come pick it up the next morning.

***

When the kit arrives at the police department, an officer will take a first look. That officer might notice if the kit is connected to a consent case, a case in which the victim and the perpetrator both agree that they had sex, but disagree on whether it was consensual. Three years ago, a consent kit would get put back on the evidence shelves at the police department instead of getting tested. It could stay there for over 30 years.

“When I was seeing patients, I couldn’t say to them, ‘Your kit will never get tested, because you know the person that assaulted you,’” Chadbourne says. “Doing this really invasive process and knowing in the back of your mind that this kit will probably never be tested… it’s a really hard pill to swallow.”

But today, with the statewide push to send all kits to the State Crime Lab, that kit won’t sit on an evidence shelf if it doesn’t meet testing requirements. Instead, an officer will log it into the North Carolina State Crime Lab’s database. A technician at the lab will accept the kit, and the officer will drive it to Raleigh, where the State Crime Lab is located.

“We place the kit into a vault until it’s time to be worked,” says Jody West, forensic sciences manager at the State Crime Lab. “Then we open it up, and start with inventory.”

Every sexual assault kit is a little different “It’s a box, but it’s not a one-size-fits-all box,” according to Chadbourne and the State Crime Lab takes note of every swab, photo, and hair inside.

A lab technician first takes a tiny portion of the swab and uses a chemical to tease out the DNA from its cotton. “It’s like cracking open an egg and removing the yolk,” West explains.

Lab technicians then use a machine to separate the yolk — human DNA — from any other type of genetic material. In sexual assault cases, they’re usually looking for male DNA. “This is the decision point,” West says. “If we determine there’s not enough male DNA, we’ll stop.”

If the kit moves ahead, it goes through amplification, or copying the yolk. The assailant’s DNA fragments are heated and cycled through a hefty gray machine — in just thirty cycles, a billion copies of that DNA are made.

The last step is electrophoresis, or separating the yolk. Analysts use an electric field to detach different fragments of DNA. The result is a complete DNA profile. “It looks a lot like a heartbeat,” West says.

After hours in the emergency room, days with law enforcement and up to five weeks at the lab, this is what a completed sexual assault kit looks like: A series of peaks on a computer screen.

Those peaks the DNA profile of the assailant will be entered into a database of millions of offenders across the country. A computer will scan each offender’s profile, checking for a perfect match. If the all of the peaks line up, the computer spits out a name. Then, it’s up to the police to investigate the sexual assault.

That is the life cycle of one sexual assault kit. To clear the backlog of 15,160, North Carolina has thousands more to go.

“Most people, if they’ve ever heard of a rape kit before, it’s from watching Law and Order SVU,” Chadbourne says. “They think it gets solved in 60 minutes. The truth is, it doesn’t. It really doesn’t.”

A sexual assault evidence kit. Photo provided by Molly Chadbourne

Resources for survivors:

Durham Crisis Response Center

Rape, Abuse & Incest National Network: What is a sexual assault forensic exam?

North Carolina Sexual Assault Kit Tracking 

North Carolina Office for Victims of Crime: Crime compensation

Shielding Durham kids from vaping addiction and illness risks

Concerned about the rise of vaping among North Carolina teenagers and younger kids, some adults in Durham are fighting back.

E-cigarette use among high schoolers in this state increased 894 percent between 2011 and 2017, according to the North Carolina Youth Tobacco Survey. Among middle schoolers statewide, vaping jumped 430 percent during the same period. 

The Men’s Health Council of Durham and the Duke University Cancer Institute recently hosted a public forum titled “Smoking, Vaping & Other Inhalants: What You Need to Know.” 

“Since this is a viable product and available to everyone, we want to make sure that [kids] get this data before it is too late,” said Elvert Dorsey, chairman of the council, which promotes health among Durham men, especially black and Latino men.

Organizers handed out pamphlets, including one advising parents to remain nonjudgmental and honest when discussing e-cigarettes and to set a good example by neither smoking or vaping.

“It’s important for parents to introduce this information to their kids, even if their kid is not directly involved in this activity, because they surely know someone who is,” Dorsey told council members and parents at the Durham Human Services Building. 

Duke University pulmonologist Loretta Que urged everyone concerned about the health of young people to embrace the precautionary principle when it comes to e-cigarettes. That public health practice says when something may be harmful, steps should be taken to reduce exposure to the potential threat.

That’s true even when science hasn’t firmly established cause and effect.

“As of Nov. 13, 2019, there have been 2,172 cases of vaping related lung injuries and 42 related deaths in 24 states …  the lungs look like they have been burned in these patients that died,” Que said in a presentation. “Since substance causing these lung injuries is not known for sure yet, you should not start to vape or use an e-cigarette.”

Michael Scott, program manager of the National African American Tobacco Prevention Network, discussed how the tobacco industry has a long history of targeting young people with  advertising designed to make smoking look alluring. Specifically, big tobacco companies targeted young teens in order to gain life-long users, by hooking them on addictive nicotine. 

E-cigarette vendors have used using similar tactics, he said. Four out of five middle and high school students saw e-cigarette ads in 2106, in stores, on social media and in newspapers and magazines, according to a Centers for Disease Control and Prevention study.

JUUL for example, has used magazine ads, Instagram ads and sponsored events such as the Music in Film Summit” at the 2018 Sundance Film Festival in Utah to burnish its image with young consumers. Multiple states have sued JUUL, which recently changed its practices, for targeting young people with deceptive marketing. 

“Big tobacco and vape companies have to continue to recruit new customers as kids, and we want to prevent that,” Scott said. 

Scott said African Americans and members of LGBTQ+ community can also targeted by e-cigarette companies. 

“African Americans, people of low socioeconomic status, LGBT folks, Latino folks… those are the people disproportionately affected by smoking… and now vaping,” he said.

Durham has fairly progressive laws against smoking tobacco. Durham’s Board of Health in 2012 banned smoking in many outdoor public spaces, and a few indoor spaces such as public restrooms. Scott favors vaping bans too. 

“Vaping is less dangerous than smoking, but it still has its significant dangers,” Scott said. “Any anti-smoking laws need to include e-products and vaping products.”

But parents and all adults in the community can help now, Scott and Que said. Their number-one weapon for good in this domain? Education. 

“Be educated about the products that you see; be aware that these products exist, because your kids are seeing them in school and on social media. Secondly, be supportive of policies that are going to be put in place that will prevent this, such as banning menthol, banning flavors, banning e-cigarettes in general,” said Scott.

The best way to address this issue with teens is through nurturing, said Wanda Boone, executive director of Together for Resilient Youth, an organization trying to reduce substance abuse in Durham. Suspensions, expulsions and other forms of punishment in school and outside is not the right answer, she said.

“Holding young people totally accountable for smoking and vaping is like holding fish responsible for dying in a polluted stream,” Boone said. “Our responsibility is to protect them from this environment so that they have the opportunity to grow.

In that spirit, the men’s health council plans to hold more events on vaping at local schools to further spread the word on their risks.

At top: A young guy blows a dramatic vaping cloud. Photo by Micadew at Wikimedia