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PtD Project (IRCT, HRFT, REDRESS, PHR) MODULE 8 Prevention through Documentation Project Case Example #2 CONTRIBUTORS: Vincent Iacopino, MD, PhD, Physicians for Human Rights Önder Özkalıpçı MD, International Rehabilitation Council for Torture Victims Alejandro Moreno, MD, JD, Boston Center for Refugee Health and Human Rights
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Case #2 Outline of Demonstration Role-play interview Interview divided into 8 components Learning Objectives for each component Time-outs: A break in the interview action used to make teaching points PtD Project (IRCT, HRFT, REDRESS, PHR)
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Case #2 Outline for Demonstration Role-play interview Interview divided into 8 components – Learning objectives for each component Time-outs: A break in the interview action used to make teaching points PtD Project (IRCT, HRFT, REDRESS, PHR)
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Interview Components Interview Components Introduction – Conditions of interview – Identification information Past history – Medical, surgical, psychosocial (Pre-Arrest) Trauma history Review of torture methods Physical symptoms (acute & chronic) and disabilities Psychological assessment and mental status examination Physical examination Interpretation of findings & conclusions PtD Project (IRCT, HRFT, REDRESS, PHR)
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Case Summary/Referral #2 Name: Mr. Hassan Bashir Adam Date Reporting to the Center: dd/mm/yyyy Date of Birth: dd/mm/yyyy Age: 25 yrs Marital Status/Children: Single, no children Religion: Muslim Ethnic Group: Darfurian, Zagawa tribe Profession: Student, Khartoum University Political/Social Affiliation: Member of Student Democratic Front (SDF) Date of Detention: dd/mm/yyyy Place of Detention: XXX police station Period of Detention: 3 days PtD Project (IRCT, HRFT, REDRESS, PHR)
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Case Summary/Referral #2 Trauma History: – On dd/mm/yyyy – Mr. Adam as arrested by four officers from the NSA – Placed in truck with blackened windows, blindfolded and taken to police station – Mobile phone and ID card confiscated – Hands restrained – He was punched, kicked and beaten with black water hoses and electric wires – Suspended him by his wrists and applied electric shocks to his genitals PtD Project (IRCT, HRFT, REDRESS, PHR)
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Case Summary/Referral #2 Alleged Perpetrators: Security personnel from NSA, including Abdel Salih, and Kaleel Rahim, also 2 perpetrators referred to as Rasoul and Mujahid. Reasons for visit: Treatment for problems related to torture and to take legal action against perpetrators. Client has already met with SOAT legal advisors, and they have requested a medical evaluation of client’s allegations of torture. Effects of Torture: Musculoskeletal pain, multiple bruises and burns. PtD Project (IRCT, HRFT, REDRESS, PHR)
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Begin Interview PtD Project (IRCT, HRFT, REDRESS, PHR)
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1. Introduction/Conditions of Interview & Identification Information Learning Objectives – Provide clear and effective introduction: identity of examiner, purpose of interview, who medical evaluation will be sent to and limitations on confidentiality – Explain nature of evaluation and simultaneous need for detail and accuracy. Uncertainties should be discussed due to likely adverse effect on credibility. – Obtain informed consent on Standard Evaluation Form (#1-3) – Ensure comfortable stetting, respectful interaction – Earn trust, establish alleged victim’s control over interview process – Ability to accurately record relevant case information – Develop appropriate responses to police coercion PtD Project (IRCT, HRFT, REDRESS, PHR)
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2. Past Medical and Surgical History & Psychosocial History – Pre-Arrest Learning Objectives – Obtain a complete medical history, including prior medical, surgical and/or psychiatric problems – Document any history of injuries before period of detention and any possible after-effects. Knowledge of prior injuries may help differentiate scars, or other physical evidence, related to torture from those that are not – Summarise any previous forensic evaluation related to allegations of torture and/or ill treatment PtD Project (IRCT, HRFT, REDRESS, PHR)
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3. Trauma History Learning Objectives – Understand various techniques of questioning and apply them appropriately – Elicit a coherent and accurate account of alleged torture/ill treatment – Structure inquiries to elicit a chronological account of events experienced – Understand sources of variability and effect of such variability on history taking – Pursue and clarify possible inconsistencies in the trauma history – Take note of non-verbal (process) information and links between emotional affect and content of trauma history PtD Project (IRCT, HRFT, REDRESS, PHR)
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4. Review of Torture Methods Learning Objectives – Understand advantages and disadvantages of direct questions about specific methods of torture/ill treatment – Assess a wider range of possible physical and psychological methods of torture PtD Project (IRCT, HRFT, REDRESS, PHR)
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5. Physical Symptoms (acute and chronic) and Disabilities Learning Objectives – Assess relevant physical symptoms (acute and chronic) and disabilities experienced after alleged torture/ill treatment – Anticipate physical symptoms and/or disabilities for specific methods of alleged torture – Correlate reported physical symptoms (acute and chronic) and disabilities with specific allegations of abuse PtD Project (IRCT, HRFT, REDRESS, PHR)
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6. Psychological Assessment and Mental Status Examination Learning Objectives – Conduct a mental status examination – Be aware of factors that may contribute to psychological outcomes – Assess symptoms of common psychological conditions associated with torture and ill treatment. – Recognise signs and symptoms of possible organic brain dysfunction – Recognise and respond effectively to transference and countertransference reactions – Recognise and respond effectively in court when asked qualifications of physician to conduct a psychological evaluation PtD Project (IRCT, HRFT, REDRESS, PHR)
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7. Physical Examination Learning Objectives – Recognise physical signs of torture/ill treatment in acute and chronic settings and understand sensitivity and specificity of common findings – Anticipate pertinent positive and negative findings based on specific allegations of torture and/or descriptions of acute/chronic symptoms or disabilities following torture or ill treatment – Understand the advantages and disadvantages of conducting complete vs. directed physical examinations – Understand how mitigating factors may affect physical sequelae of torture and ill treatment – Document photographic evidence where appropriate and make effective use of anatomical drawings PtD Project (IRCT, HRFT, REDRESS, PHR)
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Virtual Physical Examination Cases #2 Cases Developed by Vincent Iacopino, MD, PhD, Alejandro Moreno, MD, JD, and Önder Özkalıpçı, MD
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Case #2 25 year-old man with alleged wrist injuries These lesions were noted during the current examination
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Case #02 24 year-old man with circumferential lesions of the wrists
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Case #2 25 year-old man who alleged cigarette burns to the right arm These lesions were noted during the current examination
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Case #02 24 year-old man with multiple circular lesions on the left forearm
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Case #2 25 year-old man with injures to chest and back The following photographs were taken by a friend 6 days following the alleged torture.
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8. Interpretation of Findings and Conclusions Learning Objectives: – Provide interpretations on physical, psychological and, if relevant, historical evidence of torture/ill treatment – State unequivocally in the conclusion the student’s opinion on possibility of torture and/or ill treatment, and indicate degree of certainty. Consider recommendations in Istanbul Protocol – Provide appropriate recommendations for further evaluations and treatment PtD Project (IRCT, HRFT, REDRESS, PHR)
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Debriefing Role-players provide feedback on student performances and process issues Consider relevant transference and countertransference issues PtD Project (IRCT, HRFT, REDRESS, PHR)
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