Actor Jennifer Coisman sat on a medical exam table on the University of Alaska Anchorage campus pretending to be a patient named Mary.
“I got picked up off the ground by a chokehold from behind,” she said, speaking both to the actor playing a nurse and to the students watching virtually on a laptop.
Coisman’s neck and hands were painted with fake bruises. She described a scenario where her brother assaulted her, choking her till she passed out, and emergency medical technicians revived her.
“I thought I was gonna die,” Coisman said.
Student Georgia Davenport spoke up on the video call, instructing the “nurse” in the room.
“Take a swab and do a buccal swab inside of Mary's cheek for me,” Davenport said.
Then, she asked the nurse to swab underneath “Mary’s” nails, in case she’d scratched her attacker, to collect skin cells that could later be used as evidence.
This roleplay was part of a December training on forensics and trauma-informed responses to assault and violence, run by nurse and professor Angelia Trujillo and UAA. Most of the 17 students in the free three-day healthcare forensics training were providers who work in Alaska. They learned how to watch out for signs of abuse and assault; how to connect people to sexual assault and domestic violence resources; and if needed, how to collect and document evidence that could be used later in court.
Angelia Trujillo designed the course, which has been offered since 2018. She said healthcare providers have a unique opportunity to support people who’ve experienced violence.
“We see people every day, they're coming in, and maybe they're a sexual assault victim. Maybe it's domestic violence, child abuse, the person who got beat up in a bar fight, the person who got assaulted in a park,” Trujillo said.
The state already has a team that responds to sexual assaults and strangulations, called the SART or sexual assault response team. The course isn’t meant to replace that, but to train healthcare workers on how to gather evidence if someone can’t or doesn’t want to access the response team. The SART only gathers evidence within a seven-day window, and may not always be able to reach rural Alaskans within that time frame.
“In some of our rural communities, the healthcare person may be the only person that that individual trusts. And it doesn't even have to be a rural community, it could be an urban community,” Trujillo said. “The challenge is, does the health care provider know what to say and how to say it, and then how to help them afterwards?”
Trujillo was motivated to design the class after learning about a woman who was killed by her partner after years of domestic violence. Trujillo was floored by how many times the woman had seen healthcare providers who hadn’t documented or reported the abuse.
“She went to five or six different doctors,” Trujillo said. “She went to two different hospitals. She had a knife wound that was not reported. She had twins. There was no information in the OB [obstetrics] record or the pediatric record, despite her having injuries and broken bones and knife wounds and things over the course of her life.”
Trujillo saw that each of those healthcare visits could have been an opportunity to document signs of domestic violence, and to offer a path to safety. Trujillo had already trained people on how to respond to sexual assaults, but she saw those same skills could also help providers respond to and document other kinds of violence. That’s crucial in a state with some of the highest rates of sexual assault, domestic violence, and violent crimes, according to data from the National Domestic Violence Hotline and the FBI.
Brenda Stanfill, executive director of the Alaska Network on Domestic Violence and Sexual Assault, said sometimes it takes people a long time to report domestic violence, so documentation by healthcare workers can be crucial evidence.
“If you see certain types of injury, if you see certain things, that very well may mean that this person is being abused at home,” Stanfill said. “And being able to document in that [medical] chart really may be the difference between whether they're believed later on or not.”
Stanfill said she’d like to see all medical professionals get core training on domestic violence and sexual assault, something that’s not always included in healthcare curricula.
Susan Meskis, a UAA professor and nurse focusing on end-of-life care and labor and delivery, decided to take the training because she wanted to learn how to better support victims of sexual assault. She said it’s made her think differently about her past work.
“I kept asking myself, ‘How many patients have come through for labor and delivery that I've missed the signs that they were in an abusive relationship, maybe they didn't even want to be pregnant?’” Meskis said.
She said she’s learned how to better ask questions and look for body language that might mean she should ask even more. She also learned to look for subtle physical signs of abuse, she said, like tiny pink flecks on someone’s head.
“We learned if somebody's been strangled, you'll notice it behind the ears and in the scalp and in the eyes,” Meskis said.
She said it also helped her have a more hopeful approach to her patients who are in domestic violence relationships. When people come in again and again and don’t want to leave an abusive relationship, Meskis said, it can feel exhausting. But with more training on domestic violence, she now knows how important it is to offer resources every single time she sees someone.
“It might be that one time that we address it, or that one resource that gets them out of that situation and maybe even saves their life,” she said.
Course designer Angelia Trujillo said victims of one kind of violence are much more likely to become victims of another kind later in life. But she said the better care victims of violence get, the less likely they are to be victimized in the future. She hopes this class helps create a critical mass of healthcare providers that can provide support and documentation to Alaskans experiencing violence across the state.
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