[00:00:00] Dr Sanjaya Senanayake: This episode touches on sensitive topics including sexual assault and domestic violence. Links to support services can be found in the show notes.

[00:00:17] Dr Sanjaya Senanayake: Hi, this is Dr. Sanjaya. Have you ever wondered what forensic medicine actually involves or the important role it plays in police investigations? I sit down with Dr. Vanita Parekh for a fascinating chat about the vital work her team does every day. Let's jump into our chat.

[00:00:43] Dr Sanjaya Senanayake: I'm delighted today to have with us Dr. Vanita Parekh. Vanita is a Clinical Associate Professor of Clinical Forensic Medicine at the ANU. She's a Senior Staff Specialist in Forensic Medicine and Sexual Health at Canberra Health Services and establishing, and a former Director of the Clinical Forensic Services in the ACT and just, uh, to add a cherry on the icing on top.

[00:01:12] Dr Sanjaya Senanayake: She's got a well-deserved order of Australia. Welcome, Vanita.

[00:01:18] Vanita Parekh: Thank you, Sanjaya. It's lovely to be here.

[00:01:20] Dr Sanjaya Senanayake: Oh, it's lovely to have you. And look, you are in a field which I think excites and interests a lot of people, specifically because of all the TV shows around forensic medicines and what it entails.

[00:01:35] Dr Sanjaya Senanayake: But tell me for you, what does forensic medicine mean?

[00:01:40] Vanita Parekh: So forensic medicine is really where medicine, uh, the worlds of medicine and law collide. And so, we make things hopefully, more, understood in the legal setting about medical issues, but there's a clinical side to it, and that is the examination of victims and suspects.

[00:02:03] Vanita Parekh: Um, impaired drivers, for all sorts of different reasons, whether that's drugs and alcohol or the medical conditions. We look after patients in the city watch house or in the police custody. We'll write a lot of medical legal reports and we present a lot of evidence in court and lots of legal writing and court reports explaining various medical terms to the general population, the lay population.

[00:02:30] Vanita Parekh: So very akin to what we would do in clinical practice. And in fact, we do have clinical practice, but, where we're translating essentially the medical terminology and the consequences of specific injuries, for instance. Um, and making it accessible so that legal decisions can be made based upon those.

[00:02:51] Dr Sanjaya Senanayake: Yeah. As you've explained it, it's not all about investigating murders. It goes far beyond that. Would you, how would you describe forensic medicine in the ACT?

[00:03:03] Vanita Parekh: So, first of all, the first thing that I would say is that therapeutic care or looking after patients is always the priority. The forensic evidence collection is secondary to that, and we obviously, we try as best we can to get the, the highest quality forensic evidence with integrity.

[00:03:22] Vanita Parekh: Um, so we're making sure that the right sample comes from the right patient, and that, that that can be analysed forensically. And in the ACT we're quite lucky because we're quite small jurisdiction, which is fantastic for collaborative working relationships with the road transport authority, with police, with the forensic labs, with the courts, and with defence lawyers and the prosecutors.

[00:03:50] Vanita Parekh: So, we actually have this amazing jurisdiction where we can do so many things because we all, you know, it's a small sandpit if you like, and we often play nicely in that sandpit, but it, what we can get is fantastic results and we can start to look at patterns that can't be seen in other jurisdictions because they are so large and disparate.

[00:04:09] Vanita Parekh: So, in terms of the forensic medicine and the ACT, there is one service and that is the Clinical Forensic Medicine Service, called CFMS. And I established that starting in the year 2000. And that service has got lots of different elements to it. It's got the sex assault service, which was the initial service.

[00:04:29] Vanita Parekh: And, that started really after a particular incident that occurred in the year 2000. Um, and that, that because of that incident, a sexual assault service was funded. Then in 2006, ACT Policing needed to have people to do general forensic medicine, and obviously we did that work as well.

[00:04:52] Vanita Parekh: And then in 2010 we had a series of fatalities on Canberra roads on a very rainy day. And it just so happened that I was on call that day and had discussion with the person who was the superintendent in charge of traffic because it was really all hands on deck that day and asking about what was going on with these collisions.

[00:05:14] Vanita Parekh: And the impact of medical conditions on unsafe driving behaviour. And, then in about 2019-20, we started to look at the research, that we could do not only with from our own data sets, which I’d set up as established those services, but also how we could merge those data sets to track outcomes across the ACT.

[00:05:38] Vanita Parekh: So that's been part of an incredible journey really over the last three years in terms of research, where we've actually been able to track outcomes right from when the patient presents until sentencing outcomes actually for specific crimes. So, where we've got a victim, we can track it through police, through the director of public prosecutions, through the court system, and then right through sentencing to outcomes.

[00:06:04] Vanita Parekh: You know, what, what was the, what did the conviction result in?

[00:06:08] Dr Sanjaya Senanayake: I mean, that's really fascinating and I do want to take you back to that other point just, about the ACT being a wonderful place for collaboration. I think we've heard this from a lot of our other guests as well within the health service, that it's a small place, but it's got a lot of departments.

[00:06:30] Dr Sanjaya Senanayake: Doing different things, but who are close together in real life and therefore we manage to collaborate in a way that other jurisdictions can't. So that's the Canberra bubble, I guess, isn't it?

[00:06:41] Vanita Parekh: It is absolutely fantastic and it's so underestimated. You know, we often look at these big studies from massive hospitals.

[00:06:49] Vanita Parekh: And, we think, well, that's what real research is around. And actually it's not, it's about the patient or the victim or the suspect journey. Um, and this is the ideal jurisdiction to do that, you know, where else can you walk to the coffee shop and bump into, and you think about how many times this has probably happened to you.

[00:07:08] Vanita Parekh: Yes. Ah, there's Sanjaya, I must ask him about brain worms or whatever it is. Um, and, you know, we have that amazing ability to interact with each other. That really doesn't happen in, in lots of other settings.

[00:07:24] Dr Sanjaya Senanayake: Forensic medicine itself is, as you talk about, you've talked about it as, as a process, I guess, at an individual level, because none of us.

[00:07:33] Dr Sanjaya Senanayake: In medicine, I certainly don't understand how it works. For you as an on-call person, for forensic medicine, what would happen? You get a call from the police saying there's been a victim of sexual assault. Then how would you proceed?

[00:07:49] Vanita Parekh: So, the first and most important thing is that we, in the ACT, which is quite novel, we work with a nurse and the nurse triages those calls.

[00:07:58] Vanita Parekh: We then arrange where we're going to meet, and the first and most important thing is to make sure that that person's physically alright. I think we all get so worked up about collecting forensic evidence, but what do they need? What do they need at that time? What, what do they, because it could be that they're really worried about getting a sexually transmitted infection or emergency contraception. Could be that, they're worried about other people finding out.

[00:08:24] Vanita Parekh: And in fact, 90% of victims are worried about someone else finding out, and only about 40% are worried about something medically being wrong with. So, it's really, directed by the patient. Um, and I use that the word patient specifically because there's a therapeutic relationship that we have with patients and there's a power differential in a clinical scenario.

[00:08:51] Vanita Parekh: And we have to, as clinicians understand that and make it as easy as possible for a patient to report and tell us things. And we know there's lots of barriers to reporting sexual assault, and in fact, clinician attitude is a really big one. So, it's about making, um, developing a rapport.

[00:09:08] Vanita Parekh: And, you know, the test of that is at the end of the consultation when they walk out with a smile. After something so horrendous. That to me is the magic. That's what, that's why we do it. So, we would then sort of, have a chat with them and then if they, they can either decide if they want to report or if they just want to have medical care.

[00:09:26] Vanita Parekh: Sometimes it's a really big decision and they're not sure if they want to report and in which instance, we can offer what's called a, just in case forensic medical, where we collect the evidence and it gives them a little bit of time to then decide if they want to report or not. So, there's lots of different options, and the things that we'll be doing is asking them about what happened.

[00:09:47] Vanita Parekh: Um, to them, and we are not investigators. We are there to look after them. Um, and medical evidence, really in sexual assault cases is based on three things. It's DNA evidence, which we all hear about, and we see that and, you know, we see the probabilities and the billions. You know, the other things, um, are toxicology evidence and the administration of substances and also injury.

[00:10:11] Vanita Parekh: And in fact, the commonest finding after sexual assault is no injury at all. And that's really important for patients to understand because it all, it is actually a barrier to reporting. You know, when you look at media and you look at victims, they often, you know, are very injured. Um, and that's actually not the case.

[00:10:30] Vanita Parekh: And so, people think, well, have I been sexually assaulted because I'm not injured. And in fact, what we know about patients is, and I give this evidence regularly in court, is up to 70% have that freeze reaction where they don't, they look as if they're awake, their eyes are open, but they can't shout out, they can't move.

[00:10:48] Vanita Parekh: Now, in no way does that imply any form of consent. What's happening. And 50% of people have complete immobility, they cannot move. And that's actually very scary for people and it's much more likely to lead to post-traumatic stress disorder. So, there's some really big myth busting that we do in court giving expert evidence.

[00:11:08] Vanita Parekh: So, once we've collected that evidence, it goes under what we call chain of custody. So that means it's sort of, the integrity of that evidence is, is maintained and it's chain of custody and then that can be handed over to the police, if that's the route that person wants to go down.

[00:11:26] Dr Sanjaya Senanayake: So, as you've said, if the victim decides, actually, no, I don't want to proceed with this, even though the evidence has been collected, it won't be processed.

[00:11:37] Vanita Parekh: That's correct. Yes. So, and we can't process that without their permission.

[00:11:42] Dr Sanjaya Senanayake: And you've certainly busted one myth there. I think a lot of us assume with sexual assault there'll be, because again, of TV and the media, there'll be bruising and other evidence because that's what we see on tv.

[00:11:55] Dr Sanjaya Senanayake: But you, you've clearly shown that that's, that's not always the case.

[00:11:59] Vanita Parekh: Absolutely. And, you know, as I say, you know, people look at those images and think, well, that that's not me. So, I couldn't have been sexually assaulted. The one thing that is always true though is that the doctor that looks after people at three o'clock in the morning is always gorgeous and that, I mean that that's true in fiction as well as it is in real life.

[00:12:20] Dr Sanjaya Senanayake: Excellent, excellent. We'll definitely make sure that gets mentioned in the podcast. And you also mentioned the longer-term issues with, sexual assault, someone having post-traumatic stress, stress disorder. Is there a provision for that longer term care that comes through that,  forensic medicine encounter at the start?

[00:12:43] Vanita Parekh: Um, when that is reported, when that sexual assault is reported, don't have to proceed to court or anything, patients can then apply to the victim services scheme and they can get the, the psychological help that they need from that scheme. So, and that's partly funded through the proceeds of crime. So, yes, there are other options, but I think the thing is about disclosing what's happened.

[00:13:10] Vanita Parekh: And often we get really worried as clinicians or as friends or a family of somebody, what, what are we going to do when they tell us that they've been sexually assaulted? And there's lots of good things. I mean, the first thing for anyone is to recognise that, my goodness, this person trusted me enough to be able to tell me what's happened to them.

[00:13:29] Vanita Parekh: And that's an absolute privilege to hear that. And then the next thing is, you might not know what to do, but what you can say to the person, look, I'm going to come with you on this journey. I'm going to help you as I can. I'm not sure what to do. And there's lots of resources like the Canberra Rape Crisis Centre.

[00:13:46] Vanita Parekh: For men there's the service assisting male survivors of sexual assault. There's a domestic violence crisis service, which is 24 hours. So, 1-800-RESPECT, which is 24 hours. So, there's lots of different mechanisms by which people like us who, other friends, family, patients make those disclosures to, can actually get advice and help to support that person.

[00:14:13] Vanita Parekh: But the great thing is when they tell you, don't feel, oh my goodness, you should think, I feel really lucky that they've been able to tell me.

[00:14:20] Dr Sanjaya Senanayake: And look, I think, an important take home message for people out there who may have been a victim or, or suspect they know, a victim that you've said is. People will believe you.

[00:14:33] Dr Sanjaya Senanayake: Even if you don't have any marks all over you, it's not an uncommon thing. Just present and be aware that you'll meet someone who'll be friendly and willing to listen to you. So don't hold. Don't hold back.

[00:14:46] Vanita Parekh: Yeah, absolutely. And they've trusted you, so that's a really important thing that you don't break that trust for that.

[00:14:54] Dr Sanjaya Senanayake: Now Vanita, when you were talking about the various services that were available for victims, you did mention services for men. How often do men get sexually assaulted?

[00:15:07] Vanita Parekh: So, from epidemiological studies, what we know that one in 20 adult males have been sexually assaulted. So it, it is pretty huge.

[00:15:17] Vanita Parekh: And when you add in the childhood sexual abuse, it probably drops to about one in six. So, it's huge numbers that we're talking about and it's a really…

[00:15:25] Dr Sanjaya Senanayake: and sorry, I am going to interrupt. Can I just ask what the figures are for women?

[00:15:29] Vanita Parekh: Yes, the figures are about one in five women, and when you take into account childhood sexual abuse about one in three women.

[00:15:36] Dr Sanjaya Senanayake: you are kidding.

[00:15:37] Vanita Parekh: No, and you know, every time I give a lecture, one of the first things that I say to the audience is, this is going to happen, have happened to people in this audience. You know, this is not an uncommon thing that happens. Coming in to, to men, we do know that they're much less likely to report. The levels of shame are really high and embarrassment.

[00:16:00] Vanita Parekh: Um, and they're just very scared about coming forward. And so, this is some, we did a study, over an 18-year period. We, looked at all males that came into our service now, of the male victims, 6.4%, sorry, 6.4% of all victims were males, adult males. And what we did with this group was we looked at lots of different factors, characteristics and demographics, but we also worked with our colleagues in ACT Policing and developed our coded matching system where we could compare our data and police data without either group knowing anything about the identity of the individuals.

[00:16:43] Dr Sanjaya Senanayake: Wow.

[00:16:43] Vanita Parekh: And what we found in that was we were able to not only look at the patient characteristics, but we could track them through what happened police, through the court system and right through to conviction. Um, so we, we did that study and now we're working on the bigger data set where we're looking at the 93.6% of females.

[00:17:04] Vanita Parekh: And we're actually going to run exactly the same process. But what we found in that study was that the collection of forensic evidence really, probably tripled the conviction rate, from people who didn't have forensic evidence. So, with that collaborative working that we've done with police, and we've got police as authors on most of our papers.

[00:17:28] Vanita Parekh: They are so excited by what we are doing, and we are sort of thinking, well, this is fairly so standard clinical practice for us, and they actually see massive benefits and a bit like we were talking about earlier, they can see applications that we have no idea about. Um, and in the male paper what we did was we measured the court outcomes.

[00:17:48] Vanita Parekh: We measured the health outcomes. We looked at rates of sexually transmitted infections. We looked at how much HIV post-exposure prophylaxis, so drugs that we give after sexual assault, to prevent HIV. Um, we looked at how many patients got that, how many continued treatment, what the follow-up rates were and, and really what came out of it was the lack of support for male victims.

[00:18:15] Vanita Parekh: It was quite incredible, how unsupported they were. And, and also then, what we've been able to do that do with that is work with police and talk about, let's have a think about how we support men who report sexual violence. So very, very common. Um, finding, and I think we are starting to see worldwide, we're actually starting to see an increase in the number of female perpetrators of male sexual assault as well, which is something that hasn't really been described in the adult population that's been described in the child population very well, but not with adults.

[00:18:49] Dr Sanjaya Senanayake: So, look, that sounds like groundbreaking research that you've started in the ACT with this great collaboration that's been adopted by other jurisdictions in Australia. Is that correct?

[00:18:59] Vanita Parekh: So, we are certainly working with our colleagues around Australia and internationally. And, all of our papers, we are really, everything's open access so that if you're in London you can look at these papers.

[00:19:13] Vanita Parekh: And another paper that we've done, we've looked at non-fatal strangulation in the ACT.

[00:19:20] Dr Sanjaya Senanayake: So, do you want to tell us about non-fatal strangulation please?

[00:19:24] Vanita Parekh: Yeah. So non-fatal strangulation is something that we know is increasing in terms of reporting, in all populations, in all developed countries. And, you know, when I started in sexual assault, it was about 2% of our cases.

[00:19:39] Vanita Parekh: Now it's about 25% of our cases. Um, and that's over a 25-year period. Um, when we look at things like domestic violence, it's about 50% of the cases that we're seeing

[00:19:51] Dr Sanjaya Senanayake: And Vanita, so it can be its own thing or all part of a sexual assault.

[00:19:57] Vanita Parekh: That's correct. So, it can be used, it can be part of a sexual assault as you say, or it can be part of the family violence scenario.

[00:20:07] Vanita Parekh: And, and what we found actually in one of our studies was that it was about 93% of people who were strangled or, experienced non-fatal strangulation in the ACT. It was from a family member or a partner. So, certainly in the domestic violence setting, it's also very gendered violence.

[00:20:27] Vanita Parekh: Um, 95% of our patients who presented were female. And what was really incredible in that study was that in 28% of patients who experienced non-fatal strangulation, their children witnessed what was going on.

[00:20:41] Dr Sanjaya Senanayake: Wow.

[00:20:42] Vanita Parekh: So, then we think about what effect that has on that child growing up in terms of becoming a victim.

[00:20:49] Vanita Parekh: Because if you grow up in a household with domestic violence, you're much more likely to become a victim. And there's also some data, which really sadly, shows that, you're more likely to become a perpetrator. Um, but it's not absolutely by. It's a small difference that we are aware of, but it certainly sits there.

[00:21:08] Vanita Parekh: So, I think, lots of things came out that collaborative working again with police officers and, um, you know, we saw the repeat offense rate, in about 65% of cases. So, what we know is that these offenders keep doing this to the same victims and the presence of children for me is tragic.

[00:21:34] Dr Sanjaya Senanayake: It's heartbreaking.

[00:21:35] Vanita Parekh: The other thing that came out of that initial research was a need for forensic photography at the time of, when police attend those domestic violence incidents. And, um, we know that body-worn camera evidence, for instance, has really good quality. So, we can have images, um, of, someone's body or well for, for their neck.

[00:22:00] Vanita Parekh: I mean obviously they not, not anywhere that's not exposed, but we can get all those images, and we can actually look at them, and that again, has a huge evidentiary value. Whilst we were doing that research, what we noticed just, we're talking about logistic regression before we started, was that there's a strong association with eye injury and non-fatal strangulation.

[00:22:21] Vanita Parekh: We found that in, in over 40% of cases, the people that presented after family violence had an eye injury, and we looked at this a bit more closely. Blunt force injury to the eye actually has lifetime consequences. We often think of just, you know, black eye and now has black eye, but actually it has much higher rates of things like glaucoma in later life.

[00:22:47] Vanita Parekh: So, these patients actually need to be screened for the rest of their life through an optometrist.

[00:22:52] Dr Sanjaya Senanayake: Wow.

[00:22:52] Vanita Parekh: Um, and so, you know, again, that's that collaborative working. Um, what we did was in this paper, we looked at the patients who had eye injuries and because we wanted to illustrate what type of eye injury that was.

[00:23:08] Vanita Parekh: We had to use a picture of somebody with an eye injury. And of course we couldn't use any patient images, so we found out about Getty Images, and we bought a Getty image and we used that. And, so we put that into the paper, and we also worked with our colleagues in policing, and we said, look, you, you know, one of the things doing this review of cases was how do we photograph eye injuries?

[00:23:30] Vanita Parekh: And we developed a scheme for photographing eye injuries. And, what we did was in this paper we actually had, you know, front of the face, eyes open, eyes closed, looked left right up and down. Um, and we were talking to police about this and, one of the co-authors on the paper said, actually we can have this on our evidence collection systems, um, on the phones that police take out to every incident.

[00:23:58] Vanita Parekh: So, it tells police officers: Take this sequence and, you know, all photographs and they can be interpreted by, you know, an ophthalmologist in Japan. Anybody can look at those. So that evidence is there right from the beginning. And we not, not only ruling out across ACT policing, but also AFP. So, the whole of the federal poilce and New South Wales have picked up on it and, Victorian Police.

[00:24:26] Vanita Parekh: So, we are getting, you know, these findings from collaborative work are amazing. So, we traditionally feel quite sort of, what can we actually do in Canberra? You know, research can't be that impactful. Actually, we can be even more impactful. Um, and we've shown that. The other thing that happens and other police forces are taking this on board are when police officers see an eye injury in family violence, they automatically ask about non-fatal strangulation.

[00:24:55] Dr Sanjaya Senanayake: Oh, wow.

[00:24:55] Vanita Parekh: And the victim liaison officers organise an optometry review for those patients within two weeks under Medicare. So, they sit with that patient, they go, look, you need to go and see an optometrist, let's, I can help you book that in. And so, these are, although they're small changes, they're actually have got really big consequences, and we probably won't see the results of that for another 30 years.

[00:25:22] Vanita Parekh: We're not going to be able to measure that. I don't think that, you know, if you can't measure it, you can't improve it. And that was Lord Kelvin who was, also worked at the University of Glasgow. Yeah.

[00:25:33] Dr Sanjaya Senanayake: Where you from?

[00:25:34] Vanita Parekh: Where I studied medicine. Um, I wouldn't say I was from there, I was from Edinburgh. Um, so, you know, that was a pretty big paper in terms of, what the implications were.

[00:25:44] Vanita Parekh: So, we're making these little steps for in, in terms of how we address domestic violence in our community. Nobody has one fix all answer, and we, it's just these little things that we're going to do that will change practice.

[00:26:00] Dr Sanjaya Senanayake: It's extraordinary, and I was always thinking back to one of my tutors when I was doing a master's in applied epi and he would say, if you're ever doing research, just don't do it for research sake.

[00:26:13] Dr Sanjaya Senanayake: There's the so what factor? The, so what, what is it going to do? Is it going to make a difference? And clearly this, this research or that you've described is making a big impact, not just in the ACT but in other jurisdictions and probably internationally as well. So that's, that's wonderful to see.

[00:26:31] Vanita Parekh: Yeah. I, I don't think there's any point.

[00:26:33] Vanita Parekh: No. I think Fred Hollows said something along the lines of, no survey without service. So, you know, and we do need to think about that. And now we might not see the clinical applications, which is why it's really important to have different people on your research team. Um, and I absolutely agree.

[00:26:50] Vanita Parekh: I mean, I wasn't interested in doing esoteric research. This comes from being a clinician of 32 years. Um, and then thinking, well, how do we look at this to make a difference.

[00:27:02] Dr Sanjaya Senanayake: And in terms of recognising non-fatal strangulation, I can tell you many, many years ago when I was an intern or as a medical student, I can't ever recall being taught how to recognise signs of domestic violence.

[00:27:19] Dr Sanjaya Senanayake: Has that changed? Now, if a woman presents with an eye injury to the emergency department. Have the doctors and nurses being trained to recognise it as potentially domestic violence or assault?

[00:27:34] Vanita Parekh: So that's really about the implementation of our research, and we're still doing the initial publishing in peer reviewed medical journals, but absolutely, the next phase of implementation, that will absolutely happen.

[00:27:48] Vanita Parekh: Um, so I think that, yes, how do we get this message out to police? How do we get it out to emergency clinicians? You know, one person can't do all of that. So having a combination of authors who can deliver it in a number of different settings is actually really important.

[00:28:03] Dr Sanjaya Senanayake: And just to go back to the eye injury as well.

[00:28:05] Dr Sanjaya Senanayake: So, with the eye injury, we're not talking about little petechial haemorrhages from the strangulation itself. We're talking about someone being punched in the eye during strangulation.

[00:28:17] Vanita Parekh: Yes, we’re talking about, um, all different types of eye injuries actually. So, it does include particular injury as well at our particular conjunctival particularly, but it does in lid and conjunctival.

[00:28:28] Vanita Parekh: Conjunctival injuries were actually what we focused on, right? So yes, you're absolutely right. It's from the direct application of blunt force to the eye.

[00:28:37] Dr Sanjaya Senanayake: And Vanita, we've talked about testing for STIs in, in these victims that, as you say, many of them are so traumatised when you first meet them, they're, that's even a secondary thought for them.

[00:28:53] Dr Sanjaya Senanayake: How often are STIs a consequence of sexual assault in men and women?

[00:28:57] Vanita Parekh: So, we did publish a paper, with some fantastic colleagues from Canberra Sexual Health Centre. And what we. It's very difficult because of the nature of testing to determine whether the sexually transmitted infection arose from the sexual assault or whether it arose, from a pre-existing infection.

[00:29:17] Vanita Parekh: And that's because the test that we've got for sexually transmitted infections now is so incredible that they pick up the smallest domains, which is brilliant, but it doesn't help us work out who got an STI from the sexual assault. Um, so even, we don't actually know, and I don't think we'll ever find this out, was it from a pre-existing infection.

[00:29:42] Vanita Parekh: Um, but what we did find was that patients were willing to be tested. They wanted to be tested, and that's fantastic. So, what we can say after sexual assault is let us test you. Um, our results really did show, a prevalence in keeping with what we have in our general population in Canberra. Um, so we can't necessarily apply that to say, Northern Territory, where STR rates might be higher.

[00:30:07] Vanita Parekh: But what we could, what we did find was that patients really wanted this testing. Um, and the other thing was, despite doing a lot of logistic regression, there were absolutely no factors that were associated with, um, the acquisition of STI, so you might think things like the number of assailants, for instance, or the level of gentle injury or, and we couldn't find anything.

[00:30:30] Vanita Parekh: And that just about drove me a bit wild because I was trying to find a factor and I actually couldn't find it. But what's really exciting is that we've got people who've done the same research in Norway and also in Ireland and they found exactly what we found. So, we know that this is a real result.

[00:30:48] Vanita Parekh: And in fact, I'll be off to work on some international collaborative work with the Irish, which is really exciting. Um, and thinking about, 'cause they want to learn how we've done this case tracking for instance. Through the, and it's very, it's, it's quite straightforward. Um, so they we're going to work with the Irish, um, potentially to look at that so that, you know, you always.

[00:31:09] Vanita Parekh: I think, and, and you'd be aware of this, when you get research out, you're thinking, oh, somebody else got in before me. But actually, what it does is it confirms that that person's research wasn't isolated or once off. So we, we all have a role to play in that. Um, and it's not just victims that we see. We also see perpetrators.

[00:31:33] Dr Sanjaya Senanayake: That's interesting.

[00:31:35] Vanita Parekh: And so, we've described, a lot of perpetrator demographics as well. Um, we sample, we do take forensic specimens.

[00:31:43] Dr Sanjaya Senanayake: Vanita, I’m just going to ask, why would you get asked to see a perpetrator?

[00:31:46] Vanita Parekh: So, for, for lots of different reasons. Firstly, to see if they're fit enough to participate in a police interview.

[00:31:54] Vanita Parekh: So, there's lots of things that influence how somebody might behave in a police interview. And these include medical things. So, for instance, if you haven't had enough sleep, if you haven't slept for 17 hours, your psychomotor retardation is as if you're at 0.05. If you haven't slept for 24 hours, your retardation is about 0.1.

[00:32:17] Vanita Parekh: Adding on top of that any alcohol that someone might have consumed. Now, we wouldn't expect someone to be a safe driver at 0.1. So why would we expect them to be able to calculate their own advantage in a police interview situation? So, you know, that's about getting good evidence.

[00:32:36] Vanita Parekh: It's about the admissibility of this evidence that we don't want false convictions. False convictions are really bad. That's where somebody has been convicted wrongly. They end up potentially in prison or something like that for something they didn't do, and the real perpetrator is out walking around.

[00:32:56] Vanita Parekh: So, we need to be able to minimise the chance of a false confession. And that's through sort of, fitness for interview assessments, but we also take specimens, forensic specimens from suspects, and that can be very useful, when we're looking at tying those cases together. Um, and obviously some of those sites cannot be accessed by police and parts of the body and things like that, and so we might have to take those specimens.

[00:33:25] Vanita Parekh: So, and we also provide medical care to people in police custody and, and about half of people, up to a half of people who are in police custody aren't there because they're there for any criminal reason they're there 'cause they can't look after themselves 'cause they're too intoxicated with alcohol or other substances or something like that.

[00:33:42] Vanita Parekh: So actually, that is the missing piece. You know, we actually need to make sure that the evidence that we get from suspects is robust, and, and that's absolutely a critical role for a forensic physician. So, it's not always about victims, it's about a whole range of other issues.

[00:34:01] Dr Sanjaya Senanayake: Vanita, I think we could keep talking for ages, but unfortunately we have to draw this wonderful discussion to a close.

[00:34:09] Dr Sanjaya Senanayake: You’ve taken us in depth into the world of forensic medicine. Talked about the amazing research you've generated here in the ACT with collaborations that you can really only do in the ACT and talked about the jurisdictional and international implications of that. Thank you so much for coming in today to speak to me, and thank you so much for the wonderful work you're doing in forensic medicine.

[00:34:33] Dr Sanjaya Senanayake: Thank you, Sanjaya.

[00:34:41] Dr Sanjaya Senanayake: Thank you for listening. I hope you'll join us behind the curtain for our next episode where we'll delve into the story of another of our fantastic health professionals here at Canberra Health Services. If you're interested in starting an exciting career with us, head to our website to join Team CHS, and that website is www.canberrahealthservices.act.gov.au

[00:35:31] Dr Sanjaya Senanayake: I acknowledge the Ngunnawal people as traditional custodians of the ACT, the land I'm recording on, and recognise any other people or families with connection to the lands of the ACT and region.