Why Did It Take 9 Hours and 3 Emergency Rooms For This Woman to Get a Rape Kit?
Dinisha Ball and her best friend Loraine* pushed their way through a crush of people at Houston’s upscale Belvedere Club to an empty space near the back of the courtyard, where a crowd had gathered outside to hear the live band.
迪尼莎·鲍尔 (Dinisha Ball) 和她最好的朋友洛兰 (Loraine)* 在休斯顿高档丽城俱乐部的人群中挤过，来到庭院后面附近的一个空地，外面聚集着一群人听现场乐队演奏。
The friends had left their partners at home — Dinisha’s fiancé, Daniel Koza, and Loraine’s boyfriend, Charles* — in favor of a girls’ night to celebrate Dinisha’s new job and a promotion for Loraine that would relocate her to California.
朋友们把他们的伴侣——迪尼莎的未婚夫丹尼尔·科扎和洛兰的男朋友查尔斯*——留在家里，转而举办一个女孩之夜，庆祝迪尼莎的新工作，以及洛兰的升职，并将把她搬到加利福尼亚。
It might be one of their last times together for a while.
这可能是他们最后一次在一起。
They had to make it count.
他们必须让它发挥作用。
The women had taken their time getting ready at Loraine’s hotel room at the nearby Marriott, where she was temporarily living in preparation for the cross-country move.
妇女们在洛兰位于附近万豪酒店的酒店房间里花了很多时间做准备，她暂时住在那里，为跨国搬家做准备。
After their first round of vodka cranberries at the club, they moved inside and claimed two spots at the corner of the bar, where they’d have more room to talk.
在俱乐部喝完第一轮蔓越莓伏特加后，他们搬进酒吧，在酒吧拐角处占据了两个位置，这样他们就有更多的谈话空间。
As the dance floor came alive, Dinisha caught the bartender’s attention and ordered another vodka cranberry.
当舞池活跃起来时，迪尼莎引起了调酒师的注意，并点了另一杯伏特加蔓越莓。
"I can’t finish this by myself," she shouted to Loraine over the noise.
“我一个人无法完成这件事，”她在噪音中对洛兰喊道。
"I’ll help," Loraine said.
“我会帮忙的，”洛兰说。
Soon the women left their drink to dance.
很快，女人们就放下酒杯去跳舞了。
Various men approached them, but they demurred — they wanted to be alone.
各种各样的男人接近他们，但他们表示反对——他们想一个人呆着。
At some point, a tall man in an expensive-looking suit approached Dinisha.
不知什么时候，一个穿着看起来很昂贵的西装的高个子男人走近迪尼莎。
He leaned in, but the music was too loud for her to make out his words; she just smiled and nodded, taking note of his nice white teeth.
他倾身向前，但音乐太大声，她听不清他的话。她只是微笑着点点头，注意到他洁白的牙齿。
"What’s your phone number?" he shouted.
“你的电话号码是多少？”他喊道。
Dinisha called back, "I have a fiancé," she said, shaking her head no.
迪尼莎回电话说，“我有一个未婚夫，”她摇摇头说“不”。
Dinisha’s eyes creaked open.
迪尼莎的眼睛吱吱地睁开。
She blinked, confused.
她眨着眼睛，一脸困惑。
Where was she?
她在哪里？
Where was Loraine?
洛兰在哪里？
She felt dizzy; her head was shrouded in fog.
她感到头晕；她的头被雾气笼罩。
Then terror started to wash over her as she realized she wasn’t at home, in her own bed, with Daniel.
然后，当她意识到自己不在家，不在自己的床上，和丹尼尔在一起时，恐惧开始笼罩着她。
Another face came in to focus next to her.
另一张脸出现在她旁边。
White teeth.
牙齿洁白。
The man in the expensive suit.
那个穿着昂贵西装的男人。
"I can’t be here," Dinisha muttered, scared and disoriented, as she pushed him away.
“我不能在这里，”迪尼莎一边嘟哝着，一边把他推开，既害怕又迷失方向。
"I have a fiancé; we have a kid."
“我有一个未婚夫，我们还有一个孩子。”
She stumbled off the bed and staggered down the hallway, repeating Loraine’s hotel room number aloud to herself like a mantra.
她跌跌撞撞地从床上下来，摇摇晃晃地沿着走廊走下去，像咒语一样大声地对自己重复着洛兰的酒店房间号码。
In her confusion, Dinisha assumed she was at her friend’s hotel; if she could just find Loraine’s room, everything would be fine.
迪尼莎很困惑，以为自己是在朋友的旅馆里。如果她能找到洛琳的房间，一切就都好办了。
She didn’t feel drunk — it was something different, like her body was completely disconnected from her mind.
她并没有感到醉——这是一种不同的感觉，就像她的身体与她的思想完全脱节一样。
The man followed Dinisha down the hallway, grabbing her arm and steering her back to his room.
该男子跟随迪尼莎穿过走廊，抓住她的手臂，带她回到自己的房间。
"I’m taking you to see your son," he said.
“我带你去见你的儿子。”他说。
Hours later, Dinisha woke up again, still wearing her black-and-orange striped club dress.
几个小时后，迪尼莎再次醒来，仍然穿着黑橙条纹俱乐部礼服。
The man was on top of her.
男人压在她身上。
Now she felt more in control.
现在她感觉自己更有掌控力了。
"Get off me!" she screamed.
“放开我！”她尖叫起来。
He didn’t argue.
他没有争辩。
Instead, he stood up and handed Dinisha her underwear, as casually as a waiter would hand her a bill.
相反，他站起来，把内衣递给迪尼莎，就像服务员递给她账单一样随意。
How could I have gone home with this guy?
我怎么可能和这个家伙一起回家呢？
she wondered, horrified, as she pulled on her underwear with shaky hands.
当她用颤抖的手拉上内衣时，她惊恐地想知道。
She would never cheat on Daniel.
她永远不会欺骗丹尼尔。
"Do you want a ride back to your car?" the man offered.
“你想搭车回你的车吗？”男人提议道。
Dinisha just wanted to get away, but as she looked around, she found she had nothing with her: No cell phone or purse.
迪尼莎只想离开，但当她环顾四周时，她发现自己什么也没带：没有手机，也没有钱包。
Numbly, she followed him out of the apartment.
她麻木地跟着他出了公寓。
As she left, she noticed that there was no furniture in the apartment other than a bed.
当她离开时，她发现公寓里除了一张床之外没有任何家具。
And a pile of shoes, stacked up by the door.
还有一堆鞋子，堆在门边。
A bang on the front door woke up Charles, who’d drifted into an uneasy sleep after putting Loraine under a cold shower.
前门的一声巨响吵醒了查尔斯，他在给洛兰洗了冷水澡后就睡着了。
He’d discovered her at the Belvedere at 1 a.m., making out with a stranger — her eyes glassy, a blank expression on her face — after he’d gone to pick up the duo.
凌晨 1 点，他在 Belvedere 去接两人后发现了她，当时她正在和一个陌生人亲热——她的眼睛呆滞，脸上表情茫然。
When he tried to call Dinisha’s cell, it rang from inside Loraine’s clutch, where he also found Dinisha’s credit cards, cash, and keys.
当他试图拨打迪尼莎的手机时，洛兰的手机里响起了铃声，他还在那里找到了迪尼莎的信用卡、现金和钥匙。
Charles had assumed Daniel had come to pick her up; it crossed his mind that maybe Dinisha had gone home with someone else, but he didn’t want to cause trouble by calling Daniel to check.
查尔斯以为丹尼尔是来接她的；但事实并非如此。他突然想到，也许迪尼莎已经和别人一起回家了，但他不想打电话给丹尼尔去查，以免引起麻烦。
He opened the hotel room door to find Dinisha, sobbing and gasping for breath.
他打开酒店房间的门，发现迪尼莎正在抽泣，气喘吁吁。
She pushed past Charles, crawled under the covers, and curled up next to Loraine.
她推开查尔斯，爬到被子下面，蜷缩在洛兰身边。
She didn’t really know how to explain what had happened: The man with the white teeth had given her a ride to the hotel in his black BMW and driven away.
她实在不知道该如何解释发生的事情：那个白牙男人开着他的黑色宝马送她去酒店，然后开走了。
She was too distraught to say anything else.
她心烦意乱，说不出其他的话。
Loraine, now fully coherent, gave Charles a look.
洛兰现在已经完全明白了，她看了查尔斯一眼。
"Call Daniel," she said.
“打电话给丹尼尔，”她说。
Daniel had been frantic since he’d woken up at 4 a.m.
丹尼尔从凌晨 4 点起床后就一直处于疯狂状态。
and realized Dinisha wasn’t there.
并意识到迪尼莎不在那里。
He’d called her 23 times by now.
到目前为止，他已经给她打了 23 通电话。
(He didn’t know Loraine or Charles well enough to have their phone numbers.) Dinisha was too upset to talk to Daniel herself, so she gave Charles Daniel’s phone number.
（他不太了解洛兰或查尔斯，无法知道他们的电话号码。） 迪尼莎很沮丧，无法亲自与丹尼尔交谈，所以她给了查尔斯·丹尼尔的电话号码。
When Daniel arrived, with their 2-year-old trailing him, he found Dinisha lying in Loraine’s lap, sobbing.
当丹尼尔带着他们两岁的孩子跟着他到达时，他发现迪尼莎躺在洛兰的腿上哭泣。
He knew right away that they’d both been drugged.
他立刻就知道他们都被下了药。
"I’ve never seen her look like this before," Daniel said to Charles, as panic rose in his chest.
“我以前从没见过她这个样子，”丹尼尔对查尔斯说道，心中一阵恐慌。
Charles agreed: "I think they were roofied."
查尔斯同意：“我认为他们有屋顶。”
Dinisha reached out to her son, but he recoiled, scared to see his mother crying.
迪尼莎向儿子伸出手，但儿子却退缩了，因为害怕看到母亲哭泣。
"Just take me home," she begged Daniel.
“带我回家吧，”她恳求丹尼尔。
"We need to get you to a doctor," Daniel insisted, staying calm and logical, as he usually did in high-stress situations.
“我们需要带你去看医生，”丹尼尔坚持说，保持冷静和逻辑，就像他在高压情况下通常所做的那样。
Daniel carried her to their gray Dodge and buckled their son into his car seat.
丹尼尔把她抱到他们的灰色道奇车上，然后把他们的儿子扣到汽车座椅上。
Dinisha stared out the window and tried to take deep breaths.
迪尼莎凝视着窗外，试图深呼吸。
At the hospital, she’d be safe.
在医院，她会很安全。
"I think she’s been sexually assaulted," Daniel said, gesturing to Dinisha and holding their son on his hip, when they walked up to the counter of St. Michael’s Emergency Room-Westheimer, the emergency room closest to Loraine’s hotel, about 20 minutes away.
“我认为她受到了性侵犯，”丹尼尔指着迪尼莎说，并把儿子抱在臀部，然后他们走到圣迈克尔韦斯特海默急诊室的柜台，这是距离洛兰酒店最近的急诊室，距离大约 20 分钟路程。
Still in shock and fuzzy from the drugs she’d been given, Dinisha hadn’t been able to tell Daniel exactly what happened, but Daniel knew that if she’d been raped, she’d need a rape kit — a forensic evidence-collecting exam that can lead to identifying an assailant through their DNA.
迪尼莎仍然对服用的药物感到震惊和模糊，无法告诉丹尼尔到底发生了什么，但丹尼尔知道，如果她被强奸，她需要一个强奸工具包——一种法医取证检查，可以通过 DNA 识别袭击者。
The receptionist hesitated.
接待员犹豫了。
"Do you have any insurance?" she asked.
“你有保险吗？”她问道。
Dinisha and Daniel looked at each other in disbelief.
迪尼莎和丹尼尔难以置信地看着对方。
That was it?
就是这样吗？
Dinisha’s new job did offer health insurance, but she had to wait 90 days before it kicked in, and she’d only started a few days prior.
迪尼莎的新工作确实提供健康保险，但她必须等待 90 天才能开始工作，而且她是在几天前才开始工作的。
"That shouldn’t be the first question that you ask me when we ask for a rape kit," Daniel said, his voice rising in anger.
“当我们索要强奸工具包时，这不应该是你问我的第一个问题，”丹尼尔说，他的声音因愤怒而提高。
"We can pay."
“我们可以付钱。”
"We need insurance to perform anything," the receptionist explained.
“我们做任何事情都需要保险，”接待员解释道。
"If she doesn’t have any insurance, we can’t see her."
“如果她没有任何保险，我们就看不到她。”
This would be the first time that an emergency room turned Dinisha away on that day.
这将是迪尼莎当天第一次被急诊室拒绝。
It wouldn’t be the last.
这不会是最后一次。
It’s hard enough for sexual assault survivors to report a rape at all: Only 15.8 to 35 percent of survivors do, according to the U.S. Bureau of Justice .
对于性侵犯幸存者来说，举报强奸案已经很困难了：根据美国司法局的数据，只有 15.8% 至 35% 的幸存者会举报。
(Rape is so woefully underreported that exact statistics are impossible to come by.) And while the rape kit backlog has been well reported — the hundreds of thousands of untested kits sitting in police departments nationwide — what’s lesser-known is that getting a rape kit is not as simple as heading to the nearest emergency room.
（可悲的是，强奸案的报道严重不足，无法获得准确的统计数据。）虽然强奸工具包积压的情况已经得到了充分报道——全国各地的警察部门里有数十万个未经测试的工具包，但鲜为人知的是，获取强奸工具包并不像前往最近的急诊室那么简单。
Once there, survivors are often faced with compounding obstacles to care, from the lack of emergency personnel trained to accurately perform rape kits, to buck-passing between insurers and hospitals around who is billed for that care, to loophole-filled state and federal laws that are often murky and unclear even to legal experts.
一旦到达那里，幸存者往往会面临复杂的护理障碍，从缺乏经过培训能够准确执行强奸包的急救人员，到保险公司和医院之间围绕谁负责护理费用的相互推诿，以及充满漏洞的州和联邦法律，这些法律甚至对法律专家来说也往往是模糊和不清楚的。
Daniel didn’t understand.
丹尼尔不明白。
Why did they have to go somewhere else?
为什么他们必须去别的地方？
Wasn’t rape an emergency?
强奸不是紧急情况吗？
St. Michael’s Emergency Room-Westheimer has since closed down, but it was part of a Texas-based chain of for-profit freestanding emergency departments.
圣迈克尔韦斯特海默急诊室现已关闭，但它是德克萨斯州一家营利性独立急诊科连锁机构的一部分。
In Texas, licensed and operating freestanding ERs are not supposed to turn away patients based on an ability to pay, said Christine Mann, a press officer at the Texas Department of State Health Services.
德克萨斯州卫生服务部新闻官员克里斯蒂娜·曼 (Christine Mann) 表示，在德克萨斯州，获得许可并运营的独立急诊室不应因患者有支付能力而拒绝患者。
A federal law passed in 1986 known as EMTALA (the Emergency Medical Treatment and Labor Act) requires that anyone who walks into an emergency room be treated, whether they can pay or not; while freestanding ERs in Texas are not mandated to follow EMTALA, a section of the Texas Administrative Code , which Mann is referring to, uses similar language.
1986 年通过的联邦法律 EMTALA（《紧急医疗和劳工法案》）要求任何走进急诊室的人都必须接受治疗，无论他们能否付费；虽然德克萨斯州的独立急诊室没有强制要求遵守 EMTALA，但 Mann 提到的德克萨斯州行政法规的一部分使用了类似的语言。
Another state law — Texas Senate Bill 1191, passed in 2013 — should have offered Dinisha further options.
另一项州法律——2013 年通过的德克萨斯州参议院第 1191 号法案——本应为迪尼沙提供更多选择。
S.B.
S.B.
1191 mandates that all Texas emergency rooms have staff trained in basic forensic evidence collection , even though most emergency doctors receive little to no training in how specifically to treat sexual assault patients, administer rape kits, or collect forensic evidence.
1191 法案要求德克萨斯州所有急诊室的工作人员都接受过基本法医证据收集方面的培训，尽管大多数急诊医生几乎没有接受过关于如何具体治疗性侵犯患者、管理强奸工具包或收集法医证据的培训。
(In fact, there is no standard forensic medicine training protocol for emergency medicine residents at all.) If they don’t have anyone on staff who can perform a rape kit, they’re supposed to help patients get to a hospital that does.
（事实上，根本没有针对急诊科住院医师的标准法医培训方案。）如果他们的工作人员中没有可以执行强奸套件的人员，他们应该帮助患者前往能够执行强奸套件的医院。
So at the very least, Dinisha was legally entitled to a screening exam and a transfer to another ER.
因此，至少，迪尼莎在法律上有权接受筛查检查并转移到另一个急诊室。
In an email, St. Michael’s chief financial officer Brian Orsak said that its facilities don’t have to comply with S.B.
St. Michael 首席财务官 Brian Orsak 在一封电子邮件中表示，其设施不必遵守 S.B.
1191, because the law only applies to "licensed hospitals with emergency departments" — not to "licensed free-standing emergency medical care [facilities]." (Chris Van Deusen, another Texas Department of State Health Services press officer, confirmed Orsak’s interpretation of S.B.
1191，因为该法律仅适用于“设有急诊科的持牌医院”，而不适用于“持牌独立紧急医疗[设施]”。 （德克萨斯州卫生服务部另一位新闻官员 Chris Van Deusen 证实了 Orsak 对 S.B. 的解释。
1191 — which points to a significant loophole, since freestanding emergency rooms look identical to hospital-affiliated ones to patients.)
1191——这指出了一个重大漏洞，因为对于患者来说，独立式急诊室看起来与医院附属的急诊室完全相同。）
For her part, Dinisha was still too much in shock to register what had happened and followed Daniel back to the car.
就迪尼莎而言，她仍然处于震惊之中，无法注意到发生了什么，于是跟着丹尼尔回到了车上。
As they walked through the parking lot, Daniel noticed Dinisha was barefoot.
当他们穿过停车场时，丹尼尔注意到迪尼莎赤着脚。
"I have extra sneakers in the trunk," he offered.
“我的后备箱里还有多余的运动鞋，”他说道。
But Dinisha just shook her head, silent.
但迪尼莎只是摇摇头，一言不发。
She climbed into the passenger seat, curled up into a fetal position, and closed her eyes.
她爬进副驾驶座，蜷缩成胎儿的姿势，闭上了眼睛。
After driving for half an hour through Houston’s choking, muggy traffic, Dinisha and Daniel arrived at West Houston Medical Center.
在休斯顿令人窒息、闷热的交通中行驶了半小时后，迪尼莎和丹尼尔抵达西休斯顿医疗中心。
The receptionist asked for Dinisha’s ID, but as she didn’t have any identification on her — her belongings were still with Loraine — Daniel gave her his own ID instead.
接待员要求迪尼莎提供身份证件，但由于她身上没有任何身份证明——她的物品仍在洛兰身边——丹尼尔给了她自己的身份证件。
Dinisha collapsed into an office chair, staring at the ground.
迪尼莎倒在一张办公椅上，盯着地面。
Daniel stood, keeping one eye on their son, who played with a Batman toy, and one eye on Dinisha.
丹尼尔站着，一只眼睛注视着正在玩蝙蝠侠玩具的儿子，另一只眼睛注视着迪尼莎。
Minutes passed in silence and turned into hours.
几分钟在寂静中过去，变成了几个小时。
Finally, Daniel called his mother to collect their son.
最后，丹尼尔打电话给他的母亲来接他们的儿子。
A nurse took Dinisha’s vitals: her blood pressure, her temperature, and did some basic blood work.
一名护士测量了迪尼莎的生命体征：血压、体温，并做了一些基本的血液检查。
But when first Daniel, and then Dinisha, asked for a rape kit multiple times, they were told to wait.
但当丹尼尔和迪尼莎多次要求提供强奸工具时，他们被告知要等待。
"You need to see a doctor," a nurse replied.
“你需要去看医生。”一名护士回答道。
"We can’t do it."
“我们做不到。”
When a doctor finally appeared in the waiting room, he said the same thing — that he couldn’t perform one.
当一位医生最终出现在候诊室时，他说了同样的话——他无法进行手术。
"You don’t have a rape kit on hand?" Daniel replied, increasingly frustrated.
“你手边没有强奸工具吗？”丹尼尔回答道，语气越来越沮丧。
"It’s not that we don’t have one on hand..." the doctor said, handing Daniel a list with the names of two other hospitals.
“我们手头并不是没有……”医生一边说，一边递给丹尼尔一张清单，上面有另外两家医院的名字。
"It’s that you need to go to one of these."
“你需要去其中之一。”
The doctor didn’t specify the reason why he couldn’t perform a rape kit, but Dinisha’s experience likely would have been much different if the hospital had a Sexual Assault Nurse Examiner (SANE) on staff — a registered nurse who receives specialized training in how to collect forensic evidence for rape kits and care for sexual assault survivors’ physical and emotional needs.
医生没有具体说明他无法执行强奸工具包的原因，但如果医院配备一名性侵犯护士检查员 (SANE)，迪尼莎的经历可能会大不相同。SANE 是一名注册护士，接受过如何收集强奸工具包的法医证据以及照顾性侵犯幸存者的身体和情感需求方面的专门培训。
West Houston Medical Center did not have any SANEs at the time of Dinisha’s assault, and still does not.
迪尼莎遭受袭击时，西休斯顿医疗中心没有任何 SANE，现在仍然没有。
In the mid-1970s, in response to reports of rape victims waiting in emergency departments for hours for inadequate care, nurses launched the first SANE forensic training programs.
20 世纪 70 年代中期，针对强奸受害者因护理不足而在急诊室等待数小时的报道，护士启动了第一个 SANE 法医培训计划。
According to Jennifer Pierce-Weeks, the interim CEO of the International Association of Forensic Nurses (IAFN), most SANEs today also have other nursing jobs, often in emergency departments or maternal child health.
国际法医护士协会 (IAFN) 临时首席执行官 Jennifer Pierce-Weeks 表示，如今大多数 SANE 还从事其他护理工作，通常是在急诊科或妇幼保健部门。
The job isn’t standardized from state to state: Some emergency departments have SANEs on call 24 hours a day, but many do not.
这项工作在各州之间并没有标准化：一些急诊部门有 24 小时待命的 SANE，但许多部门没有。
Some emergency departments pay SANEs a higher salary, but many do not.
一些急诊科向 SANE 支付更高的工资，但许多急诊科却没有。
The value of SANEs is undeniable, however.
然而，SANE 的价值是不可否认的。
When a trained forensic nurse administers a rape kit, the "quality and consistency of collected evidence" improves dramatically, found a study from the Office for Victims of Crime Bulletin .
犯罪受害者办公室的一项研究发现，当训练有素的法医护士使用强奸工具包时，“收集到的证据的质量和一致性”会显着提高。
That study also found that kits collected by trained examiners are more likely to include proper collection and labeling of evidence, a complete crime lab form, and the correct number of swabs and other evidence, such as pubic hairs and head hairs.
该研究还发现，由训练有素的检查人员收集的工具包更有可能包括正确收集和标记证据、完整的犯罪实验室表格以及正确数量的拭子和其他证据，例如阴毛和头发。
This increased quality of evidence translates into higher rates of convictions .
证据质量的提高意味着定罪率的提高。
But many hospitals don’t have enough sexual assault certified providers to meet patient need.
但许多医院没有足够的性侵犯认证提供者来满足患者的需求。
"We don’t know how many SANEs or SANE programs there are across the United States because there is no mandated tracking system in place for that information," said Pierce-Weeks.
“我们不知道全美有多少 SANE 或 SANE 项目，因为没有针对这些信息的强制跟踪系统，”Pierce-Weeks 说。
Based on voluntarily entered information, though, she estimates that only about 13 percent of hospitals have a SANE on staff, or a SANE program.
不过，根据自愿输入的信息，她估计只有约 13% 的医院拥有 SANE 员工或 SANE 计划。
(There are currently 331 certified sexual assault nurse examiners in Texas, says Rose Luna, the deputy director of the Texas Association Against Sexual Assault; it is unknown how many of those are in the Houston area.)
（德克萨斯州反性侵犯协会副主任 Rose Luna 表示，德克萨斯州目前有 331 名经过认证的性侵犯护士检查员；目前尚不清楚其中有多少人在休斯顿地区。）
It doesn’t cost much to train a SANE.
训练一个 SANE 并不需要花费太多。
IAFN’s course in sexual assault care for adult patients is $350.
IAFN 为成年患者提供的性侵犯护理课程费用为 350 美元。
The course in pediatric sexual assault care is $450.
儿科性侵犯护理课程费用为 450 美元。
The formal IAFN certification exam costs an additional $275 to $400.
正式的 IAFN 认证考试额外费用为 275 至 400 美元。
It’s also not logistically prohibitive.
这在后勤上也不是令人望而却步的。
Courses are available both in person and online, and take roughly 40 hours to complete.
课程有面对面授课和在线授课两种方式，大约需要 40 小时才能完成。
An April 2016 Government Accountability Office Report blamed the shortage on limited availability of training, weak support for examiners from hospitals and other stakeholders, and low retention rates.
2016 年 4 月的政府问责办公室报告将短缺归咎于培训有限、医院和其他利益相关者对检查人员的支持薄弱以及保留率低。
"Some hospitals may not make SANE training a priority," explained Pierce-Weeks.
“有些医院可能不会优先考虑 SANE 培训，”Pierce-Weeks 解释道。
"Others have limited availability of education funds for nurses.
“其他国家为护士提供的教育资金有限。
Others prefer ’live’ versus online training." She added that low retention rate is due to limited resources — money, clinical mentorship programs, support from hospital administration — for continuing education and the high stress of the job.
其他人更喜欢‘现场’培训而不是在线培训。”她补充说，保留率低是由于用于继续教育的资源有限（资金、临床指导计划、医院管理部门的支持）以及工作压力大。
"You are listening to people’s trauma all the time.
“你一直在倾听人们的创伤。
There’s no way you won’t be impacted by that," she said.
你不可能不受到影响，”她说。
"In many instances, vicarious trauma takes a toll on nurses, and they don’t stay in the profession."
“在许多情况下，替代性创伤会给护士带来损失，他们不会留在这个行业。”
"While we are not a certified Sexual Assault Nurse Examiner program, we have caregivers trained in basic forensic evidence collection for sexual assault kits," West Houston Medical Center hospital spokeswoman Selena Mejia wrote in an email to Cosmopolitan.com.
“虽然我们不是经过认证的性侵犯护士检查员计划，但我们的护理人员接受过性侵犯工具包基本法医证据收集方面的培训，”西休斯顿医疗中心医院发言人 Selena Mejia 在给 Cosmopolitan.com 的电子邮件中写道。
"The emergency room physicians and nurses at the hospital strive to provide the best possible treatment at the time of the patient’s visit, and we work with them, their family members and other healthcare providers to help ensure patients receive the appropriate level of care, based on their needs.
“医院的急诊室医生和护士努力在患者就诊时提供最好的治疗，我们与他们、他们的家人和其他医疗保健提供者合作，帮助确保患者根据他们的需求获得适当水平的护理。
Our hearts go out to all victims of sexual assault." (When asked why Dinisha was not able to see one of those "caregivers trained in basic forensic evidence collection," Mejia said the hospital would not comment on specific cases.)
我们的心与所有性侵犯的受害者同在。” （当被问及为什么迪尼莎无法见到其中一位“接受过基本法医证据收集培训的护理人员”时，梅吉亚表示医院不会对具体案件发表评论。）
Daniel gazed down at the paper the doctor had given him.
丹尼尔低头看着医生给他的纸。
In Houston, the fourth-most populous city in the United States, with 2.3 million people, the paper listed only two hospitals where Dinisha could get a rape kit.
在拥有 230 万人口的美国第四大城市休斯顿，该报只列出了迪尼莎可以获得强奸工具包的两家医院。
The first option was in Galveston, Texas — 68 miles away.
第一个选择是位于 68 英里外的德克萨斯州加尔维斯顿。
The second option, Memorial Hermann Texas Medical Center, was 14 miles away.
第二个选择是纪念赫尔曼德克萨斯医学中心 (Memorial Hermann Texas Medical Center)，距此 14 英里。
While it didn’t sound far, Dinisha and Daniel knew that Houston’s weekend traffic might make it an hourlong — or more — drive.
虽然听起来不远，但迪尼莎和丹尼尔知道休斯顿周末的交通堵塞可能需要一个小时甚至更长时间的车程。
Daniel asked the receptionist for his ID.
丹尼尔向接待员要了他的身份证。
The receptionist handed him papers to sign.
接待员递给他一些文件让他签字。
"I’m not going to sign this," Daniel scoffed.
“我不会签署这个，”丹尼尔嘲笑道。
"You didn’t do anything for us!"
“你没有为我们做任何事！”
"You have to fill this out before I give back your ID," the receptionist said.
“在我把身份证还给你之前，你必须先填好这个，”接待员说。
Cursing under his breath, Daniel scribbled his name and Social Security number onto the papers.
丹尼尔低声咒骂着，在纸上写下了他的名字和社会安全号码。
Faced with the prospect of spending hours in the car en route to a third emergency room, Dinisha was ready to give up.
面对在前往第三个急诊室的途中要在车里度过几个小时的前景，迪尼莎准备放弃。
"Let’s just go home," she begged Daniel, exhausted and discouraged.
“我们回家吧，”她恳求丹尼尔，疲惫而沮丧。
She desperately had to use the bathroom, but hadn’t yet, assuming that a urine sample might be able to tell which drug had knocked her out.
她非常想上厕所，但她还没有上厕所，因为她假设尿液样本可以告诉她是哪种药物导致了她的昏迷。
Daniel squeezed her hand.
丹尼尔握紧了她的手。
He tried to stay calm: If he lost it, he knew that Dinisha would break down too.
他努力保持冷静：如果他失去了冷静，他知道迪尼莎也会崩溃。
"We can’t," he insisted, mentally preparing them both for another long wait.
“我们不能，”他坚持道，让他们俩做好再次漫长等待的心理准备。
"We have to keep trying."
“我们必须继续努力。”
Daniel noticed two other hospitals along the way along the way to Memorial Hermann — a 45-minute drive to cover 14 miles.
丹尼尔在前往赫尔曼纪念馆的路上注意到了另外两家医院——驾车 45 分钟，行驶 14 英里。
Did they not offer rape kits?
他们没有提供强奸工具包吗？
But he had been told to go to Memorial Hermann, so he stayed the course.
但他被告知要去纪念赫尔曼，所以他坚持了下来。
When they finally arrived at the receptionist’s desk, Daniel repeated what had become a familiar refrain.
当他们最终到达接待台时，丹尼尔重复了一句熟悉的话。
"We need a rape kit," he recited.
“我们需要一个强奸工具包，”他背诵道。
"She’s been sexually assaulted."
“她遭到性侵犯。”
"Actually, we suggest you go to Ben Taub [Hospital]," she replied.
“实际上，我们建议你去本陶布[医院]，”她回答道。
At that, Daniel snapped.
听到这里，丹尼尔厉声说道。
"We’ve been to two hospitals already," he yelled.
“我们已经去过两家医院了，”他喊道。
"I have the paperwork from the other hospital telling us this is where we needed to go!
“我有另一家医院的文件告诉我们这就是我们需要去的地方！
Can you do a rape kit here or not?"
你能不能在这里制作强奸套件？”
"Make it happen," Daniel interrupted her.
“让它发生，”丹尼尔打断了她。
He and Dinisha settled into a plastic chairs to wait — and decided it was time to call the police.
他和迪尼莎坐在塑料椅子上等待，并决定是时候报警了。
(In Texas, medial providers are not required to report sexual assault claims to law enforcement unless the patient requests it, said Luna.) Two officers from the Houston Police Department came to take Dinisha’s statement, while a representative from the Texas Crime Victims Compensation Program also showed up, describing different programs to help Dinisha pay her medical bills.
（卢纳说，在德克萨斯州，除非患者提出要求，否则医疗服务提供者不需要向执法部门报告性侵犯指控。）休斯顿警察局的两名警官前来听取迪尼莎的陈述，而德克萨斯州犯罪受害者赔偿计划的一名代表也出现了，描述了帮助迪尼莎支付医疗费用的不同计划。
The police promised to call Dinisha within a week.
警方承诺在一周内给迪尼莎打电话。
That evening, at 6 p.m., Dinisha was given a rape kit.
当天晚上 6 点，迪尼莎收到了一套强奸工具包。
Even though too much time had passed to detect any drugs in her system, she peed into a test cup anyway — the first time she’d used the bathroom all day.
尽管已经过去了很长时间来检测她体内的任何药物，但她还是往测试杯里撒了尿——这是她一整天第一次上厕所。
A nurse completed the exam in 30 minutes, far less than the minimum of two to three hours it takes a certified sexual assault nurse examiner to complete an adequate forensic evidence collection.
一名护士在 30 分钟内完成了检查，远远低于经过认证的性侵犯护士检查员完成充分法医证据收集所需的至少两到三个小时的时间。
Afterward, Dinisha and Daniel still had to wait for a doctor to administer antibiotics and a shot for gonorrhea, just in case.
之后，迪尼莎和丹尼尔仍然需要等待医生注射抗生素和注射淋病疫苗，以防万一。
When they left the hospital to go home at 9 p.m., it was dark outside.
晚上9点，他们出院回家时，外面天已经黑了。
Dinisha and Daniel walked across the pavement toward their car.
迪尼莎和丹尼尔穿过人行道朝他们的车走去。
The soles of Dinisha’s bare feet were thick with dirt.
迪尼莎光着脚底，沾满了厚厚的泥土。
Even for people who have spent years trying to help victims of sexual assault, it’s still jarring that something like this can happen.
即使对于多年来努力帮助性侵犯受害者的人们来说，发生这样的事情仍然会感到不安。
In July 2015, Washington Sen.
2015 年 7 月，华盛顿参议员。
Patty Murray sent a letter to the Washington State Hospital Association to express concerns after a woman told her about being turned away from a hospital where she tried to get a rape kit.
帕蒂·穆雷 (Patty Murray) 致函华盛顿州医院协会，表达了她的担忧，此前一名妇女告诉她，她试图获取强奸工具包时被一家医院拒绝。
"I assumed that if you show up at a hospital door and you are a victim of sexual assault, they’ll know what to do," said Sen.
“我认为，如果你出现在医院门口，而你是性侵犯的受害者，他们会知道该怎么做，”参议员说。
Murray, who had previously focused on sexual assault from a judicial and criminal perspective as a key advocate for the Violence Against Women Act.
默里此前曾作为《暴力侵害妇女法》的主要倡导者，从司法和刑事角度关注性侵犯问题。
"I am as shocked as everyone else that that’s not the case.
“我和其他人一样感到震惊，事实并非如此。
There is a real lack of access to trained medical examiners." Broadening the conversation to look at sexual violence from a medical perspective, she said, is a logical next step.
确实缺乏训练有素的法医。”她说，下一步应该扩大对话范围，从医学角度看待性暴力。
"Nobody has ever required people to provide information [about how extreme the shortage of sexual assault forensic nurses is] before," she said.
“以前没有人要求人们提供信息（关于性侵犯法医护士的短缺程度），”她说。
"So hospitals, states, and the federal government — each of which has a role to play in supporting survivors — have gotten away with not doing it."
“因此，医院、州政府和联邦政府——在支持幸存者方面都应发挥作用——却没有这样做。”
To that end, in May 2016, Sen.
为此，2016 年 5 月，参议员。
Murray introduced the Survivors’ Access to Supportive Care Act , which would direct $12 million to address deficits in health care for sexual assault survivors.
默里提出了《幸存者获得支持性护理法案》，该法案将拨款 1200 万美元来解决性侵犯幸存者的医疗保健赤字问题。
Among other things, the bill would establish a national training and continuing education program for SANEs and establish surveys to determine state-level needs.
除其他外，该法案将为 SANE 制定国家培训和继续教育计划，并开展调查以确定州级需求。
Months after Dinisha’s hospital visit — and not, as promised, within a week — she received a follow-up call from the Houston Police Department.
迪尼莎去医院几个月后——而不是像承诺的那样在一周内——她接到了休斯敦警察局的后续电话。
There was nothing they could do, they told her.
他们告诉她，他们无能为力。
She didn’t remember the man’s license plate number or any other identifying details.
她不记得该男子的车牌号或任何其他身份细节。
But something did arrive, soon after, in the mail: a series of bills, totaling $1,400, for the blood work and other tests done at West Houston Medical Center and Memorial Hermann Hospital.
但不久之后，邮件中确实收到了一些东西：一系列总计 1,400 美元的账单，用于在西休斯顿医疗中心和纪念赫尔曼医院进行的血液检查和其他检查。
Her application for help from the Texas Crime Victims Compensation Program had been denied — because, it claimed, Dinisha had not cooperated with the police.
她向德克萨斯州犯罪受害者赔偿计划提出的帮助申请被拒绝——据称，因为迪尼莎没有与警方合作。
"I was equally victimized by this system as I was by the guy [who raped me]," says Dinisha now, nine months later.
“我同样是这个系统的受害者，就像我是那个[强奸我]的人的受害者一样，”九个月后的迪尼莎现在说道。
"I tried to handle the situation responsibly, but it was out of my hands.
“我试图负责任地处理这个情况，但这超出了我的控制范围。
I had no control."
我无法控制。”
Cosmopolitan.com contacted the Texas Attorney General’s Office, which oversees the Crime Victims Services Division, to ask how, exactly, Dinisha did not cooperate with the police.
Cosmopolitan.com 联系了负责监督犯罪受害者服务部门的得克萨斯州总检察长办公室，询问迪尼莎到底是如何不与警方合作的。
They refused to detail specific cases.
他们拒绝详细说明具体案例。
But five days after Cosmopolitan.com reached out, Dinisha received a letter from a Crime Victims Compensation Program appeals reviewer.
但在 Cosmopolitan.com 联系五天后，迪尼莎收到了犯罪受害者赔偿计划上诉审核员的一封信。
(She had not submitted an appeal.) "After a telephone interview with officer Nicole Rose with the Houston Police Department," it read, "I was advised that you have been cooperative with the investigation.
（她没有提出上诉。）“在与休斯敦警察局警官妮可·罗斯进行电话采访后，”它写道，“我被告知你一直在配合调查。
Specifically, you gave a statement regarding the incident.
具体来说，您就该事件发表了声明。
Additionally, male DNA was found, and it is apparent that sexual contact occurred.
此外，还发现了男性 DNA，显然发生了性接触。
Therefore, this application is now approved."
因此，该申请现已获得批准。”
In a year without many victories for Dinisha, this is a small one: She’ll no longer have to pay out of pocket for the tests performed to investigate her rape.
在迪尼莎没有取得太多胜利的一年里，这是一个小小的胜利：她将不再需要自掏腰包为调查她的强奸案而进行的测试。
"I know something did happen now, but I have no recollection of it," she says.
“我知道现在确实发生了一些事情，但我不记得了，”她说。
"It’s a level of violation I will most likely never be able to move past." She and Daniel recently drove by the Belvedere, she says, and "my heart sunk.
“这种违规程度我很可能永远无法超越。”她说，她和丹尼尔最近开车经过丽城，“我的心沉了下去。
I don’t have faith in the justice system, especially since I haven’t heard anything about the rape kit results.
我对司法系统没有信心，尤其是因为我还没有听到任何有关强奸试剂盒结果的消息。
I’m just a number on a box to the police."
对于警察来说，我只是一个盒子上的号码。”
Photography by Drew Anthony Smith • Edited by Whitney Joiner • Design by Katja Cho • Senior photo editor Jennifer Newman • Research by TJ Carlin • Animation by Crystal Law
摄影：Drew Anthony Smith • 编辑：Whitney Joiner • 设计：Katja Cho • 高级照片编辑 Jennifer Newman • 研究：TJ Carlin • 动画：Crystal Law