A Safe Space for Victims of Sexual Violence in Puerto Rico: Dr. Laras & PR Health Justice Center

Coral Marí Chantada, MS2

Disclaimer: Discussion of sexual violence

Dr. Linda Laras is a distinguished puertorriqueña known for her outstanding work focused on helping victims of sexual violence in Puerto Rico. She is an OB-GYN subspecialized in Pediatric and Adolescent Gynecology, a forensic medical evaluator, and an investigator who works towards bringing awareness and care to a significantly vulnerable population. In 2015, Dr. Laras founded—and developed—the Puerto Rico Health Justice Center, located at San Juan Bautista School of Medicine [1]. As director of the center, Dr. Laras aims to provide mental and physical support to survivors of sexual violence with the help of her interdisciplinary team of experts in the field. They have social workers, psychologists, nurses, and physicians ready to help [1]. She serves both adults and children who have been victims of sexual violence. The services she provides are unique to her center and can be found nowhere else throughout the island. The services offered to the victims of sexual violence come at no cost to them since the center receives donations and grants to help cover the cost. Some of the services provided include psychosocial evaluations, therapy sessions, physical workups, forensic evaluations, guidance, and help with legal procedures, among many other aids [1]. One of the most critical steps in helping the victims is preparing them for the courtroom, which is why the PR Health Justice Center has a makeshift courtroom where victims can prepare mentally to confront a very triggering situation and obtain justice. Dr. Laras has a Master's degree in Public Health and Clinical Research and is a strong advocate for conducting research at the center since there is very little data on sexual violence in PR. As Dr. Laras stated, “The limited, rather scarce, number of services for victims of sexual violence moves me. The PR Health Justice Center, from December 2015, responds to the limited involvement of health professionals in the prevention, identification, and management of sexual violence as a public health problem.”

Before the PR Health Justice Center, Dr. Linda Laras was the director of “Proyecto de Ayuda a Víctimas de Violencia Doméstica y Sexual Orientando” (PASOS de las Mujeres) from 2002 to 2015. She was awarded, in 2018, the Director's Community Leadership Award by the FBI [2]. In 2022 she received the Pete and Weesie Hollis Community Service Award [3]. This award recognizes individuals who have performed community service of excellence in the communities with which they work [3]. In 2022 Dr. Linda Laras received two other awards: US DOJ Attorney General 2022 National Crime Victims’ Service Award - Allied Professional Service Award and Excellence Award for Service to others “Sister Isolina Ferre,” House of Representatives, Government of Puerto Rico. In addition, she has been recognized by government agencies and numerous other organizations in PR. These are just a few of Dr. Laras' achievements that inspire me and so many others, all of her accomplishments highlight her dedication and determination to help survivors of sexual violence.

When talking about key moments since the beginning of her career, she mentioned four turning points:

“One, the day I was assigned the emergency room shift, and the first victim I evaluated was someone I knew. But I didn’t know what to do, and when I asked my senior Resident, he said, ‘To follow the instructions on the box, it’s just another pelvic exam.’ I can’t describe what it had meant to me when the duty ended 36 hours later, I walked straight to the Rape Crisis Center and read everything I could find and have not stopped. It happened 36 years ago, and I see her in everything I do. Every victim deserves all I can give, and if I can’t, she deserves I find who can.

Two, working as Coordinator of an Adolescent Pregnancy program, I learned the meaning of multi-interdisciplinary teamwork and the public health perspective put into action. I was proud to see how you can turn the odds of pregnancy risks when you go beyond health into well-being, what made our reduced negative outcomes as compared to the regular prenatal clinic was the nutritionist, the vocational counselor, the family support, the self-esteem, and healthy partner relationship workshops.

Three, when I worked in Oklahoma, I chose to work with patients set aside by others, patients with disabilities, mental health problems, immigration issues, and survivors of interpersonal violence. These patients taught me how to listen, how to see beyond. I learned to feel with my patients, grow with them and heal with them.

Fourth, under Dr. Robert Block and Dr. Barbara Bonner, I learned that caring isn’t enough. I learned that transdisciplinary work is the best effective and efficient strategy to help victims in their journey towards healing and justice. I studied with Police Officers, Social Workers, Nurses, District Attorneys, and Psychologists. Violence has multiple and diverse factors that influence its impact. Therefore diverse disciplines must learn to work together with the same objective. Those are the basic concepts that have moved me to a Health Justice Service.”

Currently, Oficina de la Procuradora de las Mujeres - Gobierno de Puerto Rico has registered 4,825 incidents of domestic violence from the start of 2022 up until October 31st, 2022 [4]. On November 25th, 2022, Día Internacional de la Eliminación de la Violencia Contra la Mujer, activists chanted “Una más es demasiado” while they honored the memory of the 70 women that were murdered this year in Puerto Rico [5]. This number substantially exceeds the 53 femicides registered in 2021 [5].

Recent data published by UN Women- Americas and the Caribbean on the impact of COVID-19 and violence against women in Latin America and the Caribbean showed that “12% (approximately 19.2 million) women and girls aged between 15 and 49 have experienced physical or sexual violence by their current or former intimate partner in the 12 months preceding the survey” [6,7]. I want to note that although statistically, women are predominantly more affected by domestic violence, men are also subjected to abuse and should also be provided with the necessary health and education.

There are still challenging obstacles to overcome in order to continue efforts like these. People like Dr. Laras exemplify perseverance and dedication by using these obstacles to identify room for improvement. She recognizes the work that she is doing is worth all of her effort and does not let difficulties discourage her. When commenting about specific barriers encountered and how it has impacted her work, Dra. Laras stressed how “the lack of an interagency protocol for the intervention with sexual violence that puts into the practice as a unit the mission of each agency.” This results in disconnected efforts between the agencies involved (e.g., Police, Health, Justice, Family Services, and Courts), and this lack of strategy impacts the outcome. This is the reason why the center is developing an interagency database to evaluate each case better. Another barrier encountered by Dr. Laras is “The limited effort to develop health professionals with special training in the management of patients traumatized by victimization, by interpersonal violence. In 2014, the CDC estimated that violence had an estimated cost of 3.1 trillion. More people suffer from violence than any other health condition.” Special efforts should be directed towards addressing the lack of education on the management of patients who have experienced trauma at the medical school level. Statistics for sexual violence are alarming, and we need to be prepared to identify and help our patients if they find themselves in that situation. Exposing and teaching future physicians at the medical student level will improve the care provided to the victims of sexual violence. The fact that SJBSM opens doors to this type of program is an action in the direction of developing trauma-sensitive healthcare professionals.

Providing a platform and opening conversations to create awareness of sexual violence in Latin America and the Caribbean as a means to continue helping victims is extremely important due to the lack of special training and the alarming number of people who suffer violence. Efforts to help victims of sexual violence shouldn’t go unnoticed; we thank Dr. Laras for her amazing work in caring for victims of sexual violence and bringing to light how important it is to be educated on this topic as future physicians to provide better care for each patient.

About the Author:

I am Coral Marí Chantada, born and raised in Puerto Rico. My mother is from Argentina and my father is from Puerto Rico. I am currently 24 years old and an MS2 at SJBSoM. Since I started medical school I have been involved in projects that focused on helping victims of sexual violence. Currently I am the Social Media Manager for Proyecto Carmín (@proyectocarmin) which is a project of community service focused on providing menstrual hygiene products to victims of domestic violence staying at women’s shelters in PR. I recognize how important it is that as future physicians we learn how to treat and care for victims of violence. My medical school, SJBSoM, has the PR Health Justice Center which is directed by Dr. Laras. She is an amazing physician who has made it her life’s mission to help victims of violence, her work has inspired not only me but so many other future physicians.

About the Work:

This piece highlights the work of Dr. Linda Laras who is a puertorriqueña focusing on caring for victims of sexual violence in Puerto Rico. She is the founder and director of PR Health Justice Center, a center for victims of violence, and has received numerous awards due to her amazing work. The article sheds some light on the topic of sexual violence and how places like PR Health Justice Center need to be the norm everywhere to better help each and every patient. Sadly high rates of violence are seen in Latin America and the Caribbean and as future physicians we should receive the necessary education to manage patients who have experienced trauma. Advocacy and education on special vulnerable populations is necessary!!!

References:

1. PR HEALTH JUSTICE CENTER. Escuela de Medicina San Juan Bautista. https://www.sanjuanbautista.edu/pr-health-justice-center.html. Accessed November 26, 2022.

2. San Juan - Dr. Linda Laras. FBI.

https://www.fbi.gov/how-we-can-help-you/outreach/dcla/2018/san-juan-dr-linda-la ras. Published May 3, 2019. Accessed November 26, 2022.

3. Primera Hora. Reconocen Labor de Investigadora Linda Laras en favor de las víctimas de agresión sexual. Primera Hora.

https://www.primerahora.com/noticias/puerto-rico/notas/reconocen-labor-de-inve stigadora-linda-laras-en-favor-de-las-victimas-de-agresion-sexual. Published October 26, 2021. Accessed November 26, 2022.

4. Incidentes de Violencia Doméstica año 2022 - docs.pr.gov. Incidentes de Violencia Doméstica año 2022.

https://docs.pr.gov/files/Mujer/Estadisticas/Violencia%20Domestica/Incidentes%2 0de%20Violencia%20Dom%C3%A9stica%20A%C3%B1o%202022.pdf. Accessed November 26, 2022.

5. Capella MG. "Una más es demasiado": Nuevo llamado a las autoridades a enfrentar la crisis de Violencia de Género. El Nuevo Día.

https://www.elnuevodia.com/noticias/locales/notas/una-mas-es-demasiado-nuev o-llamado-a-las-autoridades-a-enfrentar-la-crisis-de-violencia-de-genero/. Published November 25, 2022. Accessed November 26, 2022.

6. Strategies for the prevention of violence against women in the context of covid-19 in Latin America and the Caribbean. UN Women – Americas and the Caribbean.

https://lac.unwomen.org/en/digiteca/publicaciones/2020/04/prevencion-de-la-viol encia-contra-las-mujeres-frente-a-covid-19#view. Accessed November 26, 2022. 7. Ortiz S. Violence against women in Latin America: The multiple facets of a pervasive issue - data-pop alliance. Data.

https://datapopalliance.org/violence-against-women-in-latin-america-the-multiple facets-of-a-pervasive-issue/. Published May 3, 2022. Accessed November 26, 2022.