UST CPU CASE CONFERENCE

March 14, 2018

Farah is a 16 year old female from Cavite who was brought to CPU by her mother and a local
social worker to determine if she has really been sexually abused.

HPI:

One day prior to consult, Farah was influenced by her friends to join them in a drinking spree.
She did not drink but ended up sleeping over. Her mother found her the next morning in the
next-door neighbor’s house. Her mother puller her by the hair, scratched her, dragged her out of
the house and brought her to the barangay to seek assistance in bringing her to DSWD. The
barangay advised referral to a WCPU because she might have been raped.

ROS: Unremarkable

HEADSS:

Home - Farah’s parents lived together until she was 2 years old and then separated when her
father left to work in the Middle East. She grew up with her paternal grandmother and was given
back to her mother when she was 8 years old. She has no contact with her father. Her mother
works in a factory and comes home early in the morning. Farah is the 2nd of three half-sisters
(her mother had 3 different partners). The older sister is 20 years old and living-in with a partner.
The younger sister is 15 years old and lives with her paternal grandmother.

Farah does not get along with her mother. Her mother started hitting her when she was 11
years old, when she cut classes to play in the river. She was hit with a pipe causing
subconjunctival hemorrhage. Farah’s mother now wants to put her in a shelter “kasi gala ng
gala at nakikitulog sa ibang bahay”. Farah goes to school in the afternoon, goes out at night
after doing household chores and comes home in the morning. She sleeps in different places,
sometimes in another town, because she is afraid that her mother will beat her up when she
comes home. Last month, she ran away and stayed with a friend for two weeks when she had
an argument with her mother over her dance practices. She told a maternal aunt but her aunt
returned her to her mother and Farah promised to change her ways.

Education - Farah is in Grade 9. She goes to school every day but is failing in 3 subjects.

Activities - Farah loves to dance but was forced to stop by her mother because she doesn’t go
home at night. She still goes to watch her dancer friends’ practices at 7:00-10:00 pm.

Drugs - Occasional alcoholic beverage drinker but “does not get drunk”. Does not smoke nor
use drugs.

Sexuality - Denies being in a relationship or being sexually active.

 History of sexual abuse: During her interview, Farah disclosed sexual abuse by a
neighbor when she went for a vacation to her maternal grandmother’s house in Rizal when she
was in grade 6 (2012). The incident happened twice in the alleged perpetrator’s house and is
described as vaginal penetration. Farah also disclosed sexual abuse by her step-grandfather on
another vacation in 2015. The incident happened once and is described as fondling of breasts.
It was witnessed by her older half-sister who experienced the same abuse. Farah told her
grandmother about the abuse but her grandmother did not believe her. The two sisters also their
her mother and maternal aunt and refused to go back to Rizal for another vacation.

Suicide - No suicidal thoughts or attempts; no history of self-harm.

Pertinent PE:
Conscious, coherent, oriented to time, place and person
Cooperative, no suicidal thoughts or attempts
Relaxed, honest
(+)Multiple linear abrasions on the arm and forearm, right, measuring 1 cm to 3 cm
(+)Erythematous, tender, irregularly defined bruise measuring 3 x 4 cm on the upper, inner
quadrant, left breast
(+)Purplish, ill-defined, tender bruises measuring approximately 2 x 3 cm on lateral chest wall,
bilateral
Anogenital examination deferred (day 2 of menstruation)

GUIDE QUESTIONS:

1. What is your diagnosis (type of abuse)? Differentiate as to present, past and co-morbid
abuse. Support your answer with information from the history and physical examination.
● See World report on violence and health, Ch. 3
2. What are the risk factors for child abuse and neglect seen in this case?
● See World report on violence and health, Ch. 3
● See Systematic Lit Review of Drivers of VAC
3. What health consequences of child abuse and neglect does Farah manifest?
● See Review of Physical and Mental Health Consequences of CAN
4. Is protective custody (putting the child in a shelter) indicated?
● See Medico-Legal Consensus, Appendix Q