In 2017, SVA product design student Antya Waegemann was volunteering as a domestic violence advocate in a New York City hospital. She was on call for 40 hours per month, and it was her responsibility to advocate for those who arrived at the emergency room having experienced domestic abuse and/or sexual assault.
“I had one case where I was advocating for a 16-year-old sexual assault survivor,” says Waegemann during a break at Design Indaba, where she featured as one of the conference’s 2020 Global Graduates. “She was with her mother, and the situation really escalated, with her mother blaming her for what had just happened. The nurses aren’t trained like advocates are. They told me not to get involved. But it was my job to be there for the survivor—I believe her—so it’s in those moments where I get involved and ask the mother to step out of the room.”
During these nights, Waegemann would stay beside survivors while a nurse administered a rape kit to collect evidence. Sometimes these nurses would be encountering the kit for the first time, and they’d have to navigate the convoluted instructions during what can end up being a 10-hour exam. In one instance, Waegemann observed a nurse rereading instructions several times; she was fumbling over language about how to lay sheets of paper on the ground to collect debris as a victim disrobes. “She had to ask me what the instructions meant,” says Waegemann. Two sheets need to be laid on the ground, and only one of them needs to go back into the envelope: They’re both large, and it’s not immediately clear that the two sheets need to be laid on top of one another. The sheet that then needs to go back into the envelope is often so overwhelmingly large that it’s difficult to fold, and it ends up tearing the envelope. “For someone who is trying to give the patient care, it’s very confusing.”
For a kit intended to collect vital legal evidence, any misstep can invalidate the entire effort, causing more pain and frustration for victims of sexual assault, many of whom have to fight to be believed in the first place. As Waegemann found herself on the ground speaking with survivors, nurses, and doctors on a regular basis, she began speculatively redesigning the rape kit as part of her graduate thesis at SVA. Her process of co-creation focused on making the experience more trauma-focused for a survivor—geared toward promoting safety, well-being, and healing—and also easier to navigate for a nurse or doctor.
Louis Vitullo, a Chicago police sergeant turned chief microanalysis, designed the first rape kit in 1970, and it was later expanded on by a sexual assault victim named Martha Goddard. The cardboard box developed by Vitullo held instructions and items like swabs, slides, and a small comb; Goddard then advocated to get the kit into hospitals, in order to standardize protocol to collect and share forensic evidence. Despite Goddard’s involvement, the kit became known as the “Vitullo kit,” as officials believed that forensic experts should have the final say on its design features. “This history can, in fact, explain many of the problems with the current kit,” says Waegemann. “First, it was primarily designed by a man, and second, that it was not human-centred design, or designed for the victim, but instead designed for the evidence interpreters.”
In the USA, there are currently three main manufactures of rape kits, all made by large tech forensics companies for whom the kit is just one of many products. At these three main manufacturers, no designers are involved in the instruction’s design process. In New York, the current kit contains 15 envelopes that require an immense amount of patience, paperwork, and re-reading for those conducting the exam. Each envelope contains a different step for collecting evidence; inside, you’ll find tools like swabs or slides. Following the instructions, the nurse collects DNA, allows it to dry, and places it back in the envelope, seals it up, and places it back into the box. Steps include processes like swabbing bite marks, secretions, and cervical swabbing.
“How we can remodel the rape kit to lessen the cognitive overload of the nurse or doctor so that they can focus on care-giving?”
The kits do not make clear which steps need to be completed and which don’t: For instance, if a survivor has been assaulted orally, they do not need the vaginal swab. These additional steps can cause trauma by putting a survivor through unnecessary evidence-collecting, and it keeps them in the emergency room for far longer than needed. For lab technicians, this process also creates unnecessary work and increases testing costs.
“For every step of the rape kit, a nurse needs to put on fresh gloves so that they don’t temper with evidence,” says Waegemann. “But that often gets forgotten as it isn’t very clear. For the vaginal swab, a speculum needs to be introduced, but no where is that clearly stated either. I started to think about how we can remodel the rape kit to lessen the cognitive overload of the nurse or doctor so that they can focus on care-giving.”
Waegemann’s kit is simplified, with clear steps and graphic directions to guide a nurse through each envelope. It’s “as easy to understand as building an IKEA chair,” as Waegemann says, with color coordination to signal the different envelopes required for different tracks based on the survivor’s specific assault. To redesign step 15, cervical swabbing, Waegemann took note of moments when nurses tripped up on the current instructions (above); her redesign (below) emphasizes the most important information, such as how to dry the swabs so that no mistakes are made during the collection process. And crucially, by having the instructions laid out so simply, the nurse can then focus her energy on providing care to the victim.
“It’s as easy to understand as building an IKEA chair.”
Her kit, named RN Advocate, is paired with a digital platform that can offer the nurse or doctor performing the exam additional guidance through instructional videos. A second component consists of a patient-facing app that the survivor can download when they arrive in the hospital, which guides them through the process so that they know what to expect. For someone who has just been been physical violated, understanding what their body will go through at the hospital while a rape kit is being administrated can provide a crucial sense of control.
Because a rape kit is legal evidence, it’s not possible to simply create a “Do-It-Yourself” kit for the market that survivors can acquire over-the-counter like the morning after pill. Waegemann’s redesigned kit needs to be reviewed and approved by medical staff, legal entities, a committee, and the district attorney’s office before it’s implemented in emergency rooms at a state level. But she’s on the long road towards this end-goal, working closely with a New York hospital’s staff to get her design through that first step of approval. Waegemann’s “Redesign the Rape Kit” start-up is launching soon, and she imagines a future where a survivor would be able to get hold of a kit easily, cheaply, and accessibly by being administrated by nurses at something like a Minute Clinic. As the social worker Ayan Ahmed at the Office of the Mayor of New York told Waegemann, “For any trauma victim it’s not about what happened to you, it’s about what happens right after.”