Out of the ER

The agency behind the unit

Mary's Place began in 1975 as a crisis line that a group of Savannah volunteers ran out of their own homes. They had watched one of their own go through an assault with no organized support available to her, and they answered calls themselves until the first grant came in about a year later. Fifty years on, the agency covers seven counties around Savannah with a 24-hour crisis line, temporary protective order assistance, counseling, court accompaniment, forensic exams for children and adults, and prevention education in the school system. A Hispanic networking group carries wraparound services to Spanish-speaking survivors.

Doris L. Williams arrived eighteen years ago and is the agency's third executive director. She spent five years working with Mary McAlister, the founding volunteer who became the first paid staff member and stayed thirty-two years, and five more with the second director, Keisha Gibson Carter. In 2022 Doris took the question of the agency's name to the board. It had been the Rape Crisis Center of the Coastal Empire, a name the prevention team could not say out loud inside a school; educators introduced themselves as RCC, and nobody in the community connected the classroom program with the crisis center. The rename honored McAlister, who is retired and still close to the agency, and it let the organization reintroduce itself after fifty years.

What the hospital route cost survivors

Before COVID, Mary's Place held a designated spot inside each emergency room in its service area. Doris calls it premium real estate, adjacent to the ER itself. Survivors reached the agency through a 911 call, the crisis line, a police precinct, or the emergency department, and wherever they started, the forensic exam happened at the hospital.

That route carried costs the agency could not fix from inside someone else's building. The quiet room set aside for exams was the same room the hospital used when a family had to be told that someone had died, so it was sometimes occupied and survivors waited. Some clients were driving an hour to get there. Confidentiality was difficult to hold in a public waiting area: advocates left their name badges off, and a person moving through an emergency department with law enforcement alongside is visible to everyone sitting there. People could tell a crime had happened, even without being told which one.

“I tell everybody, so everybody don't need to be on the front of the line. You can write a check. You can provide a service. You can pass a water bottle. You can stuff some envelopes.”

Doris L. Williams · 7:09

Forty-eight hours

Early in the pandemic the hospital called and asked for the space back. Emergency departments were filling and Mary's Place had 48 hours to clear its things out. Doris emailed the county sexual assault response team on a Sunday.

Georgia requires a multidisciplinary sexual assault response team, which meant the people who had to agree were already assembled and already talking to one another. On the call were law enforcement, the state health department, emergency room staff, the district attorney's office, the domestic violence center, the Coastal Children's Advocacy Center, and victim witness services. By Monday morning Doris was working the phones: the state, every SART member, the board, and the agency's insurance carriers, asking what it would take to designate a room inside her own building as an exam unit. She counts roughly forty professionals agreeing to it inside a day. No vaccine existed yet, which gave everyone in the room a reason to want exams out of a crowded emergency department.

“We are so good at giving people flowers when they're gone and they can't hear it. I said, Mary is still here.”

Doris L. Williams · 10:02

Standing the unit up

The first exams were done on a stretcher, because the exam table had not arrived. A local doctor's office heard what the agency needed and sent one over.

The insurance policy was updated, funders were told what had changed, and the room started taking cases. A few months later the board made the space permanent, which is when the agency began building it out properly. The suite now closes off from the rest of the building and holds an exam room, an interview room, and a private restroom together. The ribbon cutting came the following October. At the time of this interview a separate pediatric SANE unit was still being finished; the existing unit has handled both child and adult cases from the start.

“I never seen that many people agree to something on a Sunday night.”

Doris L. Williams · 13:11

Rewriting the county protocol

Moving exams was not something Doris could authorize on her own. Chatham County has a written sexual assault response protocol, and where the exam takes place is written into it. Updating that document required sign-off from the chiefs of police, a judge, and the district attorney, along with the rest of the SART membership.

She is direct about why. Forensic evidence collection is a service the state of Georgia mandates her agency to provide, and what gets collected has to survive everything that follows it in court. For a peer organization, this is the part most likely to be underestimated. A room can be ready months before the paperwork governing it is.

“Just making sure that our resources line up with the needs of our clients to be survivor-centered and not what we think they need, but what they need.”

Doris L. Williams · 20:34

The hospital relationships stayed in place

Mary's Place kept its privileges at the emergency departments and still uses them. Advocates respond to the hospital when a client presents there and does not want to travel to the agency, and when a client has injuries that need medical treatment. With consent, they go into intensive care.

Doris frames the unit as an expansion of where a survivor can be seen, and the agency still lists hospital accompaniment among its services. Over ninety percent of cases are now done in-house. What the unit changed most concretely is wait time and privacy: clients come into a space that feels more like a home than a hospital corridor, and they can decompress there before and after the exam instead of sitting in a public waiting room.

What the exam is attached to

Once someone is connected to Mary's Place, they call about everything else. Food insecurity, rent, a door that needs repairing. Doris describes an agency whose job description keeps widening because clients keep telling it what they actually need.

Temporary protective orders are handled by the agency itself. Staff went to the judge downtown and became certified to assist with the process, and attorneys work with clients through it. Counseling runs through seven contracted counselors who offer virtual and in-person sessions, two of them in Spanish.

Housing is the constraint Doris keeps returning to. Mary's Place partners with three domestic violence centers, and because affordable housing is short, those centers are frequently at capacity. The agency will send a client as far as an hour and a half away for a safe bed. When every one of them is full, a lifeline fund pays for a hotel for five to seven days while a protective order works its way through, in the years the fund is fully funded. During COVID, United Way handled rental assistance for clients who had lost income or hours. For the rest, there is a Savannah message group of nonprofits, attorneys, and community members where an unmet need gets posted and usually answered; that is how the agency has sourced everything from space heaters to laptops.

Keeping a team on a 24-hour line

The agency is open 24 hours a day, seven days a week. Doris describes a stretch two weeks before this interview when six cases came in across 48 hours, with half the crew at home restoring their energy while the rest worked overnight.

Her version of trauma-informed care starts with the people delivering it. Therapy is encouraged and the team decompresses together; when no clients are in the building, Doris says, they are very lighthearted about a very dark subject. She sends staff home when she can see they need to go. Both of her predecessors insisted on that long before the sector had settled on language like work-life balance, and she credits them for it.

There is also an exit path, which is the harder half. Doris says a good heart and good intentions do not by themselves qualify someone for this work, and that for people closely connected to the cause the timing is sometimes wrong. The agency has a policy for transitioning someone out, usually with the departing person overlapping and training their replacement while they look for their next job. She credits that policy with the agency's staff longevity, and with an honest working environment.