Another Woman is dead from Sexual Violence

The sad commentary is that our institutions are not equipped to investigate and manage sexual violence. For every case reported in the media, there are many more we'll never get to know and the "silent" epidemic continues. Man stabs lover to death. We can't continue on this path without any concrete interventions. Soon, we'll be organizing a course on "Management of Sexual Violence" and target audience will include police officers, lawyers in both the bench and bar, medical practitioners who sometimes attend to cases of sexual assault, commonly called "Rape Cases", concerned nurses, NGOs activists in Sexual Violence prevention, and other interested persons or organizations.

First Thing First-Capacity Building in Forensic Medicine

The first step to assuring some standards of practice in forensic medicine is to build human capacity. One important point to quickly make is that local content is crucial to maintaining a standard of practice that is both acceptable and relevant to the people. While it may be inevitable to derived support and principles from foreign institutions and systems that work (in their environment), it must be emphasized that any service that will be rendered to any community in Africa must appreciate the peculiarities of our people, norms and ethos. A common mistake that professionals make, especially those trained in foreign institutions, is to adopt this one fits all approach. A training programme should be designed that takes into cognizance practical aspects of the realities in our communities. We may not suddenly have infrastructural overhaul or built up overnight but we can make do with some existing infrastructure and improve upon it with time. Often, we give up easily in frustration in an attempt to build an institution similar to a foreign one we know of, and of course meet a brick wall in funding and other resources. Our focus should be on maintaining  principles of practice; quality of personnel and facilities may differ but principles apply in all settings. So, we need to start teaching principles of practice and how they apply to our communities. In the run long, if we stay the course, we'll get to that "preeminent" stage but more importantly, the future generation must be able to track the principles upon which we've built any existing institution and practice.

Setting Minimum Standards for Forensic Medicine Practice in Africa-1

Earlier this month, March 2013, a pan-African Forensic Medicine Conference was held at Johannesburg, South Africa, under the auspices of the African Society of Forensic Medicine (ASFM) to evolve minimum standards of practice in four critical aspects of forensic medicine practice: 1. Autopsy Practice, 2. Mortuary Management, 3. Disaster Victim Identification (DVI) and 4. Management of Sexual Violence. The conference attracted forensic medicine practitioners and interested persons from all over the continent of African and beyond for days of brainstorming sessions in various committees on the subject. The need to have minimum standards of practice below which such services would not be appropriate for our peoples in Africa was evident. A common experience shared by all delegates was the poor attention paid to forensic medicine services by governments and institutions in most of Africa. This has greatly limited the application of forensic medicine practice in protecting public health, supporting the justice system, especially the criminal justice system and in promoting human rights. The civil society and human rights advocates will need to see the connection between public, social justice and forensic medicine in order to press for more investments in this specialty. It is instructive to note that the last conference was fully sponsored by the Australian Federal Police (AFP). The Australian government, through the AFP, understands what a stabilizing factor an appropriate forensic medicine practice is on any community and has committed huge resources in promoting the activities of the ASFM since inception. What are African governments doing in their respective jurisdictions in establishing and maintaining forensic medicine practice and services? At our last meeting in South Africa, we resolved, amongst other things, to take our case to African Union (AU) meeting and directly knock at the doors of African leaders for much needed attention in this neglected but vital service area to our peoples in Africa. We hope to be able to make it beyond the gate of AU and ever get close to the doors. Proper death investigation system, appropriate management of dead bodies following disasters (which are frequent in Africa) and disaster victim identification, and management of sexual assault are huge burdens begging for intervention. We need partners and friends to help us break the barriers.

Complicity of Professionals-1

What are professionals, in various fields, doing to promote the health of the nation? We attend international conferences and see how "contemporary" countries and institutions are making efforts to implement innovations aimed at advancing growth and development. Back home, we choose to "manage" the situation and often shy away from putting up strong advocacy for positive change for fear of being branded "radical" and consequently sidelined in government or establishment patronage. However, the same professionals are quick to declare strike action to protect their welfare, remunerations or status, which are mostly self-serving interests. When last did we have a professional group go on strike to protect the public interest or the rights of individuals or communities to some decent living?

Any Future is Predictable

I called up a facility outside the country when there was a need to run some toxicology tests in a forensic autopsy I handled, and after making the enquiries I felt some hollow within. It was difficult to accept there was no accredited centre in the entire country where one could carry out some forensic toxicological analyses. We have had many incomplete postmortem examinations due to the absence of basic tests that should be run in such cases to fully understand how death came about. Our efforts at preventive medicine and protection of public health will be futile if we do not fully understand the cause(s) of death. And this is an essential function of the state, to investigate certain deaths and protect public interest. Often, we bypass this limitation by seeking for any changes in the body or any diseases we could attribute death to, but any professional will admit that such is suboptimal and mediocre approach to death investigation. 

What will it cost to establish regional centres in the country equipped with appropriately trained personnel and facilities to do proper forensic medical tests in cases of suspected poisoning or as a routine in a Coroner's death investigation? It is from such data we can objectively evaluate the contribution of alcohol and drugs to the incessant road traffic crashes in Nigeria, and understand the mechanism and causes of some deaths attributable to possible poisoning and other substances. As simple as it appears, we do not even have an established national or state blood alcohol concentration (BAC) limit(s), and one wonders what objective parameters could be used to prosecute cases of drunk driving ("luckily" no one gets prosecuted!). 

The federal and state governments at various times have sponsored candidates for studies/training in specialized areas outside the country only for those who return to be frustrated out of the country for lack of tools to work with or for lack of appreciation of their services, and a good number never bother to come back to the country for a variety of reasons, one of which is the prevailing situation. Those who choose to remain often get back to a "steady state" and serve their time in service with stories about what they couldn't do, which their expertise would have enabled them to contribute to nation-building. In the present situation, it is not difficult to predict the future.

Celebrating Mediocrity In Nigeria By Femke van Zeijl

A colleague sent the above article through a linkserv and reading through it I was hoping there was some information contained in the write up I could strongly object to. Unfortunately, I couldn't mount any reasonable defense to the submissions made therein. I know some Nigerians have written much about  how we could get serious with Project Nigeria and really work hard at nation building instead of posturing in the morass of under-achievement. We can identify with some of the things written in that article. I've had to change three different Internet providers, amongst the existing network providers in Nigeria, within six months for poor service with all the advert promises and high cost. We carry multiple phones because of abysmal services they all offer, and you wouldn't want to be caught out in an emergency.  We've not talked about unexplained deductions from call credit, drop calls and other malpractices. And we appear so helpless and just too happy to be able to open a single webpage after an entire session. Often, we are rated  the "happiest people on earth" a euphemism for "lack of insight". We should be weeping at the sorry state of affairs. And one doesn't  have to be a governor, senator or some highly placed official to make a truly positive change. You may want to examine and form your opinion on Femke Becomes Funke: Celebrating Mediocrity In Nigeria By Femke van Zeijl.

Kano Bomb Blast-DVI an Inevitable Issue

Some report today in the media indicates an inevitable consequence of disasters of this nature. The story in the story is that we are never ready for such inevitability and as predicted  there is already talks of "mass burial" of "unidentified remains". This move is justifiably resisted by concerned individuals and groups as reported in the punch newspapers: .....In Kano, the President of Ohanaeze Ndigbo in the state, Chief Tobias Idika,said the association was opposed to any plan to conduct a mass burial for bodies yet to be identified.
Idika, in a telephone interview with one of our correspondents, explained that he and other members of the association were worried about reports of a planned mass burial of such bodies.
He said, “So far, relatives of the dead have identified 35 bodies. Some identified their dead using the clothes they wore last. Some used their shoes and other physical attributes because some of them were badly burnt; others had their faces still intact. We are still trying to identify others but we now hear that there are plans to conduct a mass burial.
“We are worried about this information. We would like to use this opportunity to warn the Kano State Government and the Police not to bury our people in a mass grave because this will increase tension. We will like to see the bodies of our people to give them a proper burial.
“How do you tell a mother, father, brother or sister that their loved one is dead and you do not have the body for them to see and bury properly? It is not done. We have suffered enough; people must not add salt to our injury by committing further abominations against us.” 

How much will it cost Nigeria and her component States to have a standing DVI Team and facilities for a proper disaster victim identification? When are we ever going be appropriately responsive as a matter of routine? A mass burial to the victims of this senseless attack may be far worse than the physical pains and horror of the act itself. We owe the deceased some simple dignity and right to be properly identified, and granted decent burial in accordance with their culture.

Sexual Homicide: Where is the National Outrage?

Another woman was reportedly killed in Uyo, Akwa Ibom State, after she was allegedly ganged raped by four animals in men's clothing (real men respect the dignity of a fellow human). "Mama Oliver", as she was popularly called, represents one case too many in an environment where we are quick to blame the victims, and find some excuse for perpetrators of sexual violence. The national outrage in India following a sexual violence where a woman was ganged raped in a bus and eventually died, prompted every organ of the State and the populace into action. Consequent to that incident, the Indian Parliament just recently passed a landmark law that "sets tougher penalties for rapists and for police officers who refuse to file a woman’s complaint of rape, as well as criminalizing offenses such as stalking, voyeurism and acid attacks".
What are we doing about this incessant cases of sexual violence in our country? Why do we carry on as if one more case is just another insignificant statistics in our "big" country? Why is it that our elected officials and government functionaries are not talking about this malady and doing something about it? We are still stuck with archaic laws on sexual violence, and a situation where there is lack of specialized personnel and facilities for attending to the needs of survivors of sexual violence. Why are we not investing enough in the totality of well-being of our people? Where is our outrage?

We are not Helpless-2 (The Kano bomb blast)

It often gets to a mode where the feeling is just numb. That was the experience throughout yesterday at the incident in Kano where innocent lives were brutally taken away from their families, loved ones and the entire community. Every well meaning human being should unequivocally condemn such bestiality and dastardly act. Animals won't even treat their fellows the way and manner some have subjected their fellow human beings for whatever cause or ideology. Why have we fallen so low? The aftermath of  pain and terror will last for some indefinite time. The casualty figure continues to rise from about 25 as reported in some national dailies of yesterday to about 75 as at today. Unfortunately, we may never know the actual figure and the open wound of lack of closure for some families will be for all times. It is a sad commentary that in our surpassing natural and man-made disasters, there is no standing national DVI (Disaster Victim Identification) Team for proper identification of victims of disasters. Usually everyone gets unto the scene, and the resultant chaos and unprofessional approach make a mess of any valuable lessons that could be learnt from such unfortunate incident. And before long, all the myths about dead bodies will play out and mass burial becomes the "only" option for the unidentified victims. I believe we can do things in a better way. We are not helpless.

Feeding the Beast-2

The recent "guilty" verdict handed two teenagers in the small Ohio town of Steubenville in the US underscores the seriousness any progressive society pays to issues like sexual assault. These students were found guilty of raping a fellow high school student who was under the influence of alcohol and possibly other drugs. It was not a tenable defense that alcohol and/or drugs played some role here. Someone under the influence of alcohol or drugs can't possibly give any valid consent for sex. It is therefore the responsibility of any partners or friends or any other concerned persons to protect such individuals, and not take advantage of their vulnerable state. We need to dismantle that myth that "she asks for it". How did "she ask for it"? Under what circumstance did "she ask for it"? An ongoing case in Southwest Nigeria of an alleged rape of a female youth corp member (fresh graduate undergoing a one year national service in a different geographical zone of the country) by an influential local chief. One of the debates in the media was people asking what the girl went to do in the chief's palace if she was not interested in some sexual relationship. Unfortunately, this is usually the trend of discussions in an environment where abuse of power and position is the norm. She has been ridiculed and derided for her courage to report the incident to the authorities, and the tardy justice system completes the onslaught by inadvertently passing the message that keeping silent and living with the horror of rape may be a better deal than seeking for justice. This feeds the beast.

We are not Helpless-1

How long will it take for us to change the way things are generally done on our continent-Africa?
We travel and see how things are done elsewhere, and we are so happy to pose for pictures against backgrounds and beautiful scenery that have been maintained by people-yes people like you and I. It could be as simple as regular and appropriate cleaning-nothing too hi-tech. It could be as mundane as the right person being at the point of duty at the right time. It could be just as costly as a right attitude to work, to community and to some sense of pride in collective ownership. Our people suffer needless pains for lack of basic items of life and the paradox is our great endowment in resources-human and natural resources in Africa.

Roads are often constructed without proper drainage and are usually of poor quality, and in few months down the line are washed off by rain with resultant road craters that constitute a major cause of road traffic crashes and attendant crippling injuries, loss of lives and property. A majority of forensic autopsies I perform every week is on road traffic crashes with eminently preventable environmental components being a significant causative factor. What technology do we need to acquire in order to place simple road signs on our major roads? Recently, in a major road that links to my place of work, some government officials thought it fit to place a big bump across the double lane as a speed breaker, and this was done overnight, literally, without any warning or signs! I was told the other day that an unsuspecting driver ran over the obstacle and somersaulted. Personally, my vehicle was shaken to the very last bolt when I went over it at night as I had no prior idea about the obstacle. Other road users continue to tell their own painful encounter with what should have been a safety measure. All my effort to draw attention to the need for a warning sign has been futile so far but I'm not giving up. Unfortunately no one seems to take responsibility, and no one is held responsible and we still hope to sustain a viable society in this fashion?

Our people are dying more from preventable causes than from natural diseases. While we attend local and international conferences to listen to, or present highfalutin researches or breakthroughs in medicine and science, all our people are asking for is availability of basic health facilities, essential drugs and health personnel to cater for them. I've seen on my autopsy table children who simply died of malnutrition and childhood diseases because of poverty and lack of any primary care facilities nearest to them before complications set in and eventual presentation at the city hospital where the child was essentially certified dead. In my practice so far, I'm yet to witness a request for autopsy record or mortality data by relevant government officials or policy makers in government interested in knowing what kills our people or why they die. Our reports gather dust on our shelves as we lament daily about how cheap death has become and the enormous waste of lives which occurs daily. Are we just going to "mind our business" and "do our work" and pass the "legacy" to our children for a vicious cycle or are we going to leave the "comfort" of our offices and do something within our cycle of influence for a positive change? If you can read this blog, you've been a great investment by your families and communities as majority of our people can neither read nor write and have no access, whatsoever, to any ICT. Are we going to ignore the anomalies and carry on with a stamp of personal "survival" or are we going to do something today in our little corner to provoke a change knowing that ultimately our success and survival as a people is tied to the success of our neighbours and our larger society? I believe we are not helpless.

Feeding the Beast-1

In recent times, some universities and higher institutions in Nigeria have enforced dress codes for their students. The campaign pictures and accompanying messages generally point to the main target of female students often accused of "indecent dressing". However, the danger in this aggressive campaign to create a "uniform" and "decent" population in our higher institutions is the spoken message-bad girls dress "indecently" and invite trouble upon themselves and good girls dress "decently" and stay away from trouble. The implication of this message has seeped out of the universities into towns and cities where police and other law enforcement officers often harass women in public they deem to have dressed "indecently". Some have been arrested, physically and sexually assaulted by these agents of the state who usually act on their own gauging public perception about what is "right" or "wrong" or what is "moral". This is why it is disturbing that our universities, albeit indirectly, should be involved in entrenching this myth about people, especially females, inviting sexual violence or other forms of assault upon themselves by not "dressing well". There has not been any reduction in sexual violence in regions of the world where there is strict dress code especially for women and girls. Sexual violence is an exercise of power and control by the perpetrator over the victim, and not because of "indecent" dressing. Our ivory towers will do well by promoting the universality of learning, research, innovation, excellence etc rather than promote actions that potentially fuel abuse, entrench damaging myths and cause discrimination against persons or groups perceived to be out of the "norm". A cursory look at nature will emphasize its diversity rather than uniformity. And the beauty lies in the diversity!

When Outrage does not Translate into System Change

Earlier this year, an investigative journalism carried out by Nigeria's national radio network and aired on the network service exposed the dastardly act of some soldiers in Abuja who allegedly sexually assaulted women who were randomly arrested in the city. Their only crime was that they were women seen on the street at night and that automatically classified them as "harlots" in the eyes of  men who abused their position of barrel "power". The soldiers, with their police collaborators, constituted themselves into absolute authority of law enforcer, prosecutor, judge and executioner and the result was alleged rape of these hapless women by these soldiers. The repeated violation continued despite pleas and cries from these women some of whom were married, pregnant and in different health conditions.

The military authority has taken some action in dismissing some of the soldiers implicated in this saga but the main issue is largely unaddressed.
How could women, men or children who are sexually violated be managed appropriately with due care to all aspects of medico-legal issues involved?
There is presently no system at the national, state or local council levels in Nigeria for attending to survivors of sexual violence.
Post traumatic syndrome in survivors of sexual violence is well documented and the huge negative impact on the individuals involved, their families and loved one, and on the overall health of the nation is evident.
Some African countries have instituted a system of care, and South Africa in particular has a "one stop centre" for care of survivors of sexual violence.
In Nigeria and some other African countries, what are we doing in restoring the dignity of people who have been sexually assaulted?
Our police officers and police stations are not equipped to attend to survivors of sexual violence.
Often survivors are re-victimised when very courageous few dare to report the incident to the authorities at police stations. Many of those cases are causally dismissed by station police officers as "domestic affair". This is a term I'm yet to understand the meaning in the context of sexual assault.
Police officers, usually mired in sexual violence mythology, lack empathy, are untrained in handling sexual violence cases, and lack basic facilities for care.
Our health centres still treat them as regular patients and often look for physical injuries which if they exist are only an extension of psychological wounds they have been afflicted with. Lack of trained forensic medical personnel and lack of appropriate facilities for the care of survivors often result in insensitive approach, loss of evidence, and worsening of the overall state of the survivors.
Existing Social Work at government departments and non-governmental organisation is largely pedantic, and the specific area of Women and Child protection agencies is rudimentary or non-existent in our jurisdictions.

It cannot be for lack of resources that we have failed to protect the vulnerable amongst us. Our priorities must be skewed for some other non-essential endeavours for us to have ignored the care and protection of our most vulnerable population -women and children-in sexual violence.
We must start looking at the personnel issue as much as we consider facilities necessary for rendering appropriate medical care, forensic medical evaluation, preservation of evidence and providing necessary collaboration with the police and justice system for prosecution of perpetrators.
It's time we took action on this and our professional skills must be matched with appropriate advocacy.

Connecting the Dots

It is not difficult to see a common thread running between Forensic Medicine and Human Rights especially in Africa. It calls for a sustainable system that addresses many medico-legal issues which affect the totality of health, at different dimensions, of African people. The wide disparity in social strata and the high level of poverty and disadvantaged populations on the continent call for a concerted efforts by governments, institutions, agencies, and practitioners to view their roles from a Human Rights perspective and put in place at least basic environment that will address the crippling inequalities which are prevalent in our communities. Sexual Violence, Injury Interpretation, Custodial Medicine, Management of the Dead following Disasters/Disaster Victim Identification (DVI), Medical Evidence etc, are subjects that need to be properly directed with appropriate reference to optimal facilities and expertise in medicine, the judiciary, the police, social work and supporting sciences. This blog is dedicated to sharing ideas and action points with persons, institutions or agencies that are interested in bringing about a positive change in Africa through the instrument of appropriate Forensic Medicine Practice and Human Rights Advocacy. Until what we do in our offices, laboratories and institutions translate into improving the lives of our people and upholding their dignity, the relevance of our endeavours to humanity will be called to question. This is what I call "minimum standard" for evaluating the essence of our activities and relevance to our communities.