A Mockery of Police Forensic Laboratory

Appropriate investigation is at the core of dispensation of justice. Worldwide, the police play key roles in the investigation of crimes, and they maintain close working relationship with forensic pathologists in death investigation. Police forensic laboratories are generally of the highest standard and quality of delivery. In a normal setting, it'll be shocking and will provoke an outrage for the police to appear before the court and announce that vital pieces of evidence, handed over to the them (by reason of statute and in public trust) for processing in a police forensic laboratory in Nigeria "got bad due to epileptic power supply". The Deputy Commissioner of Police (DCP) in charge of forensics at the Force Headquarters, Abuja, Ovie Oyokomino,  was reported to have declared while testifying before the court, "that the perishable evidence such as blood samples as well as the vitreous humor of the eye went bad due to interrupted power supply in the course of refrigerating".This report is carried in ThisDay Newspaper of 30 April, 2013.
This was in the course high profile Williams Murder case hearing.

In a country where some accountability counts, and where citizens are less encumbered with elements of "survival" and complacency, it will not require much discerning to apprise the danger posed to our collective safety and national security by such apparent acts of irresponsibility, gross disappointment and betrayal of trust conveyed by that statement credited to the police. Some may be aware of the gallant display of the US security apparatus after the recent Boston bombing and yet it has not deterred US lawmakers asking if the FBI mishandled case of late Boston suspect when he came under the radar in the past. That is what happens where there is accountability and sense of responsibility across board. In Nigeria, what traction will such "triviality" have on the national discuss and concern?. In fact it is understandable why the "perishable evidence" should perish with the epileptic power supply. Our lawmakers will probably be too busy with "weightier" issues of the law than pay attention to such a "minor" indicator of a system failure in our crime investigation.

However, before the matter dies with the lifespan of 30 April 2013 publication, the public may want to consider the following:
1. How much is budgeted annually for the police forensic laboratory in Nigeria?
2. How is this amount utilized since the forensic laboratory is not known to be functional?
3. Was it only the evidence in Williams case that "got bad" or were there other stored "exhibits" that perished with the Williams case? At least we can ask citing our Freedom of Information Act.
4. How does this anomaly impact the justice system in Williams murder case and similar cases?
5. Who will be held accountable for this situation that appears like some gross negligence?
6. What is the current state of the police forensic laboratory?
7. With the high volume of medico-legal cases in Nigeria and the attendant impact on national security, why has the nation not invested in modern forensics like the establishment of a National Institute of Forensic Medicine & Science (NIFMS) which will be a clearing house for modern death investigation procedures, and forensic investigation of related crimes, training of various forensic medicine and science personnel, and providing independent forensic services to Coroners from various states of the federation, to the police and other concerned agencies in forensic investigations? Presently, we spend so much money sending samples outside the country for DNA analyses and other forensic tests. The loss is in many fronts including loss of foreign exchange, loss of opportunity to train and deepen the experience of local forensic practitioners, and concerns about results that are based on statistics which may not be reflective of the profile of our local population.

The NIFMS, if established, will have the potential to become a centre of excellence for forensics in the West African sub-region and will fill the critical gap that has characterized unresolved murder cases and tardy justice system in the country.
We have the human capacity to actualize the NIFMS if government will be willing and ready to make the  necessary investments, and to be guided by professional advice, and not political patronage.

It's time we got serious with nation building in all fronts, and a mockery of expertise is not a good tag for any foundation or building blocks.

Curbing Violence Against Women

In a country besieged by terrorism, social dysfunction, corruption and misplaced priorities, I was delighted to see a major newspaper dedicate an editorial to the perennial problem of gender based violence in Nigeria. Violence against women is deep seated and rooted in misguided culture and mislaid religiosity. It is therefore not surprising that the National Assembly is yet to pass any relevant bill to curb this menace in Nigeria. As THIS DAY editorial puts it "Even then, the Violence Against Persons (Prohibition) Bill 2011 (VAPP, a harmonized compendium of nine legislation seeking to eliminate the challenges that women confront on a daily basis) has been before the National Assembly for consideration, since 2003, but it is yet to be enacted into Law."

This blog has made previous posts on this subject and unfortunately, this is not the type of headline that attracts attention in a society where women are largely looked upon as objects of pleasure or possession and are often blamed for violence against them while excusing the abuser. A cursory look at countries in the world where women are treated as inferior class would reveal prevent and unchecked backwardness, brutality, general and sectarian  violence, terrorism, civil war, poverty, corruption and other vices.
Nigeria urgently needs to do the following:
1. Pass enabling law
2.Train the police on handling gender based violence
3. Provide forensic medical service
4. Women Protection Agency
5. Reverse the tardiness of the judiciary and revamp court procedures on issues of violence
6. A coordinated Civil Society in raising awareness on this issue.
7. Other measures that are applicable.
We needed to act yesterday!

Red Alert! Impunity in Laboratory Medicine in Nigeria

Some may dismiss the lingering crises in the health sector, especially the one in laboratory medicine as some “professional” rivalry but a closer look will see the grave danger posed to public health by unchecked rascality which has become a reflection of the larger society. If we just take a look at the downstream, the mortuary, it may bring home some point. I participate in investigating many deaths traceable to some disconnect between the medical laboratory and clinical practice. Our people have walked into many of these "medical" laboratories to undertake "tests" without physician's consult, and to proceed to chemist shops for "prescription" based on the usual "test" diagnosis of combined "typhoid and malaria” and eventually ended up at autopsy tables following sudden death. Findings at autopsy have varied from complicated appendicitis to advanced cancers. These people depended on test results that were recommended and evaluated by non physicians and the accompanying medications prescribed by people unqualified to make clinical diagnosis and consider differentials based on overall clinical features of the patients. These needless deaths occurred because of failure of regulation of medical practice. Most unfortunate aspect of this malady is that usually no one is held to account.

We can't possibly move ahead without a clear understanding of the past, our roots. From the ancient time to the modern era, physicians have trained certain categories of workers to assist them in the overall management of the patient. Every profession, from law to engineering, has allied workers who assist in ensuring the respective mandates of such professions are actualized in the interest of the public and these allied workers in these professions have remained within their bounds of practice. In Nigeria, anarchy reigns in medicine especially in laboratory medicine. The radiographer challenges the authority of the radiologist; the optician that of the ophthalmologist; the pharmacist that of the clinical pharmacologist, and the laboratory technologist that of the pathologist. There is constant agitation by unions which have turned unionism into some lucrative business and “legalized” truancy. Outside the shores of Nigeria you can't buy certain drugs at the pharmacy without a physician’s prescription. Here in Nigeria, any drugs could be purchased over the counter freely. In a recent meeting of the association of medical laboratory technologist in the Ibadan, members of the public were advised they could simply walk into a medical laboratory and procure medical tests without prior physician’s consult. It is not surprising that patients present so late and too late to the hospital.

The system is broken and has betrayed the public, and concerned authorities appear impotent in tackling this quackery. Unfortunately, issues in Nigeria often get decided by the amount of violence and disregard to civility displayed by individuals and groups championing such cause, and our hospitals are now held hostage at will by unions to the detriment of patient care and public health. Conflicting and confusing laws are in place and implementation has been left to the jungle mentality of "survival of the fistful" while our health indices continue to plummet. Where else on this planet has the place of orthodox medicine practice been distorted and redefined than in Nigeria? Our leaders know the rot, which they have entrenched in the health sector as in other sectors of our national life. They and their families do not utilize public hospitals, and at huge public expense hop into the next flight abroad for treatment of even the simplest of illness. They profit from the present crises as they justify their proclivity for mismanagement of public fund on the unreliability of medical laboratory tests and lack of modern facilities in Nigeria’s public hospitals. And hapless Nigerians continue to experience needless deaths.

There are no inquests on many Coroners’ cases we conduct autopsies on. Perhaps, the general public may have been better informed about such fatalities related to misplaced agitations in the health sector. The concern is where all this will end. Will there ever be a restoration of the normal relationship between physicians and allied health workers in line with global best practice? How many captains can there possibly be in the hospital boat? When will parochial mentality give way to collaborative effort for the sake of the patient and public health? When will concerned authorities enforce regulations and restore sanity in the health sector in Nigeria. In the meantime, patients continue to come to the hospital to "see their doctor" but even that traditional quest has also been confused. It's a Red Alert!

Child Abuse-1: Predatory Orphanages in Nigeria

I teach Child Abuse topics to postgraduate students and it’s usually amazing how they quickly make up their lecture notes simply by asking them to discuss the topic. Some of them could talk up nice volumes on this subject. It comes in different shades-physical, sexual, emotional etc. We literally see Child Abuse everywhere in our Society but no government institution seems to be taking any concrete measures about curtailing this menace until another incident attracts some sensational headlines in the press and few “motions”are triggered as presently playing out in Ogun State. Concerned NGOs appear uncoordinated in bringing about any system or institutional change. Their mode of operation often appears a pursuit of some stunning incidents for media attention.  And I’m yet to know of any government in Nigeria either at the local, state or federal levels, that has paid any serious attention to the issue of Child Abuse and Child Protection. 

A good number of the orphanages in Nigeria represent dark recesses for Child Abuse. These centres are largely unregulated by government and are usually run as “concentration camps” where the main drive seems to be to attract donor agencies or charity organizations to make donations which are not uncommonly diverted for personal enterprise of the operators of these orphanage “homes”.  These shams have also been widely reported as child trafficking centres, nay “Babies Shops", where children are simply on display for sale to the highest bidder. The intense corruption perpetrated by some owners of these “shopping centres” with connivance or complicity of government officials and resultant desperation and struggle for survival by these trapped kids (akin to some modern day slavery) in a despicable and  unhealthy environment, provide a fertile ground for all manners of abuse behind the high walls and iron gates. 

The Child Rights Act of 2003 essentially provides for child protection by the state. Most of the states in Southern part of Nigeria have domesticated this Act as state law. There is still significant resistance to the Child Rights Act in Northern Nigeria, apparently because of some prevailing “cultural” practices that are clearly within the circle of Child Abuse. A notable example is child marriage. We all witnessed with horror a former state governor and senator from one of the Northern states marry a child! Not even the national outrage (his was just a very tiny tip of the iceberg of prevailing child marriages in Nigeria, especially in the North) and existence of a federal law, which prohibits child marriage, could deter Mr. Senator of the Federal Republic of Nigeria! It is such elements of impunity in virtually all spheres of governance that puts us and our institutions as a nation on a life support. Is it therefore any surprise that there is no functional, adequately funded Child Protection Agency by any government in Nigeria? Individuals and NGOs of all shades and character spring up to fill the gap in a cauldron of a confused mix and the stench continues to emit from time to time. The recent saga in Ogun state where the patron of one of the orphanages was alleged to have repeatedly raped the girls under his "care" until one of them summoned enough courage to report the incident is an index case of how dark the recess could be. The matter is still being "investigated", a euphemism for mastering ineptitude, incompetence and inactivity. Unfortunately, for every case reported, we can only imagine in horror the number of incidents we may never get to know. What promise can any future possibly hold when there is no collective sense of responsibility for these hapless kids, as “our” kids; when our government, at all levels, has better things to do than protect our hope for any future?

Traffic Medicine-2: Behavioural Factors in Road Traffic Crashes

It's trite recounting the deplorable state of our roads in Nigeria. Every traveller has one sad story or the other to tell and we all bear, directly or indirectly, the scars of the death trap we call roads in various parts of the country. However, it is important to highlight behavioural factors and decision making processes that are significant factors in road traffic crashes, injuries and fatalities notwithstanding the state of our roads.
These factors include:

• Excess speed for the prevailing conditions of the road
• Driving under the influence of alcohol and other drugs that impair driving ability and judgement
• Fatigue or driving while drowsy/sleepy
• Poor attention and distraction
• Aggressive driving behaviour
• Noncompliance with safety measures e.g., use of seat-belts
• Age-related issues and inexperience
• Decision errors
• Belief in some "invincibility" by some magical powers
• Other related behavioural factors

One of the roles of Forensic Medicine in road safety is in the evaluation of some categories of drivers for fitness to drive especially in testing for alcohol and drug use, and any medical conditions that could impair driving. At least we can agree that it is in our collective interest to have drivers truly certified to be fit to drive. Some categories of drivers are of major concern e.g. drivers of heavy duty trucks, trailers, long luxuries buses which convey scores of people at the same time, police and ambulance drivers, and other special duty drivers. It is not only important to have a "snapshot" test for alcohol or drug use by these individuals, it is also equally or perhaps more important to test them for pattern of use over a certain period. Some forensic toxicological tests can tell us a history of drug use in any individual and this will be particularly important in a pre-employment assessment of potential drivers in the category indicated. This test is also conducted periodically to ensure that there is strict compliance with regulations regarding alcohol or drug use. These are some of the activities that bring about sanity to road use in any society, and it is essentially paying attention to small details.
Unfortunately, there is no forensic toxicology testing in Nigeria, the giant of Africa! Those in authority get away with this irresponsibility and perfidy because we have resigned to fate and accepted the carnage on our roads as the "will of God". It is so easy to see our gullibility and these "leaders" have continued to exploit it on virtually all issues of national importance while we continue to waste lives on Nigeria's roads where more people die than could be attributed to any single organic disease.

Driving through our roads, burnt or irreparably damaged vehicles involved in fatal crashes with attendant human and economic loss is a common sight. In the usual attitude of "pound-foolishness", we commit so much resources in acquiring these vehicles and in making them road worthy but we ignore the vital factor-the driver. Some commercial drivers often work back to back and are celebrated by employers as "hardworking" only for them to acquire enough "confidence" to dispatch self and other passengers and road users to untimely death usually on account of  fatigue and sleepiness on wheel. At our major motor parks in Nigeria, vendors freely sell local gins or spirits and other alcoholic beverages to drivers and some of these drinks are disguised as local medicinal concoctions. Amazingly passengers themselves,  in our usual docile attitude, ignore this time bomb and board these vehicles driven by drunk drivers! We all know that the local concoction is just some roots soaked in locally brewed gins with strong alcohol content. In our investigation of road traffic fatalities, unfortunately we fail to objectively document the role of alcohol and drugs basically because we are unable to do so. Countries have legal alcohol limits. What is the legal alcohol limit for driving in Nigeria? In addition, there is no forensic toxicology laboratory to assist in the forensic medical investigation of road traffic crashes. These are some of the issues that should engage those in authority and policy makers. Making the society a safe place is one of the primary tasks of leadership and it is a gross failure to neglect this duty in any way.

Say "NO!" to another Mass Burial!

I've had this fear since the road traffic crash of last week as alluded to in one of my blog posts. The fear that the authorities will eventually take an easy path; an easy path that absolves it of responsibility but violates the dignity of the dead and denies the families and loved ones an opportunity to accord proper recognition and respect to the memory of the deceased and achieve some closure moving into the future. I woke up this morning to see a bold headline: Victims of Edo Explosion for mass burial today.

We don't need to go through this path again and again. These victims can be identified if the right experts are engaged and the authorities are willing to commit needed resources to this endeavour. We've witnessed so many of these anomalies of responsibility that will last a life-time. Why would anyone go through this needless path of mass burial simply because those in authorities prefer to spend money on vanities than on real issues that affect overall health of individuals and communities? Why is there no national outrage to the continuous profanity and abuse of our collective dignity as a people? Why are we so eager to 'move on' to nowhere?

Hear one of the statements allegedly made by a government institution:  “The management is left with no option, because the bodies were burnt beyond recognition. It is not in the best interest of the hospital and its immediate environs to continue to keep such bodies.”

What? They wanted to identify such victims by facial recognition? This is clearly absurd and shows either lack of knowledge or mischief or playing to the ignorance and complacency of the general public.  Of course the remains can be identified through appropriate methods and bodies can be preserved for as long as it takes to identify them.

I'll leave you with one thought: imagine your loved one was among the victims, how would you feel if you were faced with a needless situation where you'd never have the opportunity to pay your last respect, bury in dignity and achieve closure?

We may not be able to completely prevent disasters but we should be able to manage the situation appropriately. These victims deserve proper disaster victim identification (DVI) through known scientific means and we can do it if we just pause a little on this usual easy path.

Kindly lend your voice and let's collectively say NO! to mass burial of disaster victims in Nigeria. We collectively diminish ourselves if we tolerate this violation of basic human dignity.

"A Country of Rapists"

I read a fine article today in Punch Newspapers that highlights the burden of sexual violence in Nigeria and the pervasive myths which promote this malady. It's worth reading and I've referenced it, A Country of Rapists. People who read about rape cases in newspapers may not understand the negative impact this atrocity has on the the victims, nay survivors, and the society at large. When you have to personally deal with survivors of this heinous crime against  humanity, it may help to understand the ramifications of impact on the survivors. Many people don't get it but simply ask a police officer how he'd feel if his daughter, sister, wife or mother was raped by some police officer for "sex-for-bail"  he'd immediately retort that such an officer would be a dead man if he had any chance near him. If this were a personal outrage, why would the society just carry on like rape or other forms of sexual violence were simply a problem of the victim alone? Where is our national outrage like the Indians exhibited recently? Are Nigerians simply numb to anomalies around them and incapable of instigating a positive social change? How would you feel if your daughter, sister, wife or mother were raped or sexually assaulted by someone? We keep talking about police investigation without asking "which investigation?". The Nigerian Police do not have the modern means to investigate allegation of sexual violence. I brought home some samples of forensic kits for investigation of rape cases following a workshop we organized in one of the Southern African countries. I had an opportunity to interact with some Nigerian police officers actively engaged in investigation and none of them, and I repeat none of them, had ever seen a forensic kit for investigating sexual assault! These are kits (both for children and adults) that are used to gather forensic evidence for appropriate rape investigation and this is done in close collaboration with forensic medicine practitioners, the police and justice system. Where do we even start to address the issue when there is no functional police forensic laboratory where relevant tests could be carried out by qualified persons and and also when there is no any independent forensic lab in Nigeria for such tests? In my practice, I've collected forensic evidence from survivors of rape cases which the police never requested for, and one of the main reasons being investigating officers simply do not understand their evidential value of such items and even if they do, there is neither any funding nor facility to process them. Are we doomed to trail behind in all indices of development and responsiveness as a nation? How much will it cost Nigeria or the composite states or regions to set up a forensic laboratories, within forensic institutes, which will independently assist the police and the justice system in providing objective answers to many questions that arise in certain crimes, especially in rape cases? When are we going to back off from this primitive dependence on "confession" of alleged offenders (who usually would have been tortured enough, a violation of their human rights, to admit to any crimes whatsoever). We need to start looking at the right places for solutions. Rape cases are grossly under-reported in Nigeria and this exercise of power and control, usually by perverted men, is more rampant than reported. Their victims, mainly girls and women, are not safe anywhere anymore. The last case I'm dealing with presently took place at a religious gathering! Instinctively, the survivors already know the state does not care and people around would rather want them to "soak it" in and move on with life. Which life?

Traffic Medicine-1: Managing the Carnage on Nigeria's Roads

Last week the nation lost scores of compatriots who perished in the road traffic crash along Benin expressway. And like in many instances in Nigeria, disaster victim identification (DVI) has not been given any serious consideration by those in authorities. An eye witness account in a media report captured the situation on ground which would have required expert intervention. He stated: “I cannot tell you the number corpses taken to the mortuary, there was lot of carcass; heads, legs, it’s not possible to count them out,” In a recent national disaster, we had offered our expertise to undertake a proper DVI under the auspices of our Forensic Medicine Society but we were eventually not called upon for the duty till date. We couldn't just jump unto the scene. There are procedures and modalities for engaging in an assignment of this nature as it is essentially a medico-legal process, and appropriate mandate and minimum facilities are required. What else can one do for a country when the nation fails basic test of responsibility in identifying her citizens, upholding their dignity even in death? Effectively destroyed in this ugly situation is the means for the families, friends and the community to achieve closure and eventually move on with their lives following such unfortunate incident? This is our sorry state and we keep retelling the story. My prayers and best wishes go out to the families and friends of the victims and to the entire community in bondage of avoidable calamities and unmitigated pains and suffering.

Insightful Exchanges with one of my Blog Readers

Reader:
Please sir what can you say about the Nigerian man that kills his wife by throwing her into a pit latrine?
My Response:
Dear "Reader" any form of violence is condemnable and must be addressed by the society. There is therefore need to strengthen the justice system and provide relevant forensic medical services that will support the justice system in dealing with cases of this nature. It's a shame that some humans, for whatever reasons, get so low and appear to have a level of appreciation of life lower than that of animals. And let me make it clear, no one, for whatever reasons, has any right to violate another person or even contemplate taking the life of others. There are mechanisms set in our laws, culture and social ethos for resolving conflicts and none includes killing the other person. Domestic violence is a huge problem in Nigeria and most of Africa and shamefully the police and justice system that should intervene at some earlier stages, awkwardly term it "domestic affairs" until someone turns out dead like the case you cited. We all need to be advocates for the establishment of fully funded and functional Child and Women Protection Agencies by the State so that early signs of abuse could be tracked and survivors could tell their stories.
Reader:
Sir, i believe he may not have done that deliberately, but now that it has happened, the woman is no more and probably they have kids, if this husband is arrested what is going to become of the children? Truly, prevention is far and much more better than cure. This is a complicated issue.
My Response:
A lot of women have gone through untold hardship and abuse in the hands of their husbands or partners and either endured or suffered in silence or eventually ended up in the morgue with one of the main considerations for not taking appropriate action at the right time being "for the sake of their kid(s)". We shouldn't perpetrate the myth that arrest of the abuser(s) and bringing them to justice would hurt any kids. These kids are already damaged by the trauma of witnessing and even experiencing the abuse themselves. The State needs to urgently save these kids from further damage by these perpetrators of abuse. This is what a funded and functional Child and Women Protection Agencies seek to accomplish. Relevant forensic medical evaluation strongly supports this service. Meanwhile, whether the homicide was deliberate or not will be left to the justice process at the Court of Law to decide. We shouldn't make any excuses for any alleged abuse as it fuels more abuse and usually results in a fatal outcome.