Standing with France, Standing with Humanity and Denouncing Terrorism

This post is dedicated to the victims of the recent mindless and cowardly killing of ordinary people in France by persons and affiliate groups who have no place in our contemporary world.
Together and united, we'll defeat this barbaric ideology and they will never succeed in depriving us of our shared humanity.

"‘Dead’ man wakes up just before post-mortem"

I have decided to make this news report headline the focus of this post because of its importance to individuals and to our communities especially with regards to hospital practice vis-a-vis management of the dead. The details of the story are in The Times of India.

Certifying death may appear to be a routine task involving some quick procedures and paperwork, but it is as important as any other clinical work undertaken by a medical doctor. This is why in most countries, only a medical doctor, for good reasons, can certify that someone has indeed died. The mere appearance of lifelessness is not akin to death and that is why it takes the knowledge and skill of a physician to make that final call. Unfortunately, this all-important duty may be carried out rather in haste because of the general attitude of "finality" and low priority accorded to the apparently dead. Now you can imagine the risks individuals and the community at large may face in situations where the dead are "confirmed" dead at home, usually by non-doctors and the following action will be burial or embalmment in some mortuary depending on funeral practices.

Imagine the following:

1. The possibility that more people pronounced dead outside of the hospital may not actually be dead in the first place.

2. Some patients pronounced dead in the hospital and quickly (in minutes or a few hours) released to relations (who may already have a ready coffin to carry the body) for immediate burial, may not be dead after all and may have been buried in error! Immediate burial is common in some contexts in the developing world due to peculiar factors including culture and religion.

3. That the practice of immediate body preservation especially formalin embalmment, most of which in some countries are conducted outside of hospital facilities, could pose a potential risk of inadvertent termination of life of a patient in a possible state of "suspended animation". One may argue it is a remote possibility, but the loss of any life is 100% loss to the affected family.

The take-home is not that a state of "suspended animation" is such a common occurrence or that doctors often make mistakes in certifying death. The importance of this news report is the need to adhere strictly to protocol at all times, especially in dealing with the human body including after-life care. Often post-mortem care is neglected in many hospitals. The practice of calling the attention of the doctor to a "dead" patient often by other healthcare workers assisting and working closely with doctors, should be discouraged. Such labelling could be a potential block in the mind and attitude of the doctor in applying due clinical care, like resuscitation and diligent check for vital signs and reflexes before coming to a conclusion of "dead".

I'll recommend that a doctor's attention be brought to a patient with a simple and clear indication that the patient is no longer breathing or that the pulse is not felt etc. It therefore puts the doctor in the right frame of mind to trigger necessary steps including resuscitation measures, where applicable, before certifying death, especially in busy areas of clinical care like the Emergency Room. "Doctor this patient is dead" or "...has expired" should not be allowed. Certifying death should only be objective and meticulous and bodies should be deposited in a hospital mortuary preferably in a chiller for at least 24 hours before release to family. Similarly, when an autopsy is indicated, the body of the dead should not be taken straight to the autopsy table immediately after death certification at the ER or hospital ward. There are a lot of safeguards in bodies staying in a functional mortuary for at least 24 hours before further actions are taken except in exceptional circumstances. I must also state that in some circumstances, death is very obvious and does not require any further validation e.g., decapitation. However, the mere presence of certain features, usually associated with postmortem changes in the body of the dead, e.g., maggots, is not proof that this particular person is dead because the larvae can feed on any necrotic or dead tissues even in the living! This situation also applied to the index case, the "dead" man who woke up.

Whatever the situation, there must be dignified management of the dead in all cases, and no occasion should arise where "dead" bodies will wake up just before postmortem as reported in the Indian news report. It calls for due diligence in pronouncing someone dead and has medicolegal entailment. 

Our Humanity; a Top Consideration

It is becoming clearer by the day that despite artificial borders and differences in political leanings, religions and culture, we are simply Humanity. We all feel pain, share joy, experience frustration and seek for better lives for ourselves and loved ones. It was therefore heart wrenching to see countless number of refugees and migrants perishing in the Mediterranean Sea in attempt to escape the horror they face in their "home" of circumstance. However, the concept of "home", "our home", "our country" or "our land" has come in the way of embracing our shared humanity and the result has been a huge global refugee and migrant tragedy recently captured by the body of drowned 3 year old boy washed ashore. It is a serious opportunity to rethink our humanity and our shared values.

It is not uncommon to talk about professionalism, academics, and various institutional frameworks for governance, business, and the general polity. What may be missing sometimes may be an appropriate recognition of what the end is supposed to be. The aforementioned are undoubtedly means of achieving some end but the ultimate end is enhancing our humanity; positing our humanity into proper perspective; making the lives of people around us more wholesome and meaningful; developing the human capital towards realizing our goal of making our communities a better place. Nations, especially the developed countries, which are currently witnessing influx of refugees or immigrants, may need to change the narrative from being that of "fear and apprehension of being invaded" to a humanity narrative of "precious human capital that could drive positive change and innovation for greater progress". Humans are at the core of any development, prosperity and advancement in any geographical space. It is therefore time we started appreciating the value of our humanity in contextualizing policies and operations.

Meanwhile, some sense of order is required for any meaningful progress to be accomplished. Documentation is one of the vital tools in achieving our humanity essence. Therefore, as great human movement of refugees and migrants (unfortunately largely due to man-made disasters and violence) of our generation continues, neighboring and other concerned countries should prepare to make the process of documentation less cumbersome, transparent and devoid of profiling prejudices. We must understand that where we call "home" today was probably where our great grandparents migrated to in some distant past. One may need to check out some history about countries in the world starting in alphabetical in order to get a sense of “home” redefinition.  "Home" is in a constant state of flux and only the humility and consideration in our humanity that can bring that message home that we are not completely at "home" until everyone has a place to call "home". Forensic tools could be deployed to ensure that everyone is accounted for in manner that seeks to provide for their needs and track their progress in settling into a new environment. Good News is that in any community or groups, there are far more good people than the bad ones, who unfortunately tend to grab the headlines most times. However, trusting our humanity emboldens our common good and at the same time represses the operation and relevance of evil. We can only achieve this by focusing more on our shared values rather than on things that divide; rather than on things that cause us to fear and distrust; and rather than on terror. Humanity is a team work and we belong to one another. And this is the meaning of any skills, talents, professions or institutions we may hold. The true expression of these items is in promoting our humanity.

While I was Away....

I've missed my readers on this blog for some months. It has been a very eventful period since April 2015 when my last post was made. There have been new developments in Africa regarding the practice of Forensic Medicine and how Africa engages in addressing certain challenges on the continent and beyond with forensic knowledge and skills. Earlier this year, in the first week of March 2015, African practitioners gathered in Nairobi under the auspices of the African Society of Forensic Medicine (ASFM) for the annual forensic conference to discuss the theme: Forensic Management of Violence in Africa. Sub-themes included Management of Terrorism and Armed Conflict, Management of Sexual and Gender Based Violence and Interpersonal Violence and Injury Interpretation. Stakeholders like UN Women, International Committee of the Red Cross (ICRC), and other stakeholders were in attendance to contribute in charting a way forward towards reducing the scourge of violence in Africa especially with the upsurge in armed conflict and terrorism. Incidentally, where there is armed conflict or terrorism, sexual and gender based violence increases. The case of the Chibok girls abducted by the marauding Boko Haram terrorists in Nigeria underscores the unfortunate nexus. Practical discussions were held on modalities of managing violence and the urgent need for nation states in Africa to adopt standard protocol that will guide practitioners in offering appropriate services. Emphasis was also placed on the urgent need for infrastructural and human capital development in forensic medicine and science in Africa.

Towards addressing great human distress associated with unidentified bodies following disasters, some of which are precipitated by violence, a dedicated team of African volunteers who could be deployed at short notice to assist communities plagued by mass causalities was inaugurated. The team named DVI Team Africa is the first of its kind in Africa and volunteers are mainly practitioners in forensic medicine and science. It will be easier to mobilize much needed support to assist in disaster management in any parts of Africa where such assistance is needed. The team could also contribute to international disaster management beyond Africa, when such involvement required. It is commendable that African practitioners are stepping up to being part of the solution to a complex and pervasive problem on the continent.

Meanwhile, many events of forensic relevance have taken place during this "leave of absence" period. There was a focus on the unregulated fertility practice in Nigeria, an alarm I had raised in my earlier blogs. An investigative journalist unraveled just a portion of this sordid story in the second week of August under the title: Ovum trading: Inside Nigeria's multi-million naira human egg business. I will be writing more on this and other issues in subsequent posts.

Finally, I wouldn't want to be away for a long time like in this case. However, work situation and exigencies sometime conspire to attenuate our commitment to other important issues. Working on maintaining a delicate balance is a continuous effort. And thanks for staying with this blog. Your comments will be invaluable to gaining more understanding about what happens around us in our different points of view.

It's not usually a Stranger lurking in the Dark: "Father in Court for Raping Daughter"

The headline from a national daily, Punch Newspapers, underscores the importance of dismantling myths about sexual violence against women and children.

Not infrequently, we do not look in the right places in the fight against sexual violence in our communities. Women and children continue to suffer in silence, often out of shame and intimidation in homes and amongst family members in the hands of close relations including husbands, fathers, uncles etc. When the violation eventually blows open, it is usually too late as the victim often turns up dead in the morgue or severely injured in the hospital. I have seen some cases and it is truly pathetic. Accepting that perpetrators of sexual violence could be close family members, relations, friends and others in a trusting relationship, could go a long way in curtailing this malady.

Meanwhile, it is important that Women and Child Protection agencies are recognized as important means of addressing the scourge of violence against women and children. States should set up functional protection agencies in the relevant ministries to carry out necessary duties to ensure that children suspected of being abused at home (such suspicion may first be made in a hospital or other public facilities) are followed up with appropriate investigation and treatment, and are subsequently protected in safe shelters where applicable. Schools and places of worship are also potential places for abuse of children and women, and could also serve as a veritable vehicle for the prevention of abuse if appropriately channelled. 

Unfortunately, many States in Nigeria in particular, and Africa in general, do not have Women and Child Protection agencies established by the State with requisite powers, responsibilities and resources. I've held advocacy meetings with some government officials on the need for this very important agency of the State. On 23 October 2014 at a symposium organized by the Child Protection Network, an NGO in Ibadan on the Implementation of Child Rights and at a similar event on 3 December 2014 organized by Star Children Initiative, another NGO also in Ibadan, on Promoting Accessibility and Harnessing Resources for Children with Disability in Nigeria, we reiterated the urgent need for a Women and Child Protection agency that will provide specialist assessment and offer necessary services to children, women and their families where there is suspicion of, or ongoing abuse, maltreatment or neglect. This will also facilitate the institutionalization and standardization of the quality of care provided to survivors of sexual violence and other forms of violence. There should also be some piece of legislation that will make it mandatory for teachers, health professionals (especially family physicians and paediatricians), leaders of faith-based organizations/worship places, etc, to report suspected cases of sexual and other forms of violence to relevant State agencies for prompt action. Failure to do so by these professionals and organizations should be a severe liability as a criminal breach of trust or connivance. Preemptive surveillance and promoting safe environments will facilitate the primary prevention of sexual violence against children and women, and would be a better option than the best forensic and medical management of survivors.

It still holds true that prevention is better than cure. Nonetheless, appropriate forensic medical management and other specialist therapeutic services are inevitable in the fight against sexual violence and other forms of violence especially targeted against children and women in our communities. The time for action was yesterday; we earnestly need to catch up!

Misdirected Messaging in Sexual Violence against Children and Women

A couple of days ago, I read a newspaper headline and couldn't believe what a high ranking government official in one of cosmopolitan states in Africa was quoted to have said. The headline, Pupils urged to resist sexual abuse, once again portrays a basic lack of understanding of this subject by those whose responsibility is it to protect these children from predators. At the said workshop on violence and sexual abuse for secondary school pupils in Alausa, Ikeja, Lagos, Nigeria, a celebrity in attendance  "advised students to be careful of how they dress and the way they react to sex abuse". This is a myth that has been perpetrated by the society. A girl is not raped because of her dressing. She is raped because someone made a conscious decision to abuse his position or power and exert control over her. We are only feeding the beast, a subject of my earlier post, if we keep giving perpetrators excuse for the violation inflicted on the victims.

Meanwhile, we need to ask our government officials and agencies how exactly these pupils are supposed to resist sexual abuse. A director in the ministry of Justice, Clara Ibirogba, who spoke on behalf of the attorney general of the state provided the answer:..."pupils should avoid watching bad films, exposing private parts and reading pornographic materials."
Clearly this is a manifestation of lacking of understanding of basic issues in sexual violence and the need for proper education of policy makers and government agencies in the fight to curb this menace.
Reading through the news report shows the enormous responsibility placed on children in the fight against sexual violence and that invariably implies that they share a major blame for any failure in this regard.
This is bad messaging. It should not happen.
We need to start focusing on the perpetrators and direct attention to appropriate quarters.
Again, victims of sexual do not invite rape upon themselves. No, someone violated them and that person carries the entire responsibility. It is this kind of misdirected message that emboldens perpetrators and essentially puts their victims in the dock of public court. How could we ask children and victims of sexual violence to resist sexual abuse? Placing them on that danger line defeats the message. Society must go after predators and ensure our children are protected.

It is this attitude and poor treatment of victims that made the mother of a girl allegedly raped by a security man, again in Lagos, to cry out in a recent media headline: Police blame me for my daughter’s rape, protect rapist – Mother of eight-year-old girl raped by security man
The link provides a typical example of how deep in the hole we are about solving the problem of sexual violence especially against children and women especially in Africa. A major link in this fight, state agency like the police, is so weak in this regard that it has become part of the problem. The sad story of this woman is replicated all over.
Aggressive training programme for the police, setting up special police unit for sexual violence (often general duty police officers regard sexual violence as "domestic affair" despite the provision in the criminal code), and enlightenment for the general public on sexual violence have become an urgent need in our communities.
The agony of this hapless woman should not be the order as it is presently.

When it Feels Like Giving Up

Dear blog visitor and reader, I apologize for my long absence on blog posts. Too many factors came in the way. I had actually written some materials to post on my link but the sheer volume of occurrences of some of the issues in question and the apparent feeling of helplessness in addressing them was quite overwhelming. One of the issues is sexual violence especially childhood sexual assault. There was hardly a day that would go by (on monitoring media reports), that another gory story of a violation of a child would not turn up. After the usual apparent outrage by the public, the matter naturally dies off and nothing is done to tackle the issue.
The police appear ill equipped to handle these cases because of poor or lack of training in this aspect and lack of requisite equipment, and there are also obstacles occasioned by lack of protocol for collection of credible evidence and attendant technical blockades in the judiciary.
Generally, the issue of management of sexual violence is not a priority for a health sector grappling with budget issues while facing myriads of communicable and non communicable diseases prevalent in our communities.
This and other forensic issues remain an orphan in most of African countries. Everyone talks and pities the situation but there is very little investment in human and material resources, and practically no institutional changes are implemented in tackling the fundamental problems.
I've made presentations before stakeholders, government agencies and NGOs, and I've met with government officials whose offices I reckoned could drive a change. However, the status remains the same and there is a tendency of thinking it is a hopeless situation in our generation to take concrete action in protecting the vulnerable in our community. I've attended to cases of sexual violence in children which reached a dead end even before actual case management began because the kind of multidisciplinary and multi-agency team work required to make any meaningful impact is simply lacking.
So where do we go from here?

2014 ended on a most tragic note. The sudden death of my teacher, senior colleague, a mentor and friend shattered any fragile stability in place. Prof Effiong Essien Udo Akang, an eminent Pathologist and Neuropathologist, was the best friend a colleague could have. He was ever supportive and was a shoulder for younger colleagues to lean on especially when disillusionment beckoned. He was also my Head of Department. The sudden and unexpected nature of the incident made it even more painful. One can only hope for some recovery from this irreparable trauma occasioned by the sudden exist of someone I had interacted with on daily basis for as long as I could recall. He was my family; he was dependable and someone to confide in.

Prof Akang died on 31 December, 2014. He left a huge void that may never be filled and I will miss him every day of this life; every day I pass beside his office door almost knocking as usual to exchange ideas or pleasantries. Indeed it is hard to say Goodbye!