Dissecting forensic pathology

Dr Bernard Midia is a forensics pathologist at Kenyatta National Hospital and an honorary lecturer of pathology at The University of Nairobi both at undergraduate and post graduate levels.

He studied Master of Medicine in human pathology at the same university before training further in forensic medicine/pathology at the University of Dundee in Scotland.

He acquired his license for medical practice in 1999, and has been in the discipline of forensic pathology since 2015.

He tells us what forensic pathology entails.

“Forensic pathology is a discipline of pathology that is concerned with investigating deaths with medico-legal implications such as suspected homicides, suicide, murder, poisoning or accidents. Forensic pathologists assist in investigations by providing medical expertise based on their findings for purposes of justice, and not to support any of the parties involved in the trial.”  He says, and notes that in some countries, forensic medicine exists as a medical specialty within the legal system, and not within the healthcare system. 

What does a Forensic Pathologist do?

“On job, the pathologist identifies the subject before conducting a post-mortem or an autopsy. In a post-mortem, you examine the body without dissecting it. An autopsy, on the other hand, is a more invasive and intrusive exercise where you dissect the body and remove organs for specialised examination,” he explains. After conducting an autopsy, specimens are sent to the Government Chemist for a toxicology test.

“It is upon the pathologist to determine if further tests are required in a given case, using his or her clinical acumen,” he says.

The underlying principle of forensic pathology, Dr Midia says, is a discipline called trace evidence. 

“In this specialty, elements such as hair strands, fibres, pieces of clothing, paint and glass are collected from the scene of crime or the victim’s body and their properties examined physically, through optical means and their chemical properties established.

The analysis is done using highly-specialised scientific means to reconstruct an event, aimed at linking a suspect to the crime in question,” he says, adding that forensic pathology is also applied among rape and assault incidents.

“In a rape case, seminal material such as spermatozoa is collected from the victim and the material taken for a DNA test for comparison with that of the suspect. Trace evidence must be collected at a given point for purposes of clarity.” 

COMPLEXITIES

“On any given case, I deal with different parties with conflicting interests. I must, therefore, remain strictly professional in my work to avoid further disputes. It is nonsensical to study for half of your life and build a career only to be compromised. Signing a falsehood in the results form is unprofessional and undermines your credibility as an expert,” he says. 

TRAINING

To practice forensic pathology, one must be trained in medicine, and specifically in anatomical pathology, before specialising in forensic pathology. “Training varies in different countries. But one must have a higher sub-specialised training in forensic medicine/pathology after attaining a high specialised academic qualification in Human Pathology at a Master of Medicine level,” Dr Midia says.

But is this profession attractive for pursuit in Kenya?

 According to Dr Midia, there are about 80 pathologists in Kenya, both in the public sector and private practice, the majority of whom are concentrated in Nairobi.

 “But there are only three forensic pathologists in Kenya, who are involved in other clinical diagnostic services such as cytopathology (a diagnostic technique that examines cells to determine the cause or the nature of disease) and histopathology (the study of diseased tissue). Definitely more forensics pathologists are required.”

So, what attributes are required in this profession?

“As a medical doctor, you are sworn in by oath, which you must abide by in all medical engagements. You must uphold high standards of integrity and be passionate about your work. You must also be a team  player because this nature of work relies heavily on teamwork; to identify subjects, conduct DNA and carry out technical work during disasters,” He advices.

Dr Midia argues that Kenya has a host of lessons to learn from more advanced economies as it hopes to improve forensic pathology locally.

“There is hardly private practice in pathology and medicine in countries such as Scotland, England, South Africa and the US because remuneration in the public sector is better than here,” he observes.

“Because of the complexities involved in forensic pathology, practitioners are required to acquire additional accreditation besides their medical licenses. Some of these accreditations are issued by international medical bodies,” he says.

Challenges

“Any investigation follows a chain of custody. The pathologist will often conduct tests and hand over the report to investigators, usually the police. If for instance the investigators beyond the pathologists are compromised in any way, this affects the final outcome in the case. It is for this reason that forensic pathologists are often summoned to personally testify in court,” he says, adding that lack of reagents at the Government Chemist, greatly impedes the speedy conclusion of inquests “since all specimens drawn from the whole country depend on the institution for such chemicals. Further, a full panel toxicological screen examination costs more than Sh100,000 and is only available outside the country, delaying the investigations,” he says.

Emerging Issues

He continues to note that increase in unexpected, suspicious and unnatural deaths is one of the major emerging issues in the profession. Of these, “trauma-related deaths from road carnage are seriously on the rise. Seven out of ten post-mortem examinations that I conduct daily arise from accidents,” he reveals.

Another emerging issue in the practice of pathology in Kenya is the   National Coroners Service Act of 2017 that is about to become law.

“It addresses issues of independence of medicolegal investigations, resource mobilisation for the inquests, efficiency in operations and remuneration that meets international standards,” he says.

Being a sensitive a discipline of medicine, forensic pathology is governed by several laws.

“A practitioner must be well versed with laws that govern medicine such as the Human Tissue Act which guide on matters such as organ harvesting, preservation and disposal, Death Notification and Registration and the Constitution. The National Coroner’s Service Act will be a shot in the arm of forensic pathology in Kenya,” he says.

Would he recommend this profession to young people?

“Any day. This is an exciting profession with very rich exposure. Pathology is the bedrock of medicine; I can operate on someone, conduct a caesarean section, treat and diagnose an ailment. You have to be well-versed with all aspects medical law, ethics, science and medicine.

In forensics, you must know how to use this information for legal purposes, and that means proper exposure; know how to handle specimen and the intricacies of ballistics,” he concludes.