Dr. Eugene and I got an opportunity to witness the work of the Victorian Institute of Forensic Medicine (VIFM) in Melbourne, Australia, for a six-week forensic medical fellowship in 2014. This visit was supported by the Australian Leadership Awards Fellowships Program and was funded by the Australian Department of Foreign Affairs and Trade. We thank both of these sponsors for such a beautiful educational experience.
VIFM is an institution focused on how forensic medicine and science can serve the community and the courts. Their statutory responsibilities are to provide independent forensic medical and scientific expertise to the justice system, tissues for transplantation and to both teach and undertake research that will benefit the community. It also serves to provide the justice system with the crucial evidence that underpins safe convictions and appropriate acquittals. Their doctors and scientists investigate deaths reported to the coroner, examine sexual assault victims and alleged offenders and medically assess, treat and support victims of crime.
VIFM is regulated primarily by the Victorian Institute of Forensic Medicine Act 1985. It has a significant degree of autonomy, and for government administrative purposes, it is within the Attorney General’s portfolio in the department of Justice and Regulation. I believe establishing an Institute of Forensic Medicine (IFM) in our country along similar lines would be the ideal alternative to the present state of affairs of the medico-legal system of our country. This IFM would have a fair degree of autonomy and would be ‘governed, monitored and supported’ by the Board of the Medico-legal Commission which is formed from policy-makers from the Home, Law, Health, and Education Ministries and from the universities that are given the responsibilities of providing medico-legal service. If this is possible, then the field of forensic medicine could develop quite rapidly and people working in this field as well as the general public could get quite a sense of relief. This provision will also help to address the issue of lack of development funds for forensic medicine and will establish prompt communication links among the police, prosecution, defense lawyers, the media and the IFM, which can then enhance the overall justice system in the country.
The VIFM infrastructure and facilities are modernized, well-equipped and up-to-date. It seemed that they have made no compromise in any aspect of forensic medicine which is critical for maintaining a fair justice system. They have forensic pathology, clinical forensic medicine, histology, forensic anthropology, forensic radiology, toxicology, DNA analysis, tissue bank for transplantation services and forensic entomology all under one roof. This naturally makes the investigation process very prompt, not like our system, where even mere communication among the existing departments is difficult, and often impossible, delaying the overall verdict in the courts for years and years. They have a huge mortuary where at least 500 bodies can be stored at one time, and always ready for immediate use. Their autopsy room is large enough to perform at least 20 autopsies simultaneously. There is no shortage of mortuary assistants, running water and electricity. Cleanliness and order is the norm there. The floor of the mortuary was clean and dry at all times, with the high-tech cleaning and drying proceeding simultaneously with the autopsy work. They have a state of the art toxicology lab and radiology facilities. They are equipped with a 256-slice CT scan which is used to scan the body brought for autopsy examination. Simultaneously, a blood sample is taken from the femoral vessel for toxicology. If a cause of death is evident, through CT scan and toxicology, an open autopsy procedure is not carried out.
Here, I am not trying to imply that a CT scan and similar state-of-the-art resources should be available in our mortuaries in Nepal, when these resources are not even accessible for the overwhelming majority of our citizens when they visit the hospitals for their health problems. I am simply trying to convey that at least the basic needs required for an autopsy examination, for example, an autopsy room, a running source of water, adequate lighting, a table, a set of instruments the total cost of which would not exceed NRS. 10,000.00, and adequate gloves and a few sets of reusable protective autopsy garments should be a guarantee even before an autopsy examination can begin!
One of the reasons that I see for our not having a developed forensic medicine practice is the lack of will power among us who have, willingly or as a personal necessity, chosen this field as our career. And even if we do manage to generate the will power, the political leaders and the policy makers of the government, have – forgive me – no idea whatsoever about how to develop an efficient, low-cost and sustainable medico-legal system in the country.
The prospects for the development of the field of forensic medicine in Nepal are very poor because the political situation of the country is deteriorating and there are no political leaders who are honest and knowledgeable enough about the field and who have enough time at their disposal to acknowledge the importance and necessity of forensic medicine for a fair justice system. Having said this, does this mean that we don’t have any chance of developing our professional field? Not exactly! Think again. If everyone of us does what we can from our respective work place and if all of us combine our efforts to address this problem, all the stake holders of the criminal justice system as a whole will be ‘motivated’ to be positively involved in doing their best for the development of the medico-legal system of Nepal.
Dr. Gopal Kumar Chaudhary, MD
Department of Forensic Medicine
IOM, MMC, Maharajgunj