Medico-legal services in Nepal are not yet fully recognized as a ‘service’ sector and are treated as if they were an ‘unidentified dead body’, sadly, by all the stake holders of the medico-legal system of the country. Medico-legal cases are investigated – that is, examined, documented and reported – following almost century-old practices rather than based upon the scientific and legal guidelines necessary to the present generations.
There is no record of when the first medico-legal autopsy was done in Nepal. All the government hospitals are utilized for the investigation of all medico-legal cases, which are mostly brought by the police, but the investigation of which can be initiated through other mechanisms as well, when necessary.
Until about 16 years ago, the Ministry of Home Affairs had a health facility named the Police Surgeon’s Office attached to the Central Jail in Kathmandu. The Chief of this facility was always neither a police nor a surgeon, but a senior medical officer, a physician. The prime duties of this facility were to provide medical care to the prisoners in the various jails located in the Kathmandu Valley, admitting them to the different hospitals when necessary. The autopsy of bodies from Kathmandu and Kavre Districts were conducted at the Bir Hospital by the medical officers from the Central Jail Hospital. One small room with a concrete table was allocated for the medico-legal autopsy and an adjacent room of about 12 x 10 feet and with no tables, and no refrigeration of course, served as the body storage area.
In 2056 (1998), when I was a Medical Officer of the Central Jail Hospital after having returned from Sri Lanka with my training in Forensic Medicine, I had to strongly refuse to continue to conduct autopsies in such a poor facility without the minimum basic facilities. A search for a better facility was then made by the Health and Home ministries. Ultimately, the Cabinet of the Ministers of the government decided to shift the medico-legal autopsy service of Kathmandu District from the Bir Hospital to the Forensic Medicine Department of the Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University. The Forensic Medicine Department started to handle the medico-legal autopsies on 15 Bhadra 2057, using the mortuary there, constructed for the demonstration to medical students. The only medical officer trained in forensic medicine in the government service – that was me then, and the situation is the same now after 16 years – with four other mortuary assistants working at the Bir Hospital mortuary were deputed to the IOM Department of Forensic Medicine.
There were about 65 autopsies performed every month at the Bir Hospital 16 years ago, that is almost 800 a year. There were almost 1,638 autopsies conducted at the Department this last year, in 2072, about four a day, on average.
The three of us at the Forensic Medicine Department, Dr Pramod, Dr Tulsi and myslef, handled all the autopsy cases and some of the clinical forensic medicine case in the first ten years. Right from the beginning, dead-body-site visits with the police were quite regularly done. The number of age estimation and torture victim examination cases was higher in the first four years. Examination of cases of alleged sexual assaults began about six years ago. The MD in Forensic Medicine was started in 2067.
Though the government shifted the medico-legal services of Kathmandu from Bir Hospital to the IOM 16 years ago, it has totally failed in developing the overall medico-legal services in the country during these years. The fact that I am still the only government employee with a post-graduate degree in forensic medicine and that the other almost 40 such graduated are employed in the different medical colleges of the country is a proof of this failure. It seems to have shifted its ‘burden’, and not its ‘responsibility’, as the IOM feels that this is the responsibility of the Home Ministry. Thus, our field of forensic medicine and medico-legal services is still, practically, an UNIDENTIFIED and UNRECOGNIZED field in our country.
Today, there is no government ministry or department that is fully responsible and accountable for the management of the medico-legal services throughout the country. This ‘tri-shankhu’ state of the medico-legal services in the country has to be addressed immediately, by all the stake holders of the medico-legal system of the country.
The birth of MELESON is a result of the poor state of the medico-legal services of Nepal. Let us all MELESON members do what we can to build a strong foundation upon which a competent and efficient medico-legal system can be built upon in the next 15 years, at the latest!