Where Lack of Professionalism is a Way of Life

Rashid describes various deficiencies in the state official machinery to conduct professional forensic medical examinations, but the truth is that there is a lack of professionalism in all walks of life in Kashmir

(Dr. Rashid Para, 41, was born in Naira village in the Pulwama district. He did his childhood schooling in the local government run school in Tahab, and from the 6th grade attended the Sainik School in Nagrota, Jammu. He passed the 12th grade class with distinction. He received admission to pusue medical studies at the Pavlov Medical University, in St. Petersburg, studied Russian at a language school in Tablisi, Georgia, before proceeding to the medical university in Russia. Subsequently he completed his post graduation in anesthesia and critical care at the Government Medical College (GMC) Srinagar. He is presently serving at the Government District Hospital in Pulwama. Dr. Para is founder member and senior central executive council member of the Doctors Association Kashmir (DAK), and spokesperson of Anesthesiologists Association Kashmir. In his leisure time he enjoys playing with his children and in parent-teacher and related functions at their school.)

Our administration needs Postmortem

The recent incident of rape and murder of two young innocent females at Shopian has not only unfolded the depth of human tragedy in Kashmir but has also exposed the vulnerability of police, medical and forensic departments to handle such incidents and bring investigation to any logical conclusion. Had these departments acted professionally and on time probably the situation could have been different.

Also, this has brought out a strong message for our politicians that people in Kashmir value their chastity and dignity more than the economic development. They have lost millions as a result of on-going agitation and continuous strike and so has the education as the colleges and schools of the entire district are closed from the last one month or so. This incident did affect the over all economy of our state as well. But who is responsible?

Our state badly needs police and administrative reforms which shall empower people and not vice versa. We have to erode the present bureaucracy, police and administrative juggernaut that intimidates and petrify its own people. The political and administrative setups have to be made independent. The political system in the state should also act ex-cathedra by giving transparent administration to its people and bringing genuine, honest and dedicated people at the helm of affairs. The Shopian incident has exacerbated people and exasperated government as well. Family of the victims is equally pained and want only the perpetrators of this heinous crime be unmasked and be booked under law. The society was remorseful and government also needs to act with compassion and compunction. They are still remonstrating for justice and are not inclined towards any setup.

The medical department has handled the case unprofessionally as per the Commission of Report (CoI) and has resulted in hotchpotch and loss of pellucidity in the case. Being a doctor I would like to comment on the medical aspects of handling of such cases. Postmortems are a routine investigation in American and European countries on almost every death. But in our setup lot of social stigma is attached to it. For a common man here it is very frightening. Till now I have never seen a postmortem was ever conducted in an ambiance free from public anger and outrage. Due to the lack of trust people always carry a feeling that the truth will be stashed away.

Shopian postmortems were carried out in more difficult situation because angry mob could not be controlled and people wanted to know cause of death immediately. Postmortem has to answer the cause of death and the nature of offence and crime committed. But unfortunately our way of conducting autopsies and collection of evidences end up in misdemeanor and ultimately facing a predicament. We have to make a thorough introspection today and admit to weaknesses and shortcomings. We need to acknowledge that the procedure of conducting postmortems in our state is not developed. Forensic medicine is taught as an undergraduate medical subject and there is no post graduate specialization courses available in our state. Forensic department is also not recognized by MCI. As we know specialist care cannot be rendered without specialization courses in particular fields, similarly forensic expertise is a specialist field which can not be always carried out to perfection by simple MBBS doctors. So it will not be genuine to expect too much from the existing scenario. Dead bodies even need to be respected while performing autopsies. But unfortunately most of our district and sub-district hospitals have filthy sheds available for conducting autopsies which are even worst than cowsheds, lacking even basic facilities of water and electricity. The instruments are either rusty or obsolete which further brings humiliation to the dead body. And I know after reading this report our officers will again waste no time to please the government that everything is right and there is no deficiency.

But we have to be honest that all that is fair and right is only on papers and not on ground. And I promise if a random test on forensic medicine is taken from all these officers of health department. So let’s not unnecessarily deceive our nation.

We also know that population of the country is increasing, modernization is at pace, movement of people into and outside the state has increased multifold, hi-tech communication system is affordable and easily accessible, and perhaps all these factors will proportionately increase the crime rate as well and thus pose more challenges before the government in future. The nature of crime will change as well. And if we fail to renovate the system of collection of evidences on modern scientific lines, we may end up seeing this as a one side affair where criminals will be able to create more Shopian like incidents and all indicators of peace, development, and prosperity will be eclipsed behind the ominous and behemoth faces of criminals who will be difficult to unveil. So a well established medical jurisprudence system has to be established at earliest and I recommend following exigencies.

1) All those incidents and cases which can lead to repercussions of greater magnitude as that of Shopian, in such cases autopsies should be only carried out by most competent personnel who have a proper specialization (forensic doctor/expert).
2) Every district headquarter should be well equipped with proper infrastructure and space for conduct of autopsies.
3) To achieve the objectives for which a medico-legal autopsy is carried out, mortuaries must be properly equipped. Unfortunately, in India, most mortuaries lack basic facilities, leave aside the surgical suite-like atmosphere. Many mortuaries do not have cold storage facilities for preserving dead bodies, and the few ones that have do not have uninterrupted electric power supply to run them. As a result, dead bodies stored here decompose and crucial medical evidence is lost. So-called mortuaries in many rural hospitals lack basic cleanliness. There is a dearth of proper instruments (for example to cut the skull), and the lack of sterile containers to collect viscera for further investigations increases the chances of cross contamination. As a result of this poor infrastructure, the chances of reaching a valid conclusion on the cause of death are poor.
4) To help forensic science to usher in our state the forensic department at all medical colleges should be adequately staffed and post graduation courses started at earliest.
5) Meanwhile from every district and sub-district hospitals doctors should be sent for crash courses in forensic expertise outside state to PGI or AIIMS.
6) Autopsies should be carried out strictly under rules and not on verbal instructions.
7) There should be proper security arrangement in and around the hospitals and autopsy centers.
8) People have to be educated and awareness should be created through programmes that their cooperation can yield better results on such occasions. People should also be taught how their unnecessary interference and mishandling can lead to erosion and destruction of evidences which can turn counterproductive for getting justice in time.
9) Police and doctors should strictly work under rules and ethics in such situations and should not allow themselves to get influenced by political system and should be hold accountable before district ombudsman appointed for the purpose.
10) Political interference should be checked and controlled.
We hope and expect that such measures will help in building the trust and help in delivering justice.