Finding answers to mysterious deaths

By LILLIAN ALUANGA-DELVAUX

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KENYA: Speculation has been rife on what could have led to the recent sudden death of former Juja MP George Thuo after he collapsed while having drinks with friends. 

Eight months earlier, the nation had awoken to news that former Makueni Senator Mutula Kilonzo was no more. He, too, was found dead in unclear circumstances at his Maanzoni ranch.

Thuo and Mutula’s deaths follow a script familiar with sudden deaths, as both appeared to have been in good health prior to their deaths.

Last month’s release of Mutula’s autopsy results, however, showed he suffered massive internal bleeding.

But away from the “prominent cases” that are often likely to grab headlines, stories abound of otherwise healthy people who died ‘under mysterious circumstances,’ leaving their families with many unanswered questions.

Take, for instance, the case of 24-year-old Rose Adhiambo, who was excited to get a job in the Middle East in 2010. Adhiambo would later return home, in a casket, with a note attached to her body simply stating she had died “while trying to escape from her employer’s home”. In the same year, 29-year-old Franklin Othieno is believed to have died while in the custody of immigration officials in a European capital. A post mortem examination showed he died of “natural causes”, a theory the family disputes.

So just how is one’s cause of death determined?

According to former Chief Government pathologist Dr  Geoffrey Mutuma, a simple test of urine and sputum (mucous that is coughed up from the airways) can be used to provide the answers.

In cases of sudden death, particularly where someone is not known to have shown any signs of sickness, a forensic post mortem examination is conducted. In such cases, injuries on the body, either physical or chemical, could provide  vital clues.

“A person’s clothing, external factors like the skin, injuries to the head, chest or abdomen and an internal examination of organs like the brain, lungs, heart, kidneys, pancreas and intestines, are important in determining the cause of death,” says Dr. Mutuma.

Less than 10

Take, for instance, the death of six prisoners at the Kingo’ong’o prison in 2001. While prison authorities maintained the prisoners had died as a result of injuries sustained as they tried to scale a 40-metre wall, autopsy results showed otherwise.

To further narrow down a person’s cause of death, toxicology tests that often take much longer than the post mortem examination, may be conducted. This involves taking several samples from the body that will then be studied to make conclusions. While the number of samples may vary from one case to another, there are those considered ‘key’. These include blood, urine and bile samples. Others that may be required include those from the saliva, liver, stomach, eye, hair and nails.

Between six to 10 samples are sufficient to conduct adequate tests to determine one’s cause of death.  But even though families remain hopeful of finding answers to the sudden death of their kin, there are many instances where even the pathologists come up empty.

The pathologist argues that while up to 80 per cent of conclusions on the cause of death may be made on close examination of a body, toxicological tests are often conducted to confirm findings that may have been arrived at during the post mortem.

Should the National Coroners Service Bill become law then perhaps dozens of unexplained deaths will become a thing of the past.

While there are no statistics to back the claims, Consultant pathologist and Forensic Specialist Dr Andrew Gachii, says its possible that many cases of medical malpractice or negligence leading to death in hospitals, are going undetected.

Currently, Kenya has about 70 pathologists. This number is inclusive of pathologists in different fields like virologists, and microbiologists. But the number of pathologists specifically trained to conduct postmortems is 40, while forensic pathologists are less than 10.

“ We have heard cases where patients have died while undergoing an operation, or just 24 hours after an operation. In many cases families don’t ask for an autopsy. But in ideal situations such cases would be handled by a Coroner’s Office,” he says.

“ Just because someone has been in hospital for some time, or even where they may be having a disease that is known, isn’t enough to assume this is what killed them. In cases where families doubt the circumstances leading to the death they have a right to ask questions and lodge a formal complaint,” adds Gachii.

Currently, such cases may be reported to the police.

Among objectives of the Coroners Service Bill is to provide for coroners to investigate certain kinds of deaths to determine identities of the deceased persons, the times and date of their deaths, and manner and cause of their deaths. Should the Bill be passed into law it will also see the creation of a Coroner General’s office. According to the proposed legislation the Coroners Service shall have jurisdiction to investigate the cause of death in cases of a violent or unnatural death, sudden death, and death in police custody.

Gachii says while the Bill had envisioned having a Coroner’s office in each of the 47 Counties this might not be feasible.

“ We may have to settle for having one Coroner’s office per two Counties given the shortage of trained personnel and equipment,” he said