FORENSIC MEDICINE IN SOUTH AFRICA - SEX, GUNS, GERMS AND CRIMINALITY
Anthropology has the ability to illustrate, identify, and keep up with the real world, which is too complex to address within the confines of classic socio-political theories. As a bridge between science and humanities - culture clash, death, and issues of uneven and fragmented resource distribution are prime examples of what it can serve to address. In addition, anthropology’s scholarly pursuits often further denationalization of academic dialogues so as to encourage planet-wide dissemination of ideas in order to better understand issues that plague the world writ large.
One such issue is the conflux of the forensic method and evidence-based medicine. In 1956 Alan Moritz reflected on this issue when he said “He [the pathologist] may be highly esteemed by the police and by prosecuting counsel because he is an emphatic and impressive witness. His prestige, together with exclusive access to original evidence, places him in an exceedingly powerful position in the courtroom… the stakes are too high to play hunches in forensic pathology.” and this still holds as basically true. (Moritz, 1956)
Recently though concerns have been raised in several countries about forensic sciences effectiveness, efficiency, cost and whether it is being used in pursuit of a larger socio-political agenda not based on impartial and/or scientific evidence. Thus auditing forensic and medical evidence is an important task as it serves a ‘checks and balances’ role in terms of determining efficacy of police procedure, the importance of proper diagnosis, epidemiological and criminological trends, and subjects them to quality control assurances. Indeed this application is particularly important in my adoptive homeland by marriage - South Africa.
Per the United Nations, South Africa has the most per capita sexual assaults in the world, and such violence has striking long and short-term effects on the victim’s health. In some surveys over 25% of men have admitted to having raped a female. The World Health Organization (WHO) states “Health services for victims of rape have two important roles: to assist the victim and to gather evidence for the police and courts.” Additionally the murder rate is 4.5 times the global average, and drunk driving kills just shy of the murder rate. Couple this with an epidemiologically significant amount of people with HIV, and other potentially fatal illnesses – as well as a diaspora level of emigration – it is surprising that anyone is left in the country at all! (Jewkes R, Christofides N, Vetten L; et. al. 2009)
In an attempt to try and combat these scourges the South African Police Service (or SAPS) in 2006 created the world’s first robotic Genetic Sample Processing System (GSPS) in its Forensic Science Laboratory in Pretoria. The GSPS occupies 47 meters and can effectively process 800 samples per day – four times the previous maximum of 200 per day. As in other British Commonwealth countries initial rape kit evidence is collected either in hospitals, police stations, or in “care centres” – places where trained forensic nurses, therapists, childcare providers and police work together in one location. However in some regions of South Africa only the police station option is available, where unfortunately they are often told not to bother with charges because it might shame their family. Worst yet because of rampant corruption in local law enforcement there is a euphemism called “lost files” for when a police officer or staff working in the station requests a bribe from the victim in order to “find” the files. (Du Mont, J; White, D WHO 2007)
Next, provided the kit actually gets to the lab - per SAPS “all exhibits from criminal cases and crime scenes which may contain DNA are delivered to the Forensic Science Laboratory, registered as a case and allocated with a number. Some are processed but many are archived as suspects have not as yet been arrested or there are no samples with which to make a comparison.” Once there is an identified suspect the prosecutor (but in rare instances the victim) will request that the sample be “activated” and then DNA cross-referencing and analysis begins. When the prosecutor and/or the police investigator give the lab the court date, then the evidence is re-prioritized in a manner so everything is completed by the start of proceedings. This whole process is roughly 90 days from DNA extraction (not collection) to the time the final report is finished, thought it can be expedited when needed urgently. (De Beer, 2006) Unfortunately the entire system seems to be colossally underutilized. Currently the vast majority of samples are merely archived because the prosecutor often doesn’t bother requesting the report. Mainly because of these two factors SA is one of the few countries in the world without a DNA “backlog” but this is not a positive indicator!
In the spirit of understanding these issues the World Health Organization (WHO) and the South African Medical Research Council (SAMRC) - separately and in concert with each other and/or others, have done several studies on what measures are effective - particularly in relation to gender-based violence, murder, and HIV/Aids. Studies have utilized the analysis of rape kit collection procedures across multiple venues, morgue/autopsy reports, court proceedings documents, biological samples, drug tests, and epidemiological surveys.
My first report read is a dispiriting look at femicide by analysis of forensic measures in relation to case progression and conviction outcomes where the court dockets and all forensic records were meticulously analyzed. The study did show an improvement of DNA process speed post-GSPS implementation. However it also pointed out that doing full autopsy is a mentally exhausting as well as time intensive procedure, which cannot be automated. Furthermore that study indicated that in “21.5% of cases the perpetrator was convicted the [major] factors associated with a conviction for the female murders included having a history of intimate partner violence, weapon recovery [including ballistics] and a detective visiting the crime scenes…None of the forensic medical activities increased the likelihood of a conviction.” Later this same study showed finger scrapings had a slight but statistically significant correlation with conviction – all of which has been corroborated in some of the other later studies I read. (Abrahams N, Jewkes R, et.al. 2011)
The most stupefying thing discovered though was that laboratory quality control measures don’t improve the efficacy of forensic techniques impact on the court-room. In this and other reports from 2007-2011 there was a bit of a failure to take a page out of socio-cultural anthropology and ask larger questions such as – What do the family/friends (and in South Africa one must frequently ask Tribe) feel about the forensic processes in terms of giving them closure? This is particularly weird in light of the fact that the Netherlands, UK, and US studies that inspired the South African ones there is an effort to analyze not just forensic science and case outcomes – but also more of an effort to examine the socio-cultural factors as well. (Abrahams N, Jewkes R, et.al. 2011)
Another key study looked at 226 sexual offenses perpetrated on children as well as adult females in the Johannesburg area from January 2002 to June 2003. It determined that 13% of the cases had no forensic report attached to them at all, and that even in the 23% that did have a complete forensic report there was no evidence that a single report had even been read at a trial! (Blass 2004) Most of the others I read had similarly depressing results.
Contrasting this is that in newspapers and other non-scientific publications several people involved with these studies regularly comment on such issues. In fact one of co-authors of multiple studies - Dr. Rachel Jewkes is quoted in The Guardian as saying "The social space for debating these gender issues is now smaller than it was a few years ago. We need our government to show political leadership in changing attitudes. We need South African men, from the top to the grassroots, to take responsibility." (Smith 2009)
It is interesting to note that since the completion of the recent scientific improvements related to the processing of DNA evidence – for example it can now be effectively collected up to 96 hours after an incident. In response to these changes and internal pressure from various lobbying groups South Africa law has changed to so that there is currently no legal time limit to the collection of physical evidence and there is no longer a need for corroboration of a woman’s testimony in cases of sexual violence whether paired with murder or not. Moreover any healthcare personnel who examined and/or collected evidence from a victim may testify in court. Per WHO effective additional examinations typically comprise actions such as “acquiring victim consent to process the previous evidence, taking the medical and sexual assault histories, documenting medico-legal findings, and carrying out treatment guidelines.” (Du Mont, J; White, D WHO 2007)
Another related concern is firearm based crimes. Firearms feature in South African masculine culture where one’s manhood has long been tied to weapons ownership. Previous to European colonization the spear was the weapon of choice but since then the firearm has been the de rigueur status symbol. South Africa has the third worst rate of firearm deaths (26.8/100,000) worldwide - in fact some years it’s the second leading manner of death and always the leading cause of ‘violent’ deaths.
Though men are the majority of victims of firearm related deaths, their availability also features in the correlation between femicide and suicide. About 83% of femicides are committed with a firearm and within seven days of murdering their loved one about 19% of wrongdoers commit suicide, usually with the same firearm. Statistically speaking a gun in the home is less likely to be used to protect family members than in harming them. Estimates show that the rate of females killed by shooting to be 7.5/100,000 more than four times the US. Indeed, the intimate femicide firearm rate of 2.7/100,000 is higher than the overall US statistics of females killed by firearms period!
Utilizing homicide firearm data from 2001 to 2004 the National Injury Mortality Surveillance System (NIMSS) study collected data from mortuaries in all four major cities (Cape Town, Johannesburg, Pretoria and Durban). Using statistical regression they tested whether any changes occurred due to the implementation of the Firearms Control Act (FCA) of 2000. Findings showed a decline in homicide did occur afterward - a fast decline in firearms based homicides and a slower decline in regular homicides as well! However, the femicide rate is still about five to seven times more than that of the US showing that supplementary endeavors are needed in this direction.
There is some hope for other applications of forensic anthropology/medicine such as in the fight against HIV/Aids. In fact a recent study of autopsies which was primarily done in order to gain basic ‘cause/manner of death’ statistics noticed an interesting comorbidity correlation between HIV and tuberculosis – leading to further more specific epidemiological studies showing that TB is the leading cause of death among people infected with HIV even when on antiretroviral therapy (ARTs) as antiretroviral don’t do much in the way of counteracting TB. (Byass P, Kahn K, 2010)
In conclusion: in South Africa only two forensics procedures seem to have discernible positive outcomes in relation to sexual violence and/or murder (ballistics and finger scrapings) so the application of forensic anthropology/medicine there has had a mixed bag of results. It does seem that on the social aspects that as the general public awareness of such activities plays somewhat in decreases in firearm crime. As well there is a non-profit organization simply called “The DNA Project” currently lobbying to pass a “DNA Bill” which would make is compulsory for all those convicted or arrested to have their DNA profile entered onto the Pretoria database so as to compare crime scenes trace and rape kits – which should lead to more frequent matching and more effective use of the GSPS. The bill also calls for the creation of a second laboratory in the Cape Town where sexual assault and drug crimes are most heavily concentrated. Additionally the analysis of mortuary data has at least accidentally found out that co-morbidity of HIV with Tuberculosis is basically a death sentence, thus enabling the medical establishment to do something that it might be able to improve conditions. In the end it seems that despite relatively forward thinking laws and modern scientific equipment unresolved social issues – such as sexism, racism, poverty and law enforcement corruption – as well as a need to train more healthcare personnel in forensic procedure are to blame for the lack of efficacy.
Ideas for further research: What are the perspectives of the police investigators and/or prosecutors toward forensic science? What’s preventing prosecutors from asking/using forensic reports? How does one improve the sensitivity of law enforcement personnel? Clarification of the socio-cultural reasons that affect the adherence to proper collection procedure on initial examination? What is the value and meaning of the post sexual assault examination for victims and/or their community? Under what circumstances are which forensic tools most valuable (case adjudication, psychological, etc.)? How to prioritize resource allocation given budget constraints? What kind of training would best serve those in the healthcare community become more efficient in collecting evidence for crimes such as rape, assault, muggings, etc.? Could the marketing of ‘consensual sex culture’ as more masculine and pleasurable than ‘rape’ help to change cultural attitudes that permeate current society? Who is prone to committing femicide and thus shouldn’t be allowed gun ownership?
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