My first encounter with postmortem was during our forensic classes, which used to take place at the Institute of Medicine, Maharajgunj. Our classes were scheduled right after the 2015 Nepal Earthquake. Apart from the grief over lost lives, I was repelled by the sight of 1 cm maggots, dead bodies held together just by clothes, and the fetid smell. My experience was a disaster, especially for someone who was fascinated by forensic science, having been hooked on TV serials like Bones and CID. I prayed I would not get appointed to a center with postmortem services, but well, I ended up exactly where it had recently been established.
Our recently made autopsy room was really small. My estimate would say it was around 10 x 10. Anyone out there who has the opportunity to start postmortem services at your center, please ensure the room is spacious. In fact, we have official guidelines on the standard postmortem room design set out by the government. These drawings seem a bit far-fetched. However, considering they are official designs, I believe you can influence people building the infrastructure - especially now that we have a local government.
The second issue was the availability of water. At times, during the autopsy, water would run out, and our office assistants would carry buckets of water to clean the body and blood. We did not have a backup for electricity. Most of the time, it did not pose a problem, as autopsies are always done in broad daylight. However, once, I alone had to autopsy 2 road traffic victims. We started the autopsy around the afternoon. It was winter, and it got dark pretty soon. For some reason, that autopsy took ages, and then the lights went off. I leave it to your imagination - 2 dead bodies, you and your assistant. It might not pose a problem to most of you, but I am an avid horror film enthusiast, and my brain has been rewired to imagine the worst.
We used to get an average of 2-3 cases a month. Initially, my colleague who had received medico-legal training used to do the postmortems. I used to observe, take notes and make the autopsy report. Later, he got transferred, so I had to conduct them alone. The law states that an autopsy should be done by a Government Medical Practitioner. There are no criteria regarding if the practitioner should have had medico-legal training or should be a permanent government official. Hence, if you have the infrastructure to conduct an autopsy, you are expected to conduct them. 2 weeks of forensic lectures during MBBS is no way enough to make us feel prepared. Also, the level of first-hand experience varies among different undergraduates. However, the government has been trying to develop the capacity of medical officers. Currently, there is an online course that you need to complete before getting the opportunity to get first-hand medico-legal training. Here is the link. I completed one but wasn't invited. They probably prefer permanent medical officers over temporary, but some of my karar friends have had the opportunity, so yeah, no loss giving it a try.
From dreading autopsy to conducting them solo, there are a few tips and tricks I picked up on the way. You never quite really get used to it, but trust me, it gets better over time. In Beltar, we used to get cases from Khotang, where 6-7 people would carry their dead ones on a bed sheet and walk 16 hours on rough trails because the tractors would not agree to carry the dead or they were poor to afford one. At such times, I feel, in a way, privileged to relieve them of some of their trouble rather than again sending them to another center. Nepalese law states that any dead deemed to need an autopsy should be sent for autopsy at government expense. I don't know if that is really happening or not.
This is turning into a long post. I will share some of my must-knows in another post.