DATE: FRIDAY, 12TH APRIL, 2019

 

THIS DOCUMENT DETAILS THE NATURE AND RESULTS OF THE MEDICAL *

INVESTIGATION INTO THE DEATH OF ONE

«BULEYA LULE: CASE* NUMBER CPD/PM/LL/024/19»_

 

My full name is Charles Patrick DZAMALALA and my professional address is Malmed Healthcare Services, St. David’s Street, Blantyre, P. O. Box 1040, Blantyre. I am a Medical Practitioner specialised and fully qualified in forensic pathology and clinical forensic medicine.

 

My qualifications are: Bachelor of Medical Sciences obtained from St Andrews University in the United Kingdom; Bachelor of Medicine, Bachelor of Surgery, jointly conferred on me by the Universities of London and Malawi; Masters of Medicine in Pathology obtained from Makerere University, Kampala, Uganda and Masters in Forensic Medicine Degree obtained from Monash University in Melbourne, Australia. I am also a Fellow of the College of Pathologists of East, Central and South Africa: FCPath (ECSA).

 

I am currently working at the Malawi College of Medicine, where I am a senior lecturer in pathology. I also operate private clinic businesses under the flagship of Malmed Healthcare Services in Blantyre.

As a forensic pathologist, part of my work involves medico-legal investigations into suspicious deaths, including cause of death in a variety of circumstances, assessment of mechanisms in which various injuries may have been sustained and giving testimony in court on cases that I have personally worked on.

 

My practical exposure and experience in Forensic Medicine and Forensic Pathology commenced in 1996, when I was in training for a specialist degree in anatomical pathology at Makerere University in Uganda. Since the initial experiences in Uganda, I have worked on forensic pathology cases in Malawi, Mozambique and Melbourne, Australia, where I also obtained the Masters’ Degree in Forensic Medicine at Monash University.

 

Case No. ««CPD/PM/LL/024/19»

Re: «Buleya Lule» deceased

 

CIRCUMSTANCES SURROUNDING THIS DEATH

 

On Friday, 22nd February 2019 at 17:00hours local time I carried out medico-legal investigation into the death of whom I believed to be Mr. Buleya Lule, from Thyolo District aged 29. The medical investigation comprised a whole body inspection, an external and internal examination of the body, specimen analysis and a review of documentary materials. It was conducted at the Kamuzu Central Hospital mortuary in Lilongwe.

 

Much of the information regarding this case was already publicized in the media such that there was no need for a briefing on the case from any authorities, including the requesting authority for the autopsy: that is the Malawi Human Rights Commission (MHRC). The key points of note on this case were that late Buleya Lule died suddenly on Wednesday, 21st February 2019 while in Police custody. He was arrested a few days earlier in connection with a missing boy with Albinism in Dedza. He was believed to be the mastermind in this abduction case. He was therefore answering charges of abduction at the Magistrate Court in Lilongwe. However he only managed to appear once in the courtroom and suddenly died in the evening of the same day of the court appearance.

 

Following his death Lilongwe the Police transferred his body from their cells to Kamuzu Central Hospital mortuary and requested for an autopsy. That autopsy was conducted on the same day by Dr Maurice Mulenga, a Pathologist in Government based at the same institution (Kamuzu Central Hospital). Whether Dr Mulenga issued an autopsy report (written or verbal) at the end of the autopsy in the mortuary it remains unclear, but media reports after that autopsy indicated intracranial bleeding and hypertension as the cause of the death.

 

Angered by those media reports suggesting a natural cause of death, MHRC, with financial support from the United Nations Development Program (UNDP), engaged this author to carry out an independent forensic autopsy. The autopsy was conducted at Kamuzu Central Hospital Mortuary.

 

OBSERVERS PRESENT

 

Three groups of people witnessed this forensic autopsy case. These groups were:-

 

  1. CID Police Officers from Lilongwe Police Station, Central Region Police Headquarters and the National Police Headquarters, led by Crime Superintendent Normal Chisale.
  2. APAM, as represented by its President – Overstone Kondowe
  3. MHRC Commission Officials as represented by Mr. Lucious Pendame.
  4. Relatives of the deceased person, led by Annie Lule, a cousin to the deceased.

 

EXTERNAL EXAMINATION

 

Body:​ The body was believed to be that of Buleya Lule, a Malawian national from  Thyolo District.

Morphometry:​ The body was about «160» cm in length and about «90» kg in weight.

Skin:​There were no special identifying features. There was a sutured midline incision from prior autopsy on the anterior aspect of the body extending from the level of the superior aspect of sternum to the pubis.

​ Fresh injuries as at the time of death, are detailed below.

 

Secondary postmortem changes:  ​The body had a prior autopsy and therefore precluding adequate assessment of major secondary post-mortem changes. Rigor mortis was broken and was partial lividity in dependent areas.

 

Superficial injuries:​There were many injuries of different types and nature, ranging from bruises to scratches to burn wounds to electric wounds. However only a few of them were of critical significance and interest. These injuries were seen on three sites of the body surface – the right lower quadrant of the abdomen, the head and the buttocks:-

 

  1. The right lower quadrant of the abdomen: Grossly black pigmented lesion, measuring about 2.4 cm in greatest length. V shaped/or Y shaped with short stalk, forked lesion; extensions or arms of the fork raised and wrinkled appearance; central depression. Surrounding skin showed erythema / reddening with a diameter of about 3.2cm. This was the suspected electric burn wound.
  2. The occipital aspect (back) of the head: Only impressions of injury with a blunt cylindrical object (bruises) were noted. This injury was however best demonstrated on the inner aspect, after opening the scalp. Diameter of the cylindrical lesion was about 4.5cm.
  3. The surface overlying the left gluteal muscles (left buttock): Measured over 30 cm in diameter and covered almost the entire buttock. This was the largest wound on the body surface, with skin peeling off in certain parts (mostly at the central parts of the wound) and looked to be a burn wound; direct burn rather than scalding.

 

The World Medical Association (WMA) describes these types of injuries of different nature as being consistent with torture.

 

INTERNAL EXAMINATION

Approximate organ weights:​Brain                -​1410grams.

​Right lung        – ​460grams.

​Left lung          -​380grams.

​Heart                – ​330grams.

​Liver                – ​1140grams.

​Spleen              -​75grams.

​Right kidney    -​130grams.

​Left kidney      -​125grams.

CENTRAL NERVOUS SYSTEM

 

The tissues and organs comprising the central nervous system showed no signs of decomposition.

 

Scalp:​Inner aspect demonstrated focal areas impact, most especially an area of impact with a cylindrical object on the occipital aspect (the back) of the head.

Skull and Cranial Vault​

Dura & Cerebral vessels:​​Was re-opened. No fractures seen. There was no identifiable intracranial haemorrhage (both surface and parenchymal) at this point. There was no inflammatory exudate. Evidence of diffuse haemorrhage into the subdural space most probably best seen/demonstrated during the first autopsy.

Brain:​Normal parenchyma; no ventricular haemorrhages.

 

CARDIOVASCULAR SYSTEM

 

The tissues and organs comprising the cardiovascular system showed no signs of decomposition.

 

Pericardium:​​​       Normal. No pericardial effusion.

Heart:​Normal size and texture; normal chambers.

Coronary arteries:​Normal and patent. No evidence of atherosclerosis of the coronary arteries. No acute thrombosis. Valves were normal.

Aorta:​Normal, no evidence of arteriosclerosis or fatty streaks.

 

RESPIRATORY SYSTEM

 

The tissues and organs comprising the respiratory system showed no signs of decomposition.

 

Thoracic cage​There were no rib fractures: the diaphragm was normal

Pleural cavities:​The pleura was normal. Could not assess for hemopneumothorax in a secondary autopsy.

Lungs:​Both lungs were normal with no morphologic evidence of pneumonia or tumours.

 

GASTROINTESTINAL SYSTEM

 

The tissues and organs comprising the gastrointestinal system showed no signs of decomposition

 

Tongue and oropharynx:​Normal.

Oesophagus and stomach:​Normal. No food particles were present in the stomach.

Small bowel and large bowel:​Normal; not ruptured.

Liver:​Normal; not ruptured.

Peritoneal cavity:​There was non-clotted blood from previous autopsy examination.

 

GENITOURINARY SYSTEM

 

The tissues and organs comprising the genitourinary system showed no signs of decomposition.

Kidneys: ​The kidneys were unremarkable in size, site and configuration.

Bladder: ​The bladder was full of urine but unremarkable in configuration.

Prostate, Ureters and Urethra: Not examined.

 

MUSCULOSKELETAL SYSTEM

 

The tissues and organs comprising the musculoskeletal system showed no signs of decomposition

 

Muscles:​Mild haemorrhages into several muscles especially in areas of assaultive injuries.

Bones:​No fractures were seen on any part of the body.

 

SPECIMENS FOR ANCILLARY TESTS

 

Selected tissue samples of were taken for histological processing and interpretation.

Specimens of body organs (parts of liver, spleen, heart, kidneys, lungs and especially skin from the buttock and the right lower quadrant of the abdomen – the suspicious electric burn area) and fluids (blood, urine and stomach contents) were taken for toxicological tests. No whole organs were retained at the conclusion of the autopsy.

 

TEST RESULTS

 

Histology: On the skin at the site of the black lesion detailed above, there was loss/sloughing of epidermis, coagulative necrosis of dermis, extending almost to the margin with subcutaneous fat. At margins of lesion nuclear streaming of cells of basal layer of epidermis and extravasation of red blood cells in the dermis. Further away from margin only extravasation of red blood cells. These microscopic changes detailed here, coupled with the gross appearance of the black lesion detailed earlier in this report, are consistent with electrocution lesion of the skin. Other body organs noted were either normal or showed necrosis without inflammatory reaction, consistent with postmortem autolysis.

 

Toxicological tests on tissue samples: No poisonous substance was extracted from the sample extracts submitted to the local toxicology laboratory in Lilongwe.

 

SUMMARY OF MAJOR POSITIVE AND NEGATIVE FINDINGS

 

  1. Microscopically proven electrocution wound over abdomen.
  2. Various types of superficial assaultive wounds on different parts of the body.
  3. Diffuse traumatic haemorrhage into the subdural space as reported from the first autopsy.
  4. No gross or laboratory evidence of poisoning from sample extracts from the body.
  5. No gross evidence of an immediately fatal natural disease process, including hypertension.

 

COMMENTS/OPINION

 

The immediate cause of death was electrocution. While a Taser was considered as the possible weapon for the electrocution, the characteristics of the wound did not quite match this weapon. The implement used in this incidence of electrocution therefore remains obscure; it may have been an unconventional weapon such as a forked metal object that was used. While electrocution is the primary cause of death in this instance, it was abundantly clear that the deceased was also assaulted with different types of implements, including but not limited to a cylindrical object inflicting trauma to the head and probably also a hot iron or similar object placed on a cloth over the skin rather than directly onto the skin around the left buttock. The nature and types of the injuries seen constitute torture by WMA standards. No evidence of any fatal natural disease process such as a hypertensive crisis, as alleged in some media circles, was seen during the autopsy and also microscopically.

 

CAUSE OF DEATH

 

I (a)​Electrocution – an unnatural cause of death. This was the primary cause of death.

 

I (b) ​Sub-dural haemorrhage. This may have contributed towards the cause of death.

 

 

I hereby acknowledge that this statement is true and correct and I make it in the belief that a person making a false statement in the circumstances is liable to penalties of perjury.

 

Dr Charles Dzamalala: BMedSci; MBBS; MMED Path(MUK); MFORENSMED(Monash); FCPath(ECSA)

Forensic Pathologist and Clinical Forensic Physician

 

ACKNOWLEDGEMENTS

 

  1. Dr Tamiwe Tomoka and Professor Ndalama George Liomba.

 

Dr Tomoka was not only present during the entire autopsy but also drafted the first part of this forensic autopsy report especially the part that details the superficial injuries on the body.

 

Professor Liomba reviewed the autopsy photographs of the autopsy and assisted with the histological interpretation at the microscope and indeed the confirmation of the injury that was determined to be characteristic of an electric burn wound in the mortuary.

 

  1. MHRC for engaging the author, coordinating logistics and, more importantly for their patience as they keenly waited for this delayed forensic autopsy report. The delay was mostly due to delays in getting some laboratory testing done coupled with the busy schedules of the author

 

  1. UNDP for funding this forensic autopsy through MHRC

 

  1. Management of Kamuzu Central Hospital for allowing us to use their mortuary for this forensic autopsy case

 

FURTHER INVESTIGATIONS

 

Discreet samples to enable the search for foreign DNA on the body were taken from key focal areas on the body through use of dry swabs. These sites were key wound areas. As this was a second opinion autopsy, the usefulness and validity of the DNA yield from these samples remains speculative. However if the Police bring forward suspects in this case, for possible DNA matching, an attempt will be made to undertake this testing through Lancet Laboratories of South Africa.

 

 

 

 

 

REFERENCES