Blair Trouchet was a patient at a drug rehabilitation centre when she died early last year, but her aunt Lynda Smit remembers her as a "lovely person".
"Yes, she had problems, but so does everyone else. She would have given you the clothes off her back if you needed them; she'd take in anyone who didn't have a home, even stray dogs," Smit said in a telephonic interview.
But Smit's last recollection of her 26-year-old niece is far from pleasant.
"When Blair died, her body was taken to the Port Shepstone mortuary where her father, who had flown in from Australia, his friend and I had to go and identify her," she said.
"A guy us took us to a big fridge through the back corridors of the mortuary where blood was running into the drains and the stench was unbelievable.
"When he opened the door, we could see all the other bodies, including Blair's, lying on the floor.
"He tilted her up and put her on a trolley. A sheet was half covering her, you could see part of the incision [made during the autopsy] and her right arm and foot were sticking out.
"He was about to remove the sheet from her face but we told him he didn't have to, because we knew it was her from a tattoo on her foot.
"It was absolutely horrendous. I can still vividly picture the scene in my mind; it's not something that will ever go away."
This experience seems common, especially in KwaZulu-Natal. But it should not be because there are stipulated regulations for the running of mortuaries.
Mary de Haas, a bioethicist who is part of the Medical Rights Advocacy Network, said relatives identifying their loved ones should be shown the minimum in a special viewing room. "Bodies should be shrouded, photographs and fingerprints should be integral to body identification, and there should be support services for relatives," she said.
De Haas feels strongly about this and other issues, which she claims are rife in the medico-legal mortuary environment in KwaZulu-Natal. She has written to the province's department of health and the health MEC expressing her concerns.
"There are a number of issues we have raised, including the fact that relatives who have the painful task of identifying bodies of loved ones are not necessarily treated with compassion, and that international norms in democratic societies about identifying bodies are not necessarily adhered to," she said.
She also described the conduct of many mortuary technicians as "disgraceful".
"Most do not reportedly have the qualifications for the jobs they are doing," she said.
"Then there's the failure to maintain hygiene standards, which endangers the lives of staff, doctors and medical students who need to work at the facilities."
De Haas said there were also serious questions about whether crucial forensic evidence was properly stored so that it could be used in criminal cases.
She said that seven experienced forensic medical officers and pathologists had left the province's forensic pathology service (FPS) in two years.
Dr Steve Naidoo is one of a few specialist forensic pathologists in the country. He was the most experienced state-employed pathologist in the province until his resignation in December last year.
As is the case with all medical academic heads, his was a joint post: associate professor and head of forensic medicine at the University of KwaZulu-Natal and chief specialist of the KwaZulu-Natal department of health.
"I was directly responsible for medical supervision of the autopsy service in the academic unit serving the City of Durban at the Gale Street mortuary, but with my staff also as consultants to the doctors in the other facilities in the province," he said.
Naidoo resigned because he was disillusioned with the management and governance of the forensic pathology service.
"I believe that, despite some progress in building a few new and smart morgues in the province, the provincial government's operation of the FPS will not be fully effective because of its poor governance and incompetence of management systems."
According to him and others in the know, the background to the troubles in the province's service was twofold.
"The FPS in South Africa was transferred from the police services to the health department in 2006, with the objective that this would be a positive transformation of a service tainted by human rights violations and abuses, and poor service management under the police over many years of apartheid," he said.
"In addition, the new National Health Act (61 of 2003) provided, with actual effect from about 2005, that the forensic pathology service be run as a provincial function."
Naidoo said that, although the takeover involved new management and staff, many of the other provinces retained most of the police staff at mortuaries.
"[This was] to maintain continuity and institutional memory and operational systems.
"[However] KZN chose to replace almost all staff with completely new untrained individuals, both in management and in the technical and clerical components."
The results were disastrous, he said.
Happy to do more
"From takeover in 2006, there were challenges with both management and staff, with a lack of insight into operational protocols and systems in running the forensic morgues and supporting the forensic medical work that was done there."
He said a large part of the problem was that mortuary technicians were allowed to dictate terms, such as the pace at which autopsies could be done, to doctors.
"Mortuary staff are not managed by doctors. They are managed by facility managers who often don't support the doctors."
He said that at one mortuary the technicians refused to deal with more than two cases a day although the doctors were happy to do more.
"It's then the doctors who have to go to court and explain why they couldn't work on a fresh body."
Naidoo painted a bleak picture of the time he spent at the Gale Street mortuary, and said that untrained and belligerent staff was not the only issue he had to contend with.
"There was faulty equipment and a lack of instruments. There were no body or organ scales. The X-ray machines were not up to scratch, and sometimes there wasn't adequate personal wear for us to use."
Temperatures not monitored
He said the facility was dirty and that he was dissatisfied with the way in which bodies were kept.
"They would be decomposing in a cold room were the temperatures weren't being monitored. Often they would not be completely shrouded, which meant that, if there was a backlog, the wounds would dry out before the autopsy.
"Bodies would be dumped on the floor of the fridge in a heap, leading to an intermingling of body fluids. Sometimes the bodies would reach us decomposing and smelly."
Naidoo said he tried to address these and other concerns with the service's management, the provincial department of health and its district office in Durban.
"There was little or no effective response to my repeated pleadings for intervention, and it was clear that the district office management and staff had neither insight nor ability to manage the service, whether it related to procurement of supplies, human resource issues, occupational health and safety, or staff disciplinary processes."
But the department stated in an email sent to the Mail & Guardian that it investigated all allegations of misconduct by mortuary staff.
A critical service
"Mortuary service is a critical service. If there are any allegations of misconduct by mortuary staff, the department investigates accordingly such misconduct and appropriate remedial action is taken."
The email also stated that the department was "knowledgeable" of the reasons for the resignation of several doctors between 2009 and 2012, and did not consider it necessary to conduct formal exit interviews with them.
The department was currently waiting for the national department of health to finalise arrangements for an accredited course for mortuary technicians, it stated.
According to the email, body identification was done in a separate viewing room.
"The deceased's body is fully shrouded, with only the face exposed, to enable the visual identification by the next of kin. In a case where the face and the body is mutilated beyond recognition, alternative methods are used to establish the identity of deceased. These include fingerprints, DNA and other special identifying features, like tattoos, implants etc."
Moosa Moolla is a Muslim funeral undertaker and registrar of death, so dealing with the dead is central to Moolla's life – and it keeps him very busy. He had arrived from Swaziland with a body shortly before I met him, and was due to leave for Johannesburg with another body shortly afterwards.
His biggest gripe about the mortuaries is the inconvenience that family members have to put up with to be able to identify the deceased.
"There's a lot of unnecessary runaround," he said, sitting in his hearse during the interview.
"When someone dies and is brought to the mortuary, the staff are supposed to get a case number from the police.
"But when the family members come here, they tell them to go to the police station, find that investigating officer, and get a case number. That's not the community's job."
Moolla said he was often given bodies that were not in bags or covered. "Some just have their old clothes on, some are naked.
"After autopsies they are not re-stitched in a neat manner – they are stitched like potato bags.
"It's very scary to work so closely with mortuaries," he said. "There's a risk of diseases from overflowing blood. The trolleys look like they've been through the mill, [and] they're badly stained.
"Every mortuary I have dealt with has been like that."
A solution in the making
Support staff working at medico-legal mortuaries have a wide range of tasks. They field calls from the police, go to crime scenes and collect the bodies. They book the bodies into the system, tag them and place them in fridges. They also assist with autopsies, take notes, receive and package evidence, and conduct the physical identification of bodies with family members, before releasing them to the relevant parties.
According to Professor Jeanine Vellema, a forensic pathologist specialist based at the University of the Witwatersrand and the Gauteng department of health, developing a suitable qualification for mortuary support staff had been challenging.
"I have been involved in the initial development of a qualification called the national diploma in forensic pathology support, together with the department of health, SAQA [South African Qualifications Authority] representatives and various other stakeholders," she said.
Vellema said a qualification had been approved for registration in 2007, but SAQA changed its rules shortly afterwards, which caused problems.
The qualification was re-registered in May 2011, and has received the approval of the department of higher education.
"Before that, none of the various potential providers wanted to touch it. We are now hoping that some of them will become interested and will start looking into offering the qualification," she said.
But there were many committees that a qualification had to go through before it could be offered to students. "I think it will take at least another year," she said.
"Mortuary support staff who acquire the qualification can then register with the Health Professions Council of South Africa so they'll have a body overseeing them."
The law on unnatural deaths
There are approximately 70 000 unnatural deaths a year in South Africa, and, broadly speaking, these can be divided into homicidal, suicidal and accidental deaths. A death, the cause of which is unknown, is also considered unnatural until proven otherwise.
The forensic pathology service (FPS) involves managing medico- legal mortuaries where forensic autopsies on all cases of unnatural deaths are done and evidence for legal and court purposes are collected.
Medico-legal mortuaries differ from hospital mortuaries or mortuaries attached to the premises of funeral undertakers, where bodies are simply stored.
The law says that anyone who dies from unnatural causes must be admitted to a medico-legal mortuary, for which consent from family members is not required.