/ 1 February 2013

Who killed Charlene Makaza?

Who Killed Charlene Makaza?

This is the third in the M&G series on rape

On the night of January 5 2007, plump and gentle-eyed Charlene Makaza, a 10-year-old Zimbabwean child, went to sleep in the Christchurch home she shared with her middle-aged uncle and maternal aunt, George and Sifiso Gwaze. Her teachers described Charlene as a quiet, sweet girl who often missed school due to ill health.

The Gwazes said she was the baby of the family, who needed special attention. On that night, the Gwaze's grown daughter, Nothando, slept beside Charlene in a separate bed. Charlene's 12-year-old sister Charmaine and the Gwaze's grown son, George Junior, had retired to their own rooms downstairs. George and Sifiso's other children, Lillian, Tafadzwa and Maggie lived elsewhere.

Earlier that evening, the family had attended a three-hour prayer meeting at the local branch of the Forward In Faith Ministry, a Pentecostal church of Zimbabwean origin with a growing membership in New Zealand. Charlene, apart from a slight limp which she attributed to a fall, appeared to be in reasonable health, although Thomas Gonera, the pastor, would afterwards state in court that she "did not look as jovial as usual".

When Sifiso Gwaze returned from her evening shift as a rest-home worker, she reported that Charlene had been "perfectly well" when they said goodnight at 10pm. This would be the last time Charlene spoke. The following morning at 5.45am, Charlene, still in her clothes from the previous evening, was found unresponsive and breathing loudly in a soiled bed.

When she was five months old, Charlene's mother died of tuberculosis (TB) and Sifiso adopted Charlene and her older sister, Charmaine. The girls' biological father died two years later. In 2004, George Gwaze, a veterinary technician and Movement for Democratic Change supporter, fled the Mugabe regime by emigrating to New Zealand and was later joined by his family. When Sifiso arrived in Christchurch with Charlene in 2005, she brought with her a supply of cotrimoxazole, an antibiotic used to prevent infections in HIV-positive patients with low CD4 counts. A Zimbabwean general practitioner had prescribed the drug for Charlene.

Cotrimoxazole is taken daily until antiretroviral therapy returns the CD4 count to normal. However, Charlene never received ARVs and Sifiso dosed the girl with the cotrimoxazole whenever she seemed unwell. Although Sifiso took Charlene to a doctor in Christchurch several times for her chronically draining ears, she never mentioned the cotrimoxazole or the possibility of HIV infection to him. "I didn't think it was my responsibility," she later told the court.

On the morning of January 6, when Sifiso discovered the comatose Charlene, she first undressed the child, washed her, stripped the bed and put the sheets and clothing in the washing machine. George Gwaze watched the proceedings. Almost 40 minutes passed before Charlene was wrapped in towels, carried downstairs and driven to the nearest clinic, about five minutes away.

Thorough job
Dr Graeme Carpenter, who was on duty at the clinic, immediately identified Charlene's condition as critical. She was unresponsive, had no recordable blood pressure and was struggling to breathe. His first thought was septic shock caused by meningitis, but when a nurse administered a suppository to lower the girl's temperature, her glove revealed fresh blood.

"Carpenter struggled to face the possibility of sexual assault in a child," said Lorna Martin, a University of Cape Town professor of forensic pathology, in a recent interview with the Mail & Guardian in Cape Town. Martin herself examined more than 2 000 adult and child rape survivors while working as a district surgeon in Hillbrow. She then specialised in forensic pathology, focusing on rape homicide, and has since autopsied 560 raped and murdered children and thousands of adult victims of sexual violence, making her the world expert. All her experience was gained in South Africa and her guidelines for managing rape victims, both living and dead, have been adopted by the World Health Organisation (WHO).

"I don't know what the exact child rape statistics are for New Zealand," said Martin, "but most doctors there have never seen it." Carpenter admitted in court that the thought of Charlene having been assaulted had hit him "like a sledgehammer" and he could not even bring himself to write it in the notes, although he did warn the receiving doctors at Christchurch Hospital that the child would need a careful rectal examination when she arrived at the centre.

Dr Maude Meates-Dennis, a paediatrician who had worked in HIV clinics in London, was on duty when Charlene arrived at Christchurch Hospital. After hearing Charlene's history, she ordered an immediate blood test for HIV. But something was strange. Although Charlene's HIV test was positive, tests for other infections were negative and Charlene's blood volume, which would have been low if she was suffering from sepsis, was normal. Charlene's temperature was also normal, apart from one reading at the clinic. Meates-Dennis later told the court that although she kept looking for alternative explanations, she came to the conclusion that HIV and infection were not the cause of the child's acute deterioration. When Meates-Dennis discovered what she thought was a deep tear in Charlene's rectum she called in Spencer Beasley, a paediatric surgeon, to examine Charlene's anogenital area. In spite of admission to the intensive-care unit, Charlene died on January 7, 18 hours after her aunt had found her unresponsive.

Martin Sage, the Crown pathologist in Christchurch, performed the autopsy. He described a well-nourished child with fresh bruising of her arms. Notes were made of severe brain damage consistent with hypoxia, or lack of oxygen, and several bloody anal lacerations, bruising of the vulva and a fresh hymenal tear. He said lung and bowel findings were consistent with an established HIV infection and in the absence of other pathogens, were unlikely to have caused Charlene's death. Sage concluded that Charlene's autopsy findings suggested she had died of suffocation and been the victim of a sexual assault.

Charmaine, Charlene's older sister, was removed from the family and placed in foster care and the Gwaze's house, situated in the established suburb of Bryndwr, known for its good schools, renovated homes owned by professionals and its substantial list of the city's "notable trees", was declared a crime scene.

"The police did a very thorough job," said Martin, who as a forensic pathologist is familiar with crime-scene investigation.

Crisis of confidence
It is hard to know what the neighbours made of the police swarming the Zimbabwean family's property in an area where double-storey houses like the Gwaze's sell for half a million New Zealand dollars. But when no signs of forced entry were found at the dwelling and small amounts of DNA from George Gwaze's sperm were discovered on Charlene's sheets and in the crotch of her panties – which had been through the washing machine – George Gwaze was charged with sexually violating and murdering his niece.

The case went to trial in 2008.

Midway through the proceedings, Spencer Beasley, the paediatric surgeon who had examined Charlene's anogenital region before she died, attended a conference in Hong Kong where he fell into conversation with Professor Heinz Rode from the Children's Red Cross Hospital in Cape Town. Rode, a paediatric surgeon, is an expert in burns, but like all South African doctors working in the country, he is familiar with HIV, and like most South African paediatric surgeons, he has extensive experience in repairing the torn and damaged private parts of raped children. Each year, about 170 sexually abused children are admitted to the hospital, half of whom are acutely injured.

At a tea break, Beasley asked Rode in casual conversation if HIV could cause anal pathology and Rode said yes, in the presence of chronic diarrhoea, HIV could cause fissures, and severe diarrhoea could cause death. Rode asked Beasley for more information and by lunchtime, had reviewed Charlene's pathology report, which included photographs of her genital region.

"These were no anal fissures," he said in a recent interview in Cape Town. Rode found Beasley and told him that Charlene had been raped and smothered. But Beasley, in an apparent crisis of confidence, had already phoned the court in New Zealand to say that a South African expert had stated that HIV could cause sudden death and anal lesions in children.

There are only three HIV-positive children in Christchurch and the defence, after presenting Rode's initial comment as fact, was easily able to discredit the doctors involved in Charlene's care as lacking in sufficient experience. Although Rode testified via television camera to clarify his position, the defence also established that Sage, the Crown forensic pathologist, had never previously performed an autopsy on a raped and murdered child and had, in fact, never seen an African child's genitals before he autopsied Charlene. The judge then quoted Rode's first comment on HIV causing anal pathology when he summed up the facts for the jury. George Gwaze was acquitted of murder and sexual violation.

After unsuccessfully appealing the verdicts in the Court of Appeal, the Crown took the case to the Supreme Court, where the decision was overturned on the basis that Rode's initial evidence was hearsay and inadmissible. The New Zealand Herald quoted Maggie Gwaze, George's daughter, as saying: "I think this is more of persecution than a prosecution now. It's because of where we come from and who we are."

New Zealand bloggers expressed their outrage at the Crown's actions. It was inconceivable that Charlene had been raped and smothered by her uncle while her cousin slept in the same room. The case should never have gone to trial and the police were targeting Gwaze because he was a black immigrant. Maggie's sister, Nothando, sent Rode an email accusing him of being a racist South African intent on destroying her family.

A retrial took place in May last year. This time, the Crown called in the experts. It is a source of pride to South Africans that our doctors are world leaders in various fields and a source of shame that those fields include paediatric HIV and the rape of women and children.

Professor Martin testified that Charlene's injuries: brain damage, bowel sloughing, lung injuries and bleeding in her eyes, were in keeping with suffocation and the lacerations of her hymen and anus were consistent with blunt penetrative trauma. Although Charlene's organs showed signs of chronic HIV infection, these changes alone could not explain her overnight deterioration and subsequent demise.

Martin postulated that Charlene had probably been raped from behind and was smothered to prevent her screams waking Nothando Gwaze, who was sleeping in the same room. Martin's medical opinion was supported by Meates-Dennis, the paediatrician who cared for Charlene until her demise, and an Australian forensic pathologist who specialised in sudden paediatric deaths. Rode, the South African professor of paediatric surgery, submitted a concurring report although he was not called to testify in the second trial.

The defence called on Professor Sebastian Lucas, a histopathologist from London. Lucas takes tiny samples of tissue from corpses on the autopsy table and views his patients through the eye of a microscope. A pathology website shows Lucas in full mortuary scrubs, straddling a bicycle, and quotes him as saying that he could not face seeing the same patients day after day, so he chose histopathology because: "It's like doing crossword puzzles."  

Lucas, who claims extensive experience in HIV, conducted stain tests for the virus and showed the jury photographs of Charlene's tissues teeming with blue speckles. He admitted that while he had no experience with the clinical treatment of HIV-positive children, or with the manifestations of sexual abuse or blunt trauma, he believed the changes in Charlene's lungs could explain her subsequent brain damage and death from a lack of oxygen. He said HIV itself could cause the breakdown and bleeding of her anus and vulva. Although he was unable to cite a single publication showing  HIV causing such breakdown in children, he had heard of anal changes in HIV-positive adults and could see no reason why children could not suffer the same condition.

Brian Eley, professor of infectious diseases at Red Cross Children's Hospital and a member of the WHO panel for paediatric HIV, submitted a report stating that Charlene's ano-genital findings were not consistent with HIV infection.

Extensive media coverage
"Lucas got quite excited," Martin said in Cape Town after the trial, "he said he had never seen anything like the HIV in Charlene's tissues. I'll admit his slides did look impressive. We can stain for HIV in South Africa, but there's no need to do it, we know when the virus is there."

Under cross examination, the DNA expert for the Crown conceded that it was not impossible for DNA to have been transferred from Gwaze's underpants to Charlene's panties and sheets during the wash.

The trial received extensive media coverage in Zimbabwe and New Zealand. Online, Zimbabweans expressed sadness, disbelief and episodic outbursts of tribal hatred occurred, with sarcastic references to the sexual proclivities of "Shona savages" and a few chilling threats of genocide.

After hearing 75 witnesses, the jury began deliberating. Gwaze's family and supporters held vigils and prayed while George Gwaze reportedly appeared calm and impassive. Fourteen hours later, the jury delivered their verdict. For a second and final time, George Gwaze was acquitted of murder and sexual violation. The Gwaze children broke into applause and Sifiso, looking thin and strained, began crying what she later explained to the TV cameras were tears of joy. The New Zealand Herald quoted Gwaze as saying: "'Beyond reasonable doubt', those few words work wonders and it makes a jury think. I knew there was nothing that happened to our daughter."

"I don't know how the jury came to its conclusion. It was obvious that the child had been raped," said Rode at Red Cross Hospital.

"I think nobody in Christchurch could believe that such a thing [as child rape] could happen," Martin said later in Cape Town.

Nothando Gwaze, now a law student, was quoted as saying: "Charlene died of natural causes and we just want people to respect that. At one point, we thought we were going through a lot of racial discrimination, but we hope that the justice system will use this case to improve."

The New Zealand police declined to comment on the verdict, but Zimbabweans posting online seemed resigned to the fact that the experts had come to a conclusion, justice had been served and if Charlene had HIV, death was her fate.

But even if Charlene did not die in a brutal sexual assault on the night of January 5 2007, the fact remains that an African child contracted a preventable virus, was orphaned by the disease and then failed to receive appropriate medical care because of fear of deportation, or of stigma, or because of neglect. Tragically, the only unique facet of that part of Charlene's story is its exotic location.

In 2003, media interest in child rape spiked in South Africa after the rape of baby Tshepang, but the incidence of attacks has not changed over the past decade. The conviction rate remains 7%. So, our surgeons will continue their grisly work repairing raped children and the victims who do not survive will continue to be delivered to the autopsy tables of our forensic pathologists. We will not lose our status as world rape experts anytime soon.