Forensic pathologist

Taped to the door of Professor Lorna Martin’s office at the University of Cape Town (UCT) is a cartoon of an enraged-looking Garfield. “Don’t upset me,” reads the caption, “I’m running out of places to hide the bodies.”

“Of course, Lorna’s not like that all,” laughs June Mehl, Martin’s personal assistant and secretary. Mehl has worked in the forensic pathology department at UCT for years, first as a typist transcribing autopsy reports and then as a secretary. “The stories started getting to me,” she says. “Particularly the women and children. I opened a report the other day, then closed it again. I thought, ‘I just don’t want to know.’”

Forensic pathology, the study of the causes of sudden or unnatural injuries and death, is not for everyone. Lecture topics include death and decay, ballistics, weaponry and the difference between homicidal and suicidal slashed throats. Even the least squeamish medical students approach their first trip to the city morgue with trepidation. Mondays are usually the busiest. During a weekend of misfortune, imprudence and alcohol, victims of car accidents, homicide, drowning and suicide arrive at the mortuary door. Every day in the morgue, however, presents an endless showcase of the worst possible outcome of any given scenario.

Martin did not enter the University of the Witwatersrand (Wits) medical school intending to study forensic pathology. But as a medical student she found the science of forensics fascinating and she was further inspired when she met Dr Patricia Klepp, a senior pathologist and lecturer.

“She was very forthright, no-nonsense and capable,” says Martin, who has crinkly, smiling eyes and, apart from her spiky hair, looks nothing like the strung-out picture of Garfield on her door.

Martin graduated and completed her internship at Baragwanath Hospital in 1990 and, while waiting for a registrar post in order to specialise in forensic medicine, worked as a district surgeon in Hillbrow. There she dealt with detainees, drunken drivers and public health matters. She also appeared in court as an expert witness. Each afternoon at two o’clock police vans would deliver up to 20 rape complainants to an office at the mortuary. The women, many of whom had been waiting on benches in the surrounding police stations for hours or even days over the weekend, would file out of the vehicles and Martin, or the district surgeon on duty for the day, would examine them one by one in a bare room with a central bed.

“The procedure was to get the women up on the couch, knees apart, note any injuries, fill in the forms and take a single swab for semen,” she says. “And I started thinking, this can’t be right.”

Martin changed the protocol. By the time she left the district surgeon’s offices in 1996 she had commandeered the matron’s flat in the old nursing college in Hillbrow and turned it into a facility with an interview room and a separate, private examination area with an en-suite bathroom. She had arranged funding for 24-hour nursing staff and had persuaded her fellow district surgeons to attend to the women as soon as they presented at the clinic.

She enlisted the support of donors to provide toiletries and clean panties for the victims, who were now able to wash after their examination. She collaborated with the police to open an office where women could file their complaints on site instead of going to the police stations. And she created a rape forum where magistrates, district surgeons and police could meet to discuss individual cases.

After failing to persuade the province to provide drugs on the premises, she facilitated referral of the women to local clinics for further management of sexually transmitted diseases and post-exposure prophylaxis for HIV. She improved the forensic collection of evidence, trained other district surgeons in the techniques, wrote a protocol handbook and opened two more rape clinics, at Baragwanath and in Lenasia.

She also began collecting research data, documenting that a third of the complainants reported more than one perpetrator and that the younger the victim, the more likely the perpetrators were to be known to her. Of the 573 patients in her initial study, four were under the age of six and a further eight were younger than 12.

By the time a post in forensic medicine finally became available in 1996, Martin had examined more than 2000 rape survivors and had developed a life-long interest in rape, particularly rape homicide. As a registrar in forensics, first at Wits and then at UCT, she began working at the mortuary, in the world of rubber boots, plastic aprons, drainable floors, hoses and cold steel tables. Her case of instruments included saws, chisels and knives. She performed autopsies, visited crime scenes to collect evidence and went to court as an expert witness. She loved it.

Martin adapted the forensic evidence kit she had developed in conjunction with scientists at the South African Police Service while still a district surgeon and applied it to rape homicide cases, a move that increased the conviction rate for this crime. Her work on two of the dead victims and one of the survivors of the Nasrec serial killer, Lazarus Mazingane, contributed to his incarceration; her mentor, Klepp, conducted the autopsies on the remainder of his victims.

In 2004, at the age of 39, Lorna Martin was appointed chief specialist and head of the division of forensic pathology at UCT. She was the first woman, and the youngest person, to hold this post in South Africa. By that time she had published a substantial body of research into rape and rape homicide and she still loved forensic pathology.

Her research revealed that for every 1000 women raped in the Western Cape, 12 will be killed in the attack, that more than half of all rape victims know their perpetrator or perpetrators and that in 19% of the cases, the perpetrator is a husband or boyfriend. The cause of death of women killed by their lovers is usually blunt force. Strangers are more likely to kill using guns and knives and rapists tend to strangle and bite.

Martin’s pioneering work on the medico-legal management of rape survivors has been included in both South Africa’s national policy and the World Health Organisation guidelines for the management of victims of sexual violence. Sadly, in South Africa, in spite of the improved collection of forensic evidence, less than 20% of rape survivors coming through the ordinary criminal courts will see their assailant sent to jail. In an attempt to improve these figures Martin joined forces in 2004 with Professor Lynette Deny, a gynaecologist, and Associate Professor Lillian Artz, a criminologist, to establish the gender, health and justice research unit in the department of forensic medicine.

“Our unit represents the intersection of health and law,” says Artz, who leads a team of fellow criminologists in the field of gender-based violence. Working with the departments of forensics, gynaecology, public health and psychiatry, the unit has undertaken research into sexual violence and HIV, the characteristics of men who kill their partners, and the reasons why so many women who experience domestic violence or rape fail to follow through with their cases or never finalise their interim protection orders. The unit submits its findings to Parliament, advises on further training of police and court workers and provides educational material for complainants working their way through a labyrinthine legal system.

In 2009 Martin was elected head of the department of clinical laboratory sciences at UCT, representing the departments of forensic and anatomical pathology, chemical pathology, virology, medical microbiology, medical biochemistry, genetics, haematology and immunology.

“Lorna works 24 hours a day,” says Omar Galant, who has been a member of staff in the forensics department for 16 years and remembers Martin as a junior registrar. “She doesn’t try to take short cuts and she always has a plan about what she’s going to do next. With her it’s always ‘when’ and never ‘if’.”

Martin’s next project is to close down the old Salt River Mortuary and open a new forensics laboratory in conjunction with the state and university, which will have in-house toxicology and DNA, odontology (forensic dental studies), entymology (beetles, flies and maggots), a bone lab, an imaging suite and a body farm, where research will be conducted to determine the time elapsed since death. This will be a first for Africa.

As professor and head of department, Martin teaches medical students, trains registrars, conducts research, works as an administrator and flies around the world to act as an expert witness in rape homicide cases. It is a source of pride for South Africans to know that we are the world experts in certain fields of medicine, and a source of shame that one of those fields is the pathology of rape, particularly child and infant rape.

How does anybody do such grisly work and stay sane?

“All pathologists have to be a little crazy,” says Martin, who has organised the schedules of her registrars and specialists to include at least one day a week away from the morgue to attend to other duties. Staff in the department are also encouraged to take all holidays due to them and trauma counsellors are available.

Artz, who has been a close personal friend of Martin’s for over a decade, has a further explanation for Martin’s ability to cope.

“Lorna is incredibly good at compartmentalising. She’s seen terrible things a thousand times over and yet she’s never allowed herself to become bitter or cynical. She’s still so enthusiastic about her work. Some people are born to be forensic pathologists. Lorna is one of them.”

Medical professionals joke that physicians know everything and see nothing, surgeons see everything and know nothing, and that although pathologists see and know everything, it is too late. This is not strictly true for forensic pathologists, however, because, even after death, there is still an opportunity to see justice served.

“When I visit a crime scene, instead of getting upset, I get determined,” says Martin. “I want to see somebody brought to account.” As Martin pointed out in an inaugural lecture last year, forensic pathologists are in the privileged position of giving a voice to the dead. After the lecture, the audience was ushered to another of Martin’s projects. Using funds obtained from a grant, she has spearheaded the drive to curate and digitalise more than 3 000 specimens in the Anatomical Pathology Learning Centre. This museum, available online, is also a first for Africa and a valuable learning resource for students around the world, particularly those from poorer countries. Friends, colleagues and her family celebrated her achievements in the atmosphere in which she feels most at home: they sipped cocktails and nibbled snacks amid glass jars of enlarged spleens, nodular livers, cystic kidneys and fibrotic lungs.

— Martinique Stilwell