By Francis Kagolo
Death is as inevitable as it is feared. Yes, it’s bound to happen to every one of us. But when it knocks, would you donate your body to a university to be used for training students aspiring to become doctors? That is a question that would certainly draw a flurry of mixed feelings from many Ugandans.
Death is definitely a topic peppered with a heap of controversy – depending on where you are and the people around you – and so when such a question is randomly posed on one, you are sure to expect various reactions.
“Are you talking about giving it to cannibals?” John Walugembe, a resident of Bulemere village, Kiseka sub-county, in Lwengo district seemed a bit confused at first.
And when I make clear the actual purpose of such a donation, he is quick to chip in.
“I can’t. That is being stupid. We have one graveyard for the clan. I will also be buried there.”
Kampala city woman MP, Nabilah Nagayi Ssempala says that in a country like Uganda which still has some of the most conservative communities and cultural beliefs, donating one’s body is unheard of and almost a taboo.
MP, Nabilah Nagayi Ssempala says in a society as conservative as Uganda, donating bodies is almost a taboo
She says donating bodies is too modern for a person of her caliber who is not a scientist.
“I thought I am progressive but now I have realized I am conservative!” admits the lawmaker, who expresses her bewilderment over the practice.
“I am shocked to hear that. I can allow to be buried in a cemetery because it is more accessible. That is the extreme I can allow to be modern.”
Yet, according to Prof. Nyeko Pen-Mogi, vice chancellor Gulu University, such conservative attitude as Sempala’s is quietly threatening the quality of medical training in Uganda universities.
It emerges that students of human health disciplines are likely to miss practical anatomy lessons unless the shortage of bodies is addressed. Dead bodies, known as cadavers in medical literature, are used by students to study the anatomy of a human body.
Uganda has four universities offering disciplines related to human medicine: Makerere, Mbarara, Gulu and Kampala International universities.
Prof. Nyeko says the cadavers are treated and kept for purposes of training of first-year and second-year students of Bachelor of Medicine and Bachelor of Surgery, Dentistry and Nursing in anatomy.
The treatment process takes a minimum of six months, while one body can be used for study up to two years, according to Prof. Joseph Ochieng, the head of the department of human anatomy at Makerere University College of Health Sciences.
Shortage of cadavers worrying
According to Prof. Francis Omaswa, a veteran medical trainer, one cadaver should ideally be shared by at most four students. Yet 80 students can take a year with only one corpse, according to vice chancellor Prof. Nyeko. He says the university needs between 16 and 20 cadavers a year.
Prof. Francis Omaswa says ideally, one cadaver (body) should be shared by at most four students
“Our stocks are very low. We have only one which we received last November,” says Nyeko, and adds: “Developed countries are now using ICT-based facilities like videos for practical anatomy training, which we don’t have here. Even then, studying on real dead bodies remains the best.”
Makerere’s Dr. Ochieng also notes that “the situation [shortage of bodies] is the same everywhere in Uganda”.
Although Ochieng declines to provide the statistics, a source at the college, who prefers anonymity, tells me they receive about 12 cadavers a year, which are shared among over 300 first and second-year students.
“This is inadequate,” he says.
In order to avoid the trauma related to dealing with bodies of relatives, the college has been exchanging cadavers with another African university, according to the source. “The exchange programme is good because only then can you be assured that a student will not be presented with a body of a person they knew.”
The situation is not any better at Mbarara University of Science and Technology, where over 200 students undergo training in anatomy every year.
Going by Prof. Omaswa’s statistic of the ideal numbers required, Mbarara would require a minimum of 50 cadavers at any given time for effective anatomy training. However, a student of medicine and surgery, who does not want to be named, says they had 12 cadavers.
“Because of the shortage, some students miss a chance to dissect a body. One student dissects and shows the rest how the anatomy runs. It is a bit inconveniencing, but focused students can still learn,” she says.
In the past, some bodies used for training medical students were from unclaimed people involved in acciden. Today, the number of uncliamed bodies has declined
Mbarara University vice-chancellor Prof. Frederick Kayanja declined to comment on the issue, saying the media need not inquire about cadavers.
“What has the media got to do with cadavers?” he asked, adding: “You [media] are out of order.”
Prof. Nyeko says shortage of cadavers affects the practical training of medical doctors.
The revelation comes just months after a report by the World Bank and Uganda’s Economic Policy Research Centre (EPRC) showed that 42% of Ugandan medics do not give accurate diagnosis.
The Service Delivery Indicators (SDI) report, an abridged version of which was released in Kampala last December, shows that about 58% of Uganda’s medics got the diagnosis accurate, compared to 72% in Kenya, 57% in Tanzania and 34% in Senegal.
Ugandans reluctant to donate
Anatomy experts attribute the shortage of cadavers to the fact that most Ugandans are unwilling to donate bodies to medical schools. It is not made any better by the declining number of unclaimed bodies.
“In the past there were many immigrant workers unable to repatriate their dead relatives back to their countries. It was an opportunity to use the unclaimed bodies for training purposes. Not so many dead are unclaimed nowadays,” Omaswa, also a former director general of health services in the ministry of health, says.
Some people feel that, going by culture, bodies must be buried and should not be used for anything else
Today, unclaimed bodies in hospital mortuaries cannot simply be given to medical schools for training, according to Dr. Jane Aceng, the director general of health services in the ministry of health.
Dr. Lynnette Tumwine, a lecturer of pathology at Makerere, blames the problem on people who still insist on burying their relatives.
“People should learn that bodies are useful material; burying them is being backward,” says Tumwine, who goes on to explain that “when you bury the body, it will rot but if you give it to a university, you will be contributing to training other people who will be useful to the next generation”.
Globally, body donation is practiced to advance science. Medical schools cover the cremation or burial costs once the cadaver has served its medical training purpose. In the US, however, BCC reveals there is an increasingly commercial element to this supply and demand, with not-for-profit corporations involved in the procurement of bodies.
Some of them get more than 1,000 donations a year, according to BBC.
On his part, Tumwine says medical ethics require anyone wishing to donate their body to sign consent forms with a university of their choice before death. Relatives may also decide to donate a body of their loved ones.
Ochieng says any cadaver can be used in anatomy as long as its structure is intact.
“If the cause of the disease is HIV/AIDS or tuberculosis (TB), the body can be used if it is well treated. But it will be rejected if TB damaged the structure of some parts like lungs,” he says, and adds: “What we consider most is the safety of the students who are going to use the body and the structure of the body itself.”
This means that bodies of victims of tragic accidents where one’s body structure is damaged may not be allowed. Bodies of deaths caused by highly contagious diseases like Ebola and Marburg are also not ineligible since they have to be buried rapidly to avoid spread of disease.
Somewhat unsurprisingly, most Ugandans that New Vision spoke to felt uneasy over the idea of letting their bodies be used for learning purposes when they have died.
Others who are enlightened about the issue are also still barred by culture.
Bodies of people who have died of diseases like Ebola and Marburg do not qualify to be donated to universities
An environmentalist, who believes graveyards are killing the environment, says he would have to consult his wife and children before making that “hard” decision. “Graves are consuming a lot of land and are becoming an encumbrance to construction development,” says the conservationist who declines to be named for fear of alarming his family.
“But again culture requires that bodies are buried home and graves kept. I am still perturbed on making a decision on the way I will be buried,” he admits.
Ironically, even with the shortages, universities have not been proactive in mobilising donations from communities. “We have not been so active in this,” says Dr. Ochieng.
“There are those [people] who are aware and others who [out of curiosity] seek information and eventually offer to donate their bodies. But these come once in a while. There is no outreach programme yet, but it can be there in the future.”
Lack of legislation a hindrance
Dr. William Buwembo, a senior lecturer at Makerere’s department of human anatomy, says the absence of specific legislation also hinders their work.
Developed countries have laws and statutory bodies that govern body donations. In the UK, BBC says body donation is overseen by the Human Tissue Authority (HTA) but donations are made to individual medical schools. Under US law, according to BBC, people can say they want to donate their bodies to science, or their next-of-kin can donate them after they are dead and non-profit organisations can accept these "anatomical gifts".
Buwembo says it is hard sensitising communities to donate bodies in Uganda without supporting legislation.
On his part, Ochieng implores people willing to donate bodies to approach the different medical schools separately and agree on the terms. He also wants cultural leaders to review the restrictive burial rites.
“Cadavers are a necessity. If you are going to treat humans you need to appreciate the human body first, he says.
“We cannot do without cadavers."