EVEN after eight years in the profession, the mental image of bodies, sometimes with limbs missing, gives goosebumps to a 29-year-old man working at a state-run mortuary in a central suburb. Expecting to become a sweeper in Mumbai, he had left farming in January 2008. However, he had finally joined a autopsy centre, earning a monthly salary of Rs 15,000 to cut and stitch the corpses.
Seven years later, on January 1, 2015, he was diagnosed with TB, having picked up the infection while working on a TB patient’s body. On sick leave for over 15 months now, he now weighs 55 kilos, down from 74. Now, he fears death. “I’ve heard of other mortuary workers dying due to TB and HIV,” he says.
His fears are not unfounded. Data sought under the RTI Act by The Indian Express reveal that since 1999, at least 25 staffers, working across five autopsy centres in city, have died, while 18 of them succumbed to TB, two to HIV and two committed suicide.
Additional information indicates that at least in three cases, alcohol abuse was involved which likely triggered weak immunities. The number of deaths is especially high when it comes to JJ Hospital’s post-mortem centre. Six staffers of the centre have died. The other deaths include four staffers of Rajawadi and Cooper hospitals’ centres and six of KEM’s centre.
An application under the RTI Act sent to several AIIMS and Post Graduate Institute of Medical Education and Research (PGIMER) hospitals across India for information on mortuary staffers, who have contracted some kind of infection, yielded a response that such records were not available, but doctors and researchers believe that TB cases among mortuary staffers is significantly higher than the general average.
A concrete reply from PGIMER, Chandigarh, said that between 1994 and December 31, 2014, six resident doctors had contracted TB and one acquired Hepatitis B. One doctor attached with the autopsy centre had also succumbed to TB.
An earlier study by the Department of Forensic Medicine and Toxicology in Chandigarh’s Government Medical College had found that an autopsy “may subject the doctor and other staff involved to a wide variety of infectious agents such as HIV, Hepatitis B, Hepatitis C, Mycobacterium TB”.
In the case of the Mumbai post-mortem centre’s staffer, the infectious agent turned out to be TB bacteria. The 29-year-old used to cut and stitch over 10 bodies in a day, often working 24 hours at a stretch. The first signs of TB came in 2011. He would often feel weak and catch a fever every three days. He approached Thane-based Chhatrapati Shivaji Maharaj Hospital, but it was four years before he got a confirmed diagnosis. In those four years, the bacteria became resistant to anti-TB drugs. The drugs he now takes for multi-drug resistant (MDR) TB come with side-effects, including depression and hallucination. The family’s meagre savings are now being spent on feeding him a protein-rich diet.
At the autopsy centre where he worked, colleagues say there is no system of regular screening for workers. Like other staffers in the city’s 10 mortuaries, they get one disposable mask for every 10 bodies. They use flimsy plastic gloves which tears frequently. There is no proper meal timing. Hence, in the case of the 29-year-old, his immunity took a hit.
But when they voiced these concerns to the NHRC in a public hearing on January 6, nine mortuary workers from Rajawadi, JJ, Cooper and Bhagwati post-mortem centres were suspended. Medical officer in-charge Dr Shivaji Kachre said, “They showed misconduct. They did not listen to seniors.”
Now, the over 150 mortuary workers in the city’s 10 post-mortem centres feel compelled to stay silent, fearing that any protest regarding their work environment could cost them their much-needed salaries.
Personal protective gear is highly recommended during all autopsies, including double gloves, one of latex and the second of nitrile, as well as gumboots, goggles, surgical caps, surgical gowns with full sleeves and masks.
A visit to Mumbai’s mortuaries show that gumboots, goggles and surgical caps are used in none. At KEM’s post-mortem centre, gumboots stand like old dusty showpieces under a table. At others, they are just not available. Aprons are used only if the body belonged to a patient who had Hepatitis or TB, or was HIV-positive. And instead of double layered latex gloves, a poor quality plastic glove is provided and made use of in multiple autopsies. Masks are available, but workers don’t use it.
On March 8, an unidentified body was brought in for autopsy at JJ hospital. As an assistant filled in documents, a 35-year-old mortuary worker and a 40-year-old one wore their plastic gloves. It was past 9 pm and they had already worked for over 12 hours. The autopsy room, lit by dim tubelights, carried the familiar stench of a dead rat. The room had just been washed with water, but traces of blood were still visible on the white tiles.
The 35-year-old made an incision, with an old scalpel, from under the neck till the abdomen. As the forensic expert gave instructions, the worker carefully took out the sternum, then the heart and showed it. The liver was removed and shown next, followed by an inspection of the stomach.
Twenty minutes later, the doctor was off, leaving behind the two men to put the organs back and sew the body. That done, they wrapped the body in a white cloth and washed their hands. There was no disinfectant. A hose was picked up from the floor and the blood washed off the table. No tool was disinfected, neither was the room.
A review report on postmortem centres submitted by forensics expert committee to the Nagpur HC in January 2015 recommended a separate room for autopsy attendants with attached bathrooms so that they could bathe before heading home. While the NCRB, 2014, points out that 10,909 people died in Mumbai due to accident, suicide, and murder, converting to 30 deaths per day on an average, data from nine post-mortem centre suggests that as many as 80 to 100 autopsies are conducted every day.
Many staffers say the nature of the work is such that alcoholism invariably follows them. Dhanayshree Patil still blames the Rajawadi mortuary for her husband Nitin Patil’s death in 2010. When he started working in 1995, he did not drink. “He was assigned to cut bodies. He had to drink before he started his work,” she says.
Patil, according to his son Arpit, suffered from severe alcoholism. In 2010, at 57, he was diagnosed with tuberculosis. Four months later he committed suicide. “He became weak. Cutting dead bodies made him a drunkard,” Dhanayshree says. She had to vacate the government quarters after his death. For the past six years, she has been trying to get a government job for her son on compensatory grounds. Three months ago, the government began to pay her a Rs 7,000 monthly pension.
(Tomorrow: Overcrowded morgues, outdated infrastructure)