10th Greek Australian Legal and Medical Conference
Mykonos, Greece 2005

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FROM BALI TO TSUNAMI

Dr Pamela Craig

William Gladstone the 19th century British Prime Minister epitomised the attitude that we in the West have to the identity of deceased persons when he said: “Show me the manner in which a nation or a community cares for its dead and I will measure exactly the sympathies of its peoples, the respect for the laws of the land, and their loyalty to higher ideals.”

I gained a graduate diploma in Forensic Odontology in 1991. Since that time I have been involved in this specialty of dentistry on a regular basis. I am a Forensic Odontologist at the Victorian Institute of Forensic Medicine answerable to the Coroner for the State of Victoria. This entails being on call for 1 month in 4 on a 24-hour, 7-day per week basis, although I am always available to assist the Coroner in cases where my expertise as a forensic odontologist is required.

As a Forensic Odontologist I am responsible for the identification of unknown bodies, examination of injuries and causes of death in homicide cases, identification of bite marks on both the living and the dead, and the identification of those involved in mass disasters. The work is varied and relies on not only my formal forensic training, but also on considerable clinical dental experience in the field of general dental practice. The unknown bodies are identified by means of comparison between the post-mortem findings and the ante-mortem dental records of the missing person. Liaison between the forensic odontologist and the treating dentist is necessary, together with an ability to interpret dental records, which may in some cases have been completed in a foreign country.

To work successfully in this field one needs to be able to focus on the detail of the case without becoming emotionally involved. There is a large amount of deductive thinking required, particularly as evidence may not be immediately apparent and dental clues to identity may lie undetected clinically, only to appear on further investigation - exposure to ultra-violet light or X-ray, for example.

Although the majority of the work constitutes the establishment of the identity of people who die in the normal course of events in a community, occasionally unfortunately, disasters occur in which large numbers of people are killed and the establishment of the identity becomes a large operation involving large numbers of people from disparate disciplines.

A disaster identification process involves a large number of individuals. The on-site organisation is headed by the DVI Commander who is responsible for three branches of the operation - firstly the Police, secondly site administration officers and thirdly the forensic scientists. The Police are involved in the gathering of the data from the missing persons, investigations at the disaster scene, and for the repatriation of the identified individuals. The forensic scientists constitute pathologists, fingerprint experts, DNA experts and dental consultants.

There are two aspects to disaster victim identification. Firstly there is the reporting by friends and relatives of people who are missing in a disaster. This enables the Police to interview the relatives and friends for details pertaining to information which might assist in their identification. The information may relate to medical and dental records, fingerprint records, and details regarding physical appearance. Secondly there are the bodies of the victims which need to be examined. This examination will record aspects physical appearance, evidence of disease or medical intervention, dental records and fingerprints. Tissue for DNA analysis is taken from the bodies in the hope that this can be matched with evidence collected from a missing person's home. These two separate collections of data are then matched in the reconciliation process. Historically, mass disasters occurring on Australian soil are the responsibility of state authorities.

The experience gained in the discipline over the last 15 years resulted in my being deployed by the Australian Federal Police on 2 overseas operations, ie. the Bali bombing in October 2002, and the Thailand tsunami disaster in 2005.

There are common elements in these two mass disasters. Both involved large numbers of people of many nationalities, as they both occurred in areas frequented by large numbers of foreign tourists. They were both open disasters, in other words it is not known exactly who was present at the time. In contrast a closed disaster may be an airline crash where it is known who is involved and it is just a matter of sorting out the identity of the known individuals. In an open disaster there may be differences between the number of people reported missing and the number of dead bodies at the site.

The Bali terrorist bombing at the Sari Club and Paddy's Bar at Kuta beach in Bali claimed the lives of some 202 individuals. Most of the victims were Australians, but there were also many other nationalities involved. The subsequent investigations involved forensic odontologists from all states in Australia after the Australian Federal Police were asked by the Indonesian government to take control of the site. We were sworn in as Federal Police Officers and told that it was a very dangerous operation to be conducted under difficult conditions. The terrorists had not been apprehended at that time and threats were being received daily at the Police Forward Command Post in Kuta Beach. We were heavily guarded.

The scene was small but the damage was such that the clearing of the site took some weeks. The bodies of the dead were taken to Denpassar Hospital where a temporary mortuary had been set up. This was also the site of the data input from the missing persons and the reconciliation of the data and subsequent identification. Conditions in a temporary mortuary are always difficult. Refrigeration of the remains is a concern and in Bali this was handled initially by the twice-daily delivery of ice which was used to cover the body bags. The distribution of the ice and the body bags was actually carried out by school children who had volunteered from a nearby school. It was a very effective method of refrigeration. It was a very unusual experience working in such a mortuary because open access was provided to all interested persons. We were working in an area where several identified bodies of Korean girls were stored in a nearby refrigeration unit. Every day the relatives would come and stand silently in front of the refrigerators for a few minutes, stopping our work. At this point we would generally leave and allow them some peace. However there were other individuals wandering around including members of the international and local press and the inevitable politicians, both local and Australian.

In the reconciliation area all the records of the missing persons were collected and compared with those of the dead individuals. This matching was done by hand with the records of the dead lying on a long table and we would just go up and down checking to see if there was a possible match. The records consisted of a dental charting and radiographs. If we considered we had a dental match it was taken and compared with the evidence from property fingerprints and finally when it became available DNA.

Of the 202 bodies retrieved from the blast, 86% were identified by dental means or a combination of dental and other means such as fingerprints. DNA accounted for some identifications, but the site was so contaminated that its contribution was limited.

When the tsunami struck South East Asia on 26th December last year, the Thai Government asked the Australian Federal Police to oversee the disaster Victim Identification Process. This was due to the fact that we had, as a result of the Bali attack, world class experience in large-scale disaster management. In comparison, the tsunami disaster was a very different proposition. The area was extensive covering some 40 to 50 kilometres along several areas of the Thai coastline. It is these places, Phuket Island, Khao Lak and Krabi beaches that tourist hotel complexes were scattered along the beach in low lying areas. Such was the extent of the damage and the number of victims that it took several days to collect all the bodies of the victims and assemble the bodies in three separate three sites. It was several days after the disaster before the Thai Government realised that the extent was such that they needed external help. The Australians took control of a site north of Khao Lak which then became known as Site 1, while the Germans oversaw the operations in Krabi, and the Norwegians the site at Phuket.

I arrived in Khao Lak soon after the disaster and my first impression was of the overwhelming magnitude of the disaster. The extent of the waves could only be appreciated by travelling along the road from Phuket to Kao Lak once it had been cleared and by viewing the devastation. In one place a Coast Guard Patrol vessel, a large boat of some 50 to 60 feet, had been marooned some one and a half kilometres from the coast. On my last trip back from the site, after the area had been cleared, I noticed a small tourist bus taking a little group of tourists out to see the boat. No doubt this will be the new tourist attraction.

The Khao Lak site was in the Wat Yang Yao temple complex . There were some 30 refrigerated containers in the grounds of the temple and several pavilions had been taken over and transformed into temporary mortuaries. It was a very busy site as the Red Cross and the local Thai authorities were in attendance taking down details of missing Thai nationals. It was a very interesting experience working alongside other colleagues. For instance, although the Australians were in command of the site we worked alongside British, Dutch, German, Swedish and New Zealand colleagues. The bodies were fingerprinted and autopsy was done and then the dental examination was performed. My job was to collate all this information and to check that the Interpol DVI forms were correctly filled in by everybody on the lines and complete the dental charting with the assistance of the radiographs that had been taken in the process. It would take each body some 4 to 5 hours to progress through the examination process and there were 2,500 bodies at Wat Yang Yao. In the meantime the Police in each country that was represented were collecting information on the missing persons. This is a very difficult process as in some cases whole families had been wiped out in the disaster. Additionally, there proved to be many people who were never reported as missing.

Because of the scale of the disaster the reconciliation process had to be done by computer. A new Danish data-mining program called Plassdata was used. There were many problems associated with this not the least being that both the examinations and the collection of records were done by native speakers of many different languages. Again it was very interesting to work with international colleagues and a great sense of camaraderie developed among the many nationalities.

Following my deployment on the site at Wat Yang Yao I was then sent to the reconciliation area. There were some 4000 records from the examination of the victims on the data base and information regarding missing people was entered in and every night the computer would attempt to make matches. The reconciliation area would go through the matches in the morning by hand and pick out cases that were either good matches and an identity could be established, there were probable matches but more information was needed, they were possible or they were excluded. Such is the way a computer operates that most of my work involved exclusions. There are many problems that need to be solved when attempting a dental identification. This pertains particularly to children who may not have had much in the way of fillings etc. For instance it was very important to know when any and what examinations and in particular radiographs were taken as children's jaws develop. It may not be possible to have a perfect match in a child's case and one needs to know the chronology of the dental development in order to decide whether a match is possible. Dental radiographs are the most accurate way of obtaining an identification. Identifications are still proceeding as I write this. Of the initial 4500 bodies that were retrieved after the tsunami, some 2100 have been identified to date. It is probable that many of these will remain unidentified. There are many reasons for this. One reason is that many of the workers in the hotels were immigrants from overseas whose families for political or other reasons may not have reported them missing. Secondly there may be Thai nationals who have lost their families or who had insufficient data to assist in identification. The most surprising thing is a number of foreign nationals with large amounts of dental work and other information but they have not been reported as missing. This may have been because there was nobody that knew where they were or reported them.

The University of Melbourne recognized the extent of our humanitarian involvement in Thailand and granted the Unit of Oral Anatomy, Medicine and Surgery funds to cover my teaching for the times I am deployed. So far this has amounted to 7 weeks. I was initially involved in the examination of the bodies and the collection of dental records at the temple site at Wat Yen Yao, where some 1500 bodies had been taken from the Khao Lak area and the Australian team had set up a field mortuary. The teeth were charted and photographs and x-rays taken. Many of the victims were European holiday-makers who had been reported missing and for whom dental records were available.

The following rotation found me in the Data Input Management Centre where the dental records of the missing people are recorded in an Interpol computer based data program “Plassdata”. This program will match ante-mortem and post-mortem data not only in dental but also in other areas such as physical appearance, fingerprints and property. Therefore I was working closely with experts in many other forensic fields. Finally I am now working in the Reconciliation area where the matched records from “Plassdata” are checked manually. This is difficult work as the program is not very easy to operate nor accurate, and every case has to be examined in terms of dental chart matching, x-rays and photographs. The program is being improved and I have made several suggestions to the programmers, some of which had been implemented by the time I left last rotation. This ongoing operation, although overseen by the Australian Federal Police, is a multinational humanitarian exercise, with experts from many countries participating. This has been very interesting and valuable to me, as I have had the opportunity to work closely with forensic dentists from many countries in Asia, Europe and the Americas.

Australian involvement offshore constituted a commitment by the Australian Government to provide expertise in a foreign country. In both cases this involved the sensitive area of negotiation with these foreign governments and acting under their auspices.

Working in an offshore environment within the parameters of a foreign culture highlights the differences in attitude between that of William Gladstone and the western culture and that of the Hindu in the case of Bali and Buddhist in the case of Thailand ways of looking at life and death. To the Balinese the individual identification of the deceased was not as important. …and was handled as such. This communal grieving was also evident in Thailand where large gatherings and religious services were conducted for the deceased as a whole. The Thais however once they realised that the expertise was to hand were very co-operative. They came to the realisation that it was possible for each individual to be identified. However this seemed to be the downside of prolonging their grief, as I saw in July families coming to finally take possession of their loved one.

There were no animals lost in the Tsunami. It would appear that the animals had some idea of what was happening. For example, there were many elephants working at Khau Lak which is a very flat area taking tourists for elephant rides. In the hours preceding the Tsunami the elephants became increasingly restive. Just before the first wave came over the elephants bolted, catching several Japanese tourists in their trunks, throwing them on their backs and heading up for the hills. The elephants came back after the third wave had passed and were subsequently employed in clearing the roads so the Army transport vehicles could come in and rescue the living and retrieve the dead. One wonders if they had some idea of what was going to happen perhaps through vibrations in their feet.

We went to Thailand because we believe that the identification of our dead, be it in Australia or overseas is of paramount importance, not only to the families of the victims involved, but to us as a community. On Anzac Day the Australians and New Zealanders assembled at dawn on the beach at Phuket with our colleagues and ancient enemies the Germans and Austrians. As we read the Anzac service and listened to the Last Post played from a laptop computer on the beach the Australians, New Zealanders, the Germans and the Austrians threw a wreath into the sea as we remembered those who had died overseas so many years ago and were never able return home.

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Copyright 2005. Greek/Australian International Legal and Medical Conference.
For more information contact Jenny Crofts at jennycrofts@ozemail.com.au