Ver­bal au­top­sies bet­ter track deaths

The Morning Call - - NATION & WORLD -

au­top­sies, as well as cancer reg­istries and other pro­grams in­tended to help de­vel­op­ing coun­tries gather ac­cu­rate data about the health of their cit­i­zens.

“With more and bet­ter data on causes of death, more coun­tries can save more lives,” Michael Bloomberg, the phi­lan­thropy’s founder, said in a state­ment.

The work is badly needed, ex­perts say.

An es­ti­mated 60 mil­lion peo­ple in the world will die this year, and half will have no death cer­tifi­cates or other records de­scrib­ing what killed them. Most will be in low- and mid­dlein­come coun­tries, par­tic­u­larly in Africa and parts of Asia.

That means the com­mon un­der­stand­ing of over­all dis­ease too. It re­quires specially trained tech­ni­cians, and sam­ples have to be taken and shipped for anal­y­sis within 24 hours af­ter a per­son’s death.

Ver­bal au­top­sies “are much bet­ter to do that than do noth­ing, which is the only al­ter­na­tive” in some coun­tries, said Peter Byass, a re­searcher at Sweden’s Umea Univer­sity and an ex­pert on the in­ter­views.

The New York-based or­ga­ni­za­tion Vi­tal Strate­gies be­gan work­ing with the Rwan­dan gov­ern­ment in 2015 to de­velop a ver­bal au­topsy pro­gram, us­ing Bloomberg and other fund­ing. The pro­ject trained gov­ern­ment health work­ers — who al­ready pro­vide health and hospice care in homes — to con­duct the in­ter­views.

About 2,700 ver­bal au­top­sies have been done in nine small pock­ets of the coun­try. That’s not enough to pro­vide a good look at na­tional death trends, but the gov­ern­ment is plan­ning to scale up the work in com­ing years to achieve a rep­re­sen­ta­tive sam­ple.

At first, neigh­bors some­times per­ceived the ques­tions as in­tru­sive. But over time, most peo­ple have come to ac­cept them.

“When we ex­plain to them why we do this, in the end they will un­der­stand and an­swer our ques­tions,” said Jan­vier Ngabonz­iza, who con­ducts the in­ter­views in a ru­ral area called Rwa­ma­gana.

The ver­bal au­topsy of San­drine Umwun­geri was con­ducted by Leonie Mfi­tu­muk­iza, who had met her mother through her job as a com­mu­nity health worker. Af­ter al­low­ing sev­eral months for the fam­ily to rest and grieve, she had come to ask about Umwun­geri’s ill­ness.

Af­ter­ward, Mfi­tu­muk­iza said she be­lieves Umwun­geri died of di­a­betes, not malaria. But she noted her job that day was to gather in­for­ma­tion, not to draw any con­clu­sion.

FELIPE DANA/AP PHO­TOS

Jan­vier Ngabonz­iza, right, in­ter­views Ly­iza Uwim­babazi about her sis­ter who died re­cently in Rwa­ma­gana, Rwanda.

Alphon­sine Umur­erwa, re­flects af­ter talk­ing about her late daugh­ter San­drine Umwun­geri dur­ing a ver­bal au­topsy.

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