Fresh questions over Nebanda death

Kampala- Exactly two years ago today, Kinkiizi East MP Chris Baryomunsi and Dr Sylvester Onzivua, a pathologist at Mulago Hospital, were released on bail over the controversy surrounding the death of former Butaleja Woman MP Cerinah Nebanda. Trials connected to her death have since been concluded, but there are new questions regarding what actually killed her.

At 24 and only one-and-a-half years into her first term as an MP at the time of her death on December 14, 2012, Nebanda had brought to the House a rare fearlessness and asked inconvenient questions of those in power despite being a member of the ruling party.

Nebanda, according to the official account, collapsed at the house of Adam Kalungi, who was said to be her boyfriend, and was pronounced dead on arrival at a medical facility about two hours later. Those who were close to Nebanda say she had had no health-related complaints earlier.

Because of her critical stance against the establishment, Nebanda’s sudden death excited emotions and suspicions, and upon her death, the Parliament of Uganda attempted to conduct an independent investigation into her death.

The pathologist, Dr Onzivua, was accordingly hired by the Parliamentary Commission to conduct the investigation, but he was arrested at Entebbe International Airport as he took body samples of the late Nebanda for examination in South Africa.

The small quarrels
The duo was charged with conspiracy to commit a felony, with Dr Onzivua charged on an additional count of abuse of office. The prosecution alleged that the body samples of Nebanda’s, which Dr Onzivua was taking to South Africa, had been stolen.

All the three medics with whom Dr Onzivua had conducted the post-mortem turned up in court to pin him over stealing the body samples, chief among them, Prof Henry Wabinga, who led the team that did a post-mortem on Nebanda’s body.

Dr Onzivua maintained that during the post-mortem, the team had collected two sets of samples, one of which would be used by the police and the other by Parliament for an independent investigation. Having been contracted by Parliament, Dr Onzivua would naturally take charge of the samples set aside for the investigation by Parliament.

The other three medics were Prof Wabinga, who represented the interests of Nebanda’s family; Dr Moses Byaruhanga, the police surgeon; and Dr Samuel Kalungi, who represented the Government Analytical Laboratory.

It is not clear what led Prof Wabinga to testify against Dr Onzivua, but it seems easier to explain Dr Onzivua’s fallout with his other two colleagues.

Our sources tell us that on the Sunday that followed Nebanda’s death, Dr Byaruhanga and Dr Kalungi went to police chief Gen Kale Kayihura’s home and allegedly informed him that Dr Onzivua had stolen samples of Nebanda’s body organs and intended to take them to South Africa.

It is that information that Gen Kayihura relayed to the President, prompting an angry head of State to order that Dr Onzivua be prosecuted.

But, our sources say, the real issue was about who would have to travel to conduct the tests. Dr Byaruhanga, our sources say, wanted to take the samples to London, whereas Dr Onzivua, who already had links with laboratories in South Africa, wanted to do the tests from there.

In the end, Dr Byaruhanga took the samples to London. Dr Onzivua was acquitted of the cases despite the testimonies of all his colleagues against him, and, Sunday Monitor has learnt, he has considered suing the State over the way he was treated and malicious prosecution.

When we put it to Prof Wabinga why he decided to testify against Dr Onzivua in the samples theft, he only laughed off the question.
Dr Onzivua was guarded when contacted for a comment for this article. He only said: “This death was inconclusive because it was messed up. I am shocked that the police chief who messed it up was reappointed and promoted.”
He was referring to Gen Kayihura, who has since been promoted from Lt Gen to General and awarded a third term as police chief.

Cause of death unresolved
At the conclusion of Adam Kalungi’s trial, Esta Nambayo, the Makindye Chief Magistrate, could only raise questions than provide answers as to what caused Nebanda’s death.

But she made an important statement: “I’m convinced that the late Hon Cerinah Nebanda died of multiple organ failure due to alcohol and drugs. No excusable circumstances have been shown as (the) cause of Hon Cerinah Nebanda’s death; I therefore find that Hon Cerinah Nebanda’s death was caused by unlawful means.”

This was the conclusion of Prof Wabinga, the lead pathologist who conducted the post-mortem. Prof Wabinga, appearing as a witness for the prosecution, said Nebanda’s death was caused “by multiple organ failure due to a combined effect of alcohol and drug toxicity.”

But his statement was contradicted by Prof Edward Kakonge, a retired bio-chemist who appeared as a defence witness in the Kalungi trial. In an interview for this article, Prof Kakonge said Prof Wabinga’s conclusion that Nebanda died of multiple organ failure is “absurd”.

Prof Kakonge based his criticism on Prof Wabinga’s own statement titled Preliminary Post Mortem Examination Findings for the Late Hon Cerinah Nebanda, Butaleja Woman MP, dated December 17, 2012.

The report shows that some of Nebanda’s vital organs – the heart, brain, kidneys, liver, spleen – were “grossly normal, whereas the oesophagus, thyroid and aorta and adrenals were classified as “normal”.
On the basis of this, wonders Prof Kakonge, “how can someone die of multiple organ failure yet many of her key organs are normal or grossly normal?”
Prof Wabinga, however, said whereas the organs appeared normal or grossly normal to the naked eye, his microscopic investigations revealed that they were not normal.

His preliminary report showed that Nebanda’s lungs, “were congested and edematous ...,” with the pancreas being “dull” at the outer surface and the uterus having “a small hybroid” and the trachea and airways “containing haemorrhagic froth”.

The trial magistrate chose to believe Prof Wabinga’s conclusion, although Prof Kakonge had offered an alternative conclusion regarding the death.
“The post-mortem on internal examination findings revealed a frightening state of affairs in the chest cavity,” Prof Kakonge told the court, “There was no free air in the chest cavity; the lungs were grossly enlarged; the gut surfaces were congested with abnormal accumulation of fluid with solid/airless lower lobes; trachea and airways contained blood with foamy secretions. The above effects could have been caused by a lethal dose of medical morphine.”

More questions
The above disagreement between the two professors is not the exception as regards this death; it seems to be the rule due to the many other areas of disagreement among the scientists we talked to.

More questions, this time not of a scientific nature, were raised with utterances Gen David Sejusa made while in London, in which he accused the State of having poisoned Nebanda.

But to stick to the scientific questions, controversy rages over whether Nebanda died of drug abuse, which is the conclusion the trial magistrate reached. Hours after Nebanda was pronounced dead, police chief Gen Kayihura said she had died of drug abuse, arousing early uproar.

A post-mortem conclusion affirming this stance was always going to raise questions about how Gen Kayihura knew in advance that Nebanda had died of drug abuse.

On examining the white wine which Nebanda is said to have been taking at Kalungi’s house before she collapsed, Roar Forensics, a UK-based laboratory, concluded that it had “traces of cocaine”.

On failing to establish “any other pathological explanation for the cause of Ms Nebanda’s death, combined drug and animal toxicity offers a possible cause,” Roar Forensics concluded.

Prof Wabinga agreed with this conclusion, but Prof Kakonge rejected it.
Prof Kakonge told court: “On his (Roar’s) findings, alcohol was 35 times below the toxic levels, cocaine was 200 times below the toxic levels...” and therefore could not have led to Nebanda’s death. Prof Kakonge concludes that Roar’s statement is “absolutely absurd”.

But then there is another angle to it, particularly about whether cocaine can cause death even if it were below toxic levels if it is ingested through the mouth. A pathologist who asked not to be named said cocaine is normally taken by sniffing and injection and that it can cause sudden death if it is taken orally.

This is why many drug mule (couriers who swallow pellets wrapped in polythene to move it from country to country) usually die when the drugs burst in their stomachs.

The pathologist argues that Nebanda’s death could have been caused by someone adding cocaine to her white wine, knowing that drinking the cocaine with wine would result in death. He argues that in this case, the level of toxicity may not matter.

The investigation, the pathologist says, should therefore have focused on who put cocaine in Nebanda’s wine.

Prof Kakonge, however, discounts this view, saying whereas taking cocaine through the mouth can hasten one’s death, the cocaine “must” first reach toxic levels, which was not the case with Nebanda’s death.

Disagreement over samples used
And this opens the controversy over which samples were used.
Roar Forensics received different body samples for examination, ranging from blood and urine to stomach contents, liver, kidney and bile. They were also supplied with food items Nebanda had been using, including milk, red wine and white wine.

Whereas all the samples “were intact and suitable for analysis,” Roar wrote in their report dated December 21, 2012, “due to the preferable availability of blood and urine, the kidney, liver and bile samples were not required”.

Prof Kakonge says urine is not a reliable measure of toxicity in the body, especially since its concentration depends on whether one’s body is well hydrated or not. This means, Prof Kakonge says, that one’s urine can contain much higher levels of toxins if their body is poorly hydrated.

As regards the organs, he says, poisons are not equally distributed in all of them, requiring that as many organs as possible are examined if an accurate conclusion is to be reached.

It is therefore “absolutely wrong and highly puzzling” that Roar did not analyse all the samples provided, Prof Kakonge said, using this as a basis to fault their findings.

Prof Kakonge quotes a book, which he says is available in the Makerere University Library, to drive home his point that some body parts have more concentrations of cocaine and other substances than others. He says, had the pathologists referred to the book before collecting the samples, they would have done a better job.

For example, Prof Kakonge says, “If they had analysed the hair it would have been able to establish unequivocally whether Nebanda used cocaine on a regular basis.”

He says the same of the post-mortem blood used, saying it was drawn from only one spot of the body – in a vein on the thigh.

Prof Kakonge says the concentration of cocaine in the blood in different parts of the body varies for different reasons, meaning that the pathologist needs to sample blood from different body parts to be able to reach a reliable conclusion.

In many cases, he says, blood from the heart is preferable yet in this case it was not sampled.

Prof Wabinga told Sunday Monitor that he would not argue with Prof Kakonge over which parts needed to be sampled because he, unlike Prof Kakonge, is not a biochemist. “I am an anatomist and Prof Kakonge should argue with his fellow biochemists in Israel and London over that,” Prof Wabinga said.

Prof Wabinga said once a dead body is taken to him, his job is to open it up and establish the biophysical cause of death.
“When I don’t see the cause of death under microscope, I conclude that the cause is chemical,” Prof Wabinga said, “I then send it to police to do investigations. I don’t care where the samples are taken so long as I eventually receive the results to either find out the conclusions they will have drawn or for me to do my own interpretations.”

Were samples tampered with?
Prof Kakonge and the other doctors we talked to further note that the findings by the two laboratories – one in London and another in Israel vary in significant ways in some instances.

According to a table Prof Kakonge presented to the court, the urine provided to the laboratory in Israel had 30,000ug/L of morphine, while that provided to the UK laboratory had just “traces” of morphine. Furthermore, the urine provided to the UK laboratory had only traces of cocaine while that examined in Israel had much more cocaine in it.

Basing on this, Prof Kakonge says the results of the entire post-mortem were “discredited”.

THE BACKGROUND

Adam Kalungi, who was said to be former Butaleja Woman MP Cerinah Nebanda’s boyfriend, told the Chief Magistrate’s Court at Makindye that he returned to his house on the fateful day to find Nebanda seated on the floor, leaning against a chair and weakly supporting her huge body with one arm. He said her voice was meek and he struggled to hear what she was saying.

Moments after her death, police chief Gen Kale Kayihura said Nebanda had died of drug abuse and alcohol, stirring controversy as to how he had found out so quickly even before a post-mortem was done on the body.

Kalungi, it was said, fled Uganda shortly after Nebanda’s death and that he was later arrested in Mombasa, Kenya. On being brought back to Uganda, Kalungi confessed to having led to Nebanda’s death by supplying the drugs that are said to have led to her death, but he turned around and retracted his confession when he went on trial.

The court was told that Kalungi first brought in a medical practitioner to attend to Nebanda and delayed to take her to hospital because he feared that journalists would find out about Nebanda’s state (she was drunk), in the process losing valuable time and allowing her condition to worsen. Nebanda was pronounced dead on arrival at Mukwaya General Hospital in Nsambya at about 7pm.

Contrary to what had been said that Kalungi was a drug abuser, he said in court that he did not take drugs and he was an IT expert. A pathologist who participated in carrying out the post-mortem on Nebanda says nothing on her body showed that she had been taking drugs, an account that was reinforced in court by those who knew her.

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