It was a tiny news item on the fifth page of a national daily in India. Not designed to make headlines, it could have been easily missed. It consisted of only three sentences and described a woman, Chanti Mallamma, who had petitioned a minister of state to trace her husband, Chanti Malliah, who had left for Saudi Arabia five years ago and had not been heard of since.
The story took me back to when I was working as a microbiologist at a large tertiary care hospital in Saudi Arabia. One day I received samples for bacterial culture from a patient whose name, age, nationality, and history were not known—a regular “John Doe,” to use the US term to describe unidentified people. He was found unconscious on a road and brought to the hospital. Physical examination and investigations were not conclusive, and a diagnosis could not be made. Within 24 hours he was dead. Local customs did not permit an autopsy. Attempts to identify him were futile. No papers were found on his person, even though the law required everyone to carry an official identity card at all times.
He died unidentified and unmourned
His features suggested an origin somewhere in South Asia. Possibly he was an illegal immigrant. In due course, when nobody came forth to claim his body, he was given a decent burial in accordance with local customs. The hospital had informed the police. No inquiries were made about him. Curiosity about an unclaimed body subsided after a while—and the matter ended there. This small hiccup in the otherwise smooth functioning of the hospital was quickly forgotten. It was almost as if this John Doe had not even existed.
As I was also an expatriate in Saudi Arabia, his death struck a painful chord. Temporary migrants constituted a large proportion of the country's workforce. Disease and death took on a more poignant hue among those living away from their families. A death like his was the worst possible. He died unidentified and unmourned—a nameless individual lost to oblivion. His family would have no information about him. Years would pass by without news from him. How long would they keep their hopes alive?
Figure 1.
Hospitals should keep more meticulous records
Credit: BURTON PRITZKER/PHOTONICA
The vacuum caused by ambiguous loss—when loved ones suddenly vanish—defies emotional comprehension. It is not feasible for people to move on if they don't know whether the missing person is alive or dead. Without definite information about the death of a loved one, there is no grieving, healing, or coping. In this scenario hope and hopelessness, desire and denial, and expectations and apprehensions combine to create an unbearable situation for the family. The long term consequences can be conflicts among relatives, somatisation of negative feelings, and repressed rage against the community in general.
The inability to identify our John Doe was the crux of the problem. The only place with possible clues to his identity is the hospital where he breathed his last. However, apart from medical records there would be precious little left to go on. This is not to say that the hospital lacked commitment with respect to what was done for him. National and international guidelines were followed in letter and in spirit. The problem is an inadequacy in the guidelines that are accepted the world over. A major issue is just not being addressed. With international travel becoming increasingly common, migration is steadily on the rise, and concerns peculiar to migrants (even the illegal ones) need to be identified and tackled.
There are many John Does in many countries. The exact number will never be known. Officially they do not exist. When such people meet (or are about to meet) an unforeseen end, they may be brought to hospitals. They need to be identified. Hospitals and healthcare centres should take on greater social responsibility and put more effort into identifying the person. They should maintain more meticulous records—maybe including photographs of the deceased. Perhaps these records could be compiled in an international registry that could be posted on the internet and updated regularly. Extra work, staff, and funds would be needed, and the legal implications would need to be sorted out—but a beginning has to be made somewhere. We owe it to ourselves and to the families of all the John and Jane Does among us.