title: Post-mortem as preventative medicine in Papua New Guinea: a case in point.
abstract: BACKGROUND
  Sorcery-related killing and violence has increased in Papua New Guinea (PNG) in recent years. The international community has condemned the violence and a number of non-government organisations have called for action; however, effective and appropriate interventions at a community level remain elusive. It has been suggested within some communities and in the literature that post-mortems may help to reduce fears of sorcery and associated violence by providing an alternative biomedical explanation of death. Evidence to support this proposal, however, is limited.
  
  
  OBJECTIVE
  In 2012 the author was working in Ok Tedi Hospital, Tabubil, a remote mining town in the Star Mountains of PNG. The area is notable for a recent rise in sorcery-related violence and murders since 2009. In March 2012 a family from a nearby village requested a post-mortem following a relative's sudden death. They clearly stated that violence and killings against suspected perpetrators of sorcery had occurred due to a similar sudden death only a year before. As such they were concerned that the nature of their relative's death would rouse suspicions of sorcery and result in violence. The family hoped that a medical explanation of their relative's death would prevent rumours of sorcery developing and reduce the risk of violence against suspected perpetrators of sorcery.
  
  
  CONCLUSIONS
  The post-mortem, led by a consultant surgeon and performed in Ok Tedi Hospital, Tabubil, concluded that death was due to complications from an acute myocardial infarction. As requested these results were presented at the funeral to a congregation of approximately 80 people. Following the funeral presentation the author received feedback that fears of sorcery had been alleviated and during a 2-week follow-up period no related violence against suspected perpetrators of sorcery was observed. This case is a unique and intriguing example of biomedical and sociocultural integration in the Highlands of PNG. The presence of Ok Tedi Mine, which has provided wealth, education, transport and medical resources to the area for over 30 years, no doubt can partly explain the family's actions. For the family, however, a recent increase in sorcery-related violence would appear to be the primary reason for requesting a post-mortem. Whether these actions reduced suspicions of sorcery and the risk of subsequent violence as the family had anticipated is unclear. However, given a recent rise in post-mortem requests from regions of PNG with some of the highest rates of sorcery-related killings it seems prudent to further investigate the role of post-mortems in the prevention of sorcery-related violence and killings.
authors.affiliation: Neurosurgical Department, Western General Hospital, Lothian NHS, Edinburgh, Scotland. newc2733@gmail.com.
authors.forename: Nick R
authors.initials: NR
authors.lastname: Haslam
mesh_terms: D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D003645:Death, Sudden / Q000209:etiology / Q000473:pathology*; D003906:Developing Countries; D005260:Female; D049429:Forensic Pathology / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010219:Papua New Guinea; D011315:Preventive Medicine; D018570:Risk Assessment; D014754:Violence
keywords: Australia/Pacific; Cross-cultural Safety; Ethics; Human Rights and Ethics; Indigenous Health Worker; Medical; Practice Tips; Public Health; Qualitative Research; Sociology