Maltese dentist helped identify tsunami victims

A Maltese dentist has described as "an experience of a lifetime" the five weeks she spent in Thailand "helping out in the largest mass fatality that the world has seen so far".

Romina Carabott, a lecturer at the UK Institute of Forensic Dentistry, formed part of a victim identification team put together soon after the tsunami hit last December. She joined 200 international dentists, together with 500 Thais, recruited by the Thai Ministry of Public Health and the Thai Dental Council.

The feeling of being part of an international hard-working team, with a common goal, was

"indescribable," she told The Times.

"I had the opportunity of not only meeting but working with some of the highest authorities in forensic dentistry and mass disaster management.

"I met wonderful Thai people who, in the face of such tragedy, were working hard to get back on their feet. I witnessed a world effort of professionals and volunteers, working for a common aim. And I humbly gave the little I could.

"The future may provide me with similar experiences, which will undoubtedly teach me a lot too, but none like this first one!"

When the Boxing Day tsunami struck, the UK was one of the countries to offer aid. A private non-profit-making organisation, the Centre for International Forensic Assistance (CIFA), and the Metropolitan Police approached the UK Institute of Forensic Dentistry to help put together a UK Disaster Victim Identification (DVI) team.

The project was a "mammoth task" that would take a considerable length of time to sort out completely. Dentists are, in fact, still working on identification today, eight months after the lethal waves struck, the Maltese forensic dentist said.

Dr Carabott's duties as part of the UK DVI team consisted of spending five weeks in Phuket with the away team and a week working in London at the Metropolitan Police headquarters with the home team, that had to collect the data relating to the missing persons from their country and ensure that it reached the disaster site.

In Thailand, Dr Carabott split her days between examining bodies and inputting data in computer systems, as well as reconciling dental records for identification.

But why invest so much money and manpower in identifying the dead? Dr Carabott explained that the reasons are primarily social in that, for many, seeing and burying their dead eases the grieving process. Legal considerations are also important: in most countries, the possessions of the deceased cannot be released to their relatives until there is concrete proof that they died.

Dentists are required for identification because the teeth are resistant to high-impact collisions, fire and chemical attack, explosions, and to decomposition. This is because enamel, the outer covering of the teeth, is the strongest material in the body. Even though the body may be in a state that does not allow visual recognition by physical characteristics, it may still be identified from the teeth, Dr Carabott explained.

Dentists have records of fillings or particular characteristics in teeth, while other unique features in the bone, which do not change with time, are visible on X-rays. This means that an X-ray of a person, taken even after death, would show these same features, Dr Carabott continued.

For the purpose of examining the bodies, a temporary mortuary was set up - a task that was immediately carried out by the Australian DVI team, which was the first to arrive in Thailand. It was constructed out of plywood on a pine frame in a temple building, Dr Carabott recounted.

"It took only 36 hours to prepare a functional, air-conditioned, lined and well-lit facility, which worked like clockwork," she said.

Since it was envisaged that it would take months to wrap up the whole operation, the Norwegian team started setting up a mortuary facility on Phuket Island, aimed to last longer, as well as to provide a better working environment and facilities.

In an interesting aside, which highlighted the need for any DVI team to be sensitive to the requirements and the culture of the country involved, Dr Carabott related that when the second site was functional, it was thought that the bodies would be transferred and the workforce concentrated in one place.

But Thai culture would not allow it. "It is believed that if dead bodies are moved over water, their souls would be lost. Since Site 2 was in Phuket, an island, and Site 1 was in Takua Pa on mainland Thailand, both had to remain operational until all the bodies in Site 1 had been examined and the data recorded," she pointed out.

For the purpose of data inputting and reconciliation, the Thai government granted the team the use of a Thai telecommunications company. This became the Thai Tsunami Victim Identification Information Management Centre for the duration of the DVI operations and from which a multinational group of police officers and dentists, as well as Interpol and Thai government personnel worked.

With over 4,000 bodies recovered, matching the dental data recorded at the mortuaries to the records of the missing people sent over by the various home teams from their respective countries, was a never-ending task, Dr Carabott said.

Speaking about her experience, she said "the Thai climate was enough to make working conditions very hard. For a lot of westerners, getting used to temperatures of 40°C and very high humidity was very demanding. For a change, having lived my life in sunny Malta was to my advantage.

"But the Thai people were ever so understanding. They were always ready to advise on how to deal with the heat and tried to provide us with as good accommodation as possible and with westernised food. Many have experienced Thai cuisine, which tends to be spicy, to put it mildly. While on holiday most find it intriguing, but after a day working in hot conditions and unpleasant smells, it loses some of its appeal."

Despite the good preparation from mock disaster situations that most teams had, alertness to logical problem-solving was the key for progress, Dr Carabott learned from her experience.

"During my five-week duty, I witnessed the management team dealing with fresh problems almost every day. But it was this problem-solving attitude that ensured efficient and reliable identifications."

Regular meetings to discuss problems and update the dentists with the number of identifications and repatriations motivated them to carry on and do better. A total of 1,215 victims had been identified, mostly from dental evidence, by the time Dr Carabott returned to Cardiff in April.