By far, death is one of the most fear-inducing incidents we encounter because it marks the end of life, and the mortuary – where bodies are kept before burial, is a place many dread. However, for Assiel Ngarambe, who has worked as a morgue attendant at the University Central Teaching Hospital (CHUK) for over 20 years, the mortuary is just another workplace. He is one of the three morgue attendants at the Nyarugenge-based hospital, but his story is unique and debunks the fear and mystery around the facility, where dead bodies are kept, for hygienic storage or for examination, until burial or cremation. In an interview with The New Times, Ngarambe, 76, who was born in Bweramana, Bwinyana Cell in the current Ruhango District, in the Southern Province, explained how he became an undertaker – pointing out that he started out as a security guard, but was posted at the surgical ward, by the operation room. “I started working in 1982, but I first worked as a security guard and then they transferred me to work during the day here at CHUK. I was deployed at the operating room in the surgical block, where I spent some time before I was posted here at the morgue,” “When you work in the operating room, you become familiar with hospital procedures. That is how I was posted in the mortuary service. Our responsibility is to receive the deceased,” Ngarambe said. When he is talking about his work, Ngarambe does not use blunt words to describe the dead – using words such as ‘the deceased’ or ‘those who slept’ rather than saying ‘those who died’, which goes to show the respect and value he attaches to his work. He noted that when they receive a body, they explain to relatives of the deceased about the mortuary services, showing them two different sections; a VIP section and the ordinary or general public section. The family then decides where to keep the body, based on their means. “Family members decide where they want the body of the deceased to be kept themselves and we do it according to their wishes,” Ngarambe said, explaining the procedures that guide their work. For Ngarambe, switching to the morgue was easy because before, when he assisted in the surgical ward, he was handling patients on a daily basis – helping to carry them to and from the operating room and moving them from one place to another. This meant that he was familiar with handling patients, except that this time, in the mortuary he handles the bodies of patients who were not lucky enough to survive. “The process is almost the same,” he explained. It is a job he did so well, that when he was laid off due to lack of qualifications, when the government was retrenching workers, he was called back, because the hospital recognised a gap and decided to call him back. “When they called me back, I told them to give me an appointment letter indicating my task, so that I can have assurances, and they did that and I reported back to work,” Ngarambe said. “I started working in this service in 2004, until today. My typical day at work, in the morning, I leave home early because I live far from here, in Kimisange. So, I leave home at around 5 am and arrive here at around 6 am. I don't wait for the official working hours,” the dedicated morgue attendant noted. It is a selfless act, leaving home in the wee hours of the morning, walking all the way to town, so that his colleague who worked overnight can leave early and get to rest. “The first body comes in maybe at 7 am or between 7:30 am and 8 am, but by that time I am already at work,” he explains. From accident victims to deceased patients – the morgue is one of the busiest units, but Ngarambe’s experience and knowledge is one that allows him to be in charge, and handle everything with care and understanding. “It never bothers me at all,” he said, explaining that his job is not as difficult as many think, adding however that given what they have to deal with, it is a job they handle with care. “What I don’t understand, I ask my superiors in the social department, who advise on how to handle a situation,” he says, explaining that it is a job that requires being calm, careful and having a sense of confidentiality. When asked if he is often bothered by people or asked to speak about his work, considering the curiosity around the subject of death, Ngarambe speaks as though he has a pact with the deceased and an obligation to keep a secret out of professionalism, respect and diligence. “They do ask me a lot, but I avoid such questions most times. As a mature person, I don’t even need to be told that. Work related matters are confidential, you are not obliged to speak about what you do outside work,” Ngarambe said. It is a responsibility he takes seriously. He does not talk ill of the dead, nor does he speak about them. Whatever bothers him, he addresses it with his superiors. It is an attribute that has earned him respect, given the intriguing nature of death, which leaves too many questions in people’s minds. For Ngarambe, it is more of a calling that nothing scares him or bothers him as he goes about his work. No nightmares or hallucinations resulting from dealing with dead bodies or death in itself. Once in a while, he says his emotions get affected, based on the circumstances of the case he has to deal with, but it does not bother him much or keep him awake at night. His compassion, professionalism, and attention to detail have earned him the trust of hospital staff, doctors, and families. He approaches his job with empathy, ensuring dignity and respect for the deceased, regardless of the circumstances. ALSO READ: Understanding palliative care; why a mindset change is needed to address gaps “When I started out, doctors and nurses said this person looks like he has done this kind of work somewhere before. He knows what he is doing” he said, adding that he believes it was due to his hard work and commitment that got him the recognition. Even in hard times, like during an epidemic, Ngarambe said he never worries about anything, such as being exposed to diseases, as long as he uses protective gear, for instance during the Covid-19 or Marburg virus outbreaks. ALSO READ: How Marburg prevention measures are being embraced “We wear protective gear and gloves, and as usual, handle bodies as we should, putting them where I showed you (morgue)”, adding that pandemics do not prepare countries when they breakout and they must be handled just like any other disease when they come, rather than go into panic mode. ALSO READ: The utility of simple and clear public health communication “This job is like any other. When you are used to it, you feel that nothing can bother you at all. You go to work like anyone else and go about with passion and dedication,” he observes. For many, who lose their loved ones, Ngarambe’s handling of their bodies is not just comforting, but it's also reassuring that even in death, dignity and respect remain key, his empathy also helping in one way or another. At CHUK, Ngarambe’s stewardship and experience is recognised, and he is trusted to handle the most complex of assignments. A delicate process Considering that death is a sensitive subject that touches the lives and emotions of people, especially friends and relatives of the deceased, handling bodies comes with extra care, bearing in mind all the factors at play. Sometimes a body of the deceased can be disputed, with two or more families coming to claim the deceased as their own. It is just one of the examples. Bernadette Mukantaganda, the Head of Social Affairs Unit at CHUK, explaining the process of taking the deceased to the mortuary and releasing the body, involves working with morgue attendant, also known as an autopsy assistant, to perform a variety of tasks, including preparing a body, before it is deposited in the mortuary. The tasks involve morgue attendants bringing bodies from wards to the morgue, wrapping them in sheets, and placing them in the refrigerated compartments. They also clean and wash bodies, and prepare them for post-mortem examinations. “When the family of the deceased arrives, they are received at the reception and welcomed by three people who have the responsibility of releasing that body; that is the unity manager of the department which handled the patient, the head of social services in the ward the person was admitted in and the morgue attendant like Ngarambe,” she explains. Ngarambe and his colleagues assist pathologists as they work on the body, especially during autopsies, where they lay out surgical instruments, prepare solutions for preserving specimens, and transferring bodies to examining tables. They also remove organs and tissue specimens as instructed by the pathologist, before preparing bodies for release to the mortician by sewing up cavities, aspirating fluids, and cleaning bodies. Morgue attendants are also charged with picking up tissue specimens from surgery and other clinics, perform specimen grossing, and dispose of or release specimens as requested. They also have a responsibility to clean and sterilize autopsy rooms, instruments and equipment, and deliver soiled linen to laundry. They are also charged with maintaining equipment and facilities.
