Pakistan has a bright future in Disaster Victim Identification; Dr Humayoun Temoor

 Dr Humayoun Temoor is the first qualified and trained Forensic Odontologist in Pakistan.

-By Dr Muattar Hanif

Graduated from Isra Univesity, Dr Humayoun Temoor completed his Master of Science (MSc.) in Forensic Odontology from the University of Glamorgan, Wales. He also completed his post-graduation in Oral Implantology from Goethe University Frankfurt, Germany.

He is currently appointed as Senior Lecturer at University of Health Sciences, Lahore and continuing his services as Forensic Odontologist under Government of Punjab.

On the 22^nd of May 2020, Pakistan International Airlines (PIA) flight 8303, crashed on a second landing attempt short of the Jinnah International Airport, Karachi. 99 passengers including 8 crew members lost their lives. Most of the deceased were left unidentifiable due to the fire that erupted because of the crash. National Disaster Management Authority (NDMA) and Pakistan International Airlines Emergency response unit assembled a forensics team for purposes of identification of the deceased.

Dr Humayoun Taimoor was tasked as the Consultant Forensic Odontologist for the air crash victims’ identification. He along with his team conducted numerous Dental Autopsies and identified the bodies.

Recently Dental News sat down to talk about his journey as a forensic odontologist for our readers. Excerpts from his interview are as under:

• Dental News: Kindly introduce yourself to our readers

Humayoun Temoor: My name is Dr Humayoun Temoor Beg, and I am a dental surgeon by profession. I am trained in forensic Odontology. I am residing in Pakistan for the last ten years. I initiated my services with Officer's Surgeon Medico-Legal as a professional forensic odontologist. About my background, I belong to a small town in Azad Kashmir, and most of my family members belong to the Military or Police department. In my career so far, various air crashes, including the Junaid Jamshed flight air crash incident and multiple bomb blast incidents. Allah has blessed me with respect and I am always appreciated on many occasions.

• Dental News: What made you chose this career option?

Humayoun Temoor: I always wanted to be different from the rest. I kept on practising after graduation; then my father told me to do specialization. At that time there were not many options for specialization, hence I went to England to complete my training in maxillofacial surgery. I soon realized that my thirst for knowledge didn't quench. I talked to my supervisor about it, and he introduced me to this course, and luckily Dr Katherine Adams accepted me into her class. Now she's an excellent friend of mine and mentor as well. Now, this course of Forensic Odontology is happening at the University of Dundee, and the course lead is my class fellow, Ms Sheela. Apart from me, last year two female dental surgeons have completed their Master courses from there, Dr Suman and Dr Falak and they are Karachi based from Dow University. I also want to thank Dr Shahjahan Katpar in this regard that he supported these girls and I also foresee that more people will join this field.

I went to England to complete my training in maxillofacial surgery but my thirst for knowledge didn't quench!

• Dental News: In your experience, what would you say are the most common applications of odontology within a forensic context?

HT: Forensic Odontology has 7-8 sub-specialities like dental adjustments, disaster victim identification, bite mark analysis, criminal liabilities, medical and dental neglect and disaster management planning. Facial reconstruction and facial mapping are one of the new things for the country, dental adjustments were happening before but the process of this is detailed in Forensic Odontology. It can't be done through any other way. These techniques are further elaborated and are defined meticulously and then there's training for that, without which it will be tough to perform forensic procedures. Some people might comment that the tasks can still be performed; it doesn't seem that difficult; maybe they are right. There is nothing in the world that is difficult, but, I give an example of this very incident. A dental surgeon, who is a friend of a family came to meet us and said that he could identify the body easily. The body was not in good shape, but somehow he recognized it. The body was then buried before I could even re-check it. Later through the dental data given by the family of the deceased, it was found that the body was not correctly identified, and the wrong body was buried instead.

So it is a message to all those people who think that anybody can do this job. One cannot examine without training and certification. So it is my request to all the aspirants prefer proper international certification, and the licence is issued by Pakistan Medical and Dental Council to practice this.

• Dental News: Tell us about a few cases and your most memorable one?

HT: See, I won't discuss cases of counter-terrorism cases, but all examples are challenging. I won't mention counter-terrorism cases because they are state property and identification cases. Every case is challenging. A detailed investigation has to be done. Yes, it has to be done in specific time-frame because some cases are solved quickly. Some claims take a lot of time. You have to prepare your pieces of evidence properly so that you can prove them in the court of Law. As mentioned before, it’s a general responsibility that whatever you say or whatever observation you give or any opinion that you forward can be proven in the court of Law.

• Dental News: Is it emotionally disturbing dealing with traumatic cases such as these?

HT: I think it's a special blessing from Almighty Allah. I believe that there is no one but Allah, who can harm or benefit him. Yes, there are social pressures, work area pressures, professional demands are there. But this is for which we are trained. If we are prepared correctly, then we can overcome all these obstacles. Because without this we won't work as a team. It is a very responsible job because you are answerable to the state.

• Dental News: Share your experience related to PIA flight crash incident

HT: I cannot say much about them because the investigations are still underway. When this incident happened, we were immediately called by my Vice-Chancellor, Prof Dr Javed Akram and ordered to get ready. Mr Javed Akram has a very charismatic personality and believes in quick response. I also had experienced working with him before when Havelian air-crash took place. He was Vice-chancellor back then too of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad and he is a gem of a person. He gave me a team to take with me, and all the legal modalities were completed. NDMA Chief ordered my Vice-Chancellor and our team, one or two days before Eid reached Karachi in the evening. Here PIA, NDMA, PDMA, local Sindh council, took outstanding care of us, but for some reason, we couldn't initiate work. Still, when we commenced work, by the grace of Allah, we identified the body, on our very first day and I am very thankful to those families because we came just for them after leaving our homes and Eid celebrations. Our mission was to handover the deceased to their loved ones. Our goal is not to get fame. By the grace of Allah, I am an international consultant. I perform consultancy for two international organizations. It is very insignificant for me if someone demands fame all over the world.

Some people might comment that the tasks can still be performed; it doesn't seem that difficult; maybe they are right. There is nothing in the world that is difficult.

There are many organizations of forensic Odontology in America; there is an American Board of Forensic Odontology in Britain, there is the British Association for Forensic Odontology, also called BAFO. In the Royal College of London, Forensic Odontology has a separate chapter.  Along with these, there is a division of ICRC that look after forensic. I am their tutor for the past five years. I give lectures there.

The science of forensic Odontology is given importance on a global level because it's a cost-effective science. After the training, a forensic odontologist can perform the same tasks that many machines cannot do and with very cheap tools like simple X-rays. I am mentioning here about identification processes. This is why dental identification is the quickest, affordable and reliable. In Interpol, there is a sub-committee on Disaster Victim Identification, and there is a chair available in forensic Odontology. I am a contact to that committee in Pakistan. By the grace of Allah, our standards are being monitored by all agencies. Since we are doctors, we are not technicians; we never felt the need to write 'scientist' before our name or get worried about writing 'Dr.' before our name. We are already blessed with respect by Almighty Allah. That's why those who need it, they talk about it.

• Dental News: It is a general perspective that DNA testing is better way forward than Dental Identification. Your views on this?

HT: As I have mentioned before, as doctors, we have social acceptance. The DNA test is performed in the lab. You also know technicians do that lab testing. Technicians are called 'lab-tech' or 'DNA-tech'. These are very common terminologies. In America, just to elevate themselves, are referred to as 'Scientists'. You can look up the definition of a scientist. I won't talk much about it because I don't want to belittle anyone. My only purpose of coming here was to handover the deceased to their loved ones for which Allah has given me success for my efforts and those who have created obstacles in these tasks or they are questioning; I rest their case to Allah.

As far as the authentication of Forensic Odontology is concerned, I request all of you to look up the website of DVI of Interpol, DVI website which can be shared. It's written in English there are some steps mentioned in it. Kindly read them, and I request to go through it, 2-3 times. You will get an idea that DVI process, Disaster Victim Identification Process, the importance of dental identification. The Law of Universe is to use that science which is more cost-effective. If you try to shoot an ant with a cannon, then no one will call you smart even if you have a specialist for that in the country. The collection of dental data is no big deal.

We initiated the dental data registry, last year, in 1st UHS Dental Conference. Our Vice-Chancellor in University of Health Sciences (UHS), Dr Javed Akram, under his chairmanship. But since no response was given from the Government authorities, we were unable to work. Our mission was to compile the National Data Registry that can have verified data in case of such incidents through which we can identify people instantly, and not much funding has to be done for that. Not like billion of rupees because people here take billions of rupees just for their salary. We can work within the salary of a doctor or as a specialist. Then there is training for the people who are involved in it. We don't have to go anywhere else internationally. England, America, Australia etc. are provide training for this. I am also planning to initiate practice in Pakistan. The department is under in process, and we will start as soon as possible but to say that dental identification has no worth is not valid!

• Dental News: How is dental identification better than DNA testing?

HT: DNA testing is done on a machine performed by the operator. A device can be unpredictable. It can give False-Positive and False-Negative, but Dental Identification is a physical comparison whether a thing is present there or not, and there is an explicit opinion in it. Probability level is low. We don't go to a higher level of probability. DNA testing has a percentage level; then another percentage has to be calculated of it. Different languages and words are used which lawyers can understand. In Pakistan, all medical reports since DNA is also a medical report, linked with the human body; only a medical doctor can verify the report.

I cannot understand how courts accept these or maybe the courts are not informed well because misleading is also a trend here. This is the reality. They can only work on the request of the doctor. Only a doctor can take the sample of the DNA from the body because according to PMDC and laws of the country, the human body, other than a medical doctor cannot be touched. Only doctors can take the sample and send it to the lab

• Dental News: Do you think that public opts more for DNA testing than dental identification due to lack of awareness?

HT: DNA is a tiny word and also very easy to remember. It's also very catchy and classy. Forensic Odontology is a proper scientific term, a complicated word for people who are not very educated or are not very well aware. Unfortunately, some people have their hidden motives associated, and they are also getting benefits. DNA is an excellent source of information, but during the Disaster Victim Identification Process, there is a certain level to it. We are lucky to have NADRA thorough record with us. We have excellent data banks in NADRA, so if the body is not burnt entirely or not drowned in water, fingerprints can be easily found and can be identified easily. But if the body is burnt completely or was in the water for more than 11-12 days, it gets swollen, then teeth are the easiest and cheapest way. If you have a dental record, then you can do forensic matching with it, but in case you don't have the document, you can still quickly identify the body.

I believe that there is no one but Allah, who can harm or benefit him

You can also estimate the age, you can determine its gender, and you can also make identification through its other distinctive features. All the information combined can help you with body identification. The percentage varies so much here in identification reports. The DNA reports that I have gone through people have requested later on to make dental identification of the body with the dental data provided.

There is a family whose identification of children is under-process. I informed the concerned authority for their dental data, and one of the Ministers released a notification for that and England Ambassador and our Ambassador, are looking at this case, personally. I have personally involved Interpol in this matter and the Chair of Forensic Odontology, Dr Erina Davisdon, she is looking after this case, specifically. I am hoping to get their data from England soon, and I can confirm their matching.

I also think that we should practice speaking the truth always. Only through truth, this country will change for the better. In general dentistry, we make any claims. No one notices it, but when it's the matter of identification on which the fate of the entire family is dependent on, then we should be cautious, before giving any statement.

• Dental News: What is the importance of identification?

HT: Identity is essential. If we don't have a character, then nothing can work in society. Identity is a fundamental human right. United Nations and the Geneva Convention has mentioned this without identification; no human body can have a death certificate issued. Without the issuance of the death certificate, many issues can arise, like claims, re-marriage, distribution of properties. The death certificate cannot be released without identity.

Look, as far as emotions are concerned, being a forensic professional and a doctor, I have to focus on my work. I won't be able to perform if I involve emotions. Secondly, administrator issues are always there. But, I am thankful that I am provided with certain things like I was presented with the Mobile hospital from Sindh Government. At least, my team and I were given a clean space to work in, but since its placement was above ground level. We were facing trouble to shift bodies, up and down. Police gave us security and looked after us well. PIA, PDMA, NDMA, Sindh Government's Rehabilitation Department, the people from these departments were also working with us. But it is such a tedious process. As I have said earlier, I will write a detailed report on the problems faced and their possible solutions. I believe that my Vice-Chancellor has already planned a lot of things within these couple of days. We soon, through the platform of the University of Health Sciences will give a piece of excellent news.

• Dental News: What is the scope for Forensic Odontology for young dentists?

HT: See, the profession of medicine is very noble, and in my personal opinion, only those should opt who from the very start doesn't have the desire to earn big financially. Dentistry, all over the world, its demand, its value, its scope is excellent. We also need to change our attitude somewhat. Attitude towards the profession needs to be replaced. Students usually ask me, 'what is the scope of Forensic Odontology in Pakistan?' To be honest, I disgust this word 'scope.' My response to them is that it's the very same scope that dentistry has.

Our mission is to handover the deceased to their loved ones, as soon as possible.

Ten years back, when I came back to Pakistan, I was also mocked. I was also called 'rich spoilt guy.' I, later on, got appointed in Government services. I kept on working in it. I never asked in the very same Government job. Allah put my services into many tasks. Hard work is under your control. The result of which is under Almighty Allah's command. This questioning of scope from others according to me, this very question is wrong. If you are not practising in dentistry, then you might do something else. If you are not doing clinical after graduating, you will opt for some other field.

See, the thing is that I am not an 'Astrology Guru' that I can tell you about scope. Why don't we have trust in Allah's plans? Being a Muslim, why do we forget this that the things written in your fate, will ultimately come to you. The rizk written in your destiny cannot be given to someone else by Allah. My advice to all young dental students is to make your basics secure and then opt for specialization. New graduates should spend 2-3 years in Private or Government clinical practice so that they can get hands-on exposure with patients, and then move towards specialization and decide. The advantage of which will be your vision will be broadened, and your observational skills will develop.

• Dental News: Do you think that Dental Identification is suffering due to lack of Administrative infrastructure?

HT: Yes, very much. Unfortunately, people here have an identity crisis, and they get scared. I have my jurisdiction. I am not a DNA expert. Neither have I worked in DNA technology nor a technician. I am just a doctor. I don't go beyond my jurisdiction, and as a true professional, I don't call any science wrong, since I have my training. Now such people who have spent their lives in lab testings and have started their life as a technician because PhD programs are offered in lab technology etc. It doesn't make you a doctor. Yes a PhD doctor, for sure, but the status enjoyed by us, can never be same for them.

After the training, a forensic odontologist can perform the same tasks that many machines cannot do and with very cheap tools

My suggestion to the concerned authority is that we should form the Disaster Victim Identification (DVI) unit in Pakistan at the earliest, in which people of various specialities will be included related to the identification. Such groups are all over the world, UK DVI, DVI Italia, Australian forensics, there are so many. Our neighbouring country, Malaysia, developed one after the Tsunami. We need Pakistan DVI unit and since I am trained and know how to manage that DVI unit, how to operative administratively, my master's program project was on DVI protocols and we can do this.  We don't need massive funding. We don't need that much for this. We don't need crores! Equipment is required in this, but they are not much expensive.

This system is somewhat already present but to bring them on one page and to form central command and control centre, that is very important. This is what the DVI unit does. It is inactive and then gets active, suddenly and streamline things, all by itself which can make things a lot easier.

• Dental News: What is the importance of dental protection near you?

HT: Data protection is vital. As far as the safety of families is concerned, then, of course, it is paramount not to get them exposed, is critical. The ones who have to go through such incidents, those families are going through tough times and to lessen their pain and hardship a proper organization has to be present. When we came here, there were no help camps, of any sort, and upon my request, DCO made help desks.

The issue is that we are qualified, foreign consultants. If you ask something, we let you know how to continue the process. We already have done this before; we are trained in that. Certain things are related to Police, but then certain things are only linked with crisis management. There are different dynamics in every province of Pakistan; various problems are there. That's why I have said to have a National Authority in this regard. As far as families are concerned, who are expressing their loss and grief, it's their very right. They are in much pain.

My suggestion to the concerned authority is that we should form the Disaster Victim Identification (DVI) unit in Pakistan at the earliest.

Government organizations should lessen their pain, but we also need to understand that when such an incident happens, the process of identification is a complex process which can go wrong if done hastily. It's not a job that can be done hurriedly, but in this regard, our religious scholars can also help by guiding people, and it's also the function of Government to guide people.

We as professionals, our focus is the same, but since there are specific International protocols and guidelines have to be followed, it can take some time. Just like any DNA machine requires break time, continuous work can increase the chance of error. Similarly, humans can work for a specific period after which they need rest. All these things are planned. The time frame of which is intended. International standards are there. Forensic Odontology, which is my field, time durations, days of work, such things are standardized.

• Dental News: Your special message for our readers.

HT: Disaster Victim Identification, Pakistan is the future. All the dental surgeons and citizens have to work collectively on this. We have to save our dental record, and I hope that we will get successful in forming National Dental Registry soon and we wouldn't have to opt for expensive techniques, by the will of Almighty Allah. We will quickly become capable of that. I request you all to pray. Thank you very much.