The paper that came back with him was one page in two languages, issued by a hospital in a Gulf city, and under cause of death it said cardiac arrest. He was twenty-six. He had passed a medical examination in Kathmandu eleven months earlier, because you cannot get the visa without one, and that examination is not a formality — men fail it and are sent home and lose the fee.
I have now seen enough of these certificates that I can predict the wording before the envelope is open. Cardiac arrest. Natural causes. Sometimes death during sleep, which is a category I have never encountered in any other context in my life.
Every death is a fact and I will not speculate about any individual one of them. That has to be said first, because writing of this kind routinely assigns a cause it cannot know, and doing so does the families no good at all.
What I can talk about is the shape of the aggregate, and the aggregate is this: a population that was screened for cardiac fitness at departure is dying of cardiac events at ages where no actuarial table anywhere puts them. That is not a claim about any man. It is a claim about a set of documents, and the documents are the only thing anybody has.
So the question I care about is not what killed him. It is why the certificate is the end of the inquiry, and the answer is jurisdiction, and the jurisdiction problem is more brutal than it first appears.
The death happens in a country whose authorities issue the certificate. That country has no obligation to investigate a workplace death as anything other than what the attending physician wrote, and in most of these cases there was no attending physician until after — a man is found in accommodation in the morning. Nepal's mission can request more. It has no power to compel anything and, at the volume involved, no capacity to pursue what it requests. And by the time the body reaches Kathmandu, any examination that could have established a cause is weeks past being possible.
Then the certificate does one more thing, and this is the part I did not understand for years and that I now think is the whole mechanism.
It determines the compensation. The foreign employment welfare fund pays on death, and the amounts differ by category, and a workplace accident and a natural cause are different categories with different consequences for what the employer's insurer owes. The certificate that closes the medical question also settles the financial one, and it is issued by an institution in the country where the employer is.
I am not alleging that anybody falsifies them. I have no evidence of that and I would not print it if I had a suspicion. What I am saying is narrower and does not require anybody to lie: when the party best placed to determine a cause has no obligation to look hard, and a cheaper category is available and defensible, the aggregate will drift, and no individual has to have done anything wrong for that to happen.
The counter that carries the most weight with me comes from the families themselves, and it is why the reform everybody proposes has not happened. What a family wants is the body, quickly, for the rites, and every additional inquiry delays repatriation — sometimes by weeks. A policy requiring an autopsy before release would be a policy of holding sons in refrigerated storage in another country while a bureaucracy that has failed at every previous stage performs one more step. I have sat with a family waiting nineteen days on paperwork alone. Nobody in that room would have traded another month for a better certificate, and I would not have advised them to.
So the answer cannot be to hold the body. It has to be something that costs the family nothing.
The one I keep coming back to is a record, held here, of what the certificates say: employer, site, accommodation, age, stated cause. Not an accusation and not an investigation — a table. If four men from one labour accommodation die of natural causes in a year, that is not evidence of anything about any of them, and it is a thing somebody in Kathmandu should be able to see, and at the moment nobody can, because each certificate goes into a file with a man's name on it and nothing joins them.
His mother has the page. She cannot read either of its languages. She asked me to tell her what it said, and I told her, and she asked what cardiac arrest means, and I said it means the heart stopped, and she said yes, but why, and I said the paper does not say.