Doctors examining Charlene Makaza believed damage to her lower region could not be caused naturally, a court heard today.
The High Court in Christchurch is hearing evidence in the trial of George Evans Gwaze, 60, a former vet in Zimbabwe, who is charged with sodomising and murdering Charlene, 10, in her bed in the family home in Bryndwr, Christchurch.
Gwaze, who, with his wife, had adopted Charlene and her sister Charmaine when their parents died in Zimbabwe, allegedly injured Charlene in a violent attack on January 5-6, 2007. She died on January 7 in Christchurch Hospital.
The defence says Charlene became unwell on January 5 and died of toxic shock caused by her HIV infection.
George Downward, the clinical director of the intensive-care unit at Christchurch Hospital in 2007, said he first attended Charlene about 8am on January 6 when she was unconscious in the emergency department.
Several causes of her condition were considered, including meningitis, an infection in the brain, an abscess in the brain and toxic shock syndrome.
In the late afternoon, his attention was drawn to an anal injury by two nurses and he examined the region. He saw a tear with associated blood.
"We did not correlate it with natural causes. The blood was around the anal region.''
He said Charlene's dilated pupils led to speculation she had also been suffocated, and this was supported by another CT scan that showed damage to the brain tissues caused by lack of oxygen.
He was present when paediatric surgeon Spencer Beasley performed an examination of Charlene's rectum, and Beasley had confirmed the injury was not natural and most likely caused by external forces.
In cross-examination, Downward said Charlene's case had no comparison with anything in his experience, and he had no experience in HIV.
He was not purporting to give expert testimony on the cause of Charlene's death, he said.
He had no knowledge of a report from a defence expert that said Charlene exhibited the most "florid'' HIV encephalitis infection he had seen in a child, and nor was he aware of an analysis of samples from Charlene that concluded chronic HIV disease was a satisfactory explanation for her symptoms.
In other evidence today, Rachel Hong Clarke, who was the paediatric registrar at Christchurch Hospital attending Charlene on January 6 from about 7.30am, said she had discussed Charlene's health with Gwaze's wife, Sifiso.
Clarke was told Charlene had been well the night before and was not on any medication.
She asked Sifiso Gwaze if Charlene had been tested for HIV, and the answer was she did not have HIV and she did not think she had been tested.
She ordered the test because Charlene was of Zimbabwean descent.
Clarke said examined Charlene but did not inspect her anal area, although she had been told Charlene had a rectal bleed.
The medical team was concentrating on saving Charlene's life, she said. She did not see any fresh blood.
Fiona Blythe, a nurse in the intensive-care unit, told the court that by midnight on January 6, it was clear Charlene did not have long to live.
Sifiso Gwaze and a friend came into the room and stayed for about an hour.
More family members arrived and prayers were said in their own language for about five minutes. George Gwaze was in the room for about 20 minutes and did not speak.
Charlene died about 1am on January 7, she said.
"Everyone present knew she had died and the two women were crying. The defendant was pacing at the end of the bed.''
Blythe said she gave Charlene an all-over wash and changed her sheets before she died.
She knew doctors had been talking about an anal injury but she did not want to look because she had a 10-year-old daughter herself.
- © Fairfax NZ News
Can we afford a commuter rail service for North Canterbury?Related story: Traffic delays force commuter rail services probe