In a laboratory at the University of Hawaii's John A. Burns School of Medicine, human skulls are neatly arranged on shelves mounted on the wall, each in its own numbered clear container.
Other bones are scattered around the room, from sturdy femurs lined up on a table under a shelf to finely ground human remains in a palm-sized plastic bag next to a microscope.
The entire skeleton sits on the largest table in the world as part of a new study by forensic anthropologist Robert Mann, who calls the specimen a “silent teacher.”
These are some of the remains of about 350 Hawaii residents donated to the university. Over the course of eight years at the JABSOM Bone Laboratory, Mann, along with University of Hawaii cadaver program director Steven LaBrush, have been amassing a collection of human remains representative of the Hawaiian Islands’ residents.
Forensic anthropologist Robert Mann (right) and Wild Body Program Director Steven LaBrush have compiled a collection of bones representative of Hawaii's population. (Kevin Fujii/Civil Beat/2024)
Collected in a state with some of the greatest racial and ethnic diversity, the sample includes a broad sample of Asians and Pacific Islanders, who are underrepresented in U.S. medical research.
“This is a really diverse collection,” Mann said, looking at a list of people from a wide range of backgrounds in the collection, from Okinawans to Native Hawaiians.
The collection allows Asian researchers to literally experience the bones of a wide range of Asian ancestors with just one visit to a state conveniently located closer to the Far East than mainland China.
Mann's lifelong dedication has been helping people identify and uncover bodies, from recent victims of the Great Fire to centuries-old remains in the ruins of Pompeii, tracing the tiniest traces left in their bones to reveal details of their lives. The diversity of Hawaiian ancestry means his collection can be applied to cases from all over the world.
“We should see what we can do with human bones.”
Mann's interest in forensic anthropology began while studying archaeology at the College of William and Mary in Virginia, where he learned how to conduct excavations, including numbering pottery shards and ancient bricks.
“Before Indiana Jones, I wanted to be a classical archaeologist like Indiana Jones,” he says.
But when a colleague showed him some of the bone, the trajectory of his career changed.
“Someone came in, showed me the bones and asked, 'Do you know what this is?'”
He knew it was from a turkey he'd seen at Thanksgiving dinners past, but he was fascinated to find that the bone itself bore much more history about the bird, including its age and gender.
“If you think this is amazing, you should see what it can be done with human remains,” my colleague said.
Mann examines a skull sample from the Mann-LaBrush Osteology Collection at JABSOM. (Kevin Fujii/Civil Beat/2024)
This sparked his interest in osteology, and Mann discovered he had a keen eye for bones, which led him to attend the University of Tennessee, Knoxville, where the school had established the first “body farm,” or forensic anthropology center.
For Mann, tracing life histories after death was fascinating, and it led him down a lifelong path in forensic anthropology.
“We'll never know who these people were, but we'll know what they did,” Mann said. “And that was enough for me.”
Through his work at the University of Tennessee, Knoxville, the Smithsonian Institution and Hickam Air Force Base in Hawaii, Mann worked on a wide range of projects, from studying corruption to locating and identifying American soldiers missing from conflicts in Southeast Asia.
After spending the last few years of his 30-year government career in Hawaii, Mann began his “retirement” project at JABSOM to build this osteological collection. Mann realized that while Hawaii's population is “unlike anywhere else in the world,” there was no identified collection in the state that represented this diversity. Before Mann and Labrash started, JABSOM housed approximately 75 skulls with unknown histories.
Ethnic Transparency
Through the university's body donation program, the pair were able to select from a diverse group of individuals who offered to one day donate their bodies to science in Hawaii.
The corpse program has been a great success, and Labrash, who has been involved with it for 35 years, said some of that success is due to the university's unique memorial service.
Every year, JABSOM holds a memorial service for the families of donors, where students give hula performances and speeches to express their gratitude.
“Families come in and listen to their students' stories. Their voices are raspy,” Labrash said. “They're nervous, but you can hear the gratitude. You can't fake the gratitude.”
Twenty years ago, the university was taking in about 35 organ donations a year, but by 2020 it was receiving about 200 organ donations a year. Since the pandemic, the program has twice been closed for six months at a time because travel and social restrictions meant foreign surgeons and medical students could not train at JABSOM.
LaBrush said when the program was relaunched this year, there was a surge in applications.
“That's when we decided we needed to make some adjustments,” he said.
Mann has assembled the first identified collection of bones in Hawaii. (Kevin Fujii/Civil Beat/2024)
The program now has weight limits for new donors, which has caused a drop in applications by about 10%, and all donors must now register themselves – family members cannot register them.
When Hawaii residents fill out applications, they self-report all the ethnicities to which they belong, rather than selecting one or two primary racial affiliations.
This allowed the team to accurately classify and trace their ancestry, which can easily become complicated in a state where a quarter of the population is multiracial, according to census data from the Department of Business, Economic Development and Tourism.
This also allowed Mann to address a persistent misconduct in American medical research: the often inadvertent lumping of Asians together as a single race.
“It's really interesting to look at what people self-report and what their DNA shows,” says Mann, who has noticed a myriad of unique characteristics found among certain ethnic groups.
Nilay Shah, an assistant professor at Northwestern University Feinberg School of Medicine who studies Asian American representation in medical research, said self-identification ensures Asian immigrants are represented as they truly identify as an ethnicity.
“When you ask someone to self-identify, it's a complex, multifaceted response, and there may not be a single answer,” Shah said. “The motivation for encouraging self-identification is to represent people in the best way that we can.”
Asia's hub for bone research
The number and diversity of known Asian identities in the collection, as well as the detailed classification of specimens by individual ethnicity, have attracted forensic researchers and surgeons from Asia to Honolulu to study the Mann-LaBrush Osteologic Collection.
According to the European Society of Forensic Anthropology, there are about 150 osteological collections worldwide, of which only nine are in Asia. Asian collections are fairly homogenous in nature, as most universities and researchers collect samples locally.
“Guess what, 99 percent of the individuals in the Thai collection? They're Thai, right?,” Mann says. “You'd expect the same thing when you go to Japan or Korea. Wherever you are, the samples and collections are very local and very population specific.”
Mann lined up the two specimens to compare features of a Caucasian male (left) and a Korean female. (Kevin Fujii/Civil Beat/2024) Here's a side view of the same two skulls. (Kevin Fujii/Civil Beat/2024)
Sitthiporn Ruendit, a forensic scientist from Chiang Mai, Thailand, collaborated with Mann throughout the development of the collection to advance the field for Asians. They have studied the effects of thalassemia, a blood disorder that causes anemia, on the bones of Thai patients, analyzed various specimens resulting from trauma, and recently discovered a new bone feature the size of a fingernail near the ear canal.
The latest project, now underway, involves using around 450 skull samples from Thailand and JABSOM to measure how reliable a widely used forensic software called FORDISC is in Asian cases.
FORDISC is designed to help classify skeletal samples by ancestry and sex by inputting a series of measurements. Currently, Mann believes there is a relative lack of data from Southeast Asia, so he's also contributing his own information to the FORDISC database in the hopes of improving accuracy.
“One of the great things about JABSOM is that we have a lot of variation in samples,” Ruengdit says, “so we can do things like comparative studies between our samples and JABSOM's samples.”
By comparing local collections with Mann's, forensic experts like Luendit were able to study subtle bone differences between multiple Asian ethnicities in a single trip to Honolulu.
Lessons learned from large-scale disasters
Most of Mann's specimens are well-preserved bones, but some are broken into chunks or shattered like sand, making them difficult to identify.
Mann participated in a variety of high-profile missions involving multiple casualties, including the civilian plane crash in Guam that killed more than 200 people on board, the 9/11 attack on the Pentagon and the rescue and identification of victims of last year's Maui wildfires.
Mann has witnessed the aftermath of these disasters firsthand, seeing how the impact of trauma can change the condition of bodies, some to the point where they are unrecognizable.
This led him to his latest endeavor: training emergency responders how to find bodies at disaster scenes.
“In a major disaster where there are horrific fires that burn for days, should we expect to find nothing? No. We should always expect to find something.” — Robert Mann
Mann said he received calls from confused emergency responders who couldn't find victims who were apparently deceased in specific locations.
“That's because they didn't know what to look for,” Mann said.
Through his book, Mann hopes to help emergency responders better respond to unexpected situations they encounter in the field and to help them distinguish between different shapes on human bones.
“In a major disaster like a terrible fire that continues to rage for days, should we expect to find nothing? No. We should always expect to find something,” Mann said.
Dealing with the intense emotions – realising rescue workers may have missed or even trampled a victim during their search – is an experience Mann knows well and has learned to cope with. He reminds himself that this is important work that must be done for those left behind.
“You can never forget the cases that you worked on. Never, never. Some are much more brutal than others,” Mann said, “but I think it's important to recognize that the whole world is not like that, and there is a time and a place to focus on that.”
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