Maternal mortality

Earlier this month, on May 10, this newspaper carried an article on maternal mortality, based on a report produced by the World Bank, the World Health Organisation, UNICEF and the United Nations Population Division.

It was not good news. The report revealed that it was unlikely that any country in the Caribbean or Latin America would achieve the Millennium Development Goal (MDG) 5A. The aim of this goal; is the reduction of maternal mortality by 75% between 1990, when the goals were developed and 2015 – next year. The report revealed that Guyana had the second highest rate of maternal mortality, 250 deaths per every 100,000 live births, coming in just below Haiti’s 380 deaths per every 100,000 live births.

Over the last few years, Guyana has faced significant challenges as regards maternal mortality. In fact, health care in general at the country’s public institutions leaves a lot to be desired. Investigations have been conducted into the circumstances surrounding unexplained deaths, once the concerned relatives raise questions. To date there has not been a satisfactory response by the powers that be, starting with Minister of Health Dr Bheri Ramsaran with whom the buck stops.

The closing of ranks and circling of wagons whenever unexpected deaths occur at the public institutions is inexplicable. It would appear that the cause is the protection of the health institution and its staff. But against what? Possibly                   the chance that lawsuits would be filed if culpability is admitted.

But then what of the patients’ rights? Patients visit doctors and hospitals with the expectation that what ails them can be cured or at least treated. They go for health care. Pregnant women opt to give birth in hospital settings so that the risk of dying from complications they might not have known existed would be diminished. The high maternal mortality rate indicates that the opposite is happening. And unless the powers that be are prepared to admit that the deaths mostly result from a lack of appropriate care, women will continue to die at a high rate from a condition that is supposed to have a joyful conclusion.

In the wee hours of Monday last, a Stanleytown hairdresser and mother of two died at the New Amsterdam Hospital from complications attending the birth of her seven-month foetus. The baby survived. The young woman, Marissa La Goudoue, apparently was afflicted with gestational hypertension and was reportedly being monitored. However, it would seem that the monitoring ceased the minute she gave birth.

The woman was admitted to the medical institution on Friday and gave birth the same day. However, her blood pressure apparently remained high even after she was discharged on Sunday. It is not known whether Ms La Goudoue was discharged with the necessary blood pressure medication or if she was counselled about diet and rest. But hours after she was discharged, she was back at the hospital critically ill and she died shortly after. Since gestational hypertension is a major cause of maternal morbidity and mortality, according the available literature, the expectation is that medical personnel would be aware of this.

Is there a possibility that Ms La Goudoue could have survived if she had remained in hospital? Yes. But she would have had to be constantly monitored for spikes in blood pressure, made to rest and in receipt of the necessary medication.

An investigation is underway and one of the things it should seek to establish is why a decision was taken by the doctor/s charged with her care to discharge her from the hospital when she was clearly not well enough. It should also examine what, if any, provisions were made for her aftercare – in terms of revisiting the hospital or a health centre for blood pressure monitoring. Culpability on the part of the medical staff involved should be established and sanctions meted out.

That is the ideal situation. However, given what has occurred in recent history, Ms LaGoudoue’s condition will be blamed for her demise and her family will receive no justice. Meanwhile, the careless medical officer/s who signed her out of the hospital will continue on to perhaps make the same mistake on another day.

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