There is no doubt that the public health system is providing an invaluable service to women at its pre-natal clinics, maternity wards and ante-natal facilities. However, ever so often there are cases that lead to the deaths of women and their unborn children that give rise to questions over the quality of care and whether the appropriate decisions had been made by physicians and nurses. There have been many editorials in this newspaper about horrific deaths of pregnant women in the public health system and the fact that they continue to occur underlines the persistent challenge in bringing maternal mortality down to the minimum.
In one of two recent cases, Rashanna Dindayal, 31, and her unborn child died on October 20 at the Georgetown Public Hospital (GPHC). Rashanna, a mother of two from Lodge, apparently collapsed at the hospital while making her way to the washroom unattended. She was said to have suffered a severe head wound and died thereafter.
The dead woman’s mother, Shairma Dindayal told Stabroek News that around 10 am on October 20th she received a call from the GPHC saying her daughter was in a critical condition and to go to the hospital urgently. When she arrived she was put to sit downstairs where she was initially told by a doctor that Rashanna’s heart rate and blood count were low. At this point she said that the doctor said nothing about her daughter’s fall. According to Shairma, the doctor told her that her daughter “can’t make it”.
Shairma then questioned the doctor’s view because she recalled that on Wednesday, October 19th after her daughter began experiencing labour pains, she was rushed to the hospital and admitted at around 3 am. She said that around 7 am that day, Rashanna called her and said, ”Mommy I’m 4 cm dilated, and I will call you because the hospital don’t have any internet.” After that she was positive that her daughter was in a good condition and she questioned how all of a sudden she could have deteriorated. Shairma was eventually told that a blood vessel had burst in her daughter’s head and that she had passed away.
The hospital has since said that Rashanna only had two pre-natal visits – suggesting that she had not been attentive to her health – and that she had fallen after suffering cardiac arrest.
In the second case, a 39-year-old mother of five, Navita Maraj, and her unborn child died at the GPHC around 1:30 am on October 29. According to her husband, Phillip James, she had been administered Oxytocin tablets to induce labour. Based on his account, because she was considered a high-risk patient and as there was an unspecified complication, it had been agreed that she would undergo a Caesarean section. There is now a fundamental disagreement between him and the attending doctor over whether it was a C-section or a traditional delivery that she had agreed upon.
Both families, like many others in the past, have been left bereft, bewildered and in irremediable turmoil. This condition is worsened by the fact that they feel that the health authorities have not been forthcoming and that their loved ones might have been alive had different care and management decisions been taken by physicians.
There are meant to be mortality audits in all of these cases and the findings should be broken done and shared in their entirety with the families so they can begin to understand what had transpired. Where malpractice or poor care is found the relevant personnel have to be sanctioned. It is this lack of engagement by the hospital and the Ministry of Health that leaves families with trauma and bitterness to last a lifetime.
In the case of Ms Dindayal, the hospital has to explain to her family what happened on the day she was reported to have fallen and whether she had suffered severe injuries which then led to her death and that of her unborn child.
In the case of Ms Maraj, it has to be determined whether there had indeed been an agreement on how the baby was to be delivered and whether this 39-year-old with an undisclosed complication was given the requisite attention.
The third phase of the United Nations Population Fund’s Maternal and Newborn Health Thematic Fund (MHTF) plan from 2018 to 2022 sets out what should occur in these mortality audits. It caters for a Maternal and Perinatal Death Surveillance and Response (MPDSR) which “monitors maternal (and perinatal) deaths in real time, helps understand the underlying factors and determinants contributing to these deaths, and stimulates and guides actions to prevent future deaths. It is linked to the health information system and improves the quality of maternal health programmes by supporting multisectoral responses to address the proximate and distal determinants of maternal deaths.
“MPDSR has become more prominent in recent years. It integrates the elements of maternal (and perinatal) death monitoring, analysis and response to improve the quality of care for women and newborns, and pushes for responding to the findings of death reviews”.
It is unclear what the Ministry of Health is doing in relation to maternal mortality audits. However, in addition to the audits, it should make a special effort to reach out to all families in these circumstances to offer counselling and other support particularly where they have been left with minor children to take care of. It is harrowing enough for families to have lost a mother and then to also have to make long-term plans for children left in their care.
Two mothers have died under unclear circumstances at the GPHC and their families are entitled to answers and compassion.
