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Maternal Deaths
Two jarring events closed off 2009. They made one wonder if Guyana is under some kind of special curse of the old biblical kind – the one about famine and pestilence and so on. The events were the tragic deaths of two mothers from complications related to childbirth – after they had been admitted into medical facilities.
Last Sunday, Tricia Winth, a 35-year-old mother of three, and her unborn baby perished at the recently commissioned billion-dollar medical facility at Linden six hours after she was admitted for delivery. The nurses in attendance did not take control of the mother’s complications related to hypertension and refused to summon the physician in charge in a timely manner.
The cause of death was determined to be a ruptured blood vessel. The baby died because the new operating theatre evidently was not in a state of readiness for a caesarean. Over in West Demerara Hospital, Salima Ram, 32, mother of three of Vive-La-Force, West Bank Demerara and her baby died after over twenty four hours of screaming, after suffering mind- numbing pain as nurses determined (according to Salima’s mother) that the expectant mother was “playing tricks”. There were no claims in this instance that doctors were not in attendance or that the operating theatre was not available. One awaits the official announcement as to why Salima had to die.
Now maternal deaths are not a suddenly-discovered phenomenon. In fact, the prevention of maternal mortality is recognised as a basic right of all women and was made a priority in all developing countries. Reducing maternal mortality by three-quarters between 1990 and 2015 is a specific part of Goal 5 -Improving Maternal Health – of the eight Millennium Development Goals. The rate of maternal mortality is a signal measurement of the effectiveness of a country’s health service. In Guyana, our rate is somewhere around 110 per 100,000 compared to 70 in Trinidad and Tobago and 11 in the USA. We obviously have a far way to go to arrive at Iceland’s 0 per 100,000.
The major cause of maternal deaths has long been identified: variants of gestational hypertension, severe bleeding, sepsis, obstructed labour etc. In Guyana and the Caribbean, hypertensive disorders are the major contributors to maternal deaths. In all the countries that have lowered their Maternal Mortality Ratio (MMR), the decline has been due largely to improved asepsis, fluid management and blood transfusion, and better prenatal care.
Basic procedures have been identified to deal with all the major causes of MMR and staff normally are trained, checklist fashioned for what has to be done to identify possible complications to a safe childbirth.
It is quite obvious from the behaviour of the staff at the two hospitals – and from instances of MMR at other hospitals – that something is radically amiss in our medical institutions. The administration has expended an enormous amount of funds to refurbish and build new hospitals. In like manner it has supported the medical school at UG and in collaboration with Cuba, has trained hundreds of new doctors.
The traditional training of nurses has continued apace. So where have we gone wrong?
The senior Minister of Health is reported to have pronounced that the fundamental problem at this time is the high percentage of inexperienced doctors in the system. He also alluded to the possibility that standard procedures were not adhered to with the stringency that is demanded in a field where the choices are literally between life and death.
We agree that these may be problems that have to be rectified. But we believe that there is an underlying malaise that goes deeper and unless eradicated we will continue to have such unnecessary tragedies as the deaths of the two young mothers.
The malaise is the arrogance of the entire medical profession. The arrogance of the nurses telling the young mother that she was faking her pain typifies the attitude of most medical personnel to patients.
In Guyana, we need a Patients Bill of Rights that is standard in the hospitals of the developed countries – where, not coincidentally, patient care is so much humane, not to mention efficient.
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