Could the Georgetown Hospital become an extermination camp?

Oct 24, 2015 Letters

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Dear Editor,
Sad to report, but the Kaieteur News is gradually taking on the appearance of a Journal of Maternal Mortality, especially with the frequent reporting of maternal deaths, irregardless of the  unstated, underlying and accompanying causes. Latest journal entry surrounds the death of 17 year old Nikacia Allen, mother of three following C- Section on September 20. On reading of the demise of this young multiparous female, I was forced through shock to change my uttered response from No Way to No Mother’s Day.
As a British trained nurse/ midwife, practicing Midwifery for over thirty five years and an individual who has held until recent retirement a Charge position in a Canadian University affiliated teaching hospital (having the largest number of deliveries throughout Canada), I must confess that the reading of each maternal passing in Guyana does evoke instant activation of my lachrymal sacs.
To be truthful, growing up in Georgetown, during my adolescent years, I was privy to be acquainted through home- conducted deliveries on my mother and a few relatives with the likes of Nurse Mayers (West Ruimveldt), Nurse Rose ( First Street) and Nurse Thornhill ( Murray Street), all of whom exemplified how pregnancy and childbirth should be handled, and who up to this day serve as icons of my profession.  I so admired their professional modus operandi especially since they handled deliveries outside of the hospital environment in the absence of supplementary medical assistance.  Even the most moronic of earthlings is aware of the fact that pregnancy can be difficult and complicated and giving birth often dangerous and sometimes life threatening.
My sympathy, go out to the grieving mother/ grandmother and by extension the children. I join with the mother in calling for a thorough impartial investigation of this tragic incident, as certain stated factors do indicate gross malpractice, negligence of sort bordering on to a blatant lack of professionalism. Nikacia underwent her third C-section, and at this juncture I wonder what ante-partum care/ education she received following the birth of the second child. A factor on which great importance must be laid and which cannot be overlooked in this matter, is the age of the deceased.
As the number of previous C-sections gets higher, there is a greater risk of the uterus rupturing during labor and of losing the uterus altogether due to uncontrollable hemorrhage. We just cannot afford to base her case on that of known third time successful C- section deliveries of family relations. A C-section particularly if it is planned (as in her case) is a common and safe procedure.
In addition after each operation, the body forms scar tissue or adhesions during the healing process. This makes each subsequent surgery that much more difficult and that much more risky.
In developed countries at each admission, the name and telephone number of persons/ significant others to be contacted in case of emergency is obtained. Is this simple procedure also the present norm in Guyana? Reports state that the mother was confronted (only on asking), with the shocking revelation that her daughter had undergone a hysterectomy.  Amidst further questioning as to the rationale she was told that it was due to infection. The statutory age of consent in Guyana is now sixteen years. Granted that the deceased was seventeen years old, nevertheless she underwent a severely life threatening procedure and while she could have given consent, there still lingers a very troubling question.
Who was the other person to be contacted in case of emergency? Who was notified prior to the hysterectomy being done? Who was told about the possible complications that could arise following the removal of the womb?  After the baby is delivered, excessive bleeding from the uterus is a major concern.
Typically, delivery by Caesarean results in about twice the blood loss as vaginal delivery, partly because delivery requires an incision in the uterus, and a lot of blood is pumped to the uterus during labor. The pregnant uterus has one of the greatest blood supplies of any organ in the body, and in every cesarean section, large blood vessels are cut as the surgeon opens the wall of the uterus to gain access to the baby. Complementary to this, is the fact that the areas to the right and left of the uterus have big arteries and veins that can be torn accidentally. Often, there is nothing the surgeon can do to avoid such tears; every doctor will be confronted with this problem from time to time. If the doctor detects a tear quickly, it can be safely repaired before too much blood loss occurs. Nikacia had all the signs representative of sending out red flags, yet they were seemingly overlooked at all levels? Note that with each maternal death thus far the Minister of Public Health George Norton has promised the populace that it would be investigated and preventative measures instituted. Wasted talk, wasted thought! The newspaper reports that medical professionals have overtime maintained that with each C-section a woman undergoes her risk during delivery is increased.  No reminder necessary here, although maintenance in the absence of adherence serves no purpose.
To what infection was the reporting referring to when he gave infection as the reason for the removal of the uterus? Was it chorioamnionitis (when the tissues around the fetus are infected) leading to infection of the uterus (called endometritis)? Serious infections are rare in women who have planned C-sections before labor and before the membranes are ruptured. Fortunately, almost all cases of endometritis can be treated with antibiotics. Problems like this are more common after long labors, which clearly does not apply to the deceased.
Needless to say that in the post- partum period infection does not appear without any prodromal signs, although in this case the name or type of infection was neither stated in the newspaper nor supplied to the mother.  Was the deceased given prophylactic antibiotic therapy prior to delivery, especially since she went into I have repeatedly stated this, almost to the point of being jocularly repetitive but yet another maternal, loss is again one loss too many. If these losses are allowed to go unchecked, uninvestigated and undocumented the Public Hospital would serve as a subtle extermination camp.
I am calling on the Minister of Public Health to carry out forthwith an immediate investigation, commencement of an ongoing inquiry, documentation and reporting of all events from admission to demise, treatment protocols instituted, nursing care and quality of care administered, involvement of other health agents (reason and duration), examination of hospital policies and procedures as it applies to notification of next of kin.
Do not for one moment arrive at the hasty conclusion that I am in any way, shape or form letting the medical personnel off the hook. In fact they are the chief actors.  There should be an investigative body, or the medical board to examine the conduct, exercise of professional duty and practice of those directly involved in Obstetrics. The time may have come to moor the boat and examine the horns, looking for the Sanaan goat on board.  As part of the Hippocratic Oath states “abstain from doing harm”, ( primum non nocere). This is a truly universal expression of concern and compassion for our fellow human being especially Guyanese.
Yvonne Sam

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