Call for inquiry into the use of Cytotec

Nov 23, 2016 Letters

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Dear Editor,
With the greatest of respect for Adam Harris, whom I count among my list of friends but my cardiac system did somersaults to the surprise of my cranium, when I read recently about his having to plead with medical personnel regarding the use of the drug Cytotec (Misoprostol) on pregnant women. Kaieteur News November 20, 2016. “Cytotec use is giving me nightmares” Let me somersault back into the past to an article that I wrote on September 11, 2014 referring to the use of the same drug Cytotec, under the heading—”No Birth Mirth – Death Under Ignorance.”
I bluntly refuse to spend any additional time outlining the contraindications surrounding this drug, as I have already done so in my previously mentioned article. As a Midwife, Registered Nurse and Nursing Instructor/ Examiner, with work experience spanning two continents, I have on multiple occasions administered the said drug. When an intrauterine death has been confirmed and up until 20 confirmed weeks of gestation Cytotec is administered intravaginally. During the administration of this drug nursing care is carried out on a one and one basis, with Q15 minutes monitoring of vital signs, blood loss etc. There is no place for the use of this drug to induce labour especially a uterus that contains a live baby. After Cytotec is inserted in the vagina, it dissolves instantly. There is no turning back. There is nothing that can be given to reduce the severe tetanic (very violent and painful) contractions that usually ensue. Who will step ahead and speak for the dead? Does the Government not care or do they not the public sorrow share? Far too many children are being orphaned at birth, not to mention fathers now having to annex paternal and maternal roles. Can’t they see that the doctors in Guyana, especially those in Obstetrics are badly in need of rigorous training or immediate draining?
As far back as 2000, G.D Searle the manufacturer of Cytotec released a letter saying that it had received reports of adverse events and does not support usage of the drug for abortion. In addition to citing the “abortifacient” nature of the drug, the letter cited reports of uterine rupture and death associated with using Misoprostol to induce abortion. Incidentally, and I do not know the source of Guyana’s drug supply, but the label for Cytotec lists a contraindication that it should not be used on pregnant women, while the package insert has a pregnant woman with an X across her abdomen. I once again will quote John Stevenson “A mother does not become pregnant in order to provide employment to medical people. Giving birth is an ecstatic jubilant adventure not available to males. It is a woman’s crowning creative experience of a lifetime.” Pray tell me then why in Guyana are wombs being transformed into tombs.
Putting all humour aside, let us do roll call before calling for the immediate fall of all the shoddy practitioners involved. Who prescribed the Cytotec? Is there a protocol in place following administration of the drug? Was this protocol adhered to in its entirety? A uterus does not suddenly rupture; there are a few prodromal signs, in addition to certain patients being at risk for such an occurrence e. g previous Caesarean Section etc. I am no longer calling but instead promptly demanding that the Minister of Health, the General Nursing Council, President Granger, the Guyana Medical Council all be held accountable or as accessory to the senseless and avoidable rise in maternal mortality.
There should be an investigation followed by exemplary punishment of a nature and type both unseen and unheard of in the history of the medical and nursing profession in Guyana. Guyana may be short of doctors but at the rate we are killing off the mothers we’ll soon be short of citizens too. Let it not be forgotten in the fracas that only mothers can bear babies. I am totally unconcerned and somewhat indifferent to the constant reference that the doctors were trained in Cuba. They could even be Uber doctors. What is known is that they are humans operating under the nomenclature, and their pathetic performance reflects greatly on the Guyanese Government, who has not only employed them but failed to monitor or supervise their medical progress thereby giving them a carte blanche to commit genocide of sorts. So let us be careful of the direction in which the finger is pointed. The public should not remain silent but should also be strong advocates for the banning of the drug. On an interesting note of inquiry, have the doctors in Guyana attained the level of knowledge or training in the use of Cervidil (Dinoprsotone), a cervical ripener that helps ripen the cervix in preparation for labour. No woman should die while giving life. A baby’s first breath should not be his mother’s last.
Yvonne Sam.

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