Maternity and Neo-natal mortality (A comedy of obstetrical errors)

Mar 19, 2019 Letters

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DEAR EDITOR,

If to the profession you cannot truly be a nurse, pray therefore you do not become a curse.
Once again, another mother is denied mirth at birth as the Georgetown Public Hospital Corporation comes under the microscope. Each time a neonatal tragedy hits the media, I immediately begin to wonder what level of midwifery is currently being practised in Guyana. In fact, as a retired Obstetrical Charge Nurse I have become so mentally chagrined, that had there been alternative public delivery institutions, I would recommend a full closure of the
GPHC Delivery and Neo-Natal Unit, rigorous and intensified staff training of nursing and medical staff, and above all the implementation of an independent Commission of Inquiry into the neonatal and maternal deaths. Even the reporting of this sad demise, smacks not only of poor substandard journalism, but additionally serves to reveal a gross lack of professionalism on the part of both the nursing and medical staff. Based on the media report, it is obvious that all the signals for disaster were disregarded.
In the obstetrical arena, any pregnancy with twins or more is considered “high risk”. From the moment a twin pregnancy is confirmed by ultrasound, special care and treatment of the mother goes into effect, with even the patient’s chart prominently and legibly indicating such a status.
No details were supplied regarding the gestational age of the twins, except to state that they were delivered by Caesarean Section. In well-run modernized obstetrical units, a special team is set up for each Caesarean delivery with additional team members depending on the number of births. Among the team members and of prime presence during the delivery are the Paediatrician and the Paediatric Resuscitation team ready to give care to the baby/babies following removal from the uterus, as well as the anesthetist carefully monitoring the intravenous infusion and intra-partum medication administration .
Now the obstetrical drama is over, the plot darkens and the curtain unfolds. Was there a paediatrician present at delivery? If so, what part did he play? What was the Apgar score for each child? The Apgar Test is a tool used to document newborn well-being immediately following birth with scores recorded at one minute, five minutes and sometimes ten minutes after birth. The airways, pulse, grimace, activity and respiration is measured and the maximum score is ten. Had such an assessment been conducted in its scheduled time frame, then nowhere in reality and factuality could the live-born have been wrapped ready for the morgue. Who certifies death in Guyana? Under whose authority was the nurse carrying out death certification? Thankfully, and to some degree the relatives requesting to see the babies, allowed one of the twins a new, though somewhat brief lease on life.
I shudder to think of the roller coaster of emotions to which the grieving mother and the family were subjected. One minute they are notified of the stillbirth, the very next, they are told birth still, then the newborn is placed next to the newly-operated mother, rather than in an incubator. The imponderable explanation by the doctor regarding lung immaturity and non-necessity for oxygen not only adds to the existing obstetrical maelstrom but further shows the nescience of a member of the medical profession, in whose hands human lives lay.
An incubator provides the ideal monitored and regulated environment that enable newborns especially preemies to thrive. What obstetrical reason underlies the surviving twin being denied an incubator? Who ordered the oxygen administered to the baby? When was it ordered?
What changes in the baby brought about the need for oxygen? While the condition of prematurity results in lower oxygen level, supplemental oxygen can have significant side effects, as an excess can cause injury to the infant’s eyes and lungs. The right target balance must be found, for while too much oxygen is bad, too little is equally sad.
Conclusively, quo vadis? The evidence is in—the jury is out. At a parliamentary hearing on July 12, 2018, the Minister of Health, Volda Lawrence stated that for the period June 1, 2017 to June 30, 2018, the Georgetown Public Hospital Corporation (GPHC) recorded 119 neonatal deaths.
While such numbers are worrisome, what is of more serious concern is the fact that GPHC is home to the only Level 3 Neonatal Intensive Care Unit in Guyana, and the only public hospital capable of providing a neonate with invasive breathing support. Based on the presenting evidence this appears to be all talk and no walk.
This negligent carnage must be brought to a halt. The Minister of Health stated that as it relates to investigations every neonatal death is reported and reviewed by the Child Mortality Committee with representatives from the government and the private sector. The figures bear testimony to the inutility of this committee.
As a qualified health care professional of Guyanese origin, and with deep civic concern, I am calling on the Prime Minister, the Health Minister, the Chief Medical officer and Chief Nursing Officer to view the ongoing neonatal mortality rate with utmost concern. That an independent Advisory Committee be duly constituted to view anew and report directly to the Prime Minister.
On November 1, 1977, at the dedication of the Hubert Humphrey Building in Washington D. C., the former Vice President Humphrey spoke about the weakest members of society as a reflection of a government— “The moral test of government is how that government treats those who are in the dawn of life, the children. Enough said, some children are not even seeing the dawn, which in itself speaks volume of the government. Both the medical and nursing profession must he held accountable for the work performance of their representatives, with sanctions, discipline and even irradiation where justified.
As a nation, we cannot allow such a situation to continue where pain is borne and mothers needlessly mourn.

Yvonne Sam

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