Murdered Motherhood?

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Lack of facilities and staff in state run hospitals is putting the lives of Kashmir’s mothers and their babies in danger. Saima Bhat spends some painful hours inside valley’s main maternity hospital only to witness a mother-daughter duo die of negligence

Shaheena Bano, 34, walked into Srinagar’s Lalla Ded hospital on Wednesday, May 31, 2017. Accompanied by relatives, Shaheena, already a mother of one child was admitted the same day. Doctors expected her to deliver a baby on June 2.

Gap of a day in between and the family hoped to see a new member of their family. Her five-year-old daughter Madheeha was by her side flipping her guesses from ‘Bhaya hoga ya Behna’.

Friday, June 2, wait of months was over. Shaheena, a resident of Hamza colony, Bemina was being prepared for a cesarean delivery (C-section). Medical investigations revealed ‘she had a low blood platelet count’.

“A male paramedic, probably from the hospital’s blood bank, came in the morning and administered two packets of platelets,” Hafeeza Bano, Shaheena’s mother, alleges. “He administered platelets without the assistance of any doctor or a concerned nurse.”

In just few minutes, ‘platelets’ injected led to life-threatening allergic reaction- anaphylaxis in Shaheena. Her condition started worsening. “Her condition worsened immediately. She started shivering and developed intense pain in her back,” said Hafeeza.

As her condition deteriorated, doctors around reacted and rushed in and gave her multiple injections. She was slipping to adverse. Seeing her deteriorating state, doctors immediately shifted her to the emergency theatre where she was operated upon to deliver the baby, her hope of nine months.

Battling with the state of anaphylaxis, it took doctors around 90 minutes to operate. Finally a male baby was handed over to her husband, Tariq Iqbal. Jubilant with joy of fathering a son, Tariq was told his wife is still ‘unconscious’ and bleeding ‘profusely’.

The doctors decided to operate her again. The doctors informed the family that “removal of uterus will save her from losing more blood” and the surgery was done.

Later, when Tariq was allowed to see Shaheena, she was continuously bleeding. “She was put on ventilator in ICU. I could see her drenched in blood literally,” Tariq said. On inquiring about the improvements, if any, Tariq says he was informed that his wife was critical and needs to be referred to SMHS or SKIMS hospital along with life saving facilities.

Critical Shaheena could not be carried in ambulance available with the hospital. Lacking the basic facilities to sustain the patient, the ambulance available was just like any public vehicle. Desperate Tariq managed to get a critical care ambulance from a local NGO, Help Poor Voluntary Trust and around 10 pm, Shaheena was admitted in SKIMS where she was immediately put on multiple Life Support Systems.

“She is sinking”, doctors at SKIMS told Tariq. He remembers doctors telling him that his “wife’s vital organs including her kidneys and liver had almost failed, her heart was also giving up and she was in a very critical state.”

For the next three days, Shaheena struggled to survive. Fighting in the state of coma, her vitals had stopped to work. Finally on June 6, her daughter, Madeeha and new born unnamed son became orphans.

Shaheena and Tariq were married for six years now. Their daughter, Madeeha is a Kinder Gartner in a private school. Shaheena, a teacher by profession was posted at Government Primary School in Barthana, Qamarwari, near to her parent’s house.

Madeeha is not aware about her mother’s death. She stays mostly with her father, who is living in a joint family with his aged mother, around 70, and three brothers, who are all married. But the three-month-old infant is with Shaheena’s parents and widowed sister who are taking his care. Madeeha visits him occasionally and siblings stay together for some time.

Unlike all other professionals, doctors’s mistakes are buried. Tariq counts Shaheena as another mistake of doctors and she has not been alone. During 2015-16, 30 deaths were reported in LD hospital alone, higher than its preceding year (2014-15) when just 12 cases of maternal / neonatal mortality were reported.

However, the Medical Superintendent of LD hospital Dr Nazir Ahmad Malik sees a silver lining in the number.  “The mortality rate in our hospital, a tertiary care, is much lesser than the national mortality rate,” He said. “But nobody appreciates us.”

Every death at LD hospital is probed by the administration. “We probe every single death so that we can learn from them and next time we receive a patient with same problems, we help them with better treatment,” insists Dr Nazir. “Most of the critical patients are referrals and when they reach here, it is almost impossible to save them.”

Shaheena’s death was also a case worth probing. And as per the report, submitted to GMC principal office on June 19, it reveals Shaheena died of medical negligence on part of the staff as the set transfusion protocols were not followed.

“Written consent for transfusion was not taken. Transfusion started by nursing orderly without information of doctor on duty, there was no order for transfusion on ticket, proper receipt with signature of doctor on duty not taken on blood form. Also the resuscitation measures in labour room could have been more prompt and more effective,” reads the report. It also said the transfusion was avoidable as patient was asymptomatic.

The nursing orderly told investigators that the ‘transfusion was done on insistence of attendants’.

Shaheena’s reaction was not because of ‘platelets’ but ‘plasma’, hospital sources believe. Hospital sources confirmed that Shaheena was given “plasma instead of platelets that day”, both are of same colour and the transfusion was started by a ‘nursing orderly’ as the doctors, who monitored her condition that morning did not feel there was a need for transfusion.

The report stands submitted for three months now. The justice, Tariq says is eluding. He is knocking at every door so that the hospital administration acts against the accused. “I want justice. The staff responsible for my wife’s death should be punished,” he said almost crying.

Sunday, July 9, Afroza’s (name changed) nine months hope had died well before the birth. Carrying a dead foetus, she was referred from sub district hospital in Beerwah, Budgam to SKIMS Bemina, erstwhile JVC’s Gynaecological department. Baby could not survive in the womb despite having a full term.

Mourning the dead inside her womb, the family was desperate to save Afroza. An orphan, Afroza was accompanied by her husband, mother and a midwife. They did not expect a miracle as they knew the foetus was dead. They only wanted its removal, safely.

The trauma began once they entered the hospital. Inside the labour room, Afroza’s husband was called into doctor’s room. He was asked by an intern doctor, who was over busy in making discharge certificates of other patients to sign the consent form and manage around 13 pints of blood. Three more doctors were there, two post graduates and one more intern.

Afroza was taken inside the labour room and the PG male doctor started helping her deliver the foetus. ‘She is not cooperating’ was the only sentence that doctor and attending nurses were repeating. Then another PG-female doctor was called in to help but the patient, they said was not letting them to touch her. Shock of carrying a dead foetus and pain of delivering it, may have taken the toll.

For next 30 minutes, what one could listen outside the labour room, were the blows that Afroza got on her legs by doctors as well as nursing staff.  The abuses too were loud. This reporter is witness to the incident.

Finally she delivered a dead male baby. Afroza’s mother, who must be around 70’s, was asked to take her daughter to other room. Frail mother was asked to take care of a daughter!

Even though she had a normal delivery but Afroza was asked to stand up on her own and walk up to the bed in next room, which was around 30 foot steps away. She tried to stand up but her feet couldn’t bear her weight. Her mother and a maid were quick to give her support.

Kya Karav (what can we do). We don’t have any wheelchair or a stretcher here to move the patient to observation room,” said the maid till they managed to reach the bed.

Afroza was not able to walk. She looked pale, her eyes defocused. Once on bed, a nurse came, gave her injection and left. Her mother left too to get a last glimpse of her dead grandson. She requested other attendants in the room to look after her daughter for few minutes.

As soon as the nurse and her mother left, patient’s heart started beating fast. The nurse was called but she refused to come saying: “It happens to everybody after delivery. It is normal.”

In next 10 minutes her condition deteriorated. She was feeling breathlessness and the other patients got panicky and started shouting at doctors to check her. She was immediately shifted to another room in critical condition and was straightaway put on ventilator. By the time her husband was out to get a blanket for his dead son and her mother was in washroom to wash her clothes, Afroza was fighting a lonely battle for her life.

By the time, her mother came out of the washroom; Afroza was breathing her last breaths. Both interns came out of the room and rushed to general operation theatre upstairs to get an experienced doctor. Once the doctor came, he saw bleak hope of survival.  Outside the room, he told his two interns: “the patient already had a heart attack and due to negligence she slipped into comma.”

When the senior doctor lost hope and was out of the room, Afroza’s husband entered. Face to face with the loss of son, he stood by the side of his wife, witnessing her struggle. Lost in thoughts, his face expressions revealed that he was imagining what is going to be his and his two daughter’s future now. He was restless and shattered. Swinging between hope and despair, after few moments of togetherness, he lost his wife. “Afroza is dead.” Wailing over the fate, he started managing to take back home two corpses.

One blanket to wrap his son in hand, exhausted husband requested a security guard outside labour room to buy him another blanket so that he could wrap his wife too. Desperate, he continued begging. A maid nearby was moved by his pain, she handed him a hospital blanket knowing he was alone fighting the tragedy.

But his loneliness neutralized his wrath and saved the doctors in labour room and the hospital as well.  Lonely, he was not shouting for any inquiry so that his wife’s killers could be  booked. He could do nothing. He did not file any complaint. He quickly left carrying his loss gracefully to bury the mistakes of the doctors.

A few weeks back, same intern was on duty, was called to check a woman with labour pain. On examining her, the intern saw the baby was coming out but she tried to push the baby’s head back into womb. Attendents and this reporter was  present in the room who witnessed it happening, closed their eyes and wished for any miracle to happen!

Witness to the death of Afroza, a woman attending a patient in nearby ward was all in tears and was beating her chest. She said that their family met same kind of tragedy couple of years ago. Giving details, Shabnum, 41, said that her cousin died in the same condition in SKIMS maternity hospital Soura. “The patient (Ruqaya) died during the surgery and later doctors passed the buck as cardiac arrest.” Shabnum alleged it was anaesthesia overdose.

A resident of Ganderbal, she says they fear in going to SKIMS after that incident and came to JVC instead. But Afroza’s death reopened their wounds.

On Sunday, September 17, 2017, Aliya, a resident of Kreeri (Baramulla) was admitted in LD hospital. Becoming mother for the first time, Aliya along with her husband were in joy.

Once the C-Section was performed, the things turned upside down. She started bleeding massively after delivering a baby boy. The child died and mother was immediately shifted and put on ventilator. The second call of doctors was to remove uterus to “stop bleeding” and even after doing so, patient continues to bleed.

Attendants alleged that, “It is negligence”, however doctors claimed that, “patient suffered an uncertain condition known as post partum haemorrhage.”

The baby was buried but Aliya, in her late twenties, went into coma and is fighting battle for survival. When this report is being filed, a team of doctors are on the job to save her, while her family continues to protest against the ‘negligence.’

The doctor’s at 750-bedded LD hospital, have a different story to narrate. “We are overburdened due to less staff,” one senior doctor said. “But nobody listens to us. And then mostly each bed is shared by two patients.”

MS accepts the statement saying it is a fact.

In this tertiary care hospital, most of the patients are referrals from sub district hospitals. “You won’t believe some are referred with a note on their hospital card saying, ‘referred due to non-availability of bed’,” said a doctor.

In the post operative room of LD hospital, mostly 65 patients are under the observation of just four doctors and all of these patients need follow-up after every 15 minutes.

Presently LD hospital is managed by 97 doctors including one head of the department, four professors, two consultants, eight assistant professors, two medical officers, one contractual lecturer, 27 registrars and 52 post graduate students. And each day they perform average 90 surgeries!

The physicians available at LD hospital have to report at 10 am and leave at 4 pm but most of the emergency patients reach hospital during the night. “We try to manage at our levels but it is not possible every time,” one doctor said. “We call doctors from SMHS hospital but it takes them not less than 30 minutes to reach here.” The doctor opines if both hospitals would have been closer, then situation would have been better.

“This hospital runs on Allah Key Barosay,” rues the doctor and leaves to attend the patient.

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