The Georgetown Public Hospital (GPH) has recorded, what many believe is a staggering number of maternal and infant deaths for the year so far, but Minister of Health Dr Bheri Ramsarran said the figures are not alarming as they are on par with last year’s and consideration should be given to the fact that it is the country’s only public referral facility, which receives the high-risk and critical cases.
Statistics taken from the Ministry of Health reveal that for the period January to March of this year there was a total of 3115 deliveries with 41 stillbirths. Of the 41 stillbirths, 28 were at the GPH; high when compared to one at Linden, one at New Amsterdam, two at Suddie, three at the West Demerara Regional Hospital and six at a combination of the six private hospitals countrywide.
Maternal and infant mortality have once again been brought to the front burner. For the year there have been nine maternal deaths and 41 stillbirths reported. The Health Ministry was criticized in 2010 when there was a staggering 25 maternal deaths. This prompted the then government and ministry to implement measures as a means of bringing the numbers down. In 2011 it did decrease as 14 maternal deaths were reported.
Meanwhile, 39-year-old Vonette Husler’s 12-pound baby boy, who died on Thursday, hours after emergency caesarean surgery, is the latest in a recent spate of deaths of newborns. The mother had complained that she was left to wait in labour for three days even after she told nurses that she’d had a prior c-section. It was only after she began haemorrhaging that she was rushed into surgery. The infant’s death adds to questions raised about the neo-natal care given at public health facilities, especially the GPH. The hospital denied being responsible for Husler’s baby’s death saying he was born with respiratory problems although admitting that at the time of admittance both mother and infant were in good health.
On his return from travel duty to Geneva, Minster Ramsaran sat down for an interview with Stabroek News to discuss the recent maternal and child death cases among other issues. He said that while many would want to lay the blame on the GPH, a comprehensive evaluation should be made of the number of referral cases before casting blame. He noted that the question about which facility has the most maternal deaths and stillbirths usually arises, much to the disadvantage of the Georgetown Public Hospital. He said, “The Georgetown Public Hospital is doing a great job and we need to remember …that it is the national referral hospital. All the very serious cases will be referred there, especially the high risk pregnancies… GPH will receive most of these critical cases and of course this will reflect in the statistics. In many cases, the GPH is taking on the burden of cases sent to it from other hospitals…”
He said he had a problem with the many regional hospitals, in particular the Diamond Diagnostic Centre, which has a qualified obstetrician and state-of-the-art operating theatre, but refers patients to the GPH. He plans to raise his concerns with the officials of those hospitals. “Why should we be referring certain birthing cases to Georgetown Hospital? That’s the dilemma with Georgetown Hospital they have to take them they don’t have anywhere else to go. We have created capacity to protect Georgetown hospital and we have to make sure it happens now.”
Ramsaran said the GPH had delivered 43% (1,339) of the total 3115 babies born between January and March this year, therefore although 28 stillbirths might seem alarming it only reflected 2.1% of the GPH’s total deliveries. The New Amsterdam Hospital had 176 deliveries; Suddie Hospital, 197; and the private hospitals, 409.
Ramsaran said, “Government has zero tolerance for maternal deaths and this goes in tandem with infant mortality or deaths of children from birth to 5 years old.” As a consequence, cabinet’s subcommittee on health reviews individual cases, which are to be reported in a strict time frame, and makes decisions as to penalties or measures to be imposed. Before the reports are sent to cabinet, there is also a Maternal and Child Health Department at the ministry, headed by Dr Jennifer Woolford, that reviews the cases after they are submitted by Chief Medical Officer Dr Shamdeo Persaud. Ramsaran was also quick to mention that the current number of deaths should not be taken to be alarming as it has not surpassed last year’s figures.
“You need to take maternal deaths and mortality of [children] under five against the background of what happened. You need to compare it with a similar period. We are at the comparative level with last year; we have had no slippages in terms of more deaths…. So the frequency has not increased,” he said, it has remained constant.
Questioned as to the number of medical personnel who have been disciplined to date by the Ministry of Health, Ramsaran said none were, while informing that the only form discipline that he is aware of relates to doctors who might have come afoul of their contractual obligation. “We have not had cause so far to implement any rebuke or reprimand,” the minister said.
Asked if by a process of deduction it meant that no one was culpable of any laxity in the deaths, he informed that the Chief Medical Officer will comment on that aspect, giving “a ball-by-ball, case-by-case account,” when he holds a press conference “some time soon”.
“The medical council has made the necessary pronouncements and we are going to have the CMO account and comment on what the findings were and what were any actions taken,” he said.
The decision to have the CMO comment on the matter is not because he is the head of the public medical fraternity but because it involves the employees, he added. “You are hitting at workers when the law says that the CMO needs to intervene in the institution not only the workers.”
Many persons are of the view that family members of the dead mothers and infants should be compensated by the government should the hospital be found responsible in the deaths. When asked for his views on this, the Minister of Heath said he was not the relevant authority to speak on the issue. He said “I would have to be advised. I’m not the best authority to comment on that. The Ministry of Health will respond within the bounds of systems that exist and of course we will be advised by the agencies of the government of Guyana which are responsible for dealing with such issues. It is an interesting question probably we have not addressed it as yet in this country but I am not the competent authority to speak on that.”
As a means of enhancing the public healthcare system as it relates to maternal and postnatal care, Ramsaran outlined programmes that would assist in making the system a better one. These include the introduction of the Masters Degree in Obstetrics and Gynaecology, the training of ultrasound technicians, and commissioning of a theatre in the maternity section, workshops on high risk pregnancy and the recent neo-natal care programme for nurses, among others.
He added that while he was saddened by the news of the deaths the statistics will empower his ministry to better the system. “The deaths that have occurred will serve unfortunately as a wake-up call and material for us to analyze how to prevent this in the future. That process is well on the way and is better than it was two to three years ago,” he said.