It is time for a serious enquiry into what passes for medical care at the public hospitals in Guyana, but more urgently there is need for an in-depth investigation into what is happening at the Georgetown Public Hospital (GPH), particularly in terms of maternal and neo-natal health.
The GPH and Minister of Health Dr Bheri Ramsaran had shamelessly attempted to discount the shocking revelations made by Vonette Husler, whose 12-pound son died some hours after an emergency c-section at the hospital last Wednesday. However, two days later, even as the Minister and the hospital were attempting to discredit Ms Husler, another mother, Pamela Lashley, was mourning the death of her 12-pound baby at the same hospital.
Ms Husler had indicated to the nursing staff that given her medical history – she’d had her first child by Caesaran section 11 years ago – she had been advised that most likely she would need to have her second delivery by that method. She was scoffed at and asked if she was a doctor. Her request was ignored. After 3 days of labour, she was rushed to theatre to have the same operation performed, but her baby subsequently died of respiratory problems.
The GPH in a statement issued the day after Ms Husler’s story appeared in this newspaper, “categorically” denied that protocols were breached and said it would not “accept unnecessary blame.” Defending the callous treatment meted out to Ms Husler by its medical staff, the hospital’s statement continued, “Obstetricians have highlighted that it does not always follow to have a caesarian section done because a patient would have had one done before. There was a risk with either option, [and] physicians must concur and perform that which is less risky.”
In an interview with this newspaper that same day, Minister Ramsaran said, “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.”
In Ms Lashley’s case, she was told that her baby was bigger than usual and that an ultrasound was needed. Nevertheless, she was given Cytotec to induce labour for a normal vaginal delivery and was not properly monitored, resulting in the death of her child.
The commonality in both Ms Husler and Ms Lashley’s cases is that their babies had excessive weight (macrosomia), meaning they weighed over 8lbs 13 ounces. Midwives can usually diagnose high birth weight babies before birth by measuring the fundal height with a simple tape measure, or an ultrasound can be done. Once this is established, a c-section ought to be immediately considered, since high birth weight babies are at greater risk of foetal death. Perhaps the “obstetricians” quoted in the GPH statement were not exposed to this during their training, but there are endless studies which substantiate this, done by international medical authorities and published online. Clearly, neither they nor whoever churns out the hospital’s spin reads.
Another worrying aspect of Ms Lashley’s treatment is the reported use of Cytotec (misoprostol) to induce labour. Although it is a cheap and proven method of speeding up labour, the risks include hyperstimulation of the uterus, uterine rupture, foetal bradycardia, amniotic fluid embolism, death of the mother, and death of the child. Where is the wisdom in giving a woman carrying a baby of excessive weight this drug? Was she told in advance of these side effects? Was the person who made this decision thinking? In addition, since Ms Lashley was given Cytotec, she should have been more carefully monitored, instead of being told that she wasn’t ready to give birth when she could clearly feel that she was or made to sit in a wheelchair when the birth of her baby was already in progress.
However, Minister Ramsaran’s revelation during his interview with this newspaper last Friday – no medical personnel have ever been rebuked or reprimanded over any of the obvious missteps that have led to the deaths of mothers and babies at the GPH – sheds light on why this continues to occur.
And while, unlike his predecessor Dr Leslie Ramsammy, this Minister is a medical doctor, his management of his portfolio leaves much to be desired. In fact, it is well below par. While it must be recognized that the most maternal deaths occurred under Dr Ramsammy’s watch, he was at least empathetic and appeared genuine when he expressed concern. His “I have failed,” admission to this newspaper last year over the high incidence in maternal deaths in 2010 is a case in point. Minister Ramsaran, on the other hand, who has none of Dr Ramsammy’s charisma, seems to think that no one should bear responsibility for matching high statistics on maternal and foetal deaths. He needs to think again.
