Sunday June 22 2014

Sad tale of a woman mistreated at labour

Betty Nakiru, the woman who says she was mistreated by midwives at Kawolo Hospital

Betty Nakiru, the woman who says she was mistreated by midwives at Kawolo Hospital during labour displays one of the clothes she had bought for her unborn baby. Photos BY Christine W. wanjala 

Betty Nakiru says a nurse in the maternity wing maltreated her and even solicited for airtime as the mother was in labour. This resulted in her leaving the hospital with a dead son who she had been constantly told was all right. She shares her story.

“I wish I had never gone to that hospital and someone else had attended to me on that day,” says Nakiru in a voice suffused with regret.
On the midmorning of March 21, Nakiru, a police woman attached to Lugazi Police Station felt contractions and set off for the hospital where she had been going for antenatal check-up. There was some slight bleeding, but the mother of four was not alarmed. “I always bled a little during the births of my other children,” she says.

The midwife who examined her told her the baby was all right but also pointed out that she was in early labour and advised Nakiru to go and return later.
She heeded and only returned to the hospital around 4pm when the contractions intensified. It was another midwife Betty Nalumansi, the in-charge of the Maternity wing, who examined her.

Nakiru remembers Nalumansi being ever so kind and assuring her the baby was all right. “The only concern she had was the bleeding but I told her my history of bleeding in labour. She told me she would send someone to administer a drip,” she shares.

The “somebody” was the third midwife to attend to Nakiru at the hospital that day. Nakiru remembers her uniform to be a light pink dress although she did not get her name.

According to Nakiru, the first drip went pretty quickly and the nurse let her know she would be delivering her baby soon. “She checked for the heartbeat and said all was all right. I could also feel the baby’s movements,” continues Nakiru.

By the time the fourth midwife came, Nakiru was in the throes of full blown labour and thought this was the person to see her through the delivery. Instead, she says the midwife curtly asked her for airtime. “I was in terrible pain and I did not have any money on me so I told her to call my mother,” she says.

Nakiru’s 50-year-old mother rushed to the side of her only surviving child’s bed with some money which she held out to this midwife who never accepted the note. Nakiru remembers her instead ordering the old lady to go and purchase the airtime. “But my mother does not understand Luganda so she just stood there with the money,” she said.

It is what happens next that has her convinced money or the lack of it had everything to do with what happened to her unborn baby that day. She suspects the nurse expected a bit more money and was infuriated when all that was available was a paltry Shs10, 000. Her voice gets raspy as if her throat suddenly went dry as she describes what happened next.

Agonising moment
“She first shoved a hand roughly inside me. Then she took a large wad of cotton and shoved it up my birth canal. I was in terrible pain,” she says. Nakiru’ s pain cries and loud screams filled the ward but the nurse only ordered her to get on all fours and rest on the bed with her rear pointing upwards.

“I felt like pushing at this time but she ordered me not to. I kept telling her I felt like pushing but she warned me not to even try,” narrates Nakiru. Her voice grows ever quieter as the interview progresses, and her eyes are now permanently fixed on her hands which are on her lap.

Nakiru’s mother who wandered in was surprised and asked her why she was in that position. Even the nurse in pink was baffled by this development, but just stood by trying her best to follow what appeared to be a more senior colleague’s orders.

According to Nakiru’ s story, the midwife then disappeared for another 15 minutes during which Nakiru was valiantly bearing the pain and fighting the urge to push. When she reappeared, it was to prod Nakiru a little before declaring to the other nurse in pink that,“Yaafiridwa dda omwana (She lost the baby earlier).”

Resilience

She buried her son on what would have been his second day of life and despite still being weak, she insisted on travelling all the way to Karamoja with her baby. The death certificate issued by Kawolo Hospital signed March 22, says Nakiru’s child was born dead as the umbilical cord was twisted around the neck. It is the same explanation the midwife gave albeit wordlessly. “When my husband and sister- in- law asked her why the baby had died, she just held up the umbilical cord,” says Nakiru.

A few days after the burial Nakiru says the hospital called her and asked her to forgive them and forget the issue. “I do not understand how they can deny knowledge of the mistreatment but go ahead and ask me to be forgiven,” she says.

The mother of four wistfully raises a cute little sweater; it is part of a whole suitcase of clothes for the new baby. It is now banished to the recesses of the bed for the most time. “I feel so much pain when I see people with their babies,” she tells me. Her husband has not said anything on the matter and will still not be drawn into discussion about his deceased son.

Nakiru is not satisfied especially since none of the people she has shared her story with has offered any explanation for the cotton wool procedure. She also does not recall the nurse calling in a doctor to examine her at any one point. “Maybe if I had seen a doctor my baby would be alive,” she says.

Questionable

There are many things Betty Nakiru did not understand on that night. For one, the midwives refusal to speak a language Nakiru or her mother could understand. “I requested her to speak English more than once, but she refused.

Second, the ladies’ hostility. Nakiru says, the midwife was arrogant and rude. And she does not understand why she was asked for airtime at a free government facility, or why the cotton wool was pushed inside her with the baby still in the womb. Lastly, she says she is still trying to understand why the lifeless baby was placed on her chest and left with her for some time. “The midwife disappeared immediately after leaving me with my son’s dead body and the placenta still in my womb,” she says.

The hospital’s version

The Kawolo Hospital’s Medical Superintendent Dr Joshua Kiberu said he was aware of Betty Nakiru’s complaint. He first learnt of it when the police appeared to take statements towards the end of March.

In his version of the day’s events, “Nakiru did come to the hospital first in the morning and opted to leave for home after being told she was still in the early stages of labour. She returned at 5.30pm when on examination she was found to be towards fully dilatation. At that stage it can take a very short time, an hour or less to deliver,” says Kiberu. “And it is true the nurse who received her called her superior. Kiberu says she had felt the umbilical cord in the birth canal on examining Nakiru which is dangerous.

“I learnt the patient resisted re-examination until the first nurse who could speak some Ngakarimojong explained why it was necessary,” he continues.
When they intervened, Nakiru’s waters had burst and the cord was now hanging out properly, what Dr Kiberu called cord prolapse. According to him, this is potentially dangerous to the foetus as any attempts by the mother to push will launch the baby’s head into the birth canal putting pressure on the cord which can mean the babies oxygen supply is cut off.

A read up online points out that the best intervention for cord prolapse would be delivering the mother as soon as possible. Basically a caesarian section. But Kiberu says it was too late to take her to the theatre which was not ready anyway.

“The midwife needed to call in a doctor so she instructed the patient to assume the knee chest position. It is recommended to take pressure off the cord to increase the chances of a safe delivery. She also put a warm piece of gauze to try hold in the cord and keep it warm,” says Kiberu in explanation for the cotton wool and the position the midwife asked her to assume.

Again a research reveals these are indeed a piece of wet gauze pushed in to help replace cord in vaginal vault is recommended management for cord prolapse where surgery cannot be carried out immediately. However, Kiberu does admit that no one explained to Nakiru what was going on and for what reason and to this day she still wonders why the cotton was put inside her.

Hospital resources and challenges
According to Dr Kiberu, a patient being asked for airtime is not so strange at the hospital. “The money the hospital gets has to be stretched to cover all its needs and often some areas suffer. For example we give the maternity wing 10,000 a month for airtime. The midwives do not have airtime. Sometimes they have to ask the patients to be able to call the doctor,” said Kiberu. And he thinks this is what happened in Nakiru’s case when the midwife asked for airtime.

Last year, this newspaper ran a story highlighting the challenges the hospital is facing. It appears little has changed since then. Like a lot of other government facilities, the midwife to mother ratio is still far below the WHO recommended ratio of 2:1. “On average we deliver about 10 mothers a night but we usually have two midwives,” he says. As for doctors, there is likely to be one serving the whole hospital at a time.

Equipment shortage is still rife
Dr Kiberu shows me a printout of the medical order vis-a-vis what they received for the months of February and March. On some key items, the amount received column reads zeros. The hospital had ordered for 175 pairs of surgical gloves and received nothing; it is the same story with the 100 catheters, and the 20 anti-tetanus antitoxins they had requested for. “As we talk, patients are buying gloves,some drugs, catheters and a few weeks ago they were buying even sutures,” he said.

He also says the midwife became exasperated by Nakiru not heeding to her instructions because she was receiving different ones from her mother who turns out to be a traditional birth attendant and raised her voice. “I learnt that the mother would order her to squat while the midwife had told her to assume knee chest,” he continues.

But there is one thing he cannot explain away. The rudeness and arrogance Nakiru feels the nurse handled her with. The blatant refusal to speak in a language she could understand. It is part of a bigger problem in customer care in this country he says. “From banks to restaurants, one encounters poor customer relations,” he says.

Patient relations
We are making an effort to train our staff, encourage them to relate better with patients but in the end it is not as easy. Sometimes, they are overworked and sometimes are not paid for months,” he says, acknowledging that some staff can be temperamental, short tempered and indifferent.

Kiberu also says as matters stand, it is difficult to take disciplinary measures on a member of staff who is caught in any malpractice. “We have a Human Resource who is more or less symbolic. Since decentralisation we do not have the power to hire or fire. These people know you do not pay them. Once someone knows that they will not see a reason to listen to your warnings,” he says.

With no little one to fuss over, Nakiru’s days are long and gloomy. She spends most of her time indoors. When she gets out it is to follow up on the complaint she filed at the Lugazi Police station a few metres away. The latest developments do not give her much hope. She has since learnt that the state attorney said there was no evidence to prove her allegations against the hospital and that the file should be closed.

Henry Ayebale, the district CID said investigations are still ongoing but admits there are challenges in getting proof of Nakiru’s allegations. “For one there was no postmortem showing what really caused the death of the child and the complaint was filed after the child’s body had been buried,” he said. He confirms indeed the state attorney’s advice was to close the file for lack of evidence but says it has since been moved to higher office for further investigations.

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