The damaged generation: ‘A sight that haunts me forever’

2013-08-25 14:00

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Botched births worsen plight of young mothers, writes Zinhle Mapumulo.

A trip to a clinic for her monthly antenatal checkup ended in hospital for Nelisiwe Mthuli.

When the mother of four arrived at the Dlephu Clinic in Tsakane, her vital signs were checked, as usual. Soon after her examination, a nurse handed her a referral letter for ­Pholosong Hospital.

The doctors at Pholosong read the letter and performed an ultrasound scan. Mthuli says she was then told that she was 10 months pregnant and would have to be admitted to give birth.

She spent a week in hospital waiting for her contractions to begin. When they didn’t start, her admitting doctor prescribed 10 pills, which were supposed to induce labour.

She endured excruciating pain before giving birth, and when her son finally emerged he wasn’t breathing and doctors resuscitated him.

“I thought he was dead, but then I heard him cough,” she said.

An oxygen mask was placed over the little boy’s nose before he was put in an incubator and wheeled to the ­neonatal unit.

Hours later, Mthuli saw her son for the first time. The sight will haunt her ­forever.

“There were tubes coming from his tiny nose and I had to feed him through them. It was terrifying.”

The next day, Mthuli was discharged, but was told she couldn’t take her baby home because he needed further medical care.

Two weeks later, when she fetched him, none of the staff told her what was wrong.

When Fikani was six months old, Mthuli realised he wasn’t like other children.

“He could not sit on his own. He also started ­having seizures and episodes of fits.”

She took him back to Pholosong, where she learnt that he had suffered brain damage because he was deprived of oxygen during birth.

He turned four this year. He still can’t walk, sit, talk or eat on his own.

What the health department says

The Gauteng health department ­admits that it is facing a large number of lawsuits as a result of medical negligence in its hospitals.

However, it says the problem is not as bad as it is portrayed.

After being told that Health MEC Hope Papo was unavailable for an ­interview this week, City Press sent a list of questions relating to 336 ­lawsuits amounting to R1.9 billion, 35% of which concern poor maternal care that led to hundreds of children being brain damaged.

When asked if the department ­believed that the number of children brain damaged at birth reflected its standard of care, department ­spokesperson Simon Zwane said it did not.

“Underlying factors such as ­socioeconomic challenges and preconditions of patients contribute to the number of lawsuits,” he said.

“It is also important to note that the number of children delivered in provincial hospitals is more than 200?000 per year and almost all of them do not sustain injury. Those who sustain injuries are a tiny minority.”

However, Zwane said: “We have prioritised the employment and ­training of midwives as a key intervention to address the situation.

“Last year 120 nurses were trained in midwifery and 79 were trained in advanced midwifery and neonatology.

The training of nurses on neonatal ­resuscitation was also carried out to improve the survival of babies and prevent injuries.

“And equipment such as cardiotocography and fetal monitors were ­also purchased.”

Zwane said 34 staff members in the province had been disciplined for negligence last year.

The department had introduced a system of clinical ­audits to ensure continual improvement in the quality of care.

“There is ongoing training in all ­facilities to improve attitudes and communication between staff and ­patients,” he said.

In the 2012/13 financial year, 188 doctors and 203 nurses were trained to manage obstetric emergencies, and nurses were trained to use early ­warning charts, he said.

Chris Hani Baragwanath Academic Hospital faces the highest number of birth-related lawsuits related to babies who sustained brain injuries at birth and later developed cerebral palsy.

The department defended the ­facility’s performance, saying: “It is ­important to note that Chris Hani Baragwanath is a referral hospital and therefore deals with complicated ­cases, so it is not alarming if they have more obstetric litigations than other hospitals.”

Early last year, the hospital brought in advanced midwives from the ­military medical corps to help.

And Zwane said they were doing something about it.

“The hospital has employed more midwives and improved the availability of equipment to address factors that lead to obstetric litigation,” he said.

City Press and Media 24 Investigation’s probe revealed a number of ­cases in which medical devices such as forceps and vacuums were used to tragic effect during deliveries.

Both ­instruments can increase the risk of brain injury if used incorrectly and many countries, including Britain, no longer use them in state hospitals.

Zwane said the department has stopped its doctors from using forceps, but they continue to use the vacuum method as they believe it to be safer.

“There are operational guidelines and standards that conform to ­well-researched international ­standards. Such methods are still ­successfully applied with a high rate of successful deliveries,” he said.

About the R1.9 billion in claims it faces, Zwane said: “While we ­acknowledge there are potential ­liabilities, some of the cases have been successfully concluded, settled and closed at lesser amounts.”

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