The damaged generation: ‘He didn’t cry’

2013-08-25 14:00

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

Tears fill Busiswa Mbengo’s eyes as she relives the trauma she endured at the hands of the nurses and doctors at Pholosong Hospital a little more than two years ago.

The mother of two looks the other way, as if hoping her eyes will dry and her pain remain hidden. Then she gives up, leaving the tears to roll down her cheeks and gently wipes them away.

It was December 16 when Mbengo from Duduza, Ekurhuleni, began having contractions.

Her mother hired a car to take her to a nearby clinic in Dunnotar, from which she was transferred to Pholosong Hospital.

Her baby was apparently too big to be delivered normally and she needed a Caesarean section. But when she relayed the message to the nurse on duty and presented her with the clinic’s referral letter, she received a tongue-lashing.

The nurse demanded to know when she had become an expert in childbirth.

Mbengo was taken to the maternity ward after an examination showed she had not yet fully dilated. She remained there for another six hours, despite her cries that the contractions were intensifying and that she could feel the baby was coming.

At around 6pm, the same nurse wheeled her to the labour ward.

“She told me to push and I did, but the baby didn’t come out. She eventually inserted her hands in my vagina and pulled the baby by the head,” Mbengo said.

“The baby came out, but he didn’t cry. I asked her if my child was alive and she said, ‘What do you think?’ before putting him in an incubator.”

The nurse left Mbengo with no explanation.

Around 7.30pm another nurse walked into the labour ward and found Mbengo and her baby alone.

She then read the file lying next to the incubator and told her that her son had a problem before she summoned a doctor from the neonatal unit.

Although Mbengo was discharged from the maternity ward the next day, baby Sibusiso spent a month fighting for his life in the neonatal unit.

“Doctors told me the injury was caused by inadequate oxygen supply, either during labour or birth,” she said.

Sibusiso can’t sit, talk or walk, and suffers from epilepsy.

Mbengo who lives in a shack in Duduza with her mother and her older sister was in Grade 11 when she fell pregnant and had to drop out, hoping to go back to school after giving birth.

But because Sibusiso was a sick baby, those hopes were dashed.

“The first few months were the most difficult time I ever went through in my life.

“I was in and out of hospitals with him. I was physically and emotional drained, and if it wasn’t for my family, I don’t know if Sibusiso and I would have survived.

“I was young, his father was unemployed and nobody at home was working except for my brother, who earned less than R500 a week. He ensured that I had transport money to take Sibusiso to hospital every other week and still put food on our table.”

Mbengo had another baby in December last year, a little girl, but she died in her sleep last month.

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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