Who is at fault with recent infant deaths?
Recently we have had three infant deaths that have got the nation thinking and talking about the state of our health care service and the ability of health professionals to provide adequate care.
The first one I want to talk about is the death of a one day old baby at the CWM hospital in Suva. The mother’s account of events place the baby in the doctor’s care – an intern, when the baby fell ill and later died. After birth she claims that the baby was healthy.
It is alleged she was not told that there was anything wrong with her baby. Midwives came and took the baby for a bath on June 15. The mother claimed the baby was fine. On the same day in the evening, the midwives took sugar, blood tests and temperature. They said it was fine. On June 16 at 2am, the intern came to see the mother when she was changing the diaper. The mother did not understand why the doctor took the baby. Her curiosity and concern for her baby led her to inquire after her baby. After a couple of hours (without her baby) the doctors came and told her that her baby was in ICU and that she was sick. The baby later died. The second follows a similar pattern this time in Labasa, again an intern was allegedly involved, apparently involving an alleged overdose of medicine.
The first question I want to ask is – is there a pattern? I cannot say there is a pattern but in two cases medical interns were allegedly involved. Two babies have died at the hands of a system that seems inadequate. Both mothers were not satisfied with the outcome of the inquiries into their babies deaths. Its tragic and should never have happened. These are human lives.
My second question concerns blame. Who is to blame? The interns? The senior doctors supervising them? The mothers for not being more assertive with their inquiries? Or the system?
This is a difficult question to answer. If we are going to ensure that these fatalities don’t happen again then our health system needs to be better, our health professionals need to be better. There are systemic changes that need to take place.
Firstly, ensuring that protocols are in place that are consistent across all health providers and that health professionals are made accountable for ensuring that such processes and protocols are maintained.
It is normal practice in hospitals that interns work under supervision. Whether this happened in the two cases in question is not clear. One of the essential requirements in medical services is proper documentation. It records all the examinations, diagnosis and treatment of patients. This guarantees that the continuity of care is maintained by shift workers. Also if there is a medical misadventure it can be quickly traced and appropriate remedial action is taken. Research has shown that the patriarchal system that characterises our health care system, reminiscent of the colonial era in Fiji, remains, and is not catered to the needs of the patient. We hear stories of intimidation, lack of communication; the patient not knowing what’s going on, switching between different health care providers. There is little communication, limited understanding. Patient centred care allows the patient to be at the centre of the consultations and care. I was very happy to hear that doctor’s pay is going to be increasing from 56 per cent to 81 per cent. This is great news and a step in the right direction. What health professionals need to accept, however, is that with such investment comes responsibility. They need to lift their quality of care. They are providing a service to the people of Fiji. They are being paid for this service and so they need to ensure that the receivers of this service are satisfied with their care.
We can have the best medical facilities but unless proper systems and protocols are in place and followed by medical professionals, we will continue to have medical mishaps.