By Annah Natukunda
Women and girls demand accountability for maternal and infant deaths
The complaint was filed by a 17- year- old girl from Kamwokya–Kisenyi, a suburb of Kampala city. She wants an explanation for the death of her newborn baby at Mulago National Referral hospital.
Once the teenager found out she was pregnant, she quit going to school at Aggrey Memorial Secondary School in Kasubi, Kampala, where she was in S.3. Her mother was angry at her but soon calmed down and started looking out for the health of her only child, and the child she was carrying. She went to all the required antenatal visits at Old Mulago hospital.
It was on such a visit, on Jan.7, 2012, when after examination, she was advised to stay at the hospital. Two days later she was examined and told to go back home and wait for labour pains.
But by then she had started feeling abdominal pain and refused to go back home. For a week, she stayed at Mulago without getting any attention from the medical workers, she says. On the tenth night, Jan. 17, she got severe pain, and was moved to the labour ward. But still the health workers on duty ignored her cries for help, until an hour later when older women in the same ward started shouting and calling for the nurses to assist her.
She says by then, the baby was out and cried once. The nurse came and picked up the baby, put him on her chest and told her the baby was dead. Just like that.
“I cried because I had nothing to do,” Busingye said, her eyes tearing with unshed tears, “At that time I was alone in hospital, I was very sad and weak.”
Even if she looks like any other teenager, and is planning to go back to school next term, this teenager has kept her late son’s little clothes, and keeps going back to look at them.
Hers is one of the complaints filed at the Uganda National Health Consumers and Users Organisation (UNHCO) a copy of which The Independent has seen.
The girl says she does not really know what she hopes to achieve by filing this complaint. Her mother says her demands for an explanation from Mulago as to the cause of her grandson’s death have been met with stern rebuttals. The nurses, she says, only retort that they did their best, and her daughter was alive. What more did she want, they would ask. Both mother and daughter seem to have accepted the events of the night of Jan. 17. (This teenager will remain anonymous to protect her privacy.)
But not so for Ronald Winter Mubiru, a brother to the late Sylivia Nakalagi. Nakalagi died in the same ward, a few days after the teenager lost her baby.
“It’s deliberate murder, negligence, and everything,” a bitter Mubiru told The Independent. “That’s why I decided to take it up. I am seeking an explanation why my person died like this. I cannot bring back my sister but at least I can hold some people accountable.”
Mubiru says her sister was admitted at Mulago Hospital with complications. She miscarried, and doctors did everything they could to save her. They prescribed blood transfusion, but the nurse on duty did not give the blood, and left the three units of blood by her bedside and went back to get something and never returned. For 10 hours, Mubiru says he begged health workers to attend to his sister in vain. Each kept saying in Luganda, “Sinze mu sawo we” loosely translated to mean, “I am not her doctor”. Nakalagi finally died on Jan.28, leaving behind five children.
Such stories are numerous
It is basing on such cases, that civil society organisations working in the health sector petitioned the Constitutional Court to declare that “avoidable deaths” of mothers during childbirth in public health facilities constitutes abuse of their right to health. Petition Number 16 of 2011 was sparked by the death in labour at Mityana Hospital of Slyvia Nalubowa of Busujju Village in August 2009. The nurses allegedly demanded a bribe that she did pay. The nurses allegedly left her to die.
Petition 16 argues that by not providing essential medical commodities and health services to pregnant women, the government is violating the constitutional rights of Ugandans. They also want court to compel government to compensate families of mothers who die in labour as a result of negligence, and that every death should be thoroughly investigated.
That was in March 2012. The court case attracted both local and international media attention. But three times last year, hearings of the case came to naught. The lawyers on the government side would tell court that they were not ready to proceed with the case. Sometimes they said they had failed to secure additional affidavits from the permanent secretaries of Ministry of Health and Finance that are to be used in the case. No other date for a hearing has been set since October last year.
While the court case has most likely hit a snag, it perhaps forced government to reconsider its position on maternal health. In May last year, then-minister of Health, Dr Stephen Malinga, wrote to all Resident District Commissioners asking them to investigate all maternal and infant deaths in all health units across the country.
Maternal health activists claim, however, that this directive remained on paper, and that government does not care about issues that affect people. Mable Kukunda of UNHCO says their attempts to get maternal and infant deaths audits from Mulago hospital have been futile. The health consumer’s organisation is demanding explanations for four similar cases that occurred at the hospital in January of this year alone. Many other complaints have been received from around the country too, including four cases from Mityana hospital, the same hospital accused of negligence in Petition 16.
The Ministry of Health dismisses accusations that maternal and infant deaths are not being taken seriously. Dr Jane Ruth Aceng, the Director General of health services, says the ministry is carrying out “very aggressive audits at all levels”, and reports are sent to the ministry, parliament, and eventually to the president.
“People are free to complain, sometimes they complain from very uninformed positions, sometimes genuinely,” Dr Aceng says. “But the truth is that, immediately a mother dies, people stop work and carry out an audit, and that is done every day.”
Dr Aceng said that every month, the ministry compiles the deaths of mothers and children from across the country. They then look at which areas that have the highest number of deaths.
“We move there and you find that there are many reasons. It may be delay at home, it may be delay on the way, but if the delay that resulted into death is at our facility, then as a ministry we take action,” the Director General of Health Services said.
Some of these actions, she told The Independent, have resulted in health workers being dismissed, others have been punished. However, she says the investigations sometimes point to a systems problem, as was the case in Mbale of September 05, 2011 in which Cecilia Namboozo died due to negligence.
“An audit was done, and it found that there were 16 women who were in labour at the same time, and yet we had only two of our staff.”
Often times, mothers that lose their babies in government facilities, or relatives of deceased mothers, are quick to point fingers at government. But who’s really to blame? Health professionals say that many times, mothers, fathers and the community are to blame as well.
For example, who is to blame for a mother in labour with her 10th child, who dies of excessive bleeding after the uterus has failed to contract due to too many exposures to pregnancy? They say that rights need to go with responsibility.
The ministry of health urges people to plan for their pregnancies. Government currently has enough labour ward sundries, called `mama kits’ to give to each woman in labour, and whoever reaches the facility to have a baby is given the kit. But the government does not have enough food to give to mothers in hospitals, or cannot buy baby clothes for mothers. But sometimes mothers come without a single cloth, and when a baby dies of pneumonia, they blame the government.
Uganda has one of the highest rates of mothers dying of childbirth and pregnancy related complications at 435 per every 100,000 live births. These translate to about 6,000 deaths per year, and 16 mothers dying every day. The most common cause of deaths is excessive bleeding, followed by infection and unsafe abortions, among others.
Health activists say they have not given up the public litigation way in order to hold government accountable for avoidable deaths. But the ministry of health maintains that each death is unique, and should be looked at individually.