Jinja triplet deaths compounded by news media distortions

By Muniini K. Mulera

Uganda

October 4, 2016

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It appears that the Monitor report that triplets died last week because the mother had been refused admission to Jinja Regional Referral Hospital was a distortion of the facts.

To be sure, I was angry when I read that the staff had refused to admit Ms. Monicah Wokobeire, the triplets’ mother, because they were preparing to receive Rebecca Kadaga, the speaker of parliament. It was a believable story because of the moral darkness that has blanketed our society.

However, I have received a letter from Dr. Peter Waiswa, the principal investigator of the Preterm Birth Initiative that was launched at Jinja Hospital on the day of the alleged refusal of admission. Upon reading the story in The Monitor and Red Pepper newspapers, Dr. Waiswa, an Associate Professor at the Makerere University School of Public Health,  called the Director and the Paediatricians at the hospital. He subsequently visited Jinja to investigate.

His research officer told him: "The mother delivered at an outside facility and was referred to Jinja Hospital because the babies had had asphyxia. The story was that a grandmother had brought them in (to Jinja Hospital) without their mother. On arrival the midwife discovered that two had already died. The one who was alive was sent to Nalufenya Children's ward. That baby died a day later because of hypothermia (very low body temperature) because of the effects of having been born outside the hospital."

The Jinja Hospital Director told Dr. Waiswa: “Two of the triplets arrived at the hospital already dead and one was admitted with hypothermia and grunting (laboured breathing), but later died. 24 weeks of gestation and baby less than 1 kg. There is a twist in the (newspaper) story.”

What the reporters called "sending away" appears to have been the transfer to Nalufenya ward, a facility one kilometre from the main hospital that was donated by the Madhvanis. As part of its infection control efforts, Jinja hospital transfers outborn babies to Nalufenya.

Dr. Waiswa told me: “I was actually on the ward that day and the staff where doing a great job amidst very difficult circumstances (space, medicines and supplies, equipment etc). Indeed they have saved babies as small as 700-800g!”

I was truly relieved by Dr. Waiswa’s communication. The blemish on the Jinja Hospital staff is erased. The blot is on the journalists who misinformed the world and caused us so much distress.

However, I remain burdened by the thoughts of that mother’s pain, and the great challenges faced by mothers, especially those with high risk pregnancies.

As a man, I cannot begin to fathom Ms. Wokobeire’s anticipation of a joyful outcome as she walked into the health unit where she delivered.

As a father, I know the pleasure, mixed with a bit of anxiety, of watching my pregnant wife carrying our babies, and the indescribable happiness upon their safe birth.

As a paediatrician and neonatologist, with 35 years of my career spent learning about and caring for extremely premature and other critically ill babies, I know what it takes to give these fragile little people the opportunity to survive and thrive.

The place to start is a national attitudinal change, a rebooting of the mindset so that human life is paramount, and all people, regardless of social or economic station, are equal.

Safe care for a woman carrying triplets demands close surveillance. This should include admitting a woman such as Wokobeire into hospital before her babies get into trouble. A triplet pregnancy is, by definition, a high risk one.

There is no reason why such babies, carried to a safe gestation age, should die in 2016. (Obviously those born too early at, say, 24 weeks of pregnancy or with severe malformations generally have poor outcomes, even in the best centers in the world.)

Certainly babies should not die without an attempt to provide them with quality, evidence-based care.

Few things bring me smiles like seeing a mother and her partner walk out of the newborn intensive care unit with their carefree bundle of joy.

We call them graduates, these little people, many of whom arrive weighing less than 1 kilogram, unable to efficiently breathe or feed on their own. Some are born practically dead, with no heartbeat or breath, their bodies floppy like ragdolls, their color a deathly pale grey, unresponsive to stimulation.

With the help of a well-educated, skilled and prepared neonatology team in the delivery room, the dead baby resurrects in minutes, often letting out a triumphant cry that is sweeter than the best music by Duke Ellington.

The very premature babies arrive unprepared for life outside their mothers’ wombs, with nearly every organ system susceptible to malfunction, and even failure.

However, the great advances in the care of unborn and newborn babies in the last 30 years have markedly improved outcomes, giving these tiny tots great starts in life.

Underlying these advances in countries like Canada, Finland, United Kingdom and other advanced economies has been deliberate funding for basic and clinical research, and major investments in clinical care for the mothers and their babies.

These societies and their governments have adopted a holistic view of health as a complete state of physical, mental, social and economic wellbeing, and not merely the absence of disease. They view health and access to good health care as a human right, not a favour by the politicians.

The citizens and governments in these countries have made good health care for everyone a top priority in budgeting, alongside education and infrastructure developments.

They have placed the comforts, luxuries and travel needs of politicians very low on the totem pole of national resource allocation. They have invested heavily in health care professionals, recruiting and retaining the best, paying them excellent salaries and providing them with state-of-the-art facilities to ensure best outcomes of the at-risk citizens.

Rather than buying luxury cars for the premiers, speakers of parliament and other government officials, Canadian provincial and federal governments invest that money in the people.

Equality of citizenship extends to the doctor’s office and public health care. In Canada, for example, a prime minister’s wife and female parliamentarians deliver in the same hospitals as the welfare recipients.

I was involved in a situation where a prime minister’s wife, already on the operating table, had to have her surgery put on hold because her anesthesiologist had the unique skills we needed to manage an ill mother who needed emergency caesarean delivery. The prime minister’s wife did not make a fuss at all, and was pleased to yield her time to a fellow citizen.

It is this mindset that enables doctors and nurses in Canada and other advanced economies to keep focus on their number one obligation – the patient.

Pomp and ceremony must never matter more than the lives of the so-called ordinary people. Not even a visiting president should distract health care professionals from providing the best care to the lowliest citizen.

It takes self-liberation and a return to the great ruling principle of good medical practice: Primum non nocere – Above all, do no harm.