Gains that Malawi is registering in maternal health could be under threat in the wake of incidents of women experiencing complications after delivering through caesarean section, also known as C-Section. Our reporter FAITH KADZANJA, who went undercover to unearth the suffering of some women after going through caesarean delivery, reveals in this FRIDAY SHAKER that some of these new mothers even contract various infections due to lack of proper care.
Catherine is in agony, nursing complications after giving birth through C-Section, a surgical delivery method done by means of an incision through the mother’s abdomen and womb.
This method is done when it is determined to be safer than normal delivery for the mother, the baby or both lives.
And it was deemed safer for Catherine, a seventh-born child in a family of nine, who dropped out of secondary school while in Form Two in Mangochi District. She moved to Lilongwe to stay with her aunt who was apparently illtreating her.
“Sometimes, I was not given food and other basic necessities for my education. My friends convinced me that the only way out of my misery was to get a boyfriend,” the first-time mother said.
The decision landed her in more trouble. Months into the relationship, she discovered that she was pregnant and the only option she had was to drop out of school.
“The father of my child insisted that he could marry me only after I have finished my studies, so I kept going to school until I was four-months pregnant when I decided to drop out,” Catherine said.
Five months later, the baby was due and Catherine had to rush to Bwaila Hospital in Lilongwe where she even faced more challenges.
“I delivered through C-Section and shortly after being discharged, I noticed puss coming from my wound. I went back to the hospital where I was admitted,” she said.
Posing as her guardian, this reporter spent some time by the patient’s bedside. Around 9 o’clock in the morning, Catherine was lying on her bed restlessly waiting to be assisted.
A team of medical personnel then visited her.
“She needs to go to the theatre. Her uterus has to be checked. The patient has to be told that if the uterus is damaged, it will have to be removed,” said one medical official who appeared to be the leader of the team.
On our return in the afternoon, we found the distressed patient still lying on her bed. She had not been taken to the theatre.
Two days later, Catherine was still in the ward.
On the third day, she was referred to Kamuzu Central Hospital (KCH) where she spent three days before being taken to the theatre.
Her real guardian said doctors at the referral facility told them Catherine was bleeding after delivery. Unfortunately, she could not be rushed to the theatre because it was apparently heavily booked.
By the time we went to press, Catherine was still waiting to be operated on.
“I am so worried because if my womb has been damaged, I will only have this baby in my life. I am confused,” the young mother said.
Thoko, who is not in school, is another young mother faced with maternal complications. She gave birth through C-Section but just two days after she was discharged, her belly got distended.
“When we came back to the hospital, we were told that doctors have different stitching skills; that some are good at it while others are learners and that her case is not the first one. They also showed us another patient who had a similar problem.
“They operate on our patients today and the next day you are told to go home when the wound is still fresh. What the nurses did the day we arrived was putting cotton on her womb,” Thoko’s guardian said.
The patient was also referred to KCH where she was booked for the theatre. She had to continue nursing her baby while feeling the pain from her open wound which was oozing blood.
Three days later, she went to the theatre where doctors treated her wound.
Another woman that we found at Bwaila Maternity Wing has a story similar to Thoko’s. She has given birth to five children with her last-born delivered through C-Section “When I was discharged after C-Section, I noticed that my wound was producing watery fluids, so I returned to the hospital. When I came, they reopened it and placed cotton inside the wound that was also producing puss. My stomach felt like there were needles inside.
“Yesterday, they told me that it would be better if they just reopened the wound and stitch it again. That is what I am waiting for. They said that is a better option,” she said.
Lilongwe District Health Office Public Relations Officer, Richard Mvula, said such problems could arise from failure by the affected women to follow doctors’ instructions.
While indicating that the hospital has not received figures about people allegedly getting infections through their procedures, Mvula insisted that such cases are not many “Complications which come after surgery are many. But for the women you are mentioning, though we do not know the duration, it could be due to several factors one of them being not taking antibiotics prescribed to them after surgery.
“Sometimes infections come due to failure to take medicines or failing to take care of the wound as instructed. We tell our clients not even to bath but when they go home, some take baths and, in the course, introduce infections to the wounds,” he said.
Health rights activist, Maziko Matemba, said there is need for relevant authorities to investigate the matter.
“We believe that those working at the hospital are qualified to administer an operation and this calls for the Medical Council of Malawi and Nurses and Midwives Council of Malawi to investigate why these things are happening because it is so scary.
“Minimum recommendations from the World Health Organisation say any woman who has delivered at a health facility is supposed to stay there for a minimum of 48 hours for observation if there are any problems but we hear that women are told or allowed to go back home 12 hours after delivery,” he said.
Malawi Health Equity Network Executive Director, George Jobe, concurred with Matemba, saying the matter has to be investigated considering that women are encouraged to deliver at hospitals.
He is worried such cases can deter others from seeking maternal health services in health facilities a development which may also erode the gains the country has made so far in reducing maternal mortality rates.
“We need to do investigations on this matter because it is very worrisome. It reminds us of another situation that we heard, that women had their uteruses removed according to a report released by the Office of the Ombudsman. Is it that after operation, these women are not given proper medication?” Jobe queried.
The Ombudsman’s report emanated from investigations into allegations of medical malpractice resulting in removal of uteri from expectant women in public health facilities.
Released in August last year, the report revealed that most of the disturbing incidents of hysterectomy—a surgical operation to remove all or part of the uterus—are those arising from pure negligence and lack of care on the part of health personnel.
The report further stated that only few of such medical personnel are held to account for their misconduct.
It added that more than 100 expectant women received care in the country’s referral hospitals and had their uteruses removed during a six-month period in 2018.
“Between January and July 2018, 160 uteruses were removed in the central hospitals only. There are some patients who we picked up because they could substantiate their cases. We will refer them to Legal Aid Department for actual claim for compensation,” said Ombudsman Martha Chizuma.
The investigations by her office followed a story published by our sister paper Malawi News on June 9 2018 headlined ‘Creation of a barren nation’ which detailed a crisis where every month, Queen Elizabeth Central Hospital was registering at least six cases of teenagers having their uteruses removed after developing complications including those to do with unsafe abortions. Zodiak Radio also aired a documentary on the issue.
Ministry of Health spokesperson, Joshua Malango, said he needed to get information regarding our latest findings before commenting.
Today, there are more related complications which keep threatening the gains made in reducing maternal mortality ratio which is at more than 400 per 100,000 live births.
Sustainable Development Goal 3, which Malawi ascribes to, desires that by 2030, countries should reduce the ratio to less than 70 per 100,000 live births. Still, a life lost is one too many, health rights activists say.