Uterus ruins persist in public hospitals

On the morning of July 17 2019, Madalitso Simpokolwe of Area 18 in Lilongwe gave birth by Caesarean section at Bwaila District Hospital.

However, her motherhood was short-lived as the baby died barely 48 hours later.

Before she could fully grieve the loss of her first child, the doctor told her that her wound was infected, and the infection had spread to her uterus and damaged it.

Simpokolwe had to go through hysterectomy—an operation to remove the womb—and she may never have children in future.

Following the surgery, she spent two and a half months at Kamuzu Central Hospital (KCH) together with other women facing similar challenges, and some of them had been in the hospital for over four months.

“Three quarters of the patients I interacted with lost their babies too. Some of them have been operated on the same wound for three times because they were not done well the first time. It made me wonder what was happening to cause these problems,” said Simpokolwe.

The young woman further explained that she cannot count the number of times, while at KCH’s Ethel Mutharika Maternity Wing, when the nurses told them that they did not have the required material to clean their surgical wounds.

“Days would go by without cleaning some people’s wounds. Sometimes they advised us to buy the required medicine on our own, but most patients cannot even afford that,” she explained.

Simpokolwe’s case is one of hundreds currently occurring in the country, allegedly because health care workers are not administering prophylactic antibiotic which prevents infection to the women who undergo Caesarean section.

It is reported that painkillers are being given instead, and consequently the wounds develop infections leading to the removal of uteruses.

A recent report by Ombudsman Martha Chizuma titled Woes of the Womb indicated that between January and June this year, the country’s referral hospitals performed 160 hysterectomy procedures on women.

 Queen Elizabeth Central Hospital topped the list with 78 cases followed by 57 performed at KCH, 24 at Zomba Central Hospital and one at Mzuzu Central Hospital.

However, obstetrician and gynaecologist Frank Taulo regrets that the practice has become a norm in the country’s public hospitals.

“It is clear that there are gaps in decision-making in our public hospitals. It was very obvious in the case of Madalitso that when the water broke it meant that she was in labour.

“In the old days such a case would not have had to go for over 48 hours; she would have been taken in for Caesarean section. Women with raptured membranes need to have a Caesarean section within 24 hours,” he said.

Taulo reckoned that it is high time health workers sat down and discussed these issues and start doing things differently.

The gynaecologist emphasised the significance of improving the quality of care in public hospitals; noting that the attitude of health workers and their dedication to duty leaves a lot to be desired.

However, he argued that College of Medicine as a training institution pushes hard on professionalism; and similarly, practising clinicians also push hard that they do the best to provide quality care.

But as people, Taulo advised that it is part of clinicians’ humanity to be kind to patients and to ensure that they have good outcomes; in this case, ensuring that the mothers and babies are safe.

In her report, Chizuma pointed out that health facilities should ordinarily be a safe environment where good health and life is preserved.

She argued that it is government’s obligation to provide quality health care to its citizens, and that non-availability of resources to provide the basics such as enough personnel, medication and other resources should not be an eternal excuse for government’s failure to provide basic health care.

“Where such failure results in serious situations like avoidable hysterectomies as in this case then it becomes a national tragedy requiring non-traditional intervention. Anything outside this is injustice,” the Ombudsman reported.

On her part, chief reproductive health officer in the Ministry of Health and Population, Rosemary Bilesi, said the ministry needs to strengthen the implementation of policies at all levels.

“We also need to look into issues of quality care as well as lobbying for more resources. Women need to be cared for with respect, and when our women get out of the labour ward, they need to be happy having been well cared for, alive and with live babies,” she stated.

Nonetheless, Bilesi noted that in terms of the provision of maternal and neonatal health care in the country’s hospitals, there is need for evidence-based information to improve the practice.

She acknowledged that the numbers of stillbirths and preterm births are still very high in the country as a result of low quality care as well as delays in decision-making, affecting the outcome of pregnancies.

The factors include inadequate equipment and supplies; attitude of health care workers; few numbers of health workers; and sometimes the women themselves presenting late at the health facilities.