Friday, June 12, 2009

South African Tragedy: Part 2

So yesterday I went with Lily's mom - Khuselwa - to Stellenbosch Hospital for her meeting with the doctors involved. This sounds simple enough - for me I snuck out of work and took an extended lunch hour, but for Khuselwa it meant a R20 taxi fair from Tygerberg Hospital - where her child is now and where she is currently living! and for her sister, Shumi - it meant excusing herself from work. When you are living hand to mouth and earning R2000 in a good month these are not simple sacrifices.

We got there for the appointment only to be told the doctor was not available - he was busy at another hospital and would be there later but they couldn't say when. I explained to the appointment setter upper that that was not good enough - this mom has left her child to be here and best he ensure that the meeting happens TODAY and SOON.

In the meantime I took the ladies to Legal Aid. When we told the story the lawyers eyes just grew bigger and bigger. Next step is that they will find a law firm that specialises in case of medical misconduct and try get them to take the case on pro bono. My heart just about broke when Khuselwa discretely asked me if I knew what Legal Aid were going to charge her. Got to be careful not to take for granted that people understand things like Pro Bono!

The hospital called later to say the doctor was there. We went to get the low down from him. Amongst much waffling and jargon and me asking the same question over and over in a different way to get down to facts, the basic thing is this:
Gas was used on Lily and a number of other children that morning. All was fine and the anaethetist escorted her to recovery. She was not on oxygen as it was just gas and she was breathing fine on her own. Her oxygen levels were, however, being monitored.

A while later a nurse came to him and said the child was not waking up and she was concerned. He went back to recovery and the child was blue and the monitor registered her oxygen at zero. She was not breathing and had no pulse. He resuscitated her and gave her a shot of adrenalin to the heart. From then she was put on oxygen and transferred to Tygerberg Hospital.

He has no idea what caused her to stop breathing. He says it could be any number of things from a bit of tooth caught in her throat, to the child choking on vomit, to a heart error, to her moving her head as she began to wake up and cutting her own oxygen supply (which seems the most likely). The point is though, that what the hell is the point of an oxygen monitor is no one is watching it and if it does not have a function to alert if the levels drop. As Mrs Hall says, a child needs to be monitored throughout the anaesthesia process - including when they are waking up.

The anaesthetist brought up the fact that Lily was a prem baby and she is still small for her age - 8kg when she should be 12kg. He said this may have made her weaker and less able to respond. BULLDUST. That really got me. As Khuselwa said: Surely you had her file and you knew she was small? Is this the first small child you've worked with? Go Khuselwa. That is a bulldust argument because:
1. If there was any added risk with the child being small rather DON'T DO THE PROCEDURE! It's bloody toothache on a MILK TOOTH for goodness sake. Give the child panado and wait til it falls out rather than put a life at risk.
2. If the child WAS considered higher risk then surely she should have been even MORE closely monitored.
3. He then tried to say: what i mean is that if you strangle a healthy person and a sick person, the healthy one will be best able to cope with it. "Rubbish," I said, "the problem isn't the level of health, the problem is that the strangling happened. If you starve any brain of oxygen it will be damaged."
The reason this whole insinuation offended me so much was that I could see that it upset Khuselwa. As a pregnant woman I know that there is an implication that if you have a prem / low birth weight child it is your fault (and sometimes, frankly, it is) but the child is now 2 - she should never have been allowed to go without oxygen long enough to turn blue!!

If it is a capacity problem - shortage of nurses or whatever - then they should have allowed the mom in to sit with her child as she recovered. You can bet a mom will notice if her child stops breathing!!

Anyway, to be fair, aside from that stupid comment, the anaesthetist is tormented by this case. And the bottom line is that he cryptically implied that she should seek legal counsel.

Next it was a meeting with the medical superintendent. He was a lot more sketchy and evasive "It's not about pointing fingers, it's about looking at how we can do better". No no... if you don't figure out exactly what happened then how the hell do you prevent a rerun?? This isn't about not hurting feelings, it's about saving lives.

anyway. that is basically that from Stellenbosch Hospital. From here on they won't give access to a report or anything unless Khuselwa goes the legal route.

The burning questions for me now are:
> what if Lily lives on and on with no improvement? what will that practically mean for her impoverished mom?
> what about all the other times that something like this has happened and there's been no-one to tell the family about Legal Aid etc? How many times have things like this been swept under the proverbial carpet?


Gill said...

You go Caz! I think it's brilliant that you are helping Khuselwa to fight this battle. This sort of thing happens far too often and it is horrific! I can't bear to think about what this poor woman is going through. Please keep us updated.

Caz said...

thanks Gill. Ya when she started crying yesterday it absolutely broke my heart.

Mrs. Holly Hall said...

The post:

You are right, whatever happened-it was most likely preventable because the child should have been monitored throughout the process. ESPECIALLY SINCE she was a child and a PREMATURE CHILD at that.

There was neglect there. It appears the nurse had trouble waking the kid. At this point, the nurse left the bedside to fetch the anaethetist/doctor. The girl then stopped breathing and the oxygen deprivation began in earnest.

I am not familiar with your health care system but I can say this, whatever happened was most likely preventable.

WHAT THIS MEANS NOW-practicalities

1. Now, I want to be careful here because I do not know and have not examined the baby. And I don't want to say something that would cause harm here. Because what I am going to write next will be tough.

This is general information about oxygen deprivation and the brain.

While the child was blue, and even before when she couldn't be roused, her brain was being deprived of oxygen.

Now, there are many areas of the brain. The frontal brain (in the front) is the higher functioning part. That part helps us talk, reason, recongnize things, process and learn.

The back of the brain (in the back of the head, near the top of the neck) controls more basic function. Breathing, heart beating.

At this point, all it was oxygen deprived. All of it damaged, because oxygen deprivation is a traumatic brain injury.

Unfortunaelty, the brain and it's cells are hard to heal after damage has been done. Unlike other organs, the cells don't regenerate. Her recovery from this brain injury will, most likely, be very difficult.

But, I want to give some hope here. Nurses always have hope.

So the question becomes, what's going to happen to this girl next?

It is possible the little girl could just go on and on like she is now. The functions the lower brain, of the heart beat and breathing. these are automatic functions, and are hard wired. These brain cells can survive a lot of injury.

Now, what about the other parts of the brain?

This is where I am not sure what could happen. My hope is that because she is young and her brain is still growing, she can develop and recover the higher brain functions. My hope with enough time and the right interventions (noted below), she can recover some of who she was. I hope and pray for her. Because this is all I can do.

But, it'll take more than this to help her.

Her recovery, will be greatly aided by therapy (physical therapy, etc). The brain needs to be stimulated to enhance recovery. This requires professional help.

Which requires money.

And this is where my knowledge ends. I do not know what options or interventions would be right for this child. But, what ever happens next will need professional involvement. Which again, requires money.

And that is where legal aid can help. Because the hospital is responsible one way or another. As such they should provide funds to help this girl recover whatever she can recover.

good luck. deep breath. Realize that you are doing all you can and take care of you and the wee one inside.


Mrs. Hall

quartercenturycrisis said...

For me the scary thing is that this is not an isolated incident and is most definitely not isolated to government hospitals. I think one of the big problems is that these days nursing is just another job, not a passion or calling like it used to be. My mom is a nurse, and in the town she lives in, all the staff from the government hospital work for the agencies over their off days and get posted to the private hospital where the bad care (if you can even call it that) is continued. It's an absolute tragedy that this had to happen and it's so awesome that you are taking up this fight!