Tempers flare after yet another botched operation at KNH

Kenyatta National Hospital was last evening battling yet another storm following allegations of a caesarean section surgical mishap and the death of one of the twin girls delivered through the operation.

The mother, Susan Nekesa, has been admitted to the hospital for close to two months now and has no hopes of leaving soon as she nurses complications arising from an operation in which a patient is normally discharged within days.

She walked into the hospital on January 25 in labour and delivered twin girls the following day.

Hours after the surgery, Nekesa’s stomach started swelling and she began experiencing such excruciating pain that she could barely speak.

SMALL INTESTINES
A report by Citizen TV on Wednesday night showed the distraught new mother struggling to sit up in bed, speaking between sobs, and revealing that she has been praying that she does not lose her memory.

A week after she developed the complications, she was wheeled back to theatre, and it was then that doctors admitted they had made a mistake during the C-section.

“A portion of her small intestines — about 50cm long — was outside the chamber where it was supposed to be,” Robert Sitati, her husband, said.

Doctors removed the affected part and left a small opening, known as a stoma, in her stomach to allow her pass stool through a colostomy bag attached to her side.

Ms Nekesa is just one of the many patients who silently suffer the consequences of medical malpractice, which seems to have reached high levels in Kenya in recent days.

MALPRACTICE
Specialists define malpractice as bad, wrong, or injudicious treatment of a patient, resulting in injury or harm.

Studies have shown that malpractice and negligence in Kenyan hospitals often happens in the form of misdiagnosis, wrong decisions and treatment, prescription errors, and medical or surgical complications, all of which may result in suffering, permanent injury, or death.

And, while Nekesa’s story has gripped the nation now, complaints against Kenyan hospitals and doctors have been as frequent as they have been diverse, ranging from long waiting periods and delays in getting attended to in health facilities, to negligent management of labour resulting in stillbirths, complications with the baby or, as in Nekesa’s case, the mother; and maternal death.

JUSTICE
In 2016 the Kenya Medical Practitioners and Dentists’ Board reported that at least one in every 10 doctors in Kenya had been reported to the authorities for malpractice, but often the culprits go unpunished because of a system that is designed to pit the patient against the doctor during inquiry.

Very few offended patients have followed their cases to the Kenyan courts due to delays in determining them, and so most of them resort to settlements made privately by hospitals to pay off medical expenses or support dependents.

Mr Sitati, however, is hoping against hope that all will be well with his wife.

He, however, is a distraught father, as doctors informed him on Tuesday that one of the twins, after nearly two months in hospital, had died of a heart complication.

BABY CHOCKED
But Mr Sitati claims that he was told by a KNH staff member that the child chocked on milk.

“Someone told me that the person who fed my child was not very experienced around children,” he said, adding that he had been contacted by the hospital’s management and informed that the nurse-in-charge of the nursery had been summoned by the director of clinical services to explain the death of the child.

The past two months have been total hell for Nekesa, whose family says she often does not receive proper care such as emptying her colostomy bags.

“When the colostomy bag gets full, she has to struggle all the way to the bathroom to empty it,” Evelyne Anindo, her sister, says.

At the moment, KNH has asked the family to remain patient because the hospital’s doctors, consultants and registrars are on strike and there is no one to attend to Nekesa.

INVESTIGATION
Early this month, registrars and doctors pursuing their master's degrees went on strike after some of their colleagues were suspended following a head surgery on the wrong patient.

The hospital’s acting chief executive officer, Dr Thomas Mutie, said his office is investigating Ms Nekesa’s matter and will issue a comprehensive statement soon.

On Thursday, doctors defended themselves against accusations of misconduct, saying that, just like other surgeries, such complications are “expected” and “quite common”.

“A Caesarean section is a major surgery that can cause complications in any hospital anywhere in the world,” Dr Kireki Omanwa, a consultant obstetrician and gynaecologist, explained.

These complications, known technically as intraoperative surgical complications, include damage or injury to adjacent organs, including the bladder, urinary tract, or bowel, obstetric fistula as well as unintentional damage to the uterus or cervix.

COMPLICATIONS
Extreme cases could cause death, and 12 per cent of all C-sections in the world could result to one or more of the above complications.

The possibility of a woman developing any of these post-operative complications increases if she has undergone a previous surgery, Dr Omanwa added.

“There are unforeseeable complications, like intestines ending up twisted in a condition known as ileus, hence the need for daily reviews.”

Whereas most of these complications go unheard of, obstetric fistula, an abnormal hole between the birth canal and bladder or rectum caused by prolonged, obstructed labour without access to timely, high-quality medical treatment, is common among many women.

“Sometimes these complications might be hidden and completely missed during the operation. This is why patients are not supposed to leave the hospital for the first 72 hours,” Dr Nelly Bosire, also an obstetrician and gynaecologist, said.

MONITORING
Patients who have undergone C-section, doctors advise, should be placed under continuous monitoring and checked every four hours during the first 24 hours after the surgery to catch any complications that might have arisen during the operation.

“By the end of day three, the patient should be ready to go home. Discharge is often done on the third day after operation,” Dr Bosire said.

Doctors at KNH say that since the introduction of free maternity services, the number of women seeking maternal health care at the hospital has significantly increased, stretching the hospital’s capacity to perform C-sections.

Additional reporting by Aggrey Omboki