Kalaburagi’s alarming maternal deaths

The district recorded 70 such cases in the seven months from April to October this year, according to officials

November 26, 2017 12:02 am | Updated 12:02 am IST - Kalaburagi

  Counting losses:  Sabalabai holding a photo of her daughter Savita — who died with her unborn baby on the day she went into labour in April 2016 owing to alleged medical apathy — at Kamalanagar in Aland taluk of Kalaburagi district.

Counting losses: Sabalabai holding a photo of her daughter Savita — who died with her unborn baby on the day she went into labour in April 2016 owing to alleged medical apathy — at Kamalanagar in Aland taluk of Kalaburagi district.

Kalaburagi is a backward district in northern Karnataka notorious for its extreme heat and perennial water crisis. Many are its relative socio-economic inadequacies within the State. However disconcerting the other conditions there may be, the stories that virtually every village in the district tells — of a growing number of poor young women dying at childbirth — are probably the grimmest. Many of the deaths, it has turned out, were preventable.

The district, official sources said, tops the State in the high rate of maternal deaths: 70 maternal deaths in the seven months from April to October this year. The situation of young mothers dying after giving birth has alarmingly worsened since last year: Kalaburagi district had 52 maternal deaths in 2016–17. At least 120 newborns and other children were orphaned in the last 19 months, data provided by the District Health and Family Welfare Department shows.

In all but one of the cases, the deaths occurred after the women reached healthcare institutions. Most of them went to a district hospital or an equivalent private facility that claimed to be equipped for emergencies.

“The ground reality is worse as 15 to 20% of maternal deaths go unreported,” said Teena Xavier, health rights activist from Karnataka Janarogya Chalavali (KJC). The KJC interviewed the kin in over 60 maternal death cases that took place in 2016–17 and 2017–18 and found three leading causes of deaths: pregnancy-induced hypertension, post-partum haemorrhage, and sepsis.

‘Preventable causes’

“All these causes were preventable and largely driven by anaemia during pregnancy. The pathetic condition of the public health system pushed most of these women to the [much costlier] private hospitals — which again pushed the poor and the vulnerable families into huge debts,” Ms. Xavier said.

A survey conducted by the KJC in August and September this year showed that about 75% of maternal deaths were reported among the less privileged: people from the Scheduled Castes, Scheduled Tribes, and Muslims. Over 80% of deaths occurred after child birth; the remaining deaths were during advanced stages of pregnancy or during labour. About 40% of the women died on the day of delivery, and 71% died within a week of delivery, indicating serious gaps in managing pregnancies during later stages and post-delivery care.

The alarming rise in the number of maternal deaths has made the district administration sit up and take a few actions. Deputy Commissioner R. Venkatesh Kumar recently met department officers and deans of four medical colleges to find a way out of the situation. A multi-pronged approach would be taken to reduce or prevent maternal deaths, he said, admitting to the systemic gaps.

He said government facilities were getting burdened beyond their capacity in handling critical delivery cases. High-risk pregnancies were being referred at the last minute to the district hospital — which does 1,000 deliveries a month on an average and well beyond its capacity. The absence of specialists and anaesthetists at the taluk level also forces these government health institutions to increasingly refer critical cases to district hospitals.

“We have only three anaesthetists for the entire district and each of them is assigned two taluks. Specialist doctors are not keen on joining government institutions although we offer them ₹2 lakh a month,” Mr. Kumar said.

The cost of delivery is another factor. “I have appealed to all medical colleges in the city to perform deliveries at their own establishments instead of referring them to district hospital. But the government pays ₹3,000 per delivery while they charge a Caesarean section delivery around ₹25,000,” he said.

Tales of neglect delay and poverty

The Hindu puts together a few heart-rending cases where the lives of poor young and expectant women from rural families were nipped in the bud. And their kin attribute the deaths to medical apathy, help not coming in time or wrong diagnosis.

APRIL 2016

A fully pregnant Savita, 25, from Kamalanagar in Aland taluk of Kalaburagi district went into labour on April 25 and was rushed to a nearby PHC at V.K. Salagar village at 8.30 a.m. The lone staff nurse deputed there from a local community health centre did not examine her. A woman doctor arrived after two hours but did not see Savita.

Savita’s mother begged the doctor to see her daughter but the doctor said the nurse herself could handle the case. At 2 p.m., the doctor left for her home in Kalaburagi, 50 km away, and the nurse, too, went to her quarters. Savita’s condition became critical. That was when the nurse, who was called back, took Savita’s blood pressure reading for the first time since she was admitted six hours ago. (Sources said it violates the basic medical protocol for handling a delivery case.)

The nurse blamed the family members for being a “nuisance” and causing Savita’s hypertension. Savita was taken to a private hospital in Kalaburagi. It was 5.30 p.m. and the doctors there said it was too late for them to save her. Ten minutes later, Savita was declared dead — with her baby unborn.

Outside their small house at Kamalanagar, an inconsolable Sabalabai, Savita’s mother, held her daughter’s photo in one hand and wiped her tears. “Instead of keeping my daughter unattended for seven hours, the PHC could have simply told us to go to another hospital. The doctor was right there but did not care to see her even once,” she said.

JUNE 2017

Lakshmi of Adaki village in Sedam taluk was just 19 and did not live to see her first wedding anniversary. Her relatives said whenever they took her to the government hospital in Sedam for pregnancy-related check-ups, the doctor — who purportedly has a private practice — would insist on seeing her at her home.

On May 31, Lakshmi, who was in her ninth month of pregnancy, went to the hospital with her mother-in-law, but the doctor was absent. The next day, she returned to the hospital but fainted at the gates. The duty doctor asked for scans and instructed them to see her at her home. The poor woman went back as she did not have the money. On June 2, she collapsed at her home and was rushed to the same government hospital. The doctor reassured the family and went home for lunch around 3 p.m. When Lakshmi collapsed again, her relatives immediately took her to the Kalaburagi district hospital in an ambulance along with an accident victim. The next day, she gave birth to a baby boy by the Caesarean section, but succumbed to complications after three days.

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