Jagrutha Mahila Sanghatane (JMS)

Home » Human Right of Dalit Women » Death of Mariyamma, 20 years – Investigating Maternal Death – JMS demands prompt action against medical negligence and steps towards stopping maternal deaths

Death of Mariyamma, 20 years – Investigating Maternal Death – JMS demands prompt action against medical negligence and steps towards stopping maternal deaths

Death of Mariyamma – Investigating Maternal Death in Manvi taluka, Raichur District (Karnataka)

JMS demands prompt action against medical negligence and steps towards stopping maternal deaths

Name of the deceased woman Mariyamma W/o Ramesh
Address Sangapura village, Hirekottnekal Gram Panchayat, Manvi Taluk, Raichur.

Maternal home address: Dhumthi village, Gonavar Gram Panchayat, Sindhanoor Taluk, Raichur Dt.

Age 20 years
Caste Madiga (SC)
Name of the PHC ( reporting)

Name of the PHC (maternal home)

Hirekottnekal

Paparaocamp

Medical officer (Paparao camp)

Medical officer (Hirekottnekal)

Name of the ASHA worker (Dhumthi)

Name of the ASHA worker (Sangapura)

Dr.Veerabhadrappa: 9449783557

Dr.Chandrashekar : 9480840783

Renuka

Renuka w/o Eranna:9731207819

Date of death 6th May 2019
Place of death RIMS, Raichur
Date of delivery 30th April 2019
Mode of delivery Ceasarean
Place of delivery Taluk hospital, Sindhanoor
Hb level 7gms (as per the latest blood test done on 26/4/2019 in a pvt hospital in Sindhanoor.  On the day of admission in Taluk hospital, Sindhanoor.
Baby sex/ Birth weight Male ,  2.5 kg
Education 9th standard, Tailoring
Gravida G1
Contact number Dhumthi: Dyavanna (brother of the deceased)

Contact number Sangapura ( Husband of the deceased)

9901928485

 

7795798450

Medical records of the deceased woman Thai card (obtained from Sangapura). Abdomen and pelvic Scan reports and blood test. (ANC check-ups done in Bangalore)

ANC check-ups done in Sindhanoor during the woman’ 15 days stay in Dhumthi village)

Death of the woman: On the 4/5/2019 around 3 pm woman was shifted to RIMS, Raichur in hospital ambulance.  They reached RIMS around 7 pm.  Around 8.30 pm after the examinations by the staff nurse, woman was admitted in the MICU.  One blood transfusion was done in RIMS.  On the day of admission, several injections were written to buy from outside.  First day itself injection worth 2000/- was bought from outside.  There was no doctor to attend the woman at RIMS, staff nurse attended her.  Doctor was called on the mobile and he was giving suggestions over the phone.

Family said that the woman had BP.  No doctor saw the woman on 4th and 5th (Saturday and Sunday). On the 6th around 6 am woman developed all complications.  Though the hospital asked to shift the woman elsewhere, family did not.  Already woman’ eyes had gone up and she was unconscious.  She died around 12 noon.

https://www.facebook.com/jms.chiguru.3/posts/160529348302079

Demand by JMS regarding the actions to be taken immediately regarding the maternal death:

  • To ensure that the death is audited by the medical officer in Hirekottnekal PHC and he submits the audit report in the suggested Maternal Death Review (MDR format) in 27 pages. Get a copy of the MDR format from the PHC.
  • To ensure the survival of the new born: baby is weighed in every 15 days, milk powder supplied by the dept. etc. if necessary.
  • To ensure that the Maternal Death Audit is done at the district level this month itself and the family attend the maternal death audit and speak all their grievances. One representative from the Sanghatane who is thorough of the case to attend the audit with all the case details.

COMPLETE REPORT ON THE MATERNAL DEATH: [Please read on]

I.  Interview of the deceased woman’ mother and her brothers in Dhumthi village. (Date of  interview: 9/5/2019):  Mariyamma was married off two years back on 1st May 2017 and this was her first pregnancy.  She came to Dhumthi her maternal home for delivery  in her  9th month of pregnancy, 15 days before she developed labour pain.  When she came to Dhumthi she was anaemic and weak and her limbs were swollen.

Social and economic and educational background: Possibly the woman was married of at the age of 18 or much before that. Family said that the woman was a 9th standard dropout.  After her father died she did not continue her studies.  Later she went for tailoring.  Family took 2.5 lakhs  for her marriage.  Marriage loan is still not over.  She is from the Madiga (SC) community.

Antenatal check-ups: When the woman got pregnant she was working in Bangalore with her husband.  In Bangalore only once she had antenatal check-up which was in the 4th month.  Only once abdomen scan was done in the 4th month when she came to Sangapura for Shreemantha (cultural celebration done for pregnant woman). After the program they went back to Bangalore.  And  came back to Sangapura, Hirekottnekal PHC in the 6th or 7th month of pregnancy.

From Dhumthi the woman was taken to Paparaocamp PHC  for ANC check-up.  She had her blood tests and BP examination done there.  Within a period of  15 days she went to the PHC thrice for check-up.  She had Iron Sucrose injections thrice from Paparaocamp PHC.  Doctor saw her three times whenever she went for check-up in the PHC. Other than visiting the PHC, they also took her to a private facility for check-up. Abdomen scan was done twice.  Family said the woman had high BP.

Delivery:   On 26th April 2019 towards 7 pm woman developed stomach pain, back pain and other difficulties.  Family called for 108 ambulance by 7pm and the ambulance came at 8.30pm.  She was taken to Taluk hospital Sindhanoor.  They were told that the baby was not moving and suggested to do a scan at Sparsha hospital Sindhanoor.  After the scan the family was told that the baby is normal. They took her back to Taluk hospital, Sindhanoor as they did not have enough money to spend in a private hospital.  Doctor came in the morning and blood tests and BP all were checked.  As the woman was anaemic she had two units of blood transfused.  Doctor suggested ceasarean.  Woman underwent ceasarean on the 30th April.  After ceasarean again she had one unit of blood transfusion done.  After ceasarean mother was exhausted and tired.  A male baby weighing 2.5kg was born.  Mother was able to breastfeed the baby only one day.  Baby was fed with other milk in the hospital itself.  As the mother was getting weaker, on the 5th day after delivery  (4/5/2019) family was asked to shift the woman to RIMS, Raichur as there was no MICU facility in Sindhanoor Taluk hospital. Free ambulance was given to shift the woman.

Death of the woman: On the 4/5/2019 around 3 pm woman was shifted to RIMS, Raichur in hospital ambulance.  They reached RIMS around 7 pm.  Around 8.30 pm after the examinations by the staff nurse, woman was admitted in the MICU.  One blood transfusion was done in RIMS.  On the day of admission, several injections were written to buy from outside.  First day itself injection worth 2000/- was bought from outside.  There was no doctor to attend the woman at RIMS, staff nurse attended her.  Doctor was called on the mobile and he was giving suggestions over the phone.

Family said that the woman had BP.  No doctor saw the woman on 4th and 5th (Saturday and Sunday). On the 6th around 6 am woman developed all complications.  Though the hospital asked to shift the woman elsewhere, family did not.  Already woman’ eyes had gone up and she was unconscious.  She died around 12 noon.

Expenses for delivery and other treatment

  • During the 15 days at maternal home in Dhumthi for ANC care: 2000/-
  • During 9 days admission in Taluk hospital (towards medicines written from outside and blood): 10,000/-
  • 2 ½ days at RIMS, Raichur: Rs.15,000/- ( blood and medicines from outside)
  • Transporting the dead body home: 3000/-

Corruption explained by the family

  • Each time (3 times) when the woman was taken to Paparaocamp PHC ( Rs.150/- was charged for Iron sucrose injections (150×3= 450). They were also charged for the blood tests
  • In Taluk hospital, Sindhanoor, blood was donated by the donars……but still for each unit they had to pay Rs.1400/- each.
  • In RIMS hospital, family had to get influenced persons to speak to the doctor to say that the patient is “whom we need”…..
  • Special ambulance was not given to shift the dead body. Rs.3000/- charged.

Medical records of woman: During the interview with the family we asked for medical records.  Family said that they don’t have any records with them including the Thai card.  When the woman was referred to RIMS, from the Taluk hospital, Sindhanoor they did not give any medical records to the family.  They only gave a referral slip to the family.   Taluk hospital doctor said that the family would not need those records.  After the death of the woman from RIMS hospital also the family was not given any records.

Obtained Thai card and ANC check-up reports and scan reports done in Bangalore and Sindhanoor from the deceased woman’ house in Sangapura.  They also had the receipts of payments done in RIMS and Taluk hospital Sindhanoor and the receipts of purchase of blood.  From Taluk hospital Sindhanoor and from RIMS no case sheets of the woman or discharge summary was given to the family.

II .  Interview with the Medical officer in Paparaocamp PHC (date of interview: 9/5/2019):  Doctor said the woman had come to the PHC a couple of times and since she was anaemic Iron sucrose injection was given.  Her Hb was 7 gms on her first visit.  After administering Iron sucrose injection her Hb was 9gms.  Woman was short in stature.  Her BP was normal…….  Her pregnancy was recorded under High risk pregnancies.  And she was asked to go to the Taluk of District hospital for delivery as it was a high risk case.

Doctor said that he has informed Hirekottnekal  PHC about the maternal death.  Since the woman is from  Sangapura village, Hirekottnekal PHC has to report the case. He said her Thai card was done in Bangalore.  Woman came with the Thai card when she came for check-ups.  All her parameters are recorded there.  After forcefully asked for her HB and BP measurements only doctor said the above.  He said that everything is noted in her Thai card.  In the PHC they don’t keep a record of all these things!!!!

Medical officer had not met the family after the death of the woman.  He said all un-factual things like the woman was taken to Sindhanoor and she delivered the next day etc.  Doctor said that it is not his job to interview the family. When asked about charging the pregnant women for Iron sucrose injections (Rs.150/-) doctor did not deny and he kept quiet.  He said that whatever we want to do we can go ahead.

III. Interview of the deceased woman’ husband and family members in Sangapura village ( Date of interview:  10/5/2019)

Socio economic background: Deceased woman’ husband Ramesh is a 3rd standard dropout.  Ramesh parents and one of his brothers are illiterate. One of his brothers has studied B.Ed and is teaching in one of the private schools in Bangalore.  Their whole family migrates to Bangalore for 6 months in a year.  They have 1 ½ acres of dry land.  In Bangalore, when Ramesh, his brother and his parents worked in the construction sites, Mariyamma (deceased woman) cooked for the family.

Antenatal period and care: Woman was healthy and happy and she became pregnant when they were in Bangalore.  This was her first pregnancy.   Her first scan was done when she was three months on 4/10/2018.  Her Hb level showed 12 gms on the same day in her medical records.  In Bangalore they went to a private facility and did three abdomen scans.  Woman had only check-ups done in the private facility but no medicines or IFA tablets purchased from the private.  They made her Thai card with the Urban Health Centre in Bangalore and the ANM visited her in the working site and checked her BP.  Whatever, tablets that was given by the ANM during her visits was taken by the woman.  Family did not bother much as everything was said to be OK.

Ramesh and the woman came back to Sangapura village on 24/1/2019 when the others stayed back in Bangalore.  12/4/2019 woman went to her mother’s house in Dhumthi for delivery.  During her three months of stay in Sangapura once the ASHA worker took her to Hirekottnekal PHC for check-up.  Ramesh said that his wife was well and did all the works and was healthy.  When asked about the pedal edema and low levels of Hb when reached Dhumthi, he did not know that his wife was anaemic.  He said that during the ANC check-ups in Bangalore, he was told that she was ok.  He said that her expected date of delivery was 26/5/2019.  Family also did not think there was any problem with the woman and they all believed that her delivery will be ok.

Delivery and Death: Ramesh and his family were also with the woman when she was admitted in Taluk hospital, Sindhanoor and RIMS, Raichur.  Ramesh said that in Taluk hospital they were told that it would be of risk to wait for a normal delivery and the woman will need a C-section.  But they were asked to take the woman to RIMS for C-section since Taluk hospital does not have MICU care if at not she needs it during the surgery. But the woman’ brothers insisted to have C-section in the Taluk hospital itself.  Surgery went well but women did not feel OK after the ceasarean.  30/4/2019 was the C-section.  After surgery woman’ abdomen was abnormally big and she felt unwell and had difficulty in breathing.  In Taluk hospital, the family was not given any danger signal and they kept the woman for 5 days, until 4/5/2019. But in RIMS the family was told that the woman has been infected and it is difficult to save her life.

Rest of the narration about Taluk hospital, Sindhanoor and RIMS were same as the narration of the woman’ family in Dhumthi village.

Present status of the new born: We met the baby of the deceased woman.  Baby was quiet healthy and active.  Baby is fed with Amul powder and tonic prescribed by the doctor in RIMS.  250 gms of milk powder costs Rs.350/-.  Birth weight of the baby was 2.5 kg.  ASHA worker or ANM or Anganwadi worker had not visited the baby or weighed the baby.

IV    Interview of ASHA worker in Sangapura village (Date of Interview:  10/5/2017)

As per the statement of ASHA worker, Mariyamma and her husband Ramesh came to Sangapura village on the 24th January 2019 and the ASHA worker registered the woman in her register on the 30th January 2019 and took the woman to the PHC on 2nd February 2019. She had her Hb, weight and BP examined.  Hb was 9.5 gms.  ASHA worker showed the zerox of the Thai card taken on 2nd Feb where Hb, weight and BP was recorded. When asked why the height of the woman was not recorded, she was not sure whether the height was taken or not.  She said the woman was not put under high risk pregnancy.

Three full months the woman stayed in Sangapura and there were 3 PMSMA program conducted in the PHC.  When asked why was the woman not taken for the PMSMA for detailed examination in the PHC, she said that there was a communal riot in the village among the Madiga community and Gowda community for drinking water.  After the community clashes, many were put in the jail.  Madiga community had given complaint about the other caste people who had attacked them including the ASHA worker’s family members.  Police were in the village.  Due to these reasons ASHA worker did not attend to the woman though she was in the village.

First Information Report: 

ASHA worker rang up the ANM and informed her about the death of the woman and details known to her on the very day of death of the woman.  But she went to the PHC and reported the death in writing only on the 9th May 2019.  When asked why the death was not reported with the PHC immediately after the death of the woman she said that she is new in her job as ASHA.  It is only 10 months that the ASHA has joined the work.

V    Interview with the Anganwadi helped: When we visited the Anganwadi, the Anganwadi worker was not present.  But the helper gave some information about the deceased woman.  She said that the woman has come to the Anganwadi once for ANC check-up during the weekly immunization day.

VI      Interview of the Medical officer in Hirekottnekal PHC (Date of interview: 10/5/2019):  When asked the medical officer about the concerned maternal death and the audit of the death, he said the death has to be reported by Paparao camp PHC as the woman was in Dhumthi when she was taken for delivery.  He was at the defensive when asked about not visiting the family even after 4 days of the death.

When the case of the woman was said in detail and asked why did the woman not attend the 3 PMSMAs (detailed ANC examination by a doctor on the 9th of every month in a PHC), doctor said that she was not a High risk case (Every primi woman (first pregnancy), short stature woman, low HB etc is considered as a high risk pregnancy). When asked the woman was very short in stature and was severely anaemic , he denied those facts.  When asked about no one visiting the new born baby to monitor its health, doctor said he would ensure the baby is weighed and will make arrangements for milk powder for the baby.

At the end of the interview doctor seem to be changing his grounds after explaining the rules of reporting a maternal death.  He said he had gone the other day to the village of the deceased woman but no one was in the house.  He said he would visit the family soon and do the audit.  He had the First Information submitted by the ASHA and ANM; this had the date of delivery, place of delivery, date of death etc with minimum details about the death of the woman. He also said that every month PMSMA program is conducted well in his PHC.  There is no shortage of Iron Sucrose injection, Thai card etc in his PHC.

We mentioned that the family of the woman has to be called for the audit done at the district level.  Then the doctor laughed and said that the audit of the maternal deaths that took place even six months back is being done now only.  When we mentioned that the maternal deaths taken place in every month has to be audited in the same month, doctor again changed his statement and said that audit was not done at the district level since the DC was absent.

Demand by JMS regarding the actions to be taken immediately regarding the maternal death:

  • To ensure that the death is audited by the medical officer in Hirekottnekal PHC and he submits the audit report in the suggested Maternal Death Review (MDR format) in 27 pages. Get a copy of the MDR format from the PHC.
  • To ensure the survival of the new born: baby is weighed in every 15 days, milk powder supplied by the dept. etc. if necessary.
  • To ensure that the Maternal Death Audit is done at the district level this month itself and the family attend the maternal death audit and speak all their grievances. One representative from the Sangatane who is thorough of the case to attend the audit with all the case details.  Get prior permission for this.  ( I understand from the Medical officer that the maternal death audit of the deaths taken place in the last six months is not done at the district level.  This is a big neglect.  Collect the authentic information in this regard through RTI)
  • Severe anaemia is a major problem in the working area. PHCs seem to be charging even for the Iron Sucrose Injections.  Conduct a meeting in the concerned two PHCs in the presence of the pregnant and postnatal women in the area and discuss this maternal death and the factors that led to her death.
  • Severe aneamia in pregnant women
  • Migrant women’ issues ( regarding obtaining thai card and other services from concerned PHCs.
  • Migrant women regardless of whether they are high risk or not should attend all PMSMA programs once they come back to their village. All migrant women to be considered as High-risks.
  • Antenatal check-ups alone will not do. Woman and the family to be informed about the risks.
  • Advocacy to improve the lapses in RIMS. Doing a base line study of RIMS to assess the facilities available there.  Later paper works and representation at different levels to improve the services in RIMS
  • An investigation into type of drugs written from outside in Taluk hospital and RIMS. Are they the drugs in the essential drug list?  Is there shortage of drugs in Drug logistic society warehouse?

Report prepared by Teena Xavier and Manjula

11 May 2019


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