The Rural Doctors Association of Southern Africa (RuDASA) would like to express our serious concern in relation to the suspension from duty of two doctors from Evander Hospital in Mpumalanga for performing an emergency perimortem caesarian section in the hospital’s labour ward. RuDASA firstly extends heartfelt condolences to the family of the mother and baby who died. We hope, however, that a small measure of comfort can be gained from a proper understanding of the facts surrounding the healthcare that was provided, and the reasons for which the caesarian section was performed in such unusual circumstances.
While not privy to the full and specific details surrounding this incident, RuDASA acknowledges the necessity of a perimortem caesarian section in the event of maternal cardiac arrest as a legitimate emergency procedure that facilitates effective cardiopulmonary resuscitation (CPR). In addition, accepted best practice necessitates this intervention to be performed within 4 minutes of cardiac arrest in order to reduce the chances of intrauterine asphyxia (lack of oxygen) to the foetus.
RuDASA understands that the Evander hospital staff, a rural site in the Gert Sibande District, were forced to intervene as a matter of urgency as they witnessed their patient’s condition deteriorate while waiting for a helicopter to arrive. The promised clinical and criminal investigations will reveal whether the staff were correct in their assessment of the steps required.
Without having undertaken such investigations, however, hospital management and the Department of Health were quick to publically vilify the doctors involved and to suspend them without giving them an opportunity to argue against their suspension. Doctors with advanced skills in obstetrics and the management of obstetric emergencies are a scarce resource in rural areas and the suspension of the doctors involved has left an unnecessary gap in essential services at Evander Hospital and the community it serves.
RuDASA is well aware of challenges faced by rural health facilities, including long distances between PHC facilities and referral centers. Rural doctors and their patients are often caught in precarious situations while waiting for emergency services that need to traverse poorly lit dirt roads or triage responses to more than one facility that are long distances apart. Frozen health care worker posts, budget cuts and medicine shortages further affect the care that health care workers can provide for their patients. It is therefore critical that the full circumstances on an adverse event are fully understood before passing blame.
We call on the Department to apologise publicly and to reconsider the suspension of the doctors involved, while obtaining a full understanding and measured assessment of the facts of this case.
We call upon patients, communities and authorities to work together with health care workers to protect, promote and advance access to quality healthcare services in a healthcare system under strain.
For more information contact:
Dr Karl le Roux, 0728589751, email: firstname.lastname@example.org
Dr Desmond Kegakilwe, 0829607571, email@example.com
The Rural Doctors Association of Southern Africa (RuDASA) strives to inspire others towards rural healthcare in South Africa. Our aim is to support and empower those committed to making health care available to all South Africans.