‘For sale: baby shoes, never worn.” This — Ernest Hemingway’s famous (very) short story — is poignant enough to strike a chord in any reader, but for 63-year-old Dolly Gule, it opens a vein.
It’s her story. On August 24 2004 her youngest daughter, Tshepang, was admitted to Durban’s King Edward VIII Hospital.
She was in her ninth month of pregnancy and her labour had to be induced. Tshepang gave birth to a baby girl that night. She named her Tshiamo, meaning ‘everything is okay”. It wasn’ t .
Two days later Tshepang lost her little girl — and six days after that, Gule lost hers. ‘This is her,” Gule says, gesturing to photos lining the lounge wall: Tshepang slim and radiant in her graduation gown; with headphones on, presenting her radio show at Pretoria Technikon; in a fancy black dress, ready for a night out.
‘How my healthy, happy Tshepi went from this to dead in a matter of days still haunts me,” Gule says. She recounts what happened clearly. ‘That Tuesday morning, my cousin dropped Tshepi off at the hospital. I was ill so I couldn’t take her myself.
He visited her on his way back from work at about 6pm and told me that Tshepi was fine. She was not yet in labour. ‘Later that night I went to the hospital myself. I was shocked to discover that my daughter had given birth at about 9pm and was admitted to the intensive care unit (ICU).
No one informed me of this. I demanded to know what had happened, but the nurses wouldn’t give me clear answers.” The only explanation Gule says she was given was that Tshepi had bled profusely during her delivery.
Eddie Mhlanga, chief obstetrician at King Edward VIII at the time who was familiar with Tshepang’s case, said she had an abruptio placentae as she was about to deliver.’This refers to the separation of the placenta from the womb. It caused major internal bleeding and caused her to go into shock.
Her blood was unable to clot properly and her main organs suffered because of the lack of oxygen.” Mhlanga explains that when Tshiamo was born, she was asphyxiated because of a shortage of oxygen in the womb.
Gule, a retired nurse with 27 years of experience, first saw her granddaughter lying in a crib and covered with secretions that had not been suctioned. ‘I looked at her medical chart and saw that she had an Apgar score of 1 out of 10,” she said.
The Apgar score is used to determine a newborn’s physical condition by examining its heart rate, breathing, reflexes, muscle tone and skin colour.
A score of seven or more indicates a healthy baby; anything lower is generally cause for concern. ‘From my experience in midwifery, a 1 out of 10 score meant this wasn’t a normal birth. This was an unresponsive, almost dead child,” Gule says.
Tshiamo’s condition failed to improve and she died on August 26. ‘I remember thinking that if Tshepi pulled through, she wouldn’t have a memory of what her daughter looked like.
So I carried a camera with me to the mortuary and took a photograph of her. It’s the only one I have,” Gule says, holding out a photo frame.
In it Tshiamo is dressed in a matching white hat and romper. Her eyes are closed, her cheeks still slightly pink. There’s a hint of a smile. Gule buried her granddaughter on August 30.
Meanwhile, Tshepang remained in hospital as doctors ran tests. She was later transferred to Nkosi Albert Luthuli Hospital for a kidney dialysis.
Doctors informed Gule that most of Tshepi’s organs were failing and she was not likely to survive. She was 25 years old. ‘While burying Tshiamo, I had a feeling that Tshepi wouldn’t make it.
She was ambitious and headstrong; she lived life to the full. Yet when she passed away [on September 1], I felt that somehow she had prepared me for her death,” says Gule.
She wrote to the matron of King Edward VIII requesting an explanation for her daughter’s and granddaughter’s deaths.
The hospital is the second-largest in South Africa and provides regional and tertiary services.
‘The fact that Tshepang gave birth within three hours and then landed in the ICU convinced me that something went wrong.
I assume the nurses gave her too much of the medication to induce labour. At a meeting with the hospital they told me that Tshepang dilated too quickly, but I don’t believe that.
What’s certain is that there was gross neglect on the part of the hospital in caring for my daughter and granddaughter,” says Gule.
Mhlanga says the hospital did not find evidence of negligence. ‘One can never say with certainty that it was a labour-inducing drug, or the [placental abruption] that led to Tshepang’s death — But looking back, maybe if blood was available on site, maybe if they acted quicker, the situation would have been different.”
Mhlanga says that the doctor who attended to Tshepang admitted: ‘I should’ve come faster the first time the nurses told me she was bleeding. I delayed a few minutes in going. It may have been a matter of two or three or five minutes, but it was a few minutes too late.”
Gule chose not to pursue legal action. ‘By then I was tired of fighting. I told them that Tshepi died either because it was her time to go, or because one of them neglected her — I decided not to sue as there is no point. My child is dead. That is painful enough.”
The shocking statistics
A recent report by the government-appointed National Committee on Confidential Enquiries into Maternal Deaths found that deaths of pregnant women have soared 20%.
The Mail & Guardian reported last month that more than one-third of them could have been prevented if standard health protocols had been followed.The report further revealed:
- Between 2005 and 2007, 4 077 maternal deaths were reported, up 20% from the 3 406 deaths reported during 2002 to 2004;
- The top five causes of maternal deaths were non-pregnancy-related infections, complications of hypertension, obstetric haemorrhage, pregnancy-related sepsis and pre-existing maternal disease;
- HIV infections were the biggest killer, accounting for 43.7% of maternal deaths;
- 38.4% of maternal deaths reported were assessed as being ‘clearly avoidable”;
- Incorrect diagnoses, delays in referring patients and infrequent monitoring of patients by health workers were common problems;
- Lack of appropriately trained staff contributed to 9% of maternal deaths;
- Lack of patient transport and of ICU facilities were reported in 8% of maternal deaths;
- Lack of blood for transfusion was reported in 19% of cases; and
- These problems occurred most frequently in community health centres and district hospitals and least in provincial tertiary and national central hospitals.