Srinagar: A pregnant woman who lives in a remote ‘red zone‘ village in south Kashmir was denied admission to four hospitals and was forced to travel more than 100 km in the night before she could deliver her child at a Srinagar maternity institute.
The ordeal of the 30-year old woman from Taliwan village of Anantnag district started on April 1 when she developed labour pain at around 9 pm. The family rushed her to the nearby sub-district hospital in Shangus.
“The doctors refused to even listen to us when we told them that we are from the red zone. They said they will only admit my wife if we produce her COVID-19 report,” said Mubashir*, the husband of the woman.
As per protocol, all pregnant women in red zones have to be tested for coronavirus infection. The young woman’s samples had been taken on April 29, but the report was awaited.
Amid the paranoia, the patient was referred to the Primary Health Centre (PHC) at Achabal. “We were told that since my wife has been registered as a maternity case at the Centre, they would take care of her,” said Mubashir.
The family was first denied an ambulance to ferry the expecting mother who was in advanced labour pain. When they reached the PHC in Sumo car, the doctors did not let her enter the ward once they got to know she was from the red zone, Mubashir alleged.
She was instead referred to the Maternity and Childcare Hospital (MCH) at Anantnag. “We reached the hospital at 11 pm and showed a referral note to the doctors. As I informed them about the red zone, they refused to let us bring my wife down from the vehicle. One of the doctors said they can’t admit any patient from the red zone to be admitted,” said Mubashir.
In pain, the pregnant woman, who was expecting her second child was referred to SKIMS Hospital at Bemina in Srinagar, around 70 km away, though the MCH is well-equipped and caters to the patients from four districts of south Kashmir.
“We left for Srinagar in a state of helplessness, praying to God to see us through testing times,” he said. Besides her husband, the woman was accompanied by her sister and brother-in-law.
Mubashir’s fears came true when the doctors at the Bemina hospital refused to admit the patient at 1:30 in the night. Mubashir said a doctor told them the hospital has been designated for COVID-19 positive cases only.
“We showed them the referral note, but they didn’t listen and instead sent us to Lala Ded (LD) hospital,” said Mubashir.
The LD hospital, around 10 km from Bemina hospital, is the Valley’s only tertiary care maternity hospital and remains overburdened at any point of time. They reached the LD at 1:45 am and the woman delivered a girl child the next afternoon.
Confusion in the aftermath
The joy of the birth was, however, short-lived. Mubashir received a call from the office of chief medical officer Anantnag, informing him his wife has tested positive for COVID-19.
He rushed back to inform the doctors at the hospital. Asked why the hospital did not confirm the COVID-19 status of the woman, a doctor said she was in advance labour pain and hence saving her life was the priority.
“We were not told by anybody that she is from a red zone,” said the doctor. “The family hid the history perhaps fearing the patient might be turned away.”
Mubashir, however, said the doctors had written “everything” on the referral note. “My wife’s condition was deteriorating. I had nothing in my mind except the wellbeing of my wife and the child,” he said.
At least seven members of the medical staff at the LD including doctors, who handled the woman, have been sent to quarantine now.
An analysis of the case shows that the woman had been referred to Srinagar, in violation of an SOP which was issued by the director health services Kashmir the same day.
The fresh SOP (No DHSK/COVID-19/1150-74) regarding treatment of pregnant women in different districts, notifies the hospitals where they should be admitted to, in case of emergency.
In case of expecting mothers from Anantnag, the SOP says, the patients shall be admitted to sub-district hospital Bijbehara, which is hardly five km from the MCH Anantnag.
Asked why the hospital did not follow the SOP, the medical superintendent of MCH, Dr Mirji Andrabi claimed the protocol was issued a day later. However, the copy of the SOP mentions the date as April 1, the same day the patient was received at the hospital.
Chief medical officer of Anantnag, Dr Mukhtar Ahmad, who is the administrator of Shangus and Achabal hospitals, said it took them “some time” to prepare the SDH at Bijbehara before admitting pregnant woman, after the SOP was issued. But he acknowledged the patient could have been treated at the district level.
A senior doctor from south Kashmir said the SOP for pregnant women has been changed at least thrice since the COVID-19 lockdown begun in March, which in turn has added to the confusion among patients and doctors.
Dr Rifat, head of gynaecology department at Bemina hospital questioned the SOP designating particular hospitals for managing COVID-19 patients. She said every hospital should have a facility for managing coronavirus cases.
A clause in the May 1 SOP, however, makes it clear that a pregnant woman should not be denied admission and treatment on the pretext of non-availability of the COVID-19 report.
“In charges of the respective institutions shall ensure handling of the delivery of patients from red zones in a manner that service shall not be delayed in view of non-availability of COVID-19 test report,” reads the SOP.
Shortly after discovering that his wife was COVID-19 positive, a call from the LD hospital admissions section left him stunned. “The doctors had prepared to discharge my wife and asked me to hurry up and leave for Anantnag. I tried to make them understand that my wife is not in a position to stand up or walk, but they wouldn’t listen,” he said.
“My sister-in-law had taken our child for check-up, but she too was rushed out to the ambulance which was waiting in the hospital premises. They didn’t even let me collect the blankets and utensils which I had got from home. We were discharged less than two hours after my wife’s delivery. We can’t even imagine what she must have gone through,” he said.
While in the hospital, Mubashir said he was not provided any protective gear as he attended to his COVID-19 positive wife. Since May 2, the woman, along with her child is admitted at the Trauma Hospital at Bijbehara, another newly designated COVID-19 facility. But there too, Mubashir said, he has not been given any protective gear.
Dr Ghulam Jeelani, nodal officer of COVID-19 management in Anantnag, said Mubashir has been refusing to leave the hospital and wants to be by the side of his wife and child.
Asked what the hospital has done to ensure Mubashir or his newborn child did not contract the infection, Dr Jeelani said Mubashir can have “as much protective gear as he wants.” “We have given a mask to the patient as well. She doesn’t need any protective gear,” the doctor said.
*Mubashir’s name has been changed on request.