One Act of Negligence After the Other, Lies Upon Lies!
Last Wednesday night, Maldives recorded the death of the first child to the grips of Covid19. Even though the statement “This is the 170th COVID-19 death in the Maldives” was meant for statistics, the passing of Fathimath Mishka Mohamed hurt the whole nation as bits and pieces of the incident started exposing multiple problems in the system that is supposably handling the pandemic situation in the country.
Triggered by the uncoordinated series of events that could have evidently been handled better, followed by public criticism and calls for actions by many who voiced their concern, Ministry of Health announced a thorough investigation of the case.
The final review was released on Friday night, and the investigation proved failure to comply with set guidelines at almost each and every stage since Mishka was declared as a positive case.
It goes like this.
On May 28, 2021, Mishka’s sample was taken because she had developed symptoms of Covid19. The sample was tested on the following day, and the result came back as positive. On May 30, the contact tracing team had duly informed Mishka’s parent about her results and inquired whether a doctor’s consultation was desired by the family. Since Mishka is a special child, her parent requested for the service and even though the request was recorded on an information sheet by the contact tracing team, the request never went through – Negligence 1.
According to the guidelines, information recorded by the contact tracing team on the said sheets must be uploaded to an Outbreak System. It was not updated – Negligence 2.
The guidelines also state that all children under the age of 15 who test positive for Covid19 must be checked up on by the children’s care cluster. No calls were made to Mishka’s parents in the two days that passed prior to the incident of her death – Negligence 3.
In the afternoon of May 31, at 2.20 p.m., Mishka’s parent had called the call center to inform of Mishka’s degenerating health condition. She could not eat, was coughing, had high fever and was experiencing fatigue. The call was updated to the OB system and a ticket was raised within 4 minutes of the call, and updated on the information sheet 3 minutes later. Mishka’s parent received a call from a DMRT doctor an hour and a half later for a general consultation. She was advised to continue ongoing medication and to call back if the condition did not get any better.
That night, at 9.06 p.m., Mishka’s parent called the call center requesting to be urgently connected with a doctor. Mishka was having breathing difficulties and was now shivering too. 4 minutes in, a ticket was raised on the OB system and a ticket raised, and the call center information sheet was updated 5 minutes later. 37 minutes later, at 9.53 p.m., a doctor form the DMRT called Mishka’s parents but the call was not answered. However, it was updated as ‘attended’ on the information sheet – Negligence 4. Isn’t this a lie?
Having missed the doctor’s call, Mishka’s parent called back to the call center at 10.06 p.m. They shared the same urgent concern as before. A ticket was raised on the OB system immediately by the call center, and the information sheet was updated 6 minutes later. At 10.33 p.m., a DMRT doctor called back. Documented notes by the doctor read that Mishka’s parent detailed her condition as follows:
- Difficulty in breathing for one day
- Dry cough for six days
- Continuous fever for six days
- She was a special child who was taking therapy, and hence was not able to express her difficulties due to the sickness by herself
- Not on permanent medications of any sort
Doctor shared the information with the CMAT. Both the DMRT and CMAT have the authority to activate an ambulance response but, even though it was repeatedly told by Mishka’s parent that she has breathing difficulties, no ambulance was sent her way – Negligence 5.
More than 45 after the doctor's call, Mishka’s parent called the call center 5 times between 11.16 p.m. to 11.33 p.m. because their options were running thin in helping Mishka whose condition was worsening with every passing minute. Her parent had told the attendant that Mishka had fallen unconscious and was bleeding from her nose as well. They repeatedly inquired about the ambulance which they were told was being sent and asked for reasons of its delay. There was no record of an ambulance activation during this time – Negligence 6. Big fat lies.
Another 10 minutes later, a person from Mishka’s family went to HEOC and informed about the delays in getting an ambulance. At 11.32 p.m., the facility management team alerted EMS on the request for an ambulance and by 11.38 p.m., the ambulance was at the door at Mishka’s house. By the time they arrived, Mishka was completely unconscious and immediate CPR was initiated. Within the next four minutes, she was taken to the IGMH ER.
During the investigation of the case, MOH collected information from Medical Response Team, Clinical Management and Advisory Team, and Emergency Medical Services. All these teams are clusters formed at the Health Emergency Operation Center, intended to smoothly carry out the coordinated functions of managing the pandemic.
MOH concluded several incidents as negligence based on their review. The delay of the ambulance trigger coming 2 hours and 26 minutes after the initial call, the case not being attended to as an emergency case despite being repeatedly informed of the child’s worsening conditions – these are all events that if had been attended to accordingly, could have possibly saved Mishka’s life. MOH has said that appropriate action will be taken against everyone responsible for the negligence in this case.
It took 10 minutes for the ambulance to reach her house and take her to the ER. This is not the first patient whose death raised alarming concerns since the onset of the pandemic. A number of people have on many occasions reported delays, misinformation and obvious negligence by authorities in attending to patients, pandemic or otherwise.
It has been over a year and notable progresses have been made in preparing to combat the virus spread but who is going to answer to the piles of rubbish that is being swept under the rug?