No ICU bed for Mishka

Friday, December 28, 2007

Mohamed Irfan Sharaf's story:

"I am now out on the streets, virtually begging to make ends meet." Sharaf said to us at the first meeting of MMW on Against Abuse web community on 25th December 2007. None of us could see it, but sure as the sky above our heads, Sharaf had more than a tear running down his cheek!

Sharaf is the 2nd child born to middle class Male' family where both parents held clerical government jobs to provide for the 4 children and 2 grandmothers. His parents invested heavily, without having a laari to save for the future, in the education of all 4 siblings. They are what they are today thanks to their parents resourcefulness. Enough about Sharaf and his family, the story is actually about Sharaf's 2nd child, Mishka.

Mishka was born 2 months premature after a torrid 7 month pregnancy. She was born at IGMH and spend nearly 6 weeks in the hospital having fought terribly hard during the first 2 weeks of her life for survival. That experience gave us a lot of confidence in the new and upcoming health care providers at IGMH, hope that we were indeed in good hands and that we could expect things to finally take a turn for the better within the often negligence-riddled system.

Mishka was just less than 1.5 kg at birth and was so tiny that we were afraid to touch her, afraid that we may do her harm. Half an hour after her birth, Dr Abdulla Niyaf, the Paediatrician on duty that day briefed us on what had happened at birth, what he and his colleagues were planning to do and what we could expect within the next few hours and days. Apparently little Mishka was not able to initiate breathing on her own after birth and required assistance with breathing. Within a few minutes, she was breathing herself, but apparently not with enough of an effort to maintain good oxygen levels within her blood. She was admitted to the NICU and given mechanical breathing support.

We were already financially broke, having spent all our savings on the multiple hospital admissions for premature contractions and threatened miscarriage. Had it not been for financial support from a close friend, who we now take as a brother, we would have had to beg for money to support the daily cost of medicines for Mishka. Mishka did need very expensive medications during the first day of her life, 2 injections of surfactant had to be given into her airways each costing nearly MRf 2000.

There were times during the first 2 days when we though we would loose Mishka. We shed many a tear each time we saw her in the NICU. She was, we are sure, looked after very well but for us common people seeing several tubes coming in and out of the little baby was a sight that pained us greatly. It was a very mixed experience overall, some days we would be buoyed by the changes in her condition and the professionalism shown by the treating doctors, while on others we would struggle to talk to other doctors who were sharing the responsibility of caring for Mishka.

When Mishka was a week old, we were given a longer than usual briefing on her progress and plans for the next few days. She had stable breathing parameters and was apparently showing good effort of breathing. Dr Niyaf said that Mishka was needing only a little bit of assistance from the breathing machine. She was doing as well as they were expecting and that they hoped that Mishka would be able to come off respiratory support soon. Our prayers were answered.

The next day, Dr Niyaf and Dr Zumra gave us the happy news, Mishka was off the machine and doing very well. That was a relief. We had heard of terrible stories of medical misadventures at IGMH that we were terribly afraid that similar things could happen to our little Mishka. But Mishka was indeed in good hands. Even the foreign doctors with whom we had some tension were caring towards Mishka; Dr Balaji was himself, but a cauldron of knowledge. I know that it was a team effort, the key players just making sure that the team stayed focused. My wife fondly remembers a couple of Nurses who made her a part of the care-team. The cheerful chatter-box, Sheeza and the sweet smiling Jeba were her favorites.

We made it thorough the tough time, Mishka fighting for her life and winning the battle thanks to Allah and the efforts of a team, we learned to respect. We often complained during the last 3 weeks of our hospital stay, when Mishka played yo-yo with her weight. We were warned that this period would be long, we didn't expect it to be quite that long though.

Finally, we were given a 2.2kg and healthy Mishka to go home. We were in a hurry to go home that day and we forgot some very important things. We went back to IGMH the very next day and thanked Dr Niyaf, Dr Balaji, Dr Zumra and even Dr George; someone who would later break our hearts.

The IGMH experience, a largely good experience had cost us well in excess of MRf 50,000. We didn't have that kind of money. Letters from IGMH doctors helped secure financial assistance that helped pay most of the bill. We were happy, broke yes, but still happy. Even if we had to spend every laari ourselves, we would have, a child is worth whatever it takes!

That was the happy experience that Sharaf narrated to us before his face turned gloomy. We knew it was coming. We could see the dark clouds hidden behind the happy shimmer in his eyes.

Mishka had spent 6 months growing well and showing no signs of having been the tiny baby with several tubes coming in and out of her little body and attached to machinery to sustain her life. Her big brother was just getting used to having her around the house and getting over the jealousy sibling rivalry when we were hit by a lightening bolt.

Since discharge from hospital, we had made a terrible mistake. It wasn't easy to get an OPD appointment for our favorite doctors, the ones who gave us back a healthy Mishka. After the first 2 follow-up consultations one with Dr Niyaf and the other with Dr Balaji, we opted for "experience" and ease of getting an appointment. We consulted Dr George as advised on a monthly basis. With Mishka turning 6 months, we were scheduled to consult Dr George for the 5th time, when she had what we thought was a mild fever.

We didn't take any chances though, we took Mishka to IGMH and showed her to Dr George. Mishka was not herself that day, she didn't allow a good examination. We know Dr George struggled to see her properly. We were a bit concerned about how Mishka was breathing and mentioned it to Dr George. He dismissed our concerns rather off-handedly. We found that a bit odd, but thought that the doctor would know better.

Mishka was being given all 4 medications as advised, not a dose was missed. Her mother made sure of this. But something was not right with Mishka. She really wasn't breathing normally. It was the 3rd day of treatment and late in the evening. Mishka was breathing a bit heavily. Her cough had also become more chesty. The fever was gone though. We got an appointment to see Dr Vanitha at ADK.

Mishka was a bit restless in the doctors room and a thorough examination was not possible. The doctor said that she was having a severe form of cold and there was some "chest cold". She asked us to change the medications including the antibiotic we were prescribed before. She assured us that Mishka would get better soon.

That night was terrible for us. Mishka did sleep, perhaps because of the Phenergan that was prescribed for her. We stayed awake in shifts because Mishka tossed and turned a lot and slept fitfully.

Early morning the next day we went to IGMH and tried to see if we could meet Dr Niyaf, Dr Zumra or Dr Balaji, the very people who helped us before. It was Dr Niyaf's "off-day", Dr Zumra was busy in the NICU with a sick child and Dr Balaji was out of station. Just our luck. We saw Dr George in the corridor and requested him to see our Mishka as soon as possible. He asked us to sit outside room 37 and that he would be there shortly.

It was 9:30AM when we saw Dr George. He said that She needs admission for treatment and that he suspects that Mishka has a chest infection, he called it Pneumonia. By now Mishka was grunting and breathing terribly noisily. We were given a slip to get a chest x-ray, which would later show a large "pneumonic patch" and a "pneumothorax". After a look at the x-ray Dr George, still in room 37 said "it looks OK" but told us to get admitted anyway.

On the way to the admission desk, we met a family friend who was a close friend of Dr Razi. He took the x-ray from us and went to show it to Dr Razi, who was apparently in an OPD room too. Our friend would return to tell us that Dr Razi said it looked very bad and that he would recommend immediate admission.

We quickly got Mishka admitted. Dr Ismail Shafeeu was very helpful. He quickly started treatment. Mishka's condition was clearly critical. Dr Shafeeu had said that Mishka needs ICU care and that she may need mechanical support for breathing. It was a scary thought. We had already started making plans to take Mishka to Colombo as soon as possible. My brother was making all arrangements for that while we were in a new struggle for Mishka's life.

Sadly though, IGMH could not afford an ICU bed for little Mishka. It was full. All 8 beds in the "immense" ICU was full and not even one could be moved out. I saw how hard Dr Shafeeu and the junior staff tried to get a bed in ICU. But it just didn't happen.

Because of our experience when Mishka was in NICU, we were able to understand what the numbers on the monitor to which Misha was connected to meant. Her oxygen was way low, 85% at the best of times, with full oxygen by mask. She was agitated and very irritable. Preparations were already made by Dr Shafeeu to have a tube inserted into Mishka's chest to remove the "pneumothorax". Meanwhile my brother was able to get seats for us on Srilankan to Colombo to fly out in 4 hours. This new plan prompted the surgical team, who came to place the chest tube, to do what they called "needle drainage".

With Mishka struggling "needle drainage" was done in the treatment room. Mishka remained the same though. Dr Shafeeu wanted to have the chest drain in place for the air-travel but the surgical team though the needle drainage was sufficient. We didn't know what to think. It was beyond our comprehension. We were eager to get Mishka to an ICU; in Colombo if IGMH could not get one for us. She needed that. We needed to give that hope for her.

We flew out that day with Mishka hanging on to dear life, just so only. The 4o minutes or so travel time went off ok, Mishka didn't collapse that is. The nurse who accompanied us kept checking on Mishka every few minutes to see if anything extra needed to be done.

Our luck ran out on the ambulance ride from the airport to Apollo hospital. Mishka's breathing became ragged. She looked pale in the face, her hands were dusky and she was gasping for air. The doctor or male nurse on the ambulance worked frantically to assist Mishka to hold on till we reached Apollo Hospital. Mishka had fought hard.

We were shattered. Mishka was pronounced dead on arrival at the emergency room of Apollo Hospital. We couldn't believe it. I couldn't even cry, Mishka's mom fainted. Mishka, our lovely Mishka had left us and traveled to heaven.

Sharaf was sobbing now. He couldn't say anything more. The rest of us felt the pain and the anguish. We offered our support to Sharaf and pledged to fight on till things improve in our health care system.


Maldiveshealth said...

What a shame and so sad to hear this has happened. I feel for the parents.

Just becos of not being able to get an ICU bed? Shame.. Shame..

If i was the parent i would have gone to the limits to get an ICU bed for my child in a situation like that.If i had to i would have thrown out one person out of an ICU bed so that i can save my childs life.

Any way different people have different personalities.

although, i think it is high time that people who have been mistreated raise their voices in what ever way they can . Go to the radio stations and announce it.

It is high time that we made a BIG fuss about this. Cos this messy fuss is costing precious loved ones. OUr loved ones.

fizan said...

Incompetence, negligence and insufficiency resulted in this poor infant's death, not just the unavailability of ICUs. I am really sorry to read this and my heart goes out to the grieving parents.

And to the hospital... well, still living up to your derogatory nickname, you shameless bastards!

justiceleague said...

Well, is it just me or did I see a happy part in this story?

@fizan: those are some big words. Why not assign some names to them. Then it'd be more accurate. And also it maybe a good idea to read the good things that happened and comliment them.

My point: Give credit when good things happen. That should be there too!

justiceleague said...

It is sad to hear that the child passed away.

But I don't think that it is a reason to label the whole hospital as bad. After all, it was the same hospital that saved the baby's life 6 months before.

Dr.Didi said...

I am extremely saddened to read the above account. As an adult physician in the UK, our recommendation is that even for adults, they should not fly for at least 6 weeks after the resolution of spontaneous pneumothorax. I am bewildered that a little baby with a pneumothorax was allowed to fly out without a chest drain. On top of that, this baby also had pneumonia. I wonder what her arterial blood gases were. It would have been unwise to ventilate this baby with a persistent pneumothorax and the doctors should not have recommended her to be flown out without respiratory/ventilatory support plus chest drain.

I believe that Dr.Shafeeu was absolutely right to insist that the baby had a chest drain before flying out.

My sincere condolences to the family and prayers for little Mishka.

Anonymous said...

what is wrong with our system of health care is sad and frustrating, and perhaps will lead to more dissapointment and hurt.

I have had two encounters with the doctors in the IGMH, when one of my child was having a fever, not recently but it is unforgetable.

Don't know the name of the DOC, but she was a lady pedeatrician maybe you guys will know. I recall, we got the token number 8. By the time number 8 was diplayed, we went in to see that the DOC has gone for a meeting, because the minister had called her. Already waited for almost and hour and again had wait to for another hour and no sign of the DOC. I was furious about what was going on, had to shout at the guys at one of the counter.

Funny things is, finally when i went to speak with a Director General of IGMH, he offered me to take the 15 Rufiyaa that i had paid to see the doc in return for this unpredicted situation, Unfortunate or fortunate maybe, we did not see the doc, intead we went to a private clinic.

Next, is the encounter with an Indian DOC, this time i went to see Fathimath Ali Didi.

Since it is so common to get fever in Maldives, specially in Male, my kid was having a fever as usual. We were in the casualty, waited till the number appeared, went inside to see the DOC, just as we started explaining the problem, he got a phone call on his mobile. Started to chat on the mobile, which i clearly understod what he was saying. Also i saw the sign on the door regarding the prohibition of the use of Mobile inside the room. So we sat has he chatted, and so did his assistant.....bla blaa blaa

Finally went out since he was not gonna hangup. My wife went to the emergency, i had to shout at the doc, told him to f*** off, and even gave him a warning that he is gonna suffer in the Maldive kekek...was so frustrated

Oh, than he was threatning me cause i told him to f***-off, cudnt care less...
Next morning went to see ALi didi...told her everything and also told her that you cannot do a thing about this.....she did not say thing, felt like i was talking to myslef

By the way, the doc was talking about a computer...and he said it was an emergency, so had to take the call.

So tell me guys who is the first the patient,the minister, the meeting, the phone call or whatever......

Medical Investigator said...

Thank you Didi,

You and one other Maldivian doctor (someone who made the news in October for standing up for our rights) are the only people who have said that Dr Ismail Shafeeu was right.

We didn't know! We truly didn't know. We were desperate to do whatever we could for our child. To think that we may have contributed to our Mishkas' untimely death is unbearable.

You don't get over something like that; it just doesn't happen. We'll live with it for the rest of our lives.

We have received a lot of support from family and friends and we have just begun to move-on with our lives, because for our own sake we must.

I thank everyone for their support.


Anonymous said...

first of all let me say i am sorry for the loss to sharaf and his family.a life is never replaceable.i think you did all you can to save the life of mishka. i d like to say to maldiveshealth thats its not a solution to the problem to throw out a person in the ICU bed. what will you do if your child was the one on the bed and someone else threw. ICU beds are scarce anywhere in the world. even in developed countries.a lot of the general population do not understand the significance of the ICU bed. in our society few are willing to let go of the ICU bed even if their relative has no chance of ever leading a maningful life. sometimes prolonging the agony of the one u it is quite possible to have the ICU beds all full. today in the modern world of medicine you can find tonnes of literature on this

Anonymous said...

i know what i might say may not be comfortable for some. but isnt life finite? isnt it decided by someone else when someones time is up? sometimes seeing the things in newspapers makes me wonder if doctors are somehow at fault always if a patinet passes away in hospital.even in todays world there are processes that we dont understand. doctors follow the most probable treatment. isnt it hard to believe that its trial and error at best...some are better at solving than others no matter how well they were thought. more importnat is how information is conveyed to the families. making them a part of the decision making process might help in the wide gap between the providers and the beneficiaries.

Maldiveshealth said...

What is the solution then? You tell me and convince me of a solution and i will accept it.

Things are so bad that people and children are dying. At least nowadays we don't see the kind of experimentation being done on humans like a few years ago due to a bunch of determined professionals who are persistent in making things right.

Well to answer your question , some one has to go through my dead body to do something like that If my child had a chance of a decent life in the future by being in the ICU.

You are missing the point here. People who know me and my personality would know that i am not a person who would like to see such a day. But i will not side step from asking people to go to extreme radical lengths if it will help other children in the future. A better answer for you is this. If i had children, I will not side step from giving away a bed occupied by my child, cos my child would not be in an ICU bed for such a long time. If a child of mine had to be in a situation where it is better for her to go, i will willingly take her off a ventilator and ease her pain. Even if the treatment team and doctors and the laws say that will be killing, i would take her to a place where i could do it legally , so that my child will not go thro the suffering.

Call me a radical cos i am.

From the events described here , Mishka could have been saved. It is the negligence and incompetence of many people that she ended up at a stage where it was too late. I feel for the parents. But it is not a time to relent and let go and let this happen to another child. This whole fisco is due to a system which is letting us down. There is no way to make these people accountable. There is no way that anyone can say anything about a doctors decision because they are and they want to remain as mini gods, who know everything. That is not how things work these days. If a mistake has been done , it should be rectified and corrected and make sure that it never happens again. there is too less a coverage about these issues in the media. May me .. just may be that if someone kiks out another one from ICU due to no bed issue .. the issue will get some sort of media coverage. And coverage is what is needed in these things. If a life is lost due to mistreatment , negligence ... it has to be covered in media. BIG time.

This is not the first life that has been lost due to malpractice. There are so many such stories .

Yes i agree that ICU beds are scarce even in the developed world. But what is not scarce is that people who kill others gets a punishment.

Whether it is due to less staff or less quality equipment or no ICU beds.. in these other parts of the world you are talking about has other measures that can be taken so that unnecessary deaths do not occur. If an incident like this happened in a country of which u are talking about, the news would have been on the front page. The parents would have gone to each and every individual news group and media and radio station and made sure that justice had been done.

And justice will be done in the end in these parts of the world you are talking about.

Whose part and duty is it to inform the public of the importance of an ICU bed you are talking about.

Dont bullshit me on this.

Maldiveshealth said...
This comment has been removed by the author.
Maldiveshealth said...

I deleted a comment realising that it might hurt the parents. Not my intention tho. Sorry if they had seen it.

Desperate times will need desperate measures indeed.

I would like to ask a BIG doing from the parents. Could you please go to a radio station or to the news papers and tell the whole country your story. It will benefit many babies. Think about it.

And it will definitely help your grieving as well.

Anonymous said...

to the person who is talking about a trial and error. Mind you it is evidence based practice that is practiced nowadays. Not experimentation. Experimentation means u should go to jail. ok .

Anonymous said...

it is interesting to know that you have deleted some comments that could have hurt the parents..but did it occur to you that some of the other comments made here would have hurt the people who initally helped mishka live when she was born...
did you think that that those people would not have been hurt by this news takin into account the tremendous effort they have put for the baby's life accordin to the article.. should have more justice in deleting comments rather..
my condolences to the parents and family.

Anonymous said...

it is interesting to know that you have deleted some comments that could have hurt the parents..but did it occur to you that some of the other comments made here would have hurt the people who initally helped mishka live when she was born...
did you think that that those people would not have been hurt by this news takin into account the tremendous effort they have put for the baby's life accordin to the article.. should have more justice in deleting comments rather..
my condolences to the parents and family.

Maldiveshealth said...

i have no remorse for killers.

justiceleague said...

Are you saying the doctors in IGMH "deliberately" killed the baby or it was due to negligence?

There is a difference. Accusing them of being killers seem to imply they [the doctors] didn't care deliberately.

So which is it? Deliberate or Negligence?

Anonymous said...

The likes of Firdous are killing. Arent they?

Yafaau's daddy said...

Like everyone here, I too am sorry for the loss to Sharaf and his family. I understand how sharaf may have gone through all these. May Allah bless Mishka and her brave family.

I'd like to say this is a great work by your team. keep it up.

btw, pls do investigate well b4 publishing. I too, do not want to loose my trust on you ppl.

Anonymous said...

if you couldnt decide that doctors had deliberately killed the baby then why dont u treat yourself suckers!!am sure you would save a lot of their time!!!

Anonymous said...

y dont u ppl get together and build a hospital urself to c how it works..whether u can work n come over all the problems in igmh. instead of shouting at others y dont u do it. if throwing bad names at ppl and places u can get a so-called "perfect health care system", then u know by now its impossible. so go out there n build one n run it..mind u, remember to make it v different from igmh

Anonymous said...

how ungrateful people can b...when mishka was nearly was the same doctors n nurses whose ENORMOUS effort is not being talked abt here. Or will u say it was just Mishaka's luck n not the doctors n nurses involved?
May Allah bless Mishka's soul.Amen

Anonymous said...

People should stop going to IGMH for treatment.Instead, it would be much wiser to go abroad.People at IGMH are of no use whatsoever.They should close down the place with a big lock and throw the key away.WOW.What a relief that would be.

Anonymous said...

see, you need to understand one basic thing.if you want to create sensation among people to make your blog more popular, you can add on such tihngs against doctors and medical system superfloously.
have you ever worked one day in ICU?do you know the bed to patient ratio?whats the doctor patient ratio there?
understand fools that Drs are also Human beings......they are not gods!!death is a natural not give a different vehement perspective to a natural event to make your blog popular!!
its very tiring to go thro your blog......this dr did that that dr did this.......
enough man!!if you are really intrested in improvinmg the medical system make up a board and scrutiny the certificates of drs and then give them a job!!can u urge the government to do that?
you yourself start a medical college and produce your own DRs for your island!!
i am sure that if you keep on doing this nonsense the morale of Drs will go down and quality of healthcare will further go down thanks to your effort
i agree that there are some errors here and there.but such a blog will give a very bad pic abt the island to anybody who sees this blog