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{
"id": 48274,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/48274/?format=api",
"text_counter": 126,
"type": "speech",
"speaker_name": "Prof. Anyang-Nyongâo",
"speaker_title": "The Minister for Medical Services",
"speaker": {
"id": 193,
"legal_name": "Peter Anyang' Nyong'o",
"slug": "peter-nyongo"
},
"content": " Mr. Speaker, Sir, I beg to reply. (a) Shanu Diba Guyo was received at North Horr Health Centre on 3rd April this year at 9.00 a.m. By then, she had laboured at home for two days. She had poor maternal effort and even after administration of medication, there was no improvement. She was then transferred to Marsabit District Hospital where she arrived at 12.00 a.m. the following day. The relatives had hired a vehicle and driven for 15 hours. At Marsabit District Hospital, the admitting doctor made a diagnosis of obstructive labour for a first time pregnancy with severe anaemia. He tried to carry out vacuum extraction and when it failed, he referred the patient to Isiolo District Hospital for a caesarian section. The operation could not be done at Marsabit District Hospital because the hospital had no blood and the patient was severely anaemic. She was transferred to Isiolo in a private car as the hospital lacked an ambulance. The patient arrived at the Isiolo District Hospital at 8.30 a.m. escorted by a relative. She was semi-conscious, pale and with signs of respiratory distress. Her blood pressure was very low. The doctor ordered for preparation of blood for transfusion and, in the meantime, put her on Intravenous (IV) fluids. At 9.00 a.m. or 10.00 a.m., unfortunately, the patient started gasping. Resuscitation was attempted without success and the patient passed on. Relatives were informed and they opted to take the body home. The exact cause of death cannot be conclusively determined, as a postmortem was not carried out. It is true that Marsabit District Hospital did not have blood. However, Shanuâs death cannot be directly linked to lack of blood as her condition had seriously deteriorated by the time she arrived at the hospital. Much more important is the fact that she had laboured for too long at home and her obstructed labour was not diagnosed early enough to inform early referral. She was also referred to a very long distant facility through rough terrain for over 15 kilometers. In the case of Rukia Galgalo, who similarly originated from North Horr, she was admitted at Marsabit District Hospital on 15th March, 2011 at 1.15 p.m. She was diagnosed with premature labour with clinical malaria. She was immediately put on medication. The doctor who reviewed her in the ward confirmed the premature labour, but could not get the foetal heart. Rukia delivered a fresh still-birth the following day at 8.30 a.m. She developed post-partum hemorrhage and attempts to control the bleeding failed. She was transfused one unit of blood which was donated by the husband after grouping and cross-matching. However, the bleeding continued. Since there was no blood at the hospital, AMREF was consulted and they responded well. At 2.00 p.m., they arrived at the hospital with two units of blood which were transfused before the patient was airlifted to Kenyatta National Hospital (KNH). At KNH, the patient was received at 6.30 p.m. in the evening. She was in a coma and the doctors made an impression of severe hemodynamic shock, secondary to severe post-partum hemorrhage. Resuscitation measures were instituted but the condition of the patient deteriorated and she died at 7.45 p.m. It is noteworthy that although there was no blood at Marsabit District Hospital, efforts were made to obtain it and she was transfused with three units. (b) As it was the case with Shanu Diba, it is likely that events prior to her arrival at Marsabit Hospital played a large role in contributing to her death. Shanu Guyo was not accompanied by a nurse on the journey from Marsabit District Hospital to Isiolo District Hospital as it is required professionally. That is because the private vehicle used was inappropriate for a nurse to provide emergency support. A nurse can only add value to the referral process if she has access to the tools of work found in a proper ambulance. Besides the lack of tools, nurses express concerns about possibilities of compensation in case private vehicles are involved in accidents. (c) The Ministry is taking the following measures to improve blood transfusion, anaesthesia and patient referral services at Marsabit District Hospital. One, the Ministry plans to initiate blood donation campaigns in Marsabit from July this year. From this time, the hospital will be supplied with screening kits to ensure that only safe blood is transfused. This will enable the hospital to maintain a buffer stock of blood to ease demand. However, a public education component will be necessary as a previous attempt by the hospital to obtain blood donations faced resistance from the catchment population. Secondly, there is already an anaesthetist deployed at Marsabit District Hospital. However, the Ministry will endeavour to identify a second one from among those who are presently pursuing training. That will ensure that an anesthetist is available at the hospital always. However, the situation is not grave as doctors are also trained to perform operations under spinal anaesthesia. (c) Thirdly and finally, the Ministry will give priority to Marsabit District Hospital for the supply of a new four-wheel ambulance in the 2011/2012 Financial Year, possibly a Toyota Land Cruiser or a Land Rover, which will be determined to be an ideal vehicle for the local terrain. Let me add that, although the hospital was allocated a four- wheel ambulance in 2007, unfortunately, it could not cope with the terrain and it is now unserviceable. Regarding ambulances, we are working on a national programme to have a National Ambulatory and Emergency Services which will be managed by GPS. We will no longer have to station ambulances in particular places. They will be available in regional centers to be mobilized for use within reach of facilities and individuals who need them. This will involve both publicly and privately owned ambulances. Thank you."
}