For patients' sake, crack the whip on quacks

Five years ago, the country was subjected to the horror of a quack purporting to be a gynaecologist, sexually assaulting his patients as they sought care in his unregistered clinic.

Dozens of women had undergone untold suffering under the beastly actions of Mugo wa Wairimu before he was finally brought to justice.

This exposed the huge weakness in the regulation of health care in the country. Policing health services is one of the toughest jobs the world over. Even in the strictest countries, some really bad apples fall through the cracks.

For instance, last year, Dr Javaid Perwaiz, a Virginia gynaecologist, was found guilty of performing unnecessary surgeries on women and filing fraudulent claims. He faces up to 465 years in jail.

As health workers, we come face to face with grossly mismanaged patients in our practice, but the efficiency of holding the perpetrators is wanting, giving them a reason to get away. We are so caught up in trying to save the life of the patient that the administrative process of holding these quacks to account is neglected.

Hurriedly woken up

In 2009, while covering the graveyard shift in the operating theatre of a busy referral maternity hospital, the labour ward nurse wheeled in a mother through the swing doors. She was devastated by what the poor woman had gone through.

Alice* sat on the wheelchair, her eyes glazed with pain, her lips ash gray and cracked, expressionless. She had spent the last 17 hours in actual hell.

Alice had presented to a private hospital in her neighbourhood. The hospital was a franchise of a low-cost hospital that specialised in maternity services in the slums.

The hospitals had no surgical services and had to refer complicated patients for care to us. They had a dozen notoriously flashy ambulances that we had come to dread because every time they pulled up in our ambulance bay, we expected trouble.
This night was no different.

Alice was accompanied by a nurse and a clinical officer in the ambulance. Her distraught husband was hurriedly woken up and asked to come straight to the hospital as Alice required referral. Her referral note read that she had prolonged labour and had been referred for surgery.

While Alice was hurriedly admitted and reviewed by the doctor in the labour ward, the husband was silently weeping, clutching on to a polythene bag tightly to his chest. While Alice was being prepared for surgery, the husband finally calmed down enough to tell the nurse he was carrying the right arm of his unborn child in the bag.

The mother had come in labour but her baby was in transverse lie; a condition where the baby lies across in the womb, with shoulder and back covering the lower end of the uterus and the cervix.

As the head is not coming first, it is impossible for the baby to be delivered vaginally. This can further complicate when the waters break and the cervix is open and the baby’s arm and umbilical cord fall through, greatly increasing the risk of death to the baby.

In Alice’s case, every single thing that could possibly go wrong had gone wrong. The little one was no more. The care givers at the primary hospital had no idea what a transverse lie was, or else they would have referred Alice at least 12 hours earlier. They did not have the technical know-how to diagnose the condition or manage it and they ended up doing great harm to both mother and baby.

The poor woman endured hours of agony as they attempted to pull the baby out in all manner of crude ways until they eventually dislodged the baby’s arm. The poor baby boy died a most painful death before he ever saw the world. Through all this, Alice was having contractions augmented by an intravenous oxytocin drip. She was beyond pain. Her mind had shut down as seen through the hollow bottomless pits that were her eyes.

Plucking uteruses

Within minutes, Alice was on the operating table and was blissfully put out of her misery by the general anaesthesia. Extracting a baby in transverse lie from a uterus that had undergone hours of abuse was no mean feat.

We were anticipating torrential bleeding and gross infection at the very least. She had two intravenous cannulae running warm fluids into her body and we were silently praying for the urine bag to start filling up, signaling that her poor kidneys were still functional.

I will never be able to forget Alice. Sometimes I see her bruised womb and the still little one lying in there quietly, his first grave. It breaks my heart all over again. How many Alices never get salvaged? How many have we buried because of quack and inexperienced people?

How many Dr Javaids sit behind their hardwood desks in their fancy air-conditioned offices paid for by proceeds of plucking uteruses that were causing no harm? When does it stop?

Supporting our regulatory authorities to stamp out these criminals preying on the vulnerability of patients should be a priority to us all.