::: Star Weekend Magazine :::

Special Feature

Accident or
Negligence?

Hana Shams Ahmed

Baby Afia

When Shafiqul Islam admitted his sick baby girl to one of the best cardiac hospitals in Bangladesh he was somewhat relieved. He thought that if his baby who had a congenital heart problem had any chance of survival it would be at this hospital. And he was right. Lt. Col. Dr. Nurunnahar Fatema, the clinical and interventional child cardiac specialist who did a septostomy at Labaid Cardiac Hospital on 45-day-old Afia spent four hours at the operation theatre and the operation was a success. But Afia's operation was done at the very last moment. Another day longer would have taken her life. But her troubles had begun much earlier.

Baby Afia was born on November 10, 2007. From the very beginning it was obvious that there was something wrong with her. Her blood was very low on haemoglobin and she would turn blue when she cried. Shafiqul and Saira Islam, Afia's parents, were asked to do an echocardiogram. First she was taken to Modern Diagnostics where an echocardiogram carried out on December 3, 2007 revealed that everything was normal. But that was a wrong inference and delayed her treatment and put her in further danger. Another echocardiogram was carried out at Labaid Cardiac Hospital on December 19 which revealed that Afia had cyanotic congenital heart disease. This is when there is a problem with the heart and there is not enough oxygen being circulated around the body in the blood. The circuits running from the heart are not connected which means the blood and oxygen just goes around the first circuit from the lungs to the heart and the 'used' blood in the second circuit just keeps being pumped out from the heart back around the body. Normally a baby with this can survive for a few days after birth because of a small hole that connects the upper halves of the heart.

Afia was asked to undergo an endovascular atrial septostomy where a catheter is passed into the heart to make the hole bigger so that it doesn't close up completely. The aim of the procedure is to help the patient live long enough to have major surgery to correct the problem.

The baby had contracted pneumonia and had the operation been carried out a day later she wouldn't have survived. After the operation on December 25, baby Afia was moved to Labaid Specialised Hospital where she was kept at the Neonatal Intensive Care Unit (NICU) where she had to be kept under a ventilator machine all the time because of her pneumonia. "She looked fine after the completion of the operation,” says Shafiqul who has another six-year-old daughter, “we could see that circulation had been restored in her body, colour had come back to her face.”

But Shafiqul knew that this was just the beginning of the journey. This was just a temporary solution. Afia would have to undergo another surgery and he decided to do it India. “I had prepared our passports and all the necessary paperwork was done.”

Things took a turn for the worse, two days after the operation was completed. According to Shafiqul Islam, on the 27th the ventilator machine at the NICU stopped working. “I saw the doctors and nurses rushing in with two oxygen cylinders and were trying to pump oxygen to my daughter with that,” says Shafiqul, “when I wanted to know what was going on, they asked me to leave the room. I was asked by the hospital authorities to immediately shift Afia to another hospital with a ventilator machine. I went to two hospitals where I was turned away because their ventilator machines were not available. Finally I found it in Salahuddin Hospital where I spoke to Dr Salahuddin himself who asked me to immediately bring my baby daughter to the hospital.”

According to Shafiqul when he arrived at Labaid to take his baby to Salahuddin Hospital he was further delayed by the authorities for his bill payment. When they finally arrived at Salahuddin in a Labaid ambulance the doctors declared that 47-day-old baby Afia was already dead.

Maj. Dr AKM Mahbubul Hoque, Co-ordinator of Labaid Specialised Hospital when contacted about these allegations denied the charges of the breakdown of the ventilator machines and said, “we have lakhs of taka due from many different patients. We would never stop a release of a patient for as low as seven thousand takas.” On the first charge the question then remains as to why the baby being so vulnerable was asked by the authorities to be shifted to another hospital. It also conflicts with another statement made by the hospital authorities which was reported by the Daily Samakal. On the December 28 this daily reported that the protocol and management officer of Labaid Group 'admitted that there was a problem with their oxygen support system.'

On December 30 Shafiqul Islam booked a hall for a press conference at the Dhaka Reporters Unity (DRU) for January 1. On December 31 he was called and informed that his press conference had been cancelled. On January 1 when Shafiqul's family came to the DRU premises and started talking to several media representatives, they were stopped by the police with some DRU representatives. Later the DRU issued an apology letter signed by the general secretary Ilyas Khan saying the president, Alamgir Hossain, ordered the cancellation of the press conference on December 31 at the request of senior journalist. The letter said that the incident seriously damaged the image of the DRU. Shafiqul alleged that another member of the DRU, Madhushudan Mondol also acting president of the Crime Reporters Association of Bangladesh (CRAB), called in the police when he was speaking to the journalists there.

Only the parents of a child know what it's like to lose a baby. Little Afia's life was fraught with negligence from the very beginning. If the first echo cardiogram had been done correctly the septostomy could have been done at least two weeks earlier. After the patient Afia in her fragile situation needed uninterrupted oxygen which any hospital NICU should be capable of supplying. “We tried our very best to save our baby. The doctor did her best and was successful. We put her in the best hospital, we were ready to pay the expenses for an operation abroad. Everything was set. She could have died during the operation but she didn't. Maybe she would have died anyway. But it's difficult for us to accept her death in this way,” says Shafiqul, “I did not file a case because I didn't want my baby girl's body mutilated in the process of the autopsy. And what would be the point of filing a case? I don't want any compensation. I don't want any money in exchange for my baby's life. My only point of going public about this case was so that this does not happen to any other baby's parents again. I'm just the father. Think about the mother who kept her in her womb for nine long months and then fed her milk for more than one month. No one can compensate for the pain she is going through.”