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JAB OF DEATH?
By Kumudini Hettiarachchi
Dead at 22. Baby Bimsara, just 54 days old, in a country that boasts of having a maternal mortality rate equal to Britain – 50 deaths per 100,000 deliveries -- is motherless.

A healthy young woman in the prime of her life with no major illnesses has a baby through a caesarean section and just over six weeks later is dead. The funeral of pretty and versatile Shiromi Kumari who died last Sunday, August 7, was on Wednesday at Pahala Bomiriya in Kaduwela, with grief-stricken relatives and friends still in shock.

Was it a death in isolation? Unfortunately not………. another young woman from Ganemulla is also dead while four more mothers are engaged in a grim battle with death at the Institute of Neurology, Colombo National Hospital. Five of the mothers had undergone C-sections at the De Soysa Hospital for Women and the other at the Castle Street Women’s Hospital. The cause is widely believed to be meningitis, with the germs entering the patients’ bodies when they were given spinal anaesthesia for the caesarean operation. (See box)
June 22, for Shiromi and her family was a special day. In addition to getting their brand new baby, Shiromi was overjoyed – where earlier the scans had indicated that it would be a girl, the baby turned out to be a boy, what she had longed for in her heart of hearts.

“It was an operation. But she was conscious throughout the whole thing,” says husband Upendra Indrajith (30), adding that Shiromi “took bad” on June 20 and they rushed her to the De Soysa Hospital, with the already-packed suitcase full of nappies, little pillowcases and sheets that mother and grandmother so lovingly collected.

The baby was born at 6 in the evening of June 22. And Bimsara Bhashitha Nethmanika was Shiromi’s choice of name for the beautiful baby boy whom she held close all the time. Though suffering from a headache on and off, fever and also back pain, Shiromi, assuming it was “normal” after a caesar went home on June 25. She had been told to come back on June 28 to get the stitches cut and they dutifully returned and even complained that she was suffering from “oluwe kekkuma, konde kekkuma and una”. But nothing was wrong with the cut or the stitches.

Enjoying being with the baby, many were the times Shiromi told her mother that the handahana indicated that the baby would grow up to be a bright boy, little realising that he would have to do so without the tender care and guidance of his mother. She believed she was destined to teach him, for she too was a talented woman. Fluent in all three languages, Sinhala, Tamil and English, she was not only a daham pasal teacher but had also passed the public service examination for clerks and was computer savvy, securing a job in the internal audit section of the Samurdhi Authority.

Not satisfied with her qualifications she had also entered the Sri Jayewardenepura University where she was a second-year undergrad in arts. An all-rounder she was a good singer and could play the serpina. It was a year ago, on July 22, that she tied the knot with Upendra, working as a Samurdhi Development Officer.

Whereas July 2004 was ecstatic, this July brought only sorrow, heartache and loneliness. For the threesome, Upendra, Shiromi and Bimsara, July 2 dawned like any other day in a home where there is an infant. The baby’s routine of sleeping and feeding taking priority over all else. But that morning Shiromi couldn’t raise her head. She was suffering from a severe headache and ran a fever of 102 F. “Her spine was hurting and she couldn’t move her neck,” says Upendra who rushed her to a private hospital where they suspected that “a germ had gone into her brain”. They advised them either to enter that hospital or if they couldn’t afford it to go back to De Soysa Hospital, where she had delivered the baby. Both mother and baby son were then admitted back there.
From then started their agony of tests including spinal taps, more tests, uncertainty and finally the transfer to the Institute of Neurology, with Shiromi’s condition see-sawing, sometimes giving hope to her loved ones and then dashing them to bits.

All the while, parents, in-laws and husband were in and out of hospital taking the food she liked to eat and coaxing her to take nutrition to fight off the infection. One day she wanted cake. “She loved chocolate cake,” says Upendra.

July 30, had seemed a turning point for Shiromi. When they went to see her, she had been given a bath and her lovely long tresses were loose. “Before that she was walking and talking,” says mother D.H. Swarnalatha, looking at the tiny babe sleeping near her on the bed and smiling in his dreams. Swarnalatha is numb with shock and the tears come slowly at this unfathomable cruelty dealt to their family.

On the evening of July 31, however Shiromi was screaming in pain. “She wanted me to hold the back of her head and press hard, saying that it gave her relief,” weeps Chathurika, a childhood friend, adding, “We were together from Grade 3.”

That evening she was taken to the ICU and it broke her heart, for she had to let go her baby. “She wouldn’t allow us to take the baby. But after much persuasion she promised that she would get well soon and come home. She hugged him and kissed his tiny feet and begged me to look after him,” says Swarnalatha.

“Keep the baby close and let him feel your warmth,” she had urged her husband many times. The family ticks off the days on the calendar sadly. August 1 was the last they were able to feed her anything. Her father fed her a couple of string-hoppers and she swallowed with difficulty and her husband made her sip some milk tea. After that tubes kept her alive.

Appeals to people in high places and bodhi poojas at various temples were her frantic family’s answers to her deteriorating condition. Nool bandinna thenak thibbe ne, chokes father J.D. Chandrasiri Piyadasa.

The last time she was able to mumble a query was on August 4, when with much difficulty she held Upendra’s hand tightly and inquired after the baby. On August 7, Shiromi was dead.

It is up to the health authorities to take urgent action on a priority basis, on this life and death issue that has reached a critical point, before another mother succumbs to a deadly germ, that the hospitals are infecting healthy women with.

Death due to fungal meningitis
All medical supplies used for spinal anaesthesia such as needles, syringes and the anaesthetic in recent times, have been removed from the shelves of all government hospitals forthwith, assured Director-General of Health Services Dr. Athula Kahandaliyanage explaining that the common thread in all six cases seems to be that the mothers have been given a spinal anaesthetic before the caesarean section.

He emphasises that all possible investigations are being conducted to identify the source of the infection that is believed to be fungal meningitis. A decision has also been taken to minimise the administering of spinal anaesthetics. “We can’t take a chance.”

The six mothers were alright after the caesarean operations and most went home but were readmitted with the infection, The Sunday Times learns.
“The post-mortems on the two dead mothers have confirmed they died of a fungal infection leading to meningitis. We don’t know where the fungus came from and we are doing everything possible to locate the infection,” says the DG.

International and national agencies such as the Communicable Diseases Centre in Atlanta and the Medical Research Institute (MRI) have been mobilised to come up with answers, other health sources said. “Medical stocks sent as tsunami relief are in circulation but there has been no confirmation yet that they are the culprits. Samples from each batch are being checked.”
Spinal anaesthesia is the common trend in caesarean sections and considered safer than general anaesthesia. Under spinal anaesthesia, the mother is conscious and the side-effects on both the mother and the baby are minimal, it is understood.

Meanwhile, the DG said that a meeting was held at the De Soysa Hospital on Wednesday chaired by Health Minister Nimal Siripala de Silva and attended by consultants from De Soysa, Castle Street and also the National Hospitals along with officials of the CEB and CECB to take some conclusive action against this threat.

The decisions were:

Closure of the operating theatre of De Soysa Hospital as of Wednesday as there is an extensive leak from the toilets on the upper floor and fungus has formed on the wall of the theatre.

Routine operations at this hospital to be postponed while there will be only minimal admissions.

Stoppage of transfer of patients from other hospitals. Castle Street, Ragama and Kalubowila will take the patients, the DG said.

The old theatre of De Soysa Hospital to be repaired.

The National Hospital to loan a theatre for De Soysa Hospital operations.

The new seven-storey building being constructed at De Soysa Hospital to accommodate the theatre and ICU on the upper five floors, with the first two floors being earmarked for the premature baby unit.

The State Pharmaceutical Corporation to replace all essential drugs being taken off the shelf.

“There is no conclusive evidence of contamination to point a finger at the donations of tsunami medical stocks,” says the DG stressing that there has absolutely been no negligence on the part of the staff at these hospitals. “They have performed their duties well and continue to do so. This is purely accidental.”

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