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PUMWANI MATERNITY HOSPITAL BACKGROUND
Pumwani Maternity Hospital is a referral maternity hospital located on the East of Nairobi City.
The hospital has a vision to be an autonomous, efficient maternity hospital where all mothers receive comprehensive essential maternity care.
This was to be achieved through a mission to provide leadership in maternity services, training and development of clinical and nursing services.
The Hospital was founded in 1926 by a Charitable Organization called Lady Grigg Welfare League and was named after the founder- Lady Grigg Maternity.
In 1928 the first permanent building was put up at the Hospital and later some extensions were made to give the Hospital a bed capacity of 27.
In 1944 the Hospital was taken over by the Municipal Council of Nairobi.
The Pumwani Maternity Hospital is a pioneer Health Facility in the provision of maternity care in Sub-Saharan Africa.
The name a�?Pumwania�? is derived from the Swahili word to a�?breathea�? or a�?relaxa�? which is befitting the delivery process.
Under the management of the Municipality, the hospital services grew rapidly with a bed capacity nearly tripling from 27 to 75 while during the same period deliveries grew from 3,000 to 8,000 annually.
The old building that comprised the initial Maternity Wing was converted into a School Of Midwifery Studies and a Nurses Hostel.
In 1969, the late president Mzee Jomo Kenyatta presided over the official opening of a newly expended unit of the hospital.
During the inception of the hospital, the new block comprised 117 beds, an operating Theatre and a modern 50 bed Capacity unit for Neonates, an X-ray Department, a Laboratory, a Library and a Conference Room.
Today, it is an Obstetric and Referral Hospital for delivery of expectant mothers in Nairobi and surrounding districts.
It has 354 Obstetric beds, 144 baby cots and 2 Theatres.
Daily normal deliveries are 50 a�� 100, and Caesarean Sections are 15-22.
The hospital falls under the jurisdiction of the City County of Nairobi, Nonetheless, Pumwani Maternity Board, which is appointed by the Governor, oversees its operation.
To date the hospital remains the largest maternity hospital in the country and Sub-Saharan Africa.
It is equivalent to a Level 5 Hospital in status and is reported to be the third busiest Maternity Hospital on the African continent.
The Hospital is headed by the Medical Superintendent Officer of Health assisted by the Matron and the Hospital Secretary.
TRAINING
The Hospital provides trainings services for Nurses in Midwifery and General Nursing Courses. There is also an upcoming ICU and a third theatre for the Hospital.
STAFFING
Statistics show that the Hospital has 186 nurses against the possible 427 nurses in accordance with WHO ratio and this leaves a variance of 244 nurses. This demonstrates that the hospital is understaffed which leads to their challenges to manage patients/clients according to the laid down standards by the Nursing Council of Kenya, International Council of Nurses and the World Health Organisation.
UNION INVOLVEMENT
The Kenya National Union of Nurses Nairobi Branch came into the matter after one of the Nurses who was on day duty on 8th January, 2015 called the union to report an incident which occurred in the Hospital where twins were delivered macerated but the relatives/parents purported that the twins were born alive.
Union Visit to Hospital
On 9th January2015, the union officials visited the hospital on a fact finding mission concerning the incident. While at Pumwani in company of the hospital staff, they learnt that the Nation Newspaper had already published the story about the twins before conducting proper investigations an action which provoked demonstration to protect the image and integrity of both the hospital and the nursing staff.
Press Statement
A joint press release was done by the KNUN Nairobi Branch and the Nairobi County Management to clarify what actually transpired at Pumwani Maternity Hospital. The Nairobi City County Management, the Hospital Management and the Nairobi Branch of Kenya National Union of Nurses, demanded for an apology from the Nation Media Group for having aired to the public information that had not fully been verified order investigated, and confirmed or otherwise.
Post mortem.
Due to the complexity of the matter and following an outcry from the parents of the babies, a post mortem was ordered by Pumwani Hospital Administration who even met the cost of the tests. The post mortem was to ascertain the cause of the deaths.
Just before the post mortem test, after the two bodies were presented for the test, the father disowned them saying they were not the ones he saw at Pumwani Hospital, but ironically the mother said they were the ones.
Despite the controversy over the identity of the bodies of the two babies by the parents, the pathologist went ahead to perform the test on the two bodies that also had no tags of identity.
The hospital management also complained on the development about the post mortem and the news that went round. The Management questioned how the bodies were identified for the tests without tags. The absence of the tags were noted by all the people who were present during the post mortem i.e. the Interns (interns at city Mortuary), Dr. Okoko and Dr. Maina. The doctors questioned why the bodies had no tags of identity.
Dr. Maina then called the Matron (Ms.Kiambati) of Pumwani Hospital using her mobile phone, and reported the status of the bodies stating that they were fresh and not macerated and with no tags of identity. The city mortuary funeral superintendent then called the hospital secretary requesting for two baby tags of identity, a request that was turned down by the Hospital Secretary as the request had no justification according to Pumwani Leaders.
DNA Results
The post mortem report and, the DNA report were also released simultaneously and which further revealed that the bodies of the babies were not of the twins and that they were from different mothers. This prompted the Union to initiate an Independent Investigation.
Union Investigations
The General Secretary of KNUN,Mr. Seth Panyako led a team of Officials namely Ms. Lucy Kamau the Chairperson of Nairobi Branch who is also a Nurse at Marurui Health Center and Ms Ediah Muruli a KNUN Representative of Nairobi branch at Pumwani Maternity Hospital, to conduct their investigations, both at the Hospital and at the City mortuary.
AT THE HOSPITAL
The team KNUN visited Pumwani Maternity Hospital where they gathered the following information:-
On 5th January 2015, a lady aged 24 years by the name Jacinta Wanjiku a para 1+0, gravida 2, with 1 previous scar, came into the hospital at around 11pm accompanied by the husband presenting with labor pains. She was examined by the admitting nurse where an abdominal examination and auscultation of the fetal heart was done but fetal heart beats were not heard according to the nurse.
She explained to the mother that she had not heard the heartbeats of the baby, and in line with the hospitala��s policy, the mother was asked to sign on the file in concurrence with the absence of the heartbeat of the baby as examined.
12. On vaginal examination, the cervix was 2-3 cm dilated. The mother was admitted in labor ward. Throughout the night the fetal heart beat was not heard.
On 6th January, 2015 at around 10.30am, on doctora��s routine round,Dr. Oyaro assisted by Nurse Sarah Kilei examined Ms. Jacinta Wanjiru, and the findings were; the cervix was 7cm dilated, the abdomen felt big, and still no fetal heart beat was heard.
13. The mother was then scheduled for an emergency caesarian section since she had a previous scar and the baby seemed big. Up to this time, nobody knew that the mother was expecting twins. While being prepared for theatre, in less than an hour, the mother went into second stage of labor. On delivery position, the head of the baby was seen crowning, the student nurse who was attending to the patient, called the Nurse because she did not understand what the mother was presenting.
14. The nurse came and explained to the student that such was a sign of a macerated baby. The mother delivered and was shown the delivered baby even before the cord was separated, and she lamented,a�? sasa nitaambia bwana yangu nini?a�?, a concern of how she would break the news to the husband.
15. After the baby was born, and on further palpation of the mothera��s abdomen, the midwife felt existence of another baby and the doctor who was on routine ward round was called by the midwife. The Doctor promptly came and did a vaginal examination. After which the second twin crowned and the baby was delivered. It was also macerated just as the first one. The mother was again shown the baby, She exclaimed in anguish at the sight of the baby saying, a�?hata Mungu hangenibakishia hata kamojaa��a��? A cry that seemed to explain her anguish why God could not have spared her even only one baby.
16. The third stage was cleared and the mother counseled and bodies tagged. She (the mother) was yet again made to sign the file confirming that she had seen her two babies born dead as is the hospital policy.
17. The husband came to the hospital on the same day but arrived late. The mortuary attendant had already left the hospital and so he (husband) was asked to come the following day at 8.00 am to view the bodies of his babies. He complied and returned to the hospital the following day on 7thJanuary, 2015 accompanied by a sister. This time, he was shown the bodies of the babies.
18.His sister who had accompanied him had left shortly only to return with journalists. They were given explanations on the outcome of the delivery and all parties present said they understood. On the same day the father to the twins spoke to the mortuary attendant and requested that the hospital hands over the bodies to the mortuary for disposal.
The Mortuary attendant asked him for his National identity card which he did not have, the wife also did not have hers. They were told that they could not sign the disposal without their National identity cards and asked the father to arrange to get his identity card. He left to go home to fetch the card.
19. He came back at around 6.00 pm and found the mortuary attendant in the hospital still waiting for him. After confirming from his identity card he was made to sign that he wanted the bodies of his babies disposed off by the city mortuary in collaboration with Pumwani Hospital. On 8th of January, 2015, the Daily Nation posted the story contrary to what the Hospital Management had explained.
20. The hospital management decided that the two bodies be taken to city mortuary with clear instructions that they should not be disposed off before the emerging case was over. But before this was done the health workers took pictures of the macerated twins using their phones because the issue started to get complicated.
AT THE MORTUARY
21.The mortuary attendant from Pumwani Hospital packed 7 bodies for transmission to the city mortuary.
(a) Out of the seven, (2) bodies being jacintaa��s twin babies were put in a separate carton.
The rest were separately packed and then all of them put in a polythene paper for delivery to the mortuary after appropriate labeling/tagging.
22. He (mortuary attendant from pumwani) gave very clear instructions to the mortuary attendants who received the bodies at city mortuary (Solomon Nyongesa a�� supervisor and Jane Wangare a�� attendant), that those two specific bodies should be kept well because they had a case and that they will be disposed off only after the case is over. Below are the pictures of the macerated twins.(Refer to image below Set A)
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23. He went further to the office and emphasised to the Funeral Superintendent (Mr. Jacob Nyongesa) that the bodies should not be disposed off since they were under investigations. He even asked him to check the back page of the Daily Nation newspaper of that day to see the story about the babies and he confirmed to have read the story. Jacob then, stood outside the mortuary and shouted at Wangare who was inside the mortuary instructing her to keep those bodies safely.
24. When the KNUN Investigating team visited City Mortuary on 2nd March 2015, the City Mortuary Funeral Superintendent confirmed that the bodies were delivered to the mortuary and instructions given.
25. He further explained that bodies from Pumwani were to be disposed off after 24 hours, but since November 2014 no bodies had been disposed.
26. Normally when the mortuary attendant brings the bodies to city mortuary, he hands them over to the attendants then the City Mortuary Funeral Superintendent signs the delivery book which happened in this case.
27. After the DNA was conducted, the city mortuary Funeral Superintendent called Pumwani Hospital Secretary asking for (2) two tags for identifications, a request that was turned down.
28. The attendant Ms. Jane Wangare and the supervisor Mr. Solomon Nyongesa were called in by the City Mortuary Funeral Superintendent to give their account of events. They acknowledged the receipt of the bodies and instructions from the Mortuary attendant from Pumwani Maternity Hospital but they did not open the carton to confirm the bodies.
29. Both Ms. Wangare and Mr. Nyongesa said they were not present during the postmortem.
30. Two interns Mr. Dennis Wanyama and Ms. Beth Wanjiru who were present during the postmortem were called, they said that when they were handed over the shifts, they were only shown the carton by Ms. Wangare that they would present during the postmortem which was writtena�? do not disposea�?.
31. When asked about the identity of the babies they confirmed that the Father denied the bodies to be those for his babies, but the Mother insisted and held that they were the ones.
32. The Investigating team learnt that the post mortem was done on 27th January, 2015, to ascertain the cause of deaths, the hospital sent two representatives to witness the postmortem being done.
33. The following day, the General Secretary of KNUN Mr. Seth Panyako called Jecinta Wanjirua��s husband and asked whether he had identified the bodies of his babies. He was cunning and evasive and sounded not ready to open up on the issue. He only reported that he was confused and could not remember whether the babies were his, or not.
34. The General Secretary then posed a question to him a�?Do you remember whether the babies at post mortem had labels a�?he answered in affirmative (yes). The team that had been sent from Pumwani Maternity Hospital said that the babies had no labels/Name tags during the DNA testings.
35. The father to the babies then called the C.I.D who later called Mr. Panyako and they planned to meet. The meeting have not taken place.
36. Pumwani Medical Superintendent Dr. Omondi delegated the task to Dr. Okoko who is a consultant in obstetrics and gynecology and Dr. Maina who is a consultant pediatrician..
37. The representatives from Pumwani called the Medical Superintendent and informed him that according to the explanation they were given from the hospital the bodies were macerated and not fresh. The bodies that were presented for postmortem did not have labels and were also fresh and not macerated, while the bodies from Pumwani had labels, and were also macerated.
38. Despite the concerns raised by the Father disputing the identity of the babies and the Representatives from Pumwani Maternity Hospital, the Government pathologist went ahead and conducted the post mortem. Here are the pictures of the bodies that underwent the postmortem (Refer to image below Set B).
39. The hospital got concerned and wrote a protest letter through the Chief Officer of Health Nairobi City County but up to date no replies have been made concerning the same.
40. On the day of the postmortem, the police and the pathologist called the parents to identify the bodies, the father again denied the bodies but the mother insisted that they were the ones.
41. The hospital management together with the nurse who delivered the babies and the mortuary attendant made a visit to city mortuary to get to know what happened to the two bodies, they decided to sample the bodies which were there one by one but to their surprise they did not find the macerated bodies in question.
42. Considering that the DNA report was not handed over to the Health Department at the County Offices, the Senate decided to organize a meeting with Pumwani staff on 2nd March 2015, and they concluded that they will also go to the City Mortuary to carry out another investigation. Meanwhile, the Union demands that the Mortuary Staff be compelled to produce the two bodies of babies to facilitate proper DNA/Postmortem tests.
OBSERVATION
The union seeks answers to various questions as follows:
1. Why were the bodies handed over to the mortuary attendant with specific instructions?
2. Why did the father deny that the bodies at the city mortuary were not the ones he saw at pumwani?
3. Why postmortem/DNA ordered on controversial bodies (on bodies one parent denied were not his)?
4. Were the both parents present when they were being shown the bodies at pumwani?
5. Why was the postmortem/DNA ordered on tag less bodies?
6. .Were the actual bodies with tags of identity while being dispatched from Pumwani even after the Mortuary attendant acknowledges receiving them?
7. The mother accepted the babies while the father denied the babies at the Mortuary, who is fooling who? Could one parent be hiding something?
8. Why are the investigations being carried out without involving all the stakeholders?
9. The macerated babies were born on 6th and stayed at Pumwani up to 8th February when they were transferred to city mortuary i.e 48 hours post delivery, it also should be noted that the postmortem was carried on 27th February 2015 i.e approximately three weeks post delivery. Where the babies still expected to be fresh after such long time?
10. Was it a professional negligence or a Mortuary practice that bodies with strict instruction can be received without being viewed to confirm identity and discription?.
11. What were the tags for yet the babies had left Pumwani with tags?.
12. What is the procedure of receiving bodies at the city mortuary? How do you receive bodies in carton without confirming what is inside.
13. Why was the DNA and postmortem done at the same time why could they not wait for DNA results before they did the post mortem?
14. Why were the DNA results given to Hon. Beth Mugo who later released them to the senate and not Pumwani who had actually requested for the DNA and paid for the same? What interest did she have?
15. In a case of identical twins like in this case where one is borne macerated, what are the chances of delivering the other one alive? The mother confirmed even through the media severally that she didna��t hear the 1st baby cry but heard the 2nd one cry.
HISTORICAL INJUSTICES AGAINST PUMWANI HOSPITAL
It should be noted that as a result of mischievous misrepresentation of facts by the press and dishonest people, Pumwani Maternity Hospital and staff were once accused of swarping alive baby with a dead one in 2003, only to be vindicated following the DNA test which confirmed the relationship of the mother with the dead baby.
Similarly, some two years ago, another mother gave birth safely in Pumwani and was discharged. On her way home, she was tricked by people who offered to help her carry the baby. They later drugged her and disappeared with the baby in River Road in Nairobi town centre. The press later reported that the mother lost the baby at the Hospital. It is the involvement of police investigation which helped the hospital to clear her name.
It should also be borne in mind that in 2014 alone 25 babies were abandoned in Pumwani Hospital in healthy conditions. Of said number 19 were boys, and 6 were girls.
After the abandonment of the babies, the hospital arranged and took the children to various Childrena��s Homes through the Society of Kenya the collaboration with child welfare society of Kenya.
The day Jacinta gave birth, there were 79 deliveries in the hospitala��s Maternity.
Is it really realistic to say that it was only Jacintaa��s babies that were in the labour ward all the while so as to suggest or claim that any cry emanated from them.
CONCLUSION
The senate committee now to investigating the disappearance of the twin babies from Pumwani, Have not concerned themselves with factors and challenges affecting the provision of quality health services. Instead they are actively pursuing irrelevant reports with an aim of finding faults with nurses.
The senate committee should be sensitive to the plight of the workers in Pumwani just like any other health facilities and address the shortcomings e.g acute shortages of staff and other non-pharmaceutical supply challenges.
We wish to inform the government and the general public that the Union takes offence with impartial interrogations which does not bring on board all stakeholders like the Union which represents the nurses embroiled in this controversy. We will not allow intimidative interrogation only aimed at coercing them into submission.
We call upon the Hospital Superintendent to be vigilant in upholding the good name of pumwani Hospital and to ensure the Nurses and other health workers involved are not unduly harassed, until the right culprit is found. All summons must hence forth be formalised and should not arbitrarily be made verbally.
We reiterate our commitment for cordial relationship, and we will cooperate with the parties involved.