Unanswered question...

This morning I was in the Emergency Room briefly, to check on the supplies in the side lab. While there I overheard three family members asking the nurse to please find the doctor who was on night duty so that he could sign the death certificate of a child who passed away. The nurse was busy and I knew the doctor was down in outpatients, so I decided I would assist the family since they had already been waiting for over an hour and really wanted to settle the matter.

Apparently the 2-year old child was admitted at 10 am with severe malaria and anemia and was started on treatment. However, the child’s condition was poor and she passed away in late evening.

Officially, when a child dies, the doctor needs to pronounce the child dead, document this in the chart and fill out a death certificate. The certificate is then taken over to an office with the somewhat unusual name “Births and Deaths” where an official burial permit is given to the family so that the child can be buried at the cemetery. As you can imagine, this process can become quite a burden for a family who has just lost a child. If a child dies at night, the office is closed and the family has to return in the morning to arrange the paperwork before proceeding to take the child’s body home. This takes time and costs them money (transport) and generally is not something one wants to do after losing a child.

After comparing our hospital data with the ‘Births and Deaths’ statistics it is obvious that many deaths are simply not registered. The family simply takes the child’s body and I suppose finds someway to bury it without a legal permit.

Part of this is due to the system itself being complex with too many people who need to take part and many people who are actually too busy trying to save lives. Part of it is lack of communication to the families. A number of times, while entering data into our database, we have found a death certificate still in a patient’s chart. It simply did not make it to the ‘Births and Deaths’ office. Honestly, I think this is not a real worry. My concern is one I have had for some time now. Why did this child die within 12 hours of being in the hospital? Did she simply come too late?

In this case the family did return for the permit which proved more difficult since the death certificate had not been written at night and the doctor that was on call was no longer in the emergency room. Then, on arrival at Births and Deaths, the office was found locked. Fortunately we found someone else who can issue the permit.

While waiting on the paperwork I had the chance to talk with the grandfather and father of the deceased child. It was the second child in the family and apparently the child had been sick for some time. The mother had taken the child away to her family (possibly upcountry?) and the father and grandfather have no idea what took place. It was not until the mother returned to Freetown and showed up at the father’s house in the morning that they saw the poor condition of the child and brought her straight to the hospital. Unfortunately it was too late. I have no idea what happen. All I know is that likely this child was delayed in reaching the hospital. Is this due to lack of knowledge on the mother’s part, the traditional use of country medicine, the ease in buying anything and everything over the counter in a pharmacy? The question of why children come to the hospital in such late stage of disease remains unanswered. I’ll continue to search for an answer to this to see if there is anyway this can be addressed…