Interpreting Maternal Death: When Underlying Causes Are Non-Medical Despite Medical Indications
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 5
Abstract
The relationship between the medical caregiver and the patient usually displays an authoritative knowledge [1,2] of the former although the latter contributes to making the health care delivery more efficient [3]. Despite an involvement of the patient, his/her embodied knowledge [4] most often lacks legitimacy considering the health service delivery procedures particularly in the presence of a complication. However, the prominence of the patient’s subjective interpretation may contribute to challenging the practice of the biomedicine regarding the accountability in some context. The following reflection draws on two cases of maternal death that occur in Ouenkoro’s community health centre, a rural area in central Mali. The health facility is the first level of health care delivery in the Malian health systems. The midwife in charge of providing child birth services has been running the maternity for about thirty years. In the two cases highlighted the context of care delivery waschallenged by the parturient subjective interpretations of their conditions. Those accounts not only gained legitimacy over the clinical indications but also in reporting the maternal deaths from the perspective of the midwife. Cisse did not show any sign of weakness in the last weeks into her pregnancy. She had been active, doing her routine household chores. When the water broke (labour), Cisse collected the items she would need after the birthing and headed to the maternity. Her elder sister accompanied her. In this rural setting, women mostly give birth at home, but Cisse did not delay resorting to the health centre. At the maternity, Cisse delivered her baby without complications. She even telephoned her husband and broke the news to him. Sadly, before her husband reached the health centre, Cisse passed away. After the birth of the baby, Cisse hada retained placenta. The midwife administered three injections of oxytocin and performed some manoeuvers, but these attempts were unsuccessful, she could not expel the placenta. The attendant noticed too vaginal discharge accompanied by blood clots. Moments later, the woman died. In fact, upon arrival at the maternity, Cisse told the mid wife that she knew she would not survive the child birth. Discussing with the mid wife,Cisse told her that she consulted three different diviners, which all made a similar statement that she would experience complications in birthing that would result in her death. Cisse faced the childbirth event with uncertainty, but the invading suspicion of death was over whelming. Confronted with the failure to help the parturient to deliver the placenta, the midwife started to lose hope mainly referring to a dream she had, weeks ago. The mid wife opines that she saw in a dream the death of a woman dressed in the type of cloth that she saw in the plastic bag of the parturient. She did not say anything to the parturient, but her faith in the dream seemed to get the upper hand over her medical skills. The midwife also reported remarks from passers by some days earlier who argued that they smelt the odour of a dead body in the maternity.
Authors and Affiliations
Brahima A Diallo
Keywords
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- EP ID EP569506
- DOI 10.26717/BJSTR.2017.01.000404
- Views 151
- Downloads 0
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