The painful mess doctors can cause with a misdiagnosis

"There's no heartbeat. I'm sorry," the doctor told Elizabeth Makheti. Not believing her ears, and willing the doctor to change his statement, Elizabeth asked him to listen through the stethoscope again. Her mouth was suddenly dry and her own heartbeat was racing. She gripped her husband's hand. She had tended this pregnancy zealously— almost obsessively so.

She had attended checkups every other week throughout the pregnancy. She was on week 39, just one week away from her delivery date. She had taken multivitamins. She had eaten healthy. She had kept active. She had prayed. Just a few days previously, a doctor at Aga Khan University Hospital had assured her that her baby was fine- despite the fact that the umbilical cord had coiled around his neck. He had written "aim for normal delivery" in her report. The night before, she had counted his kicks as instructed, and assured herself that he was indeed fine. She had lost another pregnancy a couple of years previously to a Rubella infection at 32 weeks. She was desperate to keep this one. "There's no heartbeat," the doctor repeated. A scan confirmed the diagnosis.

Elizabeth's baby was no more, thanks to a doctor's mistake. In cases where a term baby has the cord wrapped around their neck, an immediate cesarean section would have been the prudent medical move. "I just broke down. I was shocked and devastated. My husband sat next to me, unable to stand," she says 36-year old Elizabeth as she wipes tears from her eyes. "We were at Mp Shah Hospital, where we had been referred for scans from Avenue Hospital. We went back to Avenue for the delivery of my stillborn baby. They put me in the normal maternity ward— where there were mothers with babies and pregnant women waiting to deliver living babies- which added to my emotional pain," she adds.

Elizabeth's story is hardly an isolated case. The cost of medical negligence, malpractice, and misdiagnosis has left an indelibly painful mark in many Kenyan lives. Statistics show that one in five Kenyans who walk into a hospital for treatment ends up dead or harmed by mistakes made by doctors. According to figures put together by medical lawyers and independent pathologists, three out of ten patients get the wrong diagnosis or treatment. Since 2012, Kenyan hospitals have been forced to pay out over Sh38 million as compensation due to misdiagnosis and negligence. Elizabeth was lucky to have come out of her medical ordeals alive, like her unborn child, many misdiagnosed patients aren't as lucky. One of them is Elizabeth's sister-in law, *Susan, who died as a result of misdiagnosis in October 2014. The 33-year-old had just delivered a baby girl barely two weeks before her demise.

"Because she was working in Kakuma, she had come to Nairobi for her baby's delivery. The pregnancy had gone well, despite the fact that she had previously been diagnosed with fibroids due to which she had lost her first child as he had been born prematurely," Elizabeth explains. After a fairly normal cesarean delivery at Aga Khan University Hospital, mother and baby were discharged a few days later. However, for Susan, this was the beginning of the end. She had a stubborn headache and her legs had swollen up. Elizabeth advised her to go back to the hospital, where they were assured that these symptoms were not unusual in new mothers. "They gave us painkillers and she was told to come back a week later. But the painkillers weren't helping. I massaged her feet in an effort to reduce the swelling, to no avail. After five days, she went back to the hospital. Again, she was assured that she was OK. They only told her to rest and take plenty of fluids," Elizabeth says.

The following afternoon, Susan called Elizabeth while she was at work. "She told me that her headache was getting really bad. A neighbour had just called me to help tow her stalled car, so I asked Susan to take a cab and proceed to the hospital with my other sister-in law. Because of heavy traffic, they got to Aga Khan University Hospital from Syokimau at around 11PM. They ran some tests and even scanned her to see if she had clots in her blood vessels- she didn't have any. But they recorded a blood pressure of 156/ 60-something, which should have been a cause of concern. "They gave her a clean bill of health and sent her home. In the morning, she hadn't gotten any relief. I told her to go to Aga Khan University Hospital's satellite clinic in Syokimau and insist on another checkup and admission. I instructed the house help to accompany Susan and help with the baby."

This was the last time Elizabeth would talk with Susan. "I was called at around 11AM and told that she had collapsed. She was put in an ambulance and rushed to the main hospital. They scanned her and told us that she had bled into her brain, resulting in a coma. They wanted to perform a procedure to drain the blood from her brain. The chances of her coming out of the surgery were 50/50," she says.

24 hours after the surgery, Susan was still in a coma. The doctors recommended a stem cell test, which showed that she was brain dead. "They told us that she was essentially dead. They asked us to decide if we wanted to keep her on life support or not. We chose to keep her on life support, but the following day she had a cardiac arrest and died. It was on 24 October 2014, 11 days after she had delivered her baby." While the family was mourning, a friend took it upon herself and wrote a complaint letter to the Kenya Medical Practitioners and Dentists Board against Aga Khan University Hospital and the attending doctor. The board asked for a postmortem report, which was done at Chiromo Mortuary. It showed that Susan's skull had cracked when she collapsed, which led to her death.

"But the fall had been as a result of high blood pressure which made a vein to burst. The report was taken to KMPDB and they conducted an investigation, which took around eight months. We had little confidence in the board, so we were surprised when they contacted us. They said that the doctor had given her due care but Aga Khan University Hospital had been negligent after she had delivered. They never checked or treated her for postpartum preeclampsia, even though she had high blood pressure," Elizabeth says.

KMPDB ordered Aga Khan University Hospital to pay for the cost of the investigation and to compensate the family. "They could opt for an out-of-court settlement or take it to court. We got a lawyer and wrote a letter to Aga Khan University Hospital and after two and a half months, they responded in favour of an out of court settlement. That's where we are at the moment. They still haven't tabled a figure. They have to base that figure on factors like Susan's income and the living standard she would have afforded her child for 18 years," she explains. Elizabeth cautions patients to always get a second opinion and most importantly, to listen to their own bodies. "As much as you're not a doctor, you know your body better than anyone. Don't be too intimidated by doctors- if you feel something is not right, insist on more tests. It is your right to ask questions. It is better to be safe than sorry. But in case of misdiagnosis or negligence, take it up with the KMPDB or the court."

Why didn't she report the case of negligence which led to the loss of her baby? "At the time, I didn't know that it was something I could do. I was deep in emotional pain and grief. I should probably have had a postmortem done before we buried the baby. Would I report it now? Probably not; it's a big painful wound in my heart that I would rather not open. I choose to believe that it was a genuine mistake by the doctor. I even went back to him when I was pregnant two years later. He looked at my file but didn't mention it, and neither did I. My husband was strongly opposed to me being attended by the same doctor, but I was convinced the doctor had learned from his mistake. He was more careful with me the second time around, although my baby was born at only 32 weeks," she says.