IF information from families who have had the experience is to be believed, babies born before 27 weeks, or the beginning of the third trimester, are routinely not given the same level of care in Jamaican public hospitals as babies born at or after that milestone. In fact, according to some, they are simply left to die.
“A good friend of mine had a baby at 25 and a half weeks and was told she could not get an incubator because her baby was not viable and that they save them for babies over 27 weeks. She sat and held her baby for about 12 hours until she died,” said one woman in a social media post in a group called IslandMoms.
Another said: “Jamaican hospitals do not place premies under 27 weeks on respirators or in incubators. They leave them to die because they are not viable.”
The subject has been dominating social and traditional media discussions since Health Minister Dr Fenton Ferguson referred to the 19 premature babies who died from bacterial infections at two of the island’s main public hospitals as “not babies in the real sense”.
Although Dr Ferguson apologised for the comment, it elicited widespread outrage and calls for his resignation. In an apparent surrender to public pressure, Prime Minister Portia Simpson Miller on Friday announced his reassignment to the Ministry of Labour and Social Security and the shifting of Horace Dalley, minister without portfolio in charge of the public service, to the health ministry.
In a national broadcast last evening, Simpson Miller said she had instructed Dalley to correct shortcomings in the sector and review the reporting structure between the four regional authorities and his office. He starts in the new role today.
But allegations of systemic, sector-wide mismanagement in general, and disregard for premature babies in particular, might be difficult to shake. The conversations on social media among people who, based on their comments are either neonatologists, paediatricians, nurses or other professionals with experience in neonatal intensive-care units (NICUs), point to issues of staffing, a critical shortage of life-saving equipment and limited physical space for quarantining.
“Not placing neonates under 27 weeks in incubators is not a matter of the hospitals being callous and insensitive towards the right to life, but it is a matter of resources available,” one person with obvious medical experience said.
“Only a few incubators are available, even for babies that meet that criteria. I have seen pediatricians make many make-shift apparatus that have saved many lives. That is a part of the reason many great doctors no longer want to work in public hospitals. You are faced with many hard and sometimes heartbreaking decisions. I have been in situations where even blood-taking tubes are rationed. Leadership in the health sector is lacking. Workers are suffering, patients are suffering and people are dying and may continue to die if we do not hold them accountable,” one person said.
Another said: “It’s not a hard and fast rule re the timeline. It depends on development and availability. There have been times where a 24-weeker has gotten a ventilator but that would be based on availability. The problem is doing that we know that they will stay on it much longer than a 28-weeker. So, imagine the 24-weeker on a ventilator for three months which, in that time period, you would have had 10 other babies come and need a ventilator. It’s unfortunate, but far too many times we have to make the difficult decision of which baby is more likely to survive.”
Yet another said: “Yes, the NICU is overcrowded and understaffed and anyone knowing anything about bacteria will know that that is the perfect environment for a tiny one with no immunity to become ill. If you observe the NICU staff they are clad in caps, cover shoes, aprons and masks while washing their hands and spraying lysol everywhere, but the point is: unitl we get more space, more equipment and more staff, there will always be an infection issue.”
And a female writing under the name of a well-known doctor added: “This issue comes down to lack of resources. We need more ventilators, for both adults and babies. Same thing happens for adults. A 22-year-old and a 60-year-old need a ventilator. We have to make the difficult decision, [which is] usually to pick the younger of the two as they are more likely to survive and lead a longer life. Far too many times we are left to play God.”
One post did say the individual has witnessed a premie at 24 weeks being housed in an incubator.
Several peadiatricians and health care professionals whom the Jamaica Observer contacted for on-the-record comment yesterday either declined or referred us to colleagues.
What happens at 27 weeks
Twenty-seven weeks is just about seven months of pregnancy. It marks the beginning of the third trimester. At this stage, a baby weighs almost two pounds, or 875 g (about the size of a head of cauliflower) and is about 14 1/2 inches from head to toe.
His eyes open and close, he sleeps and wakes at regular intervals and he may suck a finger or thumb. His brain is going through its final stages of fine tuning with some last-minute fast and furious development. He also now has very developed taste buds.
The lungs are still immature, but if he were born now, they would be capable of functioning — with medical assistance — and he would have a very good chance of survival.