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The case of NICU

In explaining the deaths of the 11 infants at the neonatal intensive care unit, the national referral hospital has blamed the thromde, the health ministry, and the media.

Its clarification, which has come more than a month after the tragic incident justifies its negligence and the deaths that the hospital management knew, could have been prevented. Where it is supposed to focus on the importance of hand washing, the hospital management appears to be washing its hands off the problem. The hospital accepts that infection control was weak. We know that its reporting mechanisms were weaker.

In exercising its constrained autonomy, the hospital did not see the necessity to inform the health ministry as soon as the problem surfaced. But blaming the ministry would not condone the hospital of its negligence that resulted in the deaths of the infants. Nor would blaming the municipality of supplying contaminated water help salvage the public confidence it has lost. The hospital management owes an apology to Thimphu Thromde.

The hospital clarifies that the number of babies that died due to Klebsiella Pneumonia caused due to Hospital Acquired Infection (HAI) is nine and not 11. While nine deaths in 15 days between July 23 and August 6 is still a concern, it is important for the people to know that the total deaths at the time of reporting was confirmed as 11. There are two reports on this case, one from the hospital, which states the number of deaths as nine and another report from the health ministry that states 11 deaths.

The hospital’s press release claims that the first signs of the bacteria Klebsiella Pneumonia was observed on July 16 at the NICU. It claims the matter was reported to the infection prevention and control focal person of JDWNRH, who immediately enforced the infection prevention and control practices and segregated the infected babies from the non-infected ones.

It is not an immediate action when it enforced the infection control measures 10 days later on July 26, when it declared the outbreak. What was happening at the NICU between July 16 and July 26? Sharing selective information to the public is a dangerous practice to indulge in. Kuensel learnt that the Royal Centre for Disease Control reached the hospital on July 26 and the first meeting chaired by the hospital president was held on July 27. Hand towels and hand hygiene measures were placed on July 29. The health ministry was informed on August 1.

The non-adherence to standard operating procedures is blatant here. To be aggrieved and defensive of negligence and blaming other institutions does not help resolve the issue. The hospital claims that four to six babies die every month at the NICU of which one to two are related to HAI. That means a baby dies every week at the NICU. The priority of the hospital and the health ministry should be to prevent these deaths, not justify their deaths. It is learnt that the hospital sees such cases every year. But it does not get reported. Under-reporting infant deaths raises serious questions on the conduct of our health workers.

Somehow, it takes deaths to bring issues to the fore in our country. It took the death of some students in Orong few years ago to highlight nutritional deficiency in school meals. In the recent case, the death of the infants reveals the resource constraints at the hospital. Its autonomy is only on paper and the hospital does not meet the requirement of nurses, cleaners and neonatologists.

The hospital is in itself a case of emergency.  For the sake of our children, its issues need to be addressed. With urgency.

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