Professional Accountability

I saw a patient with the medical students last week who was 4 months old and only weighed 2.9kg, which is the smallish end of normal even for a newborn infant. The baby was the 10th child and unusually all of her siblings were alive and well. Her mother had breast fed all the other 9 children but for some reason on this occasion she didn't produce any milk. Not producing milk is pretty unusual, but this is also a very experienced mother who has managed to keep 9 other children alive and relatively healthy in Ethiopia, which is no mean feat, so I'm inclined to believe that she knows what she is talking about. As an alternative, she had fed the baby 1/3rd cows milk, 2/3 water boiled together and cooled, 3 times a day since birth. Not surprisingly, the baby had failed to gain any weight and was subsequently admitted to our ward with severe acute malnutrition.

This story is not that unusual here, but the thing that is frustrating is that this mother had taken her child to a private health clinic 4 times since it was born and they had clearly failed to act or give appropriate advice to this woman, with the result that her child has ended up with a life threatening condition. Unfortunately there is very little that can be done about it. There is no professional accountability here at the best of times. The doctors leave for a 2 hour lunch break often regardless of the state of the ward, and although someone is nominally on duty to be called in a emergency they will be at home which could be 30 minutes away.

If a child dies here, no body asks "why did that happen? Could something have been done to prevent this? What can we learn or do better next time?" It is just accepted as part of life.

I always used to get a little irked by endless clinical governance issues at home, but seeing a world without really brings out the importance of working in a enivronment where as a professional you must be accountable for your actions, and have a responsibility to remain up to date with the evidence for the best treatment for your patients.

Safe to say that any clinic or health professional who had not picked up the baby above sooner in the UK would have their practice scrutinised and measures put in place to ensure it didn't happen again, but here we will probably never know the true story and many more child will suffer malnutrition.