Personal stories: What rights mean on the ground
TRINA BACHTEL, USA
In August 2007, two weeks after her baby was stillborn, Trina Bachtel, a 35-year-old white woman, died. She had reportedly suffered from pre-eclampsia during her pregnancy, a condition that requires careful monitoring during prenatal care.
Although insured at the time of her pregnancy, the local clinic had reportedly informed her that it required a US$100 deposit to see her, because she had incurred a medical debt some years earlier – even though the debt had since been repaid. When she fell ill, Trina Bachtel delayed seeking care, unable to afford the fee at the local clinic.
She finally received medical attention in a hospital 30 miles away, where her son was stillborn. She was later transferred to Columbus, Ohio, 75 miles away, where she died. The two local clinics in her area later denied having seen Trina Bachtel as a patient.
The associate administrator at one clinic said they may place “credit restrictions” on patients believed to be able but unwilling to pay their bills.
AÏCHA, BURKINA FASO
Aïcha, the only daughter in a family of five children, was 21 years old when she died. She met her husband, Abdou, in Ouagadougou and they were engaged for two years before getting married.
Aïcha worked until the very last day of her pregnancy, as well as fetching wood several kilometres away from their home. This was her first pregnancy, and she attended the three recommended prenatal visits at the community health centre.
One evening in April 2008, at around 8pm, Aïcha had labour pains. A friend took her to the health centre 1km from her home on a small motorcycle and her husband followed on a bicycle. She gave birth to a boy at 2am. After the delivery, the medical personnel asked the family to buy bleach to clean up her blood.
Ten minutes after the delivery, the midwife told the family that Aïcha had to be transferred to a district hospital because she was suffering from a haemorrhage. Although transfers between health centres should be free, the family had to pay.
Aïcha’s husband was then told to get his wife’s blood tested: “I first went to the hospital lab where I was told that they could not do the blood test. I was sent to the lab at a nearby health centre specializing in blood tests. It was almost 3am and I had no transport, so I went on foot. It took me an hour to get there. When I reached the health centre, the watchman was asleep. So I woke him up and spent 2,000 CFA francs (around US$4.50) on the test. I quickly went by taxi to the district hospital: the first one broke down and I had to find another, which charged 1,000 CFA francs (around US$2) – the normal fare is less than 200 (around US$0.50) but when taxis see that people are in a hurry, they charge higher prices. It was past 5am when I arrived at the hospital and delivered the blood test results. When I arrived, I didn’t find my mother and friends. I was told that they had already left. I thought that Aïcha had felt better and was cured. Then a doctor came. He told me that my wife was very weak and that ‘her blood was all gone’. I learnt that she died at 5:18am.” Abdou returned on foot to his home with his newborn baby. Abdou’s mother, who used to live in a village, came to live with her son in order to take care of the baby.
THE WOMEN OF NICARAGUA
Since July 2008 abortion in all circumstances has been criminalized in Nicaragua. The law leaves an entire nation of women and girls whose pregnancies develop complications at risk of dangerous or fatal consequences. Some groups of women and girls are particularly affected: specifically, pregnant women and girls who need treatment for life-threatening illnesses, who develop complications, who need medical treatment after a miscarriage or abortion, or who are survivors of rape or incest. In Nicaragua, the overwhelming majority of girls who are pregnant as a result of rape or incest are aged between 10 and 14 and their health and life are put at risk by unsafe abortions or by having to give birth at an early age. Rape victims who do seek an unsafe illegal abortion face prison terms if the abortion is discovered, as do those who assisted them.
The revised Penal Code criminalizes all forms of abortion and imposes prison terms on women and girls who seek or obtain an abortion, regardless of the circumstances. The Penal Code also imposes lengthy prison sentences on health professionals who cause any harm to a foetus, regardless of intent, even if it occurs in the course of providing life-saving treatment to a woman or girl. The Penal Code is in conflict with the Nicaraguan Obstetric Rules and Protocols issued by the Ministry of Health which mandate therapeutic abortions as clinical responses to specific cases, leaving health professionals in an impossible position.
Four UN treaty bodies (Committee on Economic, Social and Cultural Rights, the Committee on the Elimination of Discrimination against Women, the Committee against Torture, and the Human Rights Committee) have found the law to be in breach of Nicaragua’s treaty obligations.
Nicaragua has committed itself to reducing maternal mortality by 75 per cent by 2015. The government has introduced a number of programmes to prevent maternal mortality and increased health sector funding.
However, the criminalization of abortion runs contrary to these efforts. Yet, despite the risks that the law poses to the life and health of women and girls, the entry for Nicaragua in the UN MDG Monitor (which tracks countries’ progress on the MDGs) states that Nicaragua has “achieved” Goal 3 (according to national government reporting), while its progress on Goal 5 is “off track”.
ADAMA KAMARA, SIERRA LEONE
Adama Kamara was 25 when she died at home on 27 December 2008 in the village of Kapairo, Kambia district. Her husband felt unable to pay for the drugs she needed.
It was Adama’s fifth pregnancy. She had had one stillbirth, and had delivered three live children – three of the 10 living children of Pa Abu Kamara, her husband, who has two other wives.
On 24 December 2008 Adama was approximately six months pregnant and went into premature labour. By the next day it became clear that she was suffering prolonged labour. The family observed her at home for one day to see if her condition would improve before transporting her to Kambia government hospital in a car that evening. Transporting her to the hospital cost Le40,000 (US$13), which her husband borrowed from his neighbours. When they arrived at the hospital, Pa Abu Kamara had to pay Le2,000 (US$0.67) for registration and Le10,000 (US$3.30) for a hospital bed, in addition to charges for medicines.
At the hospital, Adama was given an intravenous drip as well as several injections by the nurses on duty. She spent that day and the next in the hospital, and no doctor was present during that time. Pa Abu Kamara came home on the second day and when he returned to the hospital after several hours, he found that Adama had delivered the baby, but it had not survived.
Adama was bleeding heavily. Despite the fact that this was an emergency situation and despite the government’s free care policy, there was no free medication. The nurse in charge at Kambia hospital told Pa Abu Kamara that he had to pay for medicines for Adama or “she will die”. Pa Abu Kamara told Amnesty International, “I didn’t have any more money. I just took Adama out of the hospital and took her home. She did not look good and also I did not want to pay the hospital charge for her body which is at least Le60,000 (US$20).” Adama was delirious by this point and unable to speak for herself, even if she had been given the chance. Pa Abu Kamara hired a taxi to take Adama from the hospital and she died at home the next day. Adama’s body was taken to her parents’ home and she was buried in her birth village.
Pa Abu Kamara told Amnesty International he felt sad about Adama’s death, “especially for her children”. He then said, “I am still struggling to pay off the debt I incurred taking Adama to the hospital and paying for medicines.”
INAMARIE STITH-ROUSE, USA
Inamarie Stith-Rouse, a 33-year-old African-American woman, was 41 weeks’ pregnant when she arrived at a hospital in Boston, Massachusetts, in June 2003. Doctors gave her medication to induce labor. When her baby’s heartbeat dropped dramatically, she underwent an emergency c-section (cesarean section) and delivered a healthy baby girl, Trinity. Her husband, Andre Rouse, told Amnesty International how following the birth: “She started to complain of shortness of breath. I couldn’t find the doctor. They kept paging her, but she wasn’t around. The oxygen machine kept beeping; maybe six or seven times in half an hour. I lost count. No one was taking it seriously. Her face was burning up; I kept putting cold compresses on her forehead.” He described how when they tried telling staff that she was distressed and struggling to breathe, they were told it was “no big deal” and that they were “too emotional.” Andre Rouse told Amnesty International he felt race played a part in the hospital staff’s lack of response to his and his wife’s requests for help.
According to court papers filed by her family, Inamarie Stith-Rouse displayed symptoms of hemorrhage, including low blood pressure, high pulse, and shortness of breath. However, it was hours before appropriate tests were undertaken. By then it was too late. Doctors found internal bleeding and first removed the uterus, and later an ovary. However, Inamarie Stith-Rouse suffered severe brain damage, slipped into a coma and died four days later.
Andre Rouse said, “Her last words to me were, ‘Andre, I’m afraid.’ Then ‘CODE RED’ was called. I was pushed out the door. Everything was in slow motion. I remember being freezing cold. My teeth were chattering. I was in shock... Nobody talked to me...
I felt as though everyone was trying to cover up their tracks. If someone had tried to explain, the whole thing would have been easier to accept. I understand: mistakes happen. But nobody took responsibility.” He told Amnesty International that, after he filed a lawsuit in December 2004, “the hospital changed protocols after Inamarie’s death. In what way and how, I don’t know to this day.”
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