A botched surgical procedure

A botched surgical procedure

MASERU – With all the excruciating pain she had endured for five months, the brownish, clotty and bloody discharge that never ceased, Limakatso Tlhatšoana*, 35, knew something was seriously wrong with her.
But the 35-year old mother of two says when the gynaecologist finally announced the diagnosis, it still was a shattering blow she had never imagined coming her way nor knew how to deal with.

The gynaecologist did not mince his words, telling her that her womb was dangerously infected and literally rotting in her body.
The choices were as hard as they were clear – she could take the gamble of trying to have the infection treated and save her womb, and face the life-threatening risks that accompanied that option should the treatment fail and the infection spreads or she could have the vital reproductive organ – without which no woman can bear children naturally – removed and with that be assured the infection was gone for good.

“I already have two children, a boy and a girl, and I had no intentions of having more but the option of having my womb removed had never crossed my mind,” Tlhatšoana told thepost this week.

In a telling example of the kind of challenge and the risks that women in Lesotho face trying to access reproductive health services, Tlhatšoana ended up settling for the ‘nastiest’ but safest of the two options she had in front of her.

She had a hysterectomy, the medical term that refers to the surgical removal of a woman’s womb. She said her gynaecologist, speaking to her after the operation, told her that she had escaped death by a whisker because the uterus was so infected and damaged that unattended it would have eventually caused her to die.

Yet all that Tlhatšoana had wanted, when she visited the Lesotho Planned Parenthood Association (LPPA) facility in Mohale’s Hoek that fateful August in 2018, was to have an Intrauterine Device (IUD) or loop as it is more commonly known inserted in her uterus to prevent her falling pregnant.
She wanted a safer and more long-lasting contraceptive method following the birth of her second child.

But that was the beginning of her nightmare after a nurse botched the insertion procedure, perforating Tlhatšoana’s uterus to touch off a series of horrendous and painful experiences that only ended with the “forced” hysterectomy.

The LPPA said it is not aware of Tlhatšoana’s case because it was never reported either to local management in Mohale’s Hoek or to the association’s head office in Maseru.
“Clients are always encouraged to come back to the facility when side-effects persist,” the LPPA said in statement, appearing to question why Tlhatšoana did not escalate her case up with the association’s management.

The LPPA, which said the IUD is a safe contraceptive method approved by Lesotho’s health ministry, firmly endorsed the device, saying “cases of misplaced IUD are very rare.”

A Maseru gynaecologist, Dr Muluken Esheta, also spoke in favour of the IUD, saying while people could experience complications or difficulties with it especially when it has been wrongly inserted, it remains one of the safest and most effective contraceptive methods that are available to women.

Though medical experts speak approvingly of the IUD’s effectiveness and safety as a birth control method, the device does not appear popular among Basotho women if figures contained in the Family Planning 2020 (FP2020) 2019 Annual Report are anything to go by.

The report says 285 000 women were on contraceptives in the past year but only a paltry 2.1 percent of them used the IUD.
Without a womb anymore Tlhatšoana no longer uses contraception to prevent pregnancy for she can’t get pregnant anymore.
But no prizes for guessing what, after her ordeal, she thinks of the IUD or the LPPA that promotes it.

In fact, she says she would have sued the LPPA for damages but decided against it for fear of the “emotional torture” she would have had to endure fighting the association in the courts.

Tlhatšoana says: “I had thoughts of suing the LPPA for negligence, but I knew that it would take forever to get justice. I was not ready and am still not ready for the emotional torture of going through the courts of law.”

“It hurts that I no longer have the option to have more children,” says Tlhatšoana, that statement putting into sharp focus how much she has endured and continues to suffer as a result of what looks like gross negligence and incompetence on the part of LPPA staff – if her account is to be believed.

According to Tlhatšoana, the pains started not long after the IUD device was inserted in her at the LPPA’s facility in Mohale’s Hoek.
If prompt action had been taken, then perhaps the device could have been removed and the wound caused by the perforation of the uterus treated.

But other women she says were also using the IUD advised her to wait a little more perhaps promising her that the pain was going to go away with time.
When she eventually went back for a check-up at the LPPA, the same nurse who had inserted the IUD told her to give it time – six months – and if she was still in pain by then that would be evidence that her body was rejecting the device.

“She told me that it could take up to six months to be sure that the body is rejecting the loop,” says Tlhatšoana.
The nurse’s words were hardly comforting as the pain never stopped nor did the bleeding.
“What got me increasingly worried was the brown clotty bleeding that never stopped,” she says.

She consulted her family general practitioner who ordered a scan but nothing wrong was detected in the uterus or organs around it. And the pain and bleeding never stopped.

“At this point I could not sleep without a hot water bottle because it kept my abdomen area warm and less painful,” she says.
A gynaecologist at the Maseru Private Hospital (MPH), whom Tlhatšoana visited for a second opinion, was the first to suspect the IUD could be the problem, recommending that it be removed.

Tlhatšoana went back to Mohale’s Hoek with the gynaecologist’s recommendation to remove the device but the same nurse who had earlier wrongly inserted it grudgingly removed it, querying why the gynaecologist didn’t do it herself.
Tlhatšoana went back to the Maseru Private Hospital gynaecologist who ordered a second scan.

It is that second scan that finally revealed the injury in the uterus because of perforation by the IUD and the infection it had caused.
Of course, Tlhatšoana’s case might be a dramatic one and in the minority given the percentage of women using the IUD as contraception, but the way she claims to have been handled by the LPPA in Mohale’s Hoek raises two worrying points.

Firstly, whether the country has done enough to ensure women – especially in rural and remote parts of the country – have access to reproductive health services.

Secondly, whether those entrusted with the reproductive health needs of women, such as the LPPA nurse, are well trained and equipped to provide a safe and reliable service.
*Not her real name.

Rose Moremoholo

 

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