I have read Frankie Asare- Donkoh’s misplaced reaction to my article titled “Baby Suweiba: Unseen, unheard and now missing” with some dismay. But given my positively provocative writing style, I am not too surprised. I live in constant fear that the superficial reader of the column is always at risk of totally missing the essence of the point being made. And so has it been with Asare-Donkoh.
The disappearance of Baby Suweiba cannot be justified. Indeed, my article never did that. Rather, it called for investigations. But it went beyond this call. It argued that basically, the systems and processes that produced a ‘disappeared’ baby did not differ from those that produced stillbirths and neonatal deaths.
If every system is perfectly designed to achieve the results it gets, then it is crucial not to react to the former as if divorced from the latter. My article also argued the point that if half of the public uproar raised to find the body of Baby Suweiba had previously been raised for the millions of non-missing stillbirths and early neonatal deaths, great progress would have been made in the fight for neonatal survival.
If, and that is a critical if, Asare-Donkoh actually reads my articles as he claims and more importantly understands them, he will be in a position to know that insults do not and have never, formed part of “Affirmatively Disruptive.” I hold my readers in too much regard for that. In the said article, this is not different. I never insulted the Suweiba family.
Baby Suweiba was simply used as a reference point to throw light on a darker problem with clearly articulated sociocultural, facility-based quality of care and policy dimensions. In fact, as somebody pointed out correctly, my article could well have been written without mention of the name Suweiba because its focus was clearly systemic as opposed to the specific.
The greatest bottleneck to achieving MDG 4 is stagnating neonatal outcomes. Historically, stillbirths, neonatal deaths and associated root causes have never attracted deserving attention. This is the situation that health experts have described as the newborn being “unseen and unheard.”
So while finding the body must be insisted on by the family, my article pushed the limits and asked the health system to do much more by way of interventions that prevent stillbirths in the first place. Now I notice that Asare-Donkoh contests the death of the baby. In fact, he emphatically accuses “medical and health personnel” of stealing the “newborn at a state-run hospital.” I do not have the evidence that Asare-Donkoh has and cannot therefore speak to this.
What I know is an interview granted Joy FM by a Komfo Anokye Hospital official who stated categorically that the baby was born dead, and immediately shown to the mother followed by the contentious disappearance. If a baby -stealing syndicate is found, I have no doubt that I will speak forcefully against it. But here comes Asare-Donkoh’s greater confusion.
The point of my article is not whether the baby was stolen or not, or whether the mother has a right to demand the baby’s body or not. The point argued by the article is that stillbirths, neonatal deaths, disappearing bodies etc. are all different snapshots of one malfunctioning system and the one should not be tackled without the other.
Asare-Donkoh is seriously worked up about my point on our collective greater affection for corpses as opposed to preventing deaths. My point is that if the dead baby had been produced by the hospital after the Ministry’s 14-day ultimatum, this whole matter would have died quietly in the public space simply because the body had been found.
I am actually arguing that that should not be the end. And this is because, there are thousands and thousands of babies being born dead or dying within minutes of their birth, but who because they did not catch media attention on account of their missing bodies, caused no fundamental systemic changes. Which CEO would be fired? Who will review standard operating procedures? Who will demand accountability from frontline staff? What is so insulting about these or so complex that Asare-Donkoh cannot grasp?
Asare-Donkoh’s other confusion occurs when he accuses me of justifying “the disappearance of Baby Suweiba from “lack of equipment and ‘salubrious working environment’”. This is a total non-starter because I never advanced that position. He probably totally missed the nuanced construction.
Rather, the article argued that a systematic intervention includes changes in management attitudes. This point is entirely different from making inefficient management practices the core justification for Baby Suweiba’s disappearance.
article actually alluded to wastage and some misplaced prioritisation in our system. It also advocated for the performance of managers to be tied to improvement in clinical outcomes as this will lead to better coordination among frontline staff and the managers with patients as the central focus.
I have for example, worked in a state-of-the-art neonatal intensive care unit in a Ghanaian public hospital which used to demand handsome advance payment upon admission. For some strange managerial and bureaucratic processes, this ‘rich’ unit could actually end up running out of gloves because the money was “with administration” and not accessible at the point of care.
The point then is this that changes in our work attitudes and professional practices ought to be accompanied by refocused and improved management practices that clearly prioritise quality of care. Unfortunately, Asare-Donkoh, it is not a case of one or the other, but both needing to happen to change the bad outcomes, be they newborn deaths or stillbirths.
As for what the Ghana Medical Association has done to improve patient care, I believe a lot has been done. But because my column does not represent the official communication channel of the medical association through the eyes of its immediate past Vice President, I believe it is not worth getting worked up over.
Asare-Donkoh attempts to ridicule me for “lack of consistency in knowing what Baby Suweiba is, referring to the baby as a foetus and baby at the same time in a single article.” I did define stillbirth as “death of a foetus in the womb from seven months onward?” The word “foetus” greatly confuses Asare-Donkoh. Well, it is generally accepted that the growing baby in the womb, before birth, is referred to as a foetus. After the baby is born, it is no longer a foetus. When that foetus dies after seven months or is born dead, it is a stillbirth. Now if that foetus dies at say three months, it is not referred to as a stillbirth, it is called an abortion.
Now because Asare-Donkoh is so easily given to bouts of confusion, I have to quickly clarify that the use of the term abortion is neither to insult the Suweiba family nor to allege that Madam Suweiba caused an abortion. In conclusion, a growing baby can be a foetus at one point and a fully bouncing baby at another point and there is no inconsistency.
As for his comments about how I may have reacted had my wife lost my baby etc., I am well-advised by balanced well-wishers to disregard same as baseless emotive effusions with no useful bearing on the more pressing fight to improve newborn survival.
What I do know, believe and will continue to preach is that stillbirths and early neonatal deaths are different snapshots of the same continuum and that reversing these outcomes will require system-wide interventions that embrace the community, health professionals and senior management. I honestly admire Mother Suweiba’s courage. Her right to find her baby’s body should be asserted at all times.