The chance of dying from an ectopic pregnancy in Australia is pretty rare these days. We are so privileged to have access to the latest and greatest of trans vaginal ultrasound technology and blood screening. When I say we I mean "the majority" of Australians.
In my case I lived in a remote aboriginal community with limited facilities. The Australian government funds the local "health facility" which on a good day has 2 doctors, a handful of nurses,a child health nurse, a midwife and whatever specialist has flown out for the day.( dentist, gynaecologist, oncologist,psychologist etc)and a couple of students thrown in for good measure.These are the days when its great to be sick because everyone is so busy running around like a headless chook you are lucky if you get to make eye contact with anyone.
On a bad day, you will have to press a button on the side of the building that goes to message bank and you have no choice but to leave a message and sit and wait. Usually when everyone has gone on leave or a convention at the same time or the odd cruise ship which has been known to happen.
On the evening I collapsed from the ectopic rupture, it was approximately 7 o'clock and the sun hadn't quite set. My son was sitting down to his dinner in front of the television and I was laying on my bed, buckled up in pain begging my husband to get me help.
We lived in the same street as most of the full time health workers. Our immediate neighbours were an old couple, one of them had worked for my husband and the other was the 2IC nurse at the health facility. We had socialised with them a couple of times during our contract. My husband ran next door and rapped on their door. No answer. He could hear them talking so he knocked again and called their names. No answer. He rang his mobile number and left a message. He was on his way to press the button when to his surprise the old man phoned back. In my husbands desperation he asked to speak with his wife, the nurse. She came to the door, he told her that I was pregnant and had collapsed in pain, he was scared and didn't know what to do. She looked at him and said" I'm not on call tonight, you'll need to see the nurse on call." and turned away.
What felt like a lifetime later he came back.The nurse that came was the nurse that had been there during my initial scan. The scan that I received because I had complained of localised pain shooting down my right side. The scan where I was told that there was a 5 week 3 day old foetus in my uterus. The first thing she asked me was if I was experiencing any blood loss. I hadn't. I will never forget the look on her face as she "treated" me. She looked at me as if i was over dramatising a simple miscarriage. She told my husband to get me a hot water bottle and said I looked a little pale. When she asked me if i could walk over to the clinic I told her that I felt as though my bowel was about to explode. My husband returned with a hot water bottle and put it where she told him to and I started to feel very ill. She walked out of the room to call the doctor.
The doctor arrived shortly after and arranged my transport to the health clinic via the ambulance. When I say ambulance I mean a landcruiser troop carrier with a broken stretcher that nobody knew how to use.When i was dragged into the emergency room I heard the doctor tell my husband that she believed it was an ectopic pregnancy. I was shocked, "but the midwife saw the baby, in my uterus,she saw it on the ultrasound." To which the doctor responded "that machine is 20 years old, I wouldn't trust it to see anything." The nurse who had sat by my side while the midwife had done the scan and had helped her take my blood was frantically trying to get a blood pressure reading on me, I waited for her to say something but she didn't.
Looking back I realise that there were a few things wrong with the whole equation.
- Why was I not suspected for ectopic pregnancy when I had showed at the clinic with abdominal pain down my right side?
- The clinic is not equipped with a trans vaginal ultrasound, so an abdominal ultrasound was used. The midwife admitted to me she did not know how to use the function to date the foetus properly.
- I was not screened to rule out the possibility of ectopic pregnancy.
- I was not told that the abdominal ultrasound is not accurate enough to rule out early complications, why wasn't i advised to see a doctor on the mainland as soon as possible?
- The nurse that was in the room when I had my initial scan meant that she was not immediately suspecting an ectopic pregnancy when she saw me on the night I ruptured, which delayed critical treatment time.
The surgeon that saved my life would not discharge me from hospital in the event that I went back home. She had no confidence in the treatment that I had received. At the time I was just happy to be alive. I was healing really well, I had my mum with me for support. I was grateful that I had survived an emergency that given the chance I had lived in another country I would have died. When I was ready, I went back to the community.
Whilst I had been in hospital my husband had been confronted by our friendly neighbour, the nurse who wasn't on call when his wife was dying. She had tried to tell him in a round about way that the clinic had nothing to do with what had happened to me, and that these things happen all the time. She suspected that I had obviously been having twins. That was the only explanation. My husband had already been told by me that the HCG levels in my blood were not high enough to warrant twins. He wasn't very obliging when she was trying to convince him of this. He got mad and in turn she told everyone in the health facility that no one was to communicate with us.
So on my arrival back to the community, not one of the health workers made any contact with me.Not even eye contact. They walked away from me in the street. Turned their heads when I walked past them. I was desperate to work out why when the nurse who had treated me on the night it happened came to my house and explained everything.
She had been told by management to have no contact with myself or my husband. The only contact i knew of was between my surgeon and the midwife who scanned me. My surgeon told me what the midwife had said to her."She said she had done the best she could with what she had at the time."
Interestingly enough though the clinic had an obstetrician come out and look at the ultrasound machine. She had told the staff that the machine is in good working order, it isn't really useful as a diagnostic tool or dating scanner because it doesn't pick up any details until 8 weeks gestation.
When the nurse told me this, I was speechless. This machine had been used as a diagnostic tool and it had been used as a dating scanner even though the midwife told me she wasn't able to use that function. I explained to the nurse that it really isn't good enough considering it isn't accurate enough until 8 weeks gestation and I ruptured at 7 weeks and 2 days. Most women rupture between weeks 7 and 8.
All three obstetricians I saw during my stay said that I would be able to get pregnant again, "but please don't get pregnant in an aboriginal community again."
Now that I have spent time researching ectopic pregnancies I have realised just how scary that statement is. Aboriginal women are at a higher risk of ectopic pregnancy than non indigenous Australians, due to the higher percentage of chlamydia, smoking and health problems within these communities. If the government is going to fund outback midwifery to be responsible for these pregnant women living in remote Australia then they should either be equipped with the appropriate resources or be able to guide the individual to the place where they can be treated as such.
The health workers continued to hide from me until I packed up and moved away, but my husband still works there in order to pay for the house I live in so that I can get better mentally. He is still treated with hostility to this day. I was grateful to be alive, but now im angry and bitter that they could treat me and my family this way because they cant face the fact they were negligent. They are just waiting to be investigated and to see if i take it any further. I havent at this stage. I just want to be me again. But every so often i think about what I have lost, and how close my family came to losing me and I get wild. I havent gone back to work, I still dont sleep properly, I still suffer from pain and for the first time in a long time I am stressed about money.
Money.....something the clinic is smothered in. They are drowning in it. I was getting sick of hearing about how much they get paid for call outs and there clicky little network. Their snide little comments about the locals and there pathetic example of a "health clinic" The icing on the cake was the award they received for"nursing and midwifery excellence." WHAT?? HOW?? WHERE?? on the cruise ship??
If remote health clinics are going to staff midwives to work with women in early pregnancy then they need to have the proper equipment for diagnosing ectopic pregnancy.In this instance a top of the range trans vaginal ultrasound would set the clinic back around $20,000. including training the midwife to use it. I hate to think what it cost to save me, with the careflight helicopter, the 3 surgical teams on call waiting for me to arrive, the 4 hour surgery, the medications and the aftercare. It would be costing the government more than that in maintenance fees to mow their lawn every month.
Something inside of me is telling me to face them and make them own up to their negligence. This has affected every aspect of my life and someone needs to acknowledge it. A simple "Im sorry Jane, we should have told you to go to another doctor sooner. We are so happy to see you are alive though" would have been sufficient. But now...I have a sneaking suspicion it may take more than just an apology.....
What do you think? Should I be content with being alive and leave it at that? or should I pursue this in court and make them answerable to their actions or lack there of? Im interested to hear it because Im struggling to to work out the right thing to do?
