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Re: KHMH: A Dozen Dead Babies [Re: Marty] #465474
05/29/13 02:20 PM
05/29/13 02:20 PM
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For what its worth the PM has scheduled a press conference for tomorrow afternoon to share with the nation his final call on the KHMH issue. LOVE TV has asked me to be on tomorrow's morning show to share an insight into how the NICU works and systems that were in place to prevent such fiascos. One week after offering o assist in any way I could to make sure that this did not happen again I am still to hear from the KHMH authorities

Alvaro Rosado

Re: KHMH: A Dozen Dead Babies [Re: Marty] #465477
05/29/13 02:33 PM
05/29/13 02:33 PM
Joined: Oct 2003
Posts: 2,460
Belize City
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GOB have a few experts in country now to assist. I hace spoken with one who says this problem is endemic around the world. Todays NY Times has a great article about the same issues; getting docs to just wash they hands. Interesting read


Belize based travel specialist
www.belize-trips.com
info@belize-trips.com
Re: KHMH: A Dozen Dead Babies [Re: Marty] #465612
05/31/13 05:15 AM
05/31/13 05:15 AM
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A Plea From the Medical Chief Of Staff

At the top of the newscast, we told you all about the ongoing investigation at the KHMH to find who or what is accountable for the 13 baby deaths in 20 days. But today the Medical Chief of Staff made a heartfelt plea on behalf of his institution when he said that Belizeans must go beyond the blame-gaming to find a staff that genuinely cares:…

Dr. Adrian Coye - Medical Chief of Staff, KHMH
"It is easy to see the wrong, it is easy to say, well 'they don't have this, they don't have that' and I am challenging you as a country to see the other side. If they don't have this, where can I fit in? How can I fix that? We see that this is a small unit; we're asked to do so much, four hundred and fifty, five hundred babies a year with a capacity that should be for ten babies, but we do twenty sometimes and I see and have seen miracles, I've seen excellent work and when all those successes are happening, no one says anything. But I just want to say, in defense, of all those I see work without praise, that I am proud to be working in such a great group."

And in a question that got mis-inserted into an earlier story, some of the families who’ve lost babies want to know if they’ll be compensated – since at least seven lives were lost due to bacterial infections. The Chairman of the board made no commitment on compensation.

Reporter
"Aside from the apology to the families, are you in a position to offer them anything else?"

Chandra Nisbet-Cansino - Chairman, KHMH
"I'm not sure exactly what compensation, because it was basically a brief admission and discharge and the only thing that they would probably be given would be a hospital bill."

Channel 7


Re: KHMH: A Dozen Dead Babies [Re: Marty] #465613
05/31/13 05:16 AM
05/31/13 05:16 AM
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KHMH: Who’s Responsible?

Who’s to blame for the death of a dozen newborns at the KHMH Pediatric Intensive Care Unit? That’s what most everyone wanted to know from a press conference held this afternoon by the KHMH, Board and Management along with the Prime Minster. But, as we found out in the hour and a half long press conference in the Hospital Conference Room, things aren’t always that straightforward. Here’s what the Chairman of the Board had to say.

Jules Vasquez
"What you said at the Press Conference was that it was really a failure of management protocols, a failure of reporting protocols so am I to determine then that no one is to blame? No human is to blame? No one is accountable?"

Chandra Nisbet Cansino - Chairman, KHMH
"If you are asking specifically about the deaths of the newborns - at this time we cannot hold any one person accountable. We have had detailed discussions with the head of the Pediatric Unit and there response was really timely, they did what they were suppose to do and when they were supposed to do it. I think as Dr. Coye explained, he was aware of what was going on - unfortunately the CEO was not. We would have liked that the CEO knew about these events as they were unfolding and so we as a board plan to have a conversation with him probably to strengthen that area because as a board as well if there is a crisis in the hospital, we also feel that we should know. We definitely will have that conversation but our first concern was to ensure that the situation was handled correctly and that there was no negligence on the part of the medical professionals."

Jules Vasquez
"But just from a visceral prospective, when you hear the stabbing statistics of 12 deaths in 21 days even if they are premature and are high risk patients. As the Prime Minister likes to say 'heads have to roll'. You mean out of all of this nobody's 'head will roll'?"

Chandra Nisbet Cansino
"I'm not saying nobody's 'head will roll' but nobody's head is rolling at this time, today - so far."

That interview was conducted after the press conference which detailed the sequence of the deaths and the medical response. As the Medical Chief of staff explained, the tragedy started unfolding on May 10th: The explanation is a little lengthy, but it’s important, so bear with us.

Dr. Adrian Coye - Medical Chief of Staff, KHMH
"The clinical course essentially happened where around the tenth of May it was recognized that a baby became unwell and this baby was screened and cultures did not show any positivity for any organism and the baby died as a result of sepsis, as presumed sepsis - thought no cultures were grown. It was recognized by the clinical team that babies were becoming septic and becoming unwell very quickly. So sepsis meaning that they stopped, they weren't feeding well, febrile, short of breath and it was recognized. All these babies that come to our unit were sick babies and they didn't just go into the unit for not being sick. The week before we had our first press conference, essentially was when more babies were becoming quite septic and dying. There was a lag in terms of us being able to identify an organism but on the ground, I was alerted that babies were becoming very septic. We went down to the unit with the head of Pediatrics and we looked at the area and talked about the cases with the head of infection control in our hospital as well and we analyzed the situation and we decided to do what we were doing in terms of adjusting the antibiotics, emphasizing the hand washing and making other measures in that area - including wearing gloves and other restrictions. Restrictions meaning moving out some of the equipment that we had in that area. Despite these measures they came the way that I described before and we made a continued antibiotic changes and the peak of it all happened on the weekend of last weekend when the majority of those babies who had the severe infection succumbed."

Reporter
"Even before the press conference was held - even before the first Press Released was sent out you had already agreed that babies were entering septic shock. Dr. Longsworth was not - he admitted in the last press conference that he learned about this by way of the media. What failed there? Shouldn't the hospital's CEO become aware that this was happening?"

Dr. Adrian Coye
"I'll start first. Yes I was aware and my pediatric team and the nursing staff, we were all aware that something unpleasant was happening and we made adjustments on clinical grounds. You may recognize something is happening but you have to make changes and also need supporting evidence so in the end we didn't have supporting evidence - it was a delay in some respects and we're able to say that it's that organism. I think Dr. Longsworth trusts me enough to make the kind of decisions on the ground at that time and I made the reporting as I could having dealt with this situation in the best way that all of us could have done in a team."

Reporter
"So the first death by Cloacae was on May 10th. In reading about it I have read that this bacteria is very deadly and recognizing that shouldn't have the NICU be closed then on May 10th?"

Dr. Adrian Coye
"If I closed the unit that has sick babies in a cluster that were most likely having the same problem - most likely."

Dr. Ricardo Bustamante - Infectologist, Ministry of Health Chile/PAHO
"Outbreaks are unfortunate events that happen not as maybe more often as we would like in any hospitals around the world. I come from Chile and in Chile we also have outbreaks. I think that the measures that were taken of the awareness of the authorities from the hospital and the Ministry of Health, from the country itself were done in a timely manner. Sometimes it isn't easy to identify an outbreak and here you had an outbreak that started in a very short span of time, we're talking about ten days where 6 or 7 newborns got infected and died. It's not always easy to be aware that this is an outbreak - most of the time it happens that doctors start treating them and giving them medications but none of them are aware that this would turn out to a certain common source of infection that they did. So I think that the approach that they did here was in a timely manner, unfortunately it created several deaths."

Chandra Nisbet Cansino
"That was our main concern as a board that the measures taken to address the situation was taken timely and with the interest of the patients first. Up to now we are convinced that that has been done and so far we don't have any reason to believe that anything was breached in the management of the cases that were with the present bacteria. We don't want to sit here and say that everything is fine - there are areas that can be strengthened, those have come out as the preliminary findings. There were issues that came up when we spoke to some of the mothers - perhaps the way they were spoken to in some of the wards, things nurses and doctors may have said or any other person may have said. We want the staff to know that we appreciate what they do but every single patient and family that walks into KHMH deserves the compassion and the respect and the courtesy and dignity that every human being deserves and we want to put them a notice that kind of behavior will not be tolerated; we need them to treat the people with the dignity that they deserve."

It was clipped out of the story, but after May 10th, no new babies were admitted to the Unit – as the medical staff tried to manage the cases that it had. For the time being, government is paying all costs to restore and re-fit the existing unit and the four newborns that were taken out of the unit are being cared for in a private room in the maternity ward. It will be another one to two months before the Pediatric Intensive care unit is re-opened. But, even then, it will only be temporary, as Government has committed to provide start-up funding for the new wings with a pediatric intensive care unit. The PM explained.

Dr. F. Gary Longsworth - CEO, KHMH
"This we anticipate will take approximately 18 months to two years to be fully completed. The new NICU - PICU will be fully completed and equipped and ready for occupancy for staff and patients."


Hon. Dean Barrow - Prime Minister of Belize
"What Government will now do is to find the first half a million dollars so that construction can commence immediately - I believe we have disbursed some of the money already Dr. Allen. That should see the project within the next few months while the promised donations are being unlocked and the entirety of the 3 million or so is gotten together to complete what will be the KHMH state of the art facilities for our babies and children."

As a closing detail, it is important to note that 13 deaths were recorded at the unit in May – and only 7 are being ruled as sepsis, or resulting from bacterial infection. The other six were due to prematurity and related conditions. On average, the unit records five deaths per month.

We’ll have a little more from the press conference later on in the news as the Medical Chief of Staff makes a heartfelt plea for his hospital.

Channel 7


Re: KHMH: A Dozen Dead Babies [Re: Marty] #465774
06/03/13 04:43 AM
06/03/13 04:43 AM
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Looks like the media are not yet ready to let go of this matter. I have been invited to discuss it on the Dickie Bradley Show on Monday. As the matter unfolds I am saddened by what the PM would describe as Collateral damage. The head (pun intended) of the Paediatric Unit is being prepared to be sacrificed on the altar of political expediency and Belize's only Cardio Thoracic (Open heart) surgeon seems to have voluntarily thrown himself under the bus. One of Belize's most highly trained and capable nurses is being brought in to KHMH as Director of Nursing Services - she is well suited for the job but I would have preferred if she were brought in after the dust had settled but it seems she will be fast tracked to add credibility to the "investigation".

Alvaro

Re: KHMH: A Dozen Dead Babies [Re: Marty] #466003
06/06/13 04:52 AM
06/06/13 04:52 AM
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Mexican physicians visit Belize

Mexican physicians visit Belize to collaborate with Belizean authorities to produce a diagnosis on neonatal health in light of recent events that have required immediate cooperation of the international community.

The Government of Belize, through the ministries of Foreign Affairs and Health, requested assistance from the Government of Mexico to collaborate through two Mexican specialists in sharing their experience on the development of national policies on health issues.

This visit is part of the programs of technical cooperation between Mexico and Belize.

Dr. Daniel Ibarra from the Children´s Hospital Federico Gómez, specialist in Neonatology and Dr. Alethse de la Torre from the National Institute of Medical Sciences and Nutrition, Salvador Zubirán, specialist in Infectology worked as part of a research medical team in Belize from June 2nd to 5th.

Re: KHMH: A Dozen Dead Babies [Re: Marty] #466099
06/07/13 05:18 AM
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COLA Protests; The Little Ones Not Forgotten

On Tuesday, 7News showed you that power press conference that COLA held in which they announced that they will protest outside of the KHMH.

Well, today, the organization managed to gather about 70 persons who marched in the sweltering heat. They were determined to show their discontent with how the hospital has handed the mass deaths of the premature babies in their Intensive Care Unit.



Daniel Ortiz was out there, and he found out that, as with everything COLA, it was done in dramatic fashion. Here’s his report.

Daniel Ortiz reporting
At the head of their procession, the supporters of COLA had a coffin, which could neatly fit one of 12 dead neonates who passed away inside Intensive Care Unit at the KHMH.

There weren’t any actually bodies inside it, unless you counted them speaking as one body about the loss of confidence which they continuously hefted along. All through the streets, in a circumference around the hospital grounds, they gave a loud lamentation of their dissatisfaction, closely monitored by wary police officers.

But those officers weren’t really threatened by this peaceful group, either physically or by numbers.

Geovanni Brackett - President, COLA
"COLA has staged this protest and demonstration to state three or four things on the record. 1 - we need an independent investigative team to audit this entire situation at the KHMH. This is not the first major incident we had; I think about 9 mothers who had issues up north, parents down south and so we need to put a health check. We need to do a reform of our health system and these grieving mothers and fathers need to get professional counseling and the government should pay for it. 2 - somebody must be held accountable, somebody needs to be held responsible for what happened."

Brackett also asserted that the importance of this issue should not be determined by a numbers game.

Geovanni Brackett
"Of course you would want to have more people but that's not an issue for us. To me the government doesn't need a protest to respond to the thirteen deaths of children who died in 20 days. If they don't respond adequately that just shows the kind of heart the government has. You would have to be a cold hearted person not to even have an impact just by the deaths of the children, much less you need a protest to have a heart? That should not be the case. So we do not need a protest for hearts to be touched, you just have to have the heart to see that 13 kids died and somebody not be held responsible. If nobody wants to hold responsibility then it tells you that not only do we have a breakdown in the health system, a breakdown in morality but a breakdown in this entire country."

These citizens believe that the any meaningful response from the hospital authorities and the Government is too late, but that the people deserve it anyway.

Geovanni Brackett
"I would hope they respond by tonight or by the next hour. If they don't it just shows that it's really what people think of the hospital."

You should remember Marissa Cruz; she is the mother who gave powerful testimony at the COLA press Conference on Tuesday describing the pain and grief she’s been forced to go through. Finally, after days of suffering, she has a minor reason to smile.

Marissa Cruz - Lost Her Baby In ICU
"I'm really glad with Ms. Shakron, with the COLA and Mr. Menzies that are behind us here that are supporting us, giving us their full support. I really think it's necessary that they give us support because with oly us, the families, we might not be heard. But with their support it gives us more of a backbone to this whole issue. I think for me to be here today, it does not only make me feel proud of myself but of all the other families that are here because since everybody is here right now it makes me feel like they want to do something about this and bring justice not to only my baby but to everyone else's."

And there were Belizeans this morning who were offering a voice in support.



Keith Yearwood - Concerned Citizen
"I'm here to support the grieving mothers and at the same time I'm a father. At any given time my children could end up in the hospital and I would hope that this tragedy would not happen to one of them."

Daniel Ortiz
"Sir, do you have any confidence in the KHMH to provide care to anyone of your family?"

Keith Yearwood
"No, Sir."

Daniel Ortiz
"Why is that?"

Keith Yearwood
"Because they have unproved themselves too many times."

Phillip 'Fawda' Henry - Concerned Citizen
"I have life and I was one of them who was born out of a hospital in this country. As a citizen of this country, we must know what is going on in our health system. Health is one of the biggest role and issue in our nation and we all have a time when we choose people to govern our country. We have failure for the past 30 years with our health system and Belizean citizens need to learn to stand up when it pertains to health. There are so many things that happen within our health care system and nobody stands up and ask why it is happening."





Carlee Orosco - Concerned Parent
"My baby could have been one of them and I thank God that He saved my baby that's why I'm here to support them."

But how did we ever arrive here? A former minister of health says that it is due to a breakdown in Leadership that ministry.






Jose Coye - Former Minister of Health
"So I think what we see here is syntomatic of a leadership crisis in the Public sector, that is precisely what I think it is."

If you ask COLA, they don’t need any accolades for organizing this protest. All they want is that the grieving families get some form of a release from the emotional toll.

Marissa Cruz
"I didn't have any courage, I was devastated that my child died. I didn't even want to speak to anyone about the issue, I just ignored the issue at thatpoint but now I feel good."

Steven Panton - Lost His Baby In The ICU
"What I think is that everybody is listening to the situation but not everyone understands or are trying to realize the situation because first of all basically most of my family members are taking it badly. My girlfriend is taking it the hardest, it is just to say, everyone knows if you have a girlfriend or a wife that has been pregnant before, everyone knows all the hardship and troubles especially if the person had been having a complicated pregnancy. There's a lot of things that you go through just before the time the kid is born and while your kid is in the womb, you have been having a relationship with that kid as well so just because my kid was seven days old doesn't mean that I didn't know or love my child because I had a relationship with my child before my kid came out of the womb. Everyone that has had a baby before could attest to that and everyone knows what we have to go through to even make the baby come to existence. So a matter like this is very serious and people are not understanding how serious this matter and the same people that are not understanding will be the same people that they will want to run over when something happens to them."

Channel 7


Re: KHMH: A Dozen Dead Babies [Re: Marty] #467267
06/26/13 05:07 AM
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PAHO Reports On Neonatal Deaths; KHMH Has Much To Explain

4 weeks ago, 7News showed you the comments of Prime Minister Dean Barrow, as he responded to the protest held by COLA about the 12 neonates who died inside the Pediatric Intensive Care Unit.

One of the major public concerns was the perception that KHMH Administration was investigating itself, and so, the issue was that if the hospital was investigating itself, they could doctor the results to hide any major mistakes and forms of negligence.

PM Barrow allayed that fear somewhat when he announced that the Pan-American Health Organization (PAHO) would be the leading organization inquiring into the mass premature deaths.

Well, it’s been about a month since that protest, and yesterday, KHMH finally announced that the full PAHO report is finally complete. They only just released today it on their website, but the date on the document suggests that it was available since last week Monday.

Our newsroom has only been able to peruse the 25 page document, but there are several findings which are of significant note.

The first is that KHMH has an oversight mechanism which is supposed to work to prevent the bacteria outbreak which ran amok in the Neonatal Intensive Care Unit. It is called the Infection Control Committee ICC, and this committee advises the hospital on its Infection Prevention and Control program, ICP. According to PAHO, the ICC as an advisory committee has not been working on a regular basis. The report does not define what “regular” is, and leave a lot of room for interpretation about the time gaps which the ICC is not active.

According to PAHO, the ICP is led by trained personnel, but it lacks direction and evaluation by the ICC, which is significant because, essentially, the report is saying that there is lack of assessment to see if the program is working.

The report adds that the hospital is equipped with a microbiology laboratory, which is able to carry out its functions; it is handicapped by a constrained and reduced space, supplies capacity, quality control measures, and training for the staff members.

Finally, the PAHO report says quote,

“Standard precautions for hospital infection control and prevention and National Infection Prevention Guidelines lack of monitoring and of a supportive environment.” End Quote. Expanding on this finding, the PAHO investigators have discovered there is not enough hand washing sinks and hand hygiene solution. Additionally, the walls and ceiling tiles show signs of exposure to water leak, mold growth, rusty furniture, and porous surfaces in critical care areas. The report lists quite a number of recommendations for improvements, which we plan to explore with the KHMH Administration, who has scheduled a press conference for tomorrow to address the report.

Channel 7


Re: KHMH: A Dozen Dead Babies [Re: Marty] #467317
06/27/13 03:53 AM
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KHMH Addresses the Damning PAHO Report
Last night, 7News told you about the now-ready report from the Pan-American Health Organization, which shows that there were a number of irregularities at the KHMH which could have contributed to the deaths of the 12 neonatal patients in May. And even if they don’t, it shows that the hospital is not up to international standards in trying to insulate its patients from contamination as best as possible. Well this afternoon, the hospital’s Administration and the Minister of Health hosted a press conference to address the concerns raised by the PAHO investigators. The media was there in full force, and the head table was grilled on this report. We’ll get to that, but first… 2 members of the head table accused the media of twisting the facts to further their own sinister agenda. So for transparency, we'll start with start with a few parts of the report which KHMH CEO chose to address. The first was that the report points to the fact that hospital has an Infection Control Committee ICC, and this committee advises the hospital on its Infection Prevention and Control program, ICP. As we’ve reported, the PAHO investigators found that this program was not functioning as well as it should, or the bacterial outbreak which caused the death of the neonates would not have been as catastrophic.

KHMH Admin Answers To All Charges
And so, when the media got an opportunity, they zeroed several important aspects of the report which are damning. We looked first on the fact that it took a great tragedy for the hospital to get its act together. Here’s how that conversation went: Daniel Ortiz "How do you respond to the criticism that all of these improvements have come too late, days have passed away and if you look at the deaths - it's 13, it's too late. These things should have been in place before, the hospital is suppose to give the utmost best care possible." Dr. Francis Gary Longsworth - CEO, KHMH "My response would be is that we've been dealing with these issues - I have been dealing with them from the first day I stepped into this hospital, we have made incremental changes in many areas. Perhaps the changes have not come fast enough but there are different reasons for that, some of them financial, some of them human resource issues but it is not that we have not been doing anything for all of these years." Reporter "It's intro venous the way the bacteria infected these neonates?" Dr. Peter Allen - CEO, Ministry of Health

KHMH Board To Discuss The PAHO Report
So if you’ve listened to the response from KHMH to this PAHO report, and you still have questions, we did too. So we asked the chairlady of the Board to comment on her impression as one of the bosses of the hospital who is now forced to answer to an upset public who believes that this is a major failure. Here’s what she told us after seeing the report, and hearing the explanation from the CEO: Daniel Ortiz "Ms. Cansino as the chairlady of the board, after seeing the report and hearing the responses from the authority, the CEO of KHMH - are you pleased or satisfied with the responses they have given. In my opinion, the public deserves a little bit more of explanation, something else to encourage them that the KHMH is taking this matter seriously." Chandra Nisbet Cansino - Chairlady, KHMH Board "When I speak, I speak on behalf of a board - I don't act alone. We just received the report on Monday and we've had one meeting since then and of course the reports/findings are not the best findings that you would want from a report which is the one that PAHO did. The board is looking very seriously in the timeline of the recommendations and we will be looking to see that the recommendations are followed based on the timeline from PAHO because I think they categorized it as a one month then a three month deadline and we will be ensuring that those are adhered to.


Re: KHMH: A Dozen Dead Babies [Re: Marty] #467400
06/29/13 04:57 AM
06/29/13 04:57 AM
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KHMH Refuses To Accept Fault In The Face Of PAHO Report

Last night, 7News showed you the first part of a 2 part series where our newsroom took a very close look at the PAHO report, which was released last week.

Well Tonight, Daniel Ortiz focused on the importance of the Karl Heusner Memorial Hospital’s infection control mechanism, which was discovered to have been handicapped.

He also looked at the very clear picture presented by the PAHO investigators about what caused the bacterial breakout, which claimed the lives of its neonatal patients:

Daniel Ortiz reporting
The PAHO Report also points to very little training in infection control. It says,

Page 9
"There is evidence that the hospital staff in its different areas has been trained in basic principles for infection control and prevention since 2008, at a beginning as a very short introduction with a few hours of information and currently as a two days course. This training has been given to personnel on duty and to the newly hired entrants. There is no assessment of knowledge acquired in this training."

And the PAHO investigators made significant observations about the Hospital’s Microbiology laboratory. This important unit is like the eyes of the Hospital, keeping a look out on infection breakouts. The investigators seemed to suggest that the hospital is blind, or something very close to it.

They say,

Page 11
"The laboratory within the hospital does not have capability for culture and susceptibility microbiological tests, therefore the samples are processed in the Central Medical Lab (CML).

The CML has the capacity to use automated identification systems or commercial manual methods, but lacks the supplies to run those tests in a routine basis.

Due to the lack of supplies, since February, 2013 the lab has been using home-made manual methods for the identification of gram negative bacteria. Manual methods also limited the susceptibility reports to a few antibiotics. The manual methods for culture and sensitivity lacked quality control measures."

Well, the Ministry is taking steps to the upgrade the CML:

Hon. Pablo Marin - Minister of Health
"The government through my ministry is making available three hundred thousand for the renovation of the middle floor of the central medical laboratory. The government through the ministry and the UNDP is making available eighty thousand for renovation to the ground floor of the cetral medical laboratory."

The Minister didn’t get into any details about what that upgrading process is, but the PAHO report notes that highly specialized equipment is needed for lab to do its work properly. But, the families of the dead neonates won’t enjoy these upgrades, and they won’t know exactly happened to cause the deaths because the lab technicians discarded the evidence.

According to Investigators:

Page 11
"The original specimens from the recent outbreak of E. cloacae were discarded due to the constrained space. Further testing and finger printing by pulse field gel electrophoresis that could have confirmed cross-transmission in the hospital environment could not be performed."

So, further testing that could have assisted them in finding out exactly what happened, cannot take place. The CEO says that it was not done for any sinister motive, or due to the staff trying to hide anything.

Dr. Francis Gary Longsworth - CEO, KHMH
"I do not think they were aware of that, that’s the lab and the lab technicians that work in a particular area of the lab. The technicians at the lab were not aware that those particular samples were related to an outbreak. They just did their work and they followed their routine. It's not that somebody went in said 'bway throw away those samples', I don't think it happened like that at all and it is not that that the samples were not tested. The samples were subjected to testing at the lab. When the experts came in to investigate the outbreak they would have liked to have sent the samples abroad for much more advance testing which we do not have available in Belize. Gel field electroscopic is not available in Belize."

We’ll have to take his word for it because he is the authority on such medical matters. But following along the report, the PAHO observers found a procedure by hospital staff which concerned them very greatly.

Page 12

The report says:
"It is a regular practice seen in pediatrics and neonatology to prepare intravenous medications left in syringes for up to 48 hours. These syringes are piled up in a small container and are to be used for several patients up until their expiry date, which is labeled in a tape surrounding each syringe. This practice was already seen in the assessment done in august 2011, and was observed as a high risk practice. The only change observed since the first report was in shortening the expiry date from 7 days to 48 hours. Being a high risk practice for patients (contamination) and for personnel (needle puncture) it should be eliminated."

When questioned about it, the CEO says that a change was made, just not the change which was initially recommended of discarding it completely.

Dr. Francis Gary Longsworth
"In the context of the report, a change was made from several days of storage to a maximum of 48 hours of storage - so we did comply."

But they didn’t comply fully with what was suggested in 2011. The report shows clearly what the PAHO investigators think probably happened. They did so by explaining the nature of the bacteria E. cloacae, and the possible mode of transmission.

Page 14
"Since this bacterium was isolated in blood samples and its transmission is via the oral-fecal route, the most plausible explanation for this infection is through contamination of any device for intravenous puncture or intravenous medication used in these patients. Their prematurity implies management with intravenous therapies permanently since their admission. The regular practice of using multi-dose syringes shared for many patients and kept in use for at least 48 hours confers a high risk of contamination by any handler."

That seems to explain as best as possible what caused the outbreak, but the CEO wasn’t convinced.

Dr. Francis Gary Longsworth

"We accept that the outbreak occurred, you know, but specifically we do not know the source of the outbreak and that is contained in the report"

And the only technical personality at the head table who was willing to deal with that concern directly was the CEO of the Ministry of Health.

Reporter
"It's intravenous the way these bacteria infected the neonates?"

Dr. Peter Allen - CEO Ministry of Health
" Yes, that is exactly what the PAHO report says and it says that the most likely route of the infection is from transmissions through introvenal therapies."

Reporter
"So would you accept that it occurred in the Neonatal Intensive Care Unit."

Dr. Peter Allen
"Well I would accept exactly what the report suggests that, that is the most likely route of the infection."

The Ministry of Health and the KHMH Authority has pledged to activate all the improvements which have been recommended by the PAHO investigating team.

Channel 7


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