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Case review into death of 10 year old child reveals major negligence.

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Drawing by: Fathmath Mishka Mohamed.

The Ministry of health has publicized the case review following the allegations of negligence surrounding the death of 10 year old Fathmath Mishka Mohamed on 2nd June 2021. The report published by the ministry revealed major negligence and violations of protocols and procedures from the Health Emergency operations Center (HEOC).

According to the Health ministry, stated that they had investigated how the call center, Medical Response Team (DMRT), Clinical management and Advisory Team (CMAT) and the Emergency Medical Service (EMS) had acted on the night of the incident.

Below are points noted by the health ministry on the events preceding the 31st May 2021.

  •  COVID-19 test samples were taken on 28th May 2021 and tested on 29th May 2021. Contact tracing teams had contacted the parents of Fathmath Mishka Mohamed on 30th May 2021 and informed that that she had been tested positive for COVID-19.
  • According to procedure, the contact tracing team inquired whether they need a doctor’s consultation for which her parents stated that they would need a doctors consultation. This was noted on the information sheets, but a doctor’s consultation was not provided as requested by her family.
  • According to procedure, all information collected should be entered into the Outbreak (OB) system.  However, none of the information collected on Fathmath Mishka Mohamed’s case was entered into the system.
  • According to set procedure, the Care Cluster has to call and check up on all patients under the age of 15. However, reports show that they did not call the parents of Fathmath Mishka Mohamed from the time she was tested positive to the time of her death.

Below is a timeline of the events that preceded the death of Fathmath Mishka Mohamed according to the Ministry of Health.

  • 14:20 –  Parents of Fathmath Mishka Mohamed informed the call center that she was experiencing high fever, coughing, tiredness and is unable to eat any food.
  • 14:24 – The information was entered into the OB system and a ticket was raised.
  • 14:27 – Information entered into the call center information system.
  • 15:53 – Based on the information provided by the parents, a general doctor from the DMRT provided consultation. They were advised to continue using the medications at home and to call back if her conditions worsened.
  • 21:06 – The parents called the call center and informed that her conditions were worsening and that she was having difficulty breathing. The parents requested urgent consultation with a doctor.
  • 21:10 – The information was entered into the OB system and a ticket was raised.
  • 21:15 – The information was entered into the call center information system.
  • 21:53 – DMRT doctor tried to call the parents of Fathmath Mishka Mohamed but was unable to contact them at the time. The case was labelled as “Attended” on the DMRT information sheet.
  • 22:06 – The parents of Fathmath Mishka Mohamed called and stated that they missed the call by the DMRT doctor and stated that she was having difficulty breathing. This information was again entered into the OB system an another ticket was raised.
  • 22:12 – The information was entered into the call center information sheet.
  • 22:33 – DMRT Doctor called the parents of Fathmath Mishka Mohamed. Based on the information provided by the parents, the doctors noted that she had been having breathing difficulty (for 1 day), dry coughing (2 for days) and fever ( for 6 days) and that she was unable to properly tell her discomforts as she was a special needs child  for which they had been receiving therapy. They also informed that she does not take any long term medications.
  • 22:39 – DMRT Doctors informed CMAT. It was noted that even though the information was received by the DMRT and CMAT which is responsible for activating ambulance service, no orders were made to send the ambulance.
  • 23:16- 23:33 The parents made calls to the call center 5 more times. In one of these calls they informed that the child’s condition was further worsening and had lost consciousness and was bleeding from her nose. In these calls the parents repeatedly asked for an ambulance for which the call center informed that an ambulance had been sent. But the ambulance was not activated at that point.
  • 23:27 – A representative of the parents of Fathmath Mishka Mohamed came  to the Health Emergency Operations Center (HEOC) at “Dharubaaruge” to inquire on why the ambulance was delayed.
  • 23:32 – HEOC facility management informed the EMS that an ambulance was needed.
  • 23:33 – EMS called the parents and informed that the ambulance was on the way.
  • 23:38 – Ambulance arrived at the house. CPR was initiated as the child was unresponsive.
  • 23:42 – Ambulance arrived at IGMH ER.

In the case review, the Health ministry also noted that the HEOC had failed to identify the case as an emergency case and failed to activated the ambulance service on time. It was noted that from the time of the first request for an ambulance, there was a delay of 2 hours 26 minutes.

However, a family member of Fathmath Mishka Mohamed has pointed out irregularities in the timeline provided by the Health Ministry. According to a screenshot of the call logs, the parents were on call with the call center  from 23:42 for 6 minutes 39 seconds while the Ministry of Health claims that the child was already at IGMH ER at the time. He also noted that she had no pulse by the time the ambulance arrived but no CPR was done.

                    Call logs of the parents of Fathmath Mishka Mohamed.

The Ministry of Health assured that steps would be taken to ensure that no such incidents would occur in the future. However, fact remains that a child died from the negligence of those appointed to guard the public health and safety.

COVID 19

India’s Telangana to lift all COVID-19 restrictions.

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South Indian state of Telangana has announced that it would be lifting COVID-19 restrictions in the state. The announcement stated that the restrictions would be lifted starting today.

According to Telangana state authorities, the restrictions, including night time curfews will be lifted starting today. However, they still urged the people to follow COVID-19 protocols such as social distancing.

The decision was made by a cabinet meeting with Telanganu Chief Minister K Chandrasekhar Rao. This comes after the state saw a drop in its number of new positive cases.

However, health professionals have warned that an inevitable third wave of COVID-19 will come to India in the coming months. They have warned to strictly follow health guidelines.

India has recorded over 29 million cases of COVID-19 with over 385,137 deaths.

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COVID 19

WHO: 30-40 countries unable to give second shot of COVID-19 vaccine.

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The World Health Organization (WHO) has revealed that 30-40 countries are unable o provide the second dose of their COVID-19 vaccine. They also stated that most of the countries experiencing shortage of vaccines were those who administered the AstraZeneca COVID-19 vaccine.

This comes as India banned the export of all COVID-19 vaccines. This includes the AstraZeneca vaccine being produced by the serum institute of India. The vaccines were planned to be distributed through the WHO led COVAX program.

Bruce Alyward, a senior advisor at WHO stated that “We have a huge number of countries currently that have had to suspend the rollout of their second doses of vaccine,”. He also noted that Sub-Saharan Africa, Latin America and the Middle East as well as neighbors of India are affected by the shortage.

WHO Director of the Department of Immunization, Vaccines and Biologicals Katherine O’Brien stated that many of those countries are at the verge of exhausting their supply of vaccines. She also warned that the current situation was brought by discontinuous supply chains and that it could cause a loss of confidence by the public.

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COVID 19

HEOC: Over Five COVID-19 variants spreading in the Maldives.

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Health Emergency Operations Center (HEOC) has confirmed the spread of over five COVID-19 variants in Maldives.

In a press conference on Tuesday evening, HEOC spokesperson and epidemiologist Dr. Nazla Rafeeg stated that the results identified the existence of the variants Delta, Alpha, G, GR, and Sub Lineage (Peru/Chile) in Maldives and a percentage of other variants. Dr. Nazla Rafeeg said the samples sent for sequencing are taken from both locals and foreigners and are sent in batches of 30 samples.

According to Dr. Nazla Rafeeg, 27 percent of the samples tested positive for the Delta variant -first discovered in India, 20 percent for Alpha variant – first discovered in the United Kingdom, and 13 percent for G variant.

She said that HEOC plans on sending more samples, and also increasing the number samples that can be sent for sequencing.

the risk of new variants from across the world getting imported to Maldives is high with the borders open said Dr Nazla Rafeeq.

Maldives experienced a massive surge in COVID-19 cases in April and May, resulting in a steep rise in fatalities with 88 COVID-19 deaths in May, alone.

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