Seven months into her “pregnancy treatment” by the government primary health centre (PHC) at Kallavi here in Uthangarai, a 22-year-old woman was found to be possessing a cyst-like growth in her uterus by a private scan centre.
While the woman and her family have alleged negligence on the part of the government PHC, the medical administration after a first-level of inquiry into the incident has claimed, the woman had not followed up on a referred scan in the initial days.
The woman Ashwini from Chandrapatty village had been married for two years. This March, she had gone to Kallavi PHC after missing her menstrual cycle. A urine test had showed pregnancy. The PHC medical staff had also promptly allotted a PICME card (Pregnancy and Infant Cohort Monitoring and Evaluation), which is a system under the Tamil Nadu government to track pregnant women and monitor their visits. This is to ensure prenatal care and prevent maternal and infant mortality.
Seven months later, in September, Ashwini had begun spotting with complaints of abdominal pain. She was referred to Dharmapuri Medical College Hospital for a scan. The woman got a scan done at a private clinic that showed that she was not pregnant, but had a cyst.
According to the woman’s PICME card, referral record and her own accounts, she was given vaccination, iron tablets, and health mix by the PHC. Ms. Ashwini alleged that the PHC had made her to believe that she was pregnant and missed out on the abnormal cyst.
The Hindu spoke to Dr. P. Priya Raj, Deputy Director of Health, who said a first-level of inquiry was conducted into the allegations.
Ms. Ashwini had first visited the PHC in the first 40 days of her missed menstrual cycle. The routine urine test had showed positive pregnancy. But, since she complained of spotting and abdominal pain, she was referred for a scan to the Dharmapuri Govenrment Medical College Hospital. But, she went home without taking the scan and returned to the PHC two months later. According to the DD Health, Ms. Ashwini had told the staff that she did not get the first scan because there was no one to go with her to the headquarters hospital and that her abdomen pain had stopped.
Asked if the PHC did not have a scan facility, Dr. Priya said, in each PHC, scan specialist visits on a particular day of the week and Ms. Ashwini was asked to come on that day. But, Ms. Ashwini came to the prenatal clinic at the PHC, waited till 1 p.m and left, Dr. Priya said.
It was after 20 weeks of assumed pregnancy, Ms. Ashwini had returned with complaints of spotting and severe pain again. She was referred for an anomaly scan to the Dharmapuri Medical College Hospital once again for a scan.
She had taken a scan in a private clinic, which showed she was not pregnant and it was a cyst that was growing inside her.
“Sometimes, cysts can mimic pregnancy, and secrete pregnancy hormones, which is why the urine test showed positive. She did not go for the referred scan the first time. Even today (Wednesday), I had sent a team to the village to bring her to the Government GH in Krishnagiri for tests and she has said she can’t travel today since there is no one to accompany her. We will try and bring her on Thursday.”
However, the incident does flag the systemic break down of grassroot level care for pregnant women with no means, who come to the PHCs. The PICME system of evaluation and monitoring also intends follow up on the compliance of the instructions given to expectant mothers, which appeared to have been missed here. The system of VHNs (Village Health Nurses) who acted as the door-to-door contact of mothers in the villages had broken down with unfilled vacancies in a majority of the panchayats.
