The public exposure of the bodies of the tiny little babies at the Pumwani Maternity Hospital in Nairobi, during the governor’s visit to the hospital, left a bitter taste in our mouths.
As if dealing with the loss of life at such a tender age wasn’t bad enough, the real devastation was in coming to terms with how these little ones were handled after death.
Putting them in cartons and disposal bags is certainly no way to see them off!
As we ponder the inefficiencies of a health system that has left us feeling very vulnerable, the reality is that we shall exit this world.
Death takes away everything from a person with such finality. We immediately stop being referred to as person X and become a ‘body’. We cease to occupy a space in the midst of others and immediately become past tense.
Our outrage at the situation in Pumwani is driven by the innate need to maintain some level of dignity even in death. Death strips us of everything; the only thing we want to exit with is dignity.
It is on this premise that the very important process of care given to a body after death, otherwise known as the “last offices”, is based on. According to Dougherty and Lister (2004), the process is performed with the aim of demonstrating respect for the deceased and focuses on respecting their religious and cultural beliefs, as well as health and safety and legal requirements. It is carried out by the nurse before the deceased is released to the mortuary.
Once a patient dies, the first step is to preserve privacy by drawing the curtains around the bed. Thereafter, the doctor confirms death by checking for the presence of a heartbeat, breathing movements and state of the pupils (they get really wide and do not react to light after death). These are documented in the patient’s file, along with the cause of death. The time of verified death is documented against the signature and name of the ascertaining doctor.
Once death has been ascertained, the patient’s next of kin are informed. If they are in hospital, they are informed immediately, and if they are away, they are summoned to the hospital and informed upon arrival.
This is one of the most challenging duties: To be able to pass on the difficult news with empathy irrespective of one’s own feelings.
Many times, the nurse is deeply heartbroken to lose a life so young, or a doctor so distraught to lose the head of a home to a tragic accident. Yet, as care providers, it is not our place to out-mourn the family.
After breaking the news, the body should be identified correctly with bands that are properly labelled.
Thereafter, the body is aligned by straightening the limbs and keeping the head to face straight ahead. The eyes and mouth are closed and the bladder is emptied. Open wounds that are oozing are dressed to prevent soaking the whole body and all medical intervention accessories are removed. The mouth, nose and anus are sealed with cotton to absorb secretions, then the body is dressed.
These procedures make the patient look presentable to ease the family’s discomfort and pain. It helps them remember the departed in a dignified manner and brings some peace of mind.
If a post-mortem is required, there is minimal intervention. Medical intervention accessories are left in place for further evaluation by the pathologist. They should never be tampered with.
After the family has viewed the body, it is wrapped in a bed sheet or hospital linen ready for transportation to the mortuary. If the patient is suspected to have died from a contagious disease, the body is put in a body bag.
The doctor fills the notification of death form, stating the identity of the patient, the immediate cause of death and all factors that may have contributed to death. The notification slip is given to the family, and a copy accompanies the body to the mortuary.
In all these steps, there is need for compassion and capacity to accommodate everyone.
The mother who lost her baby in labour should be accorded a secluded area to hold her baby and bid him farewell.
Muslim and Jewish families should be allowed to perform religious cleansing rights on the body in preparation for immediate burial within 24 hours.
Resource-starved public and private health facilities lack the means to accord the departed the dignity they deserve. It is not unique to Pumwani; it happens across the country, but we must change this narrative going forward. We cannot drop the ball on dignity immediately after death only to pick it up after the departed is in a coffin.