Azerbaijan: The value of a child’s life
It’s been one year since the death of two newborn infants in the maternity hospital in the town of Salyan (130 km from Baku). Mirzabita Abdullayeva gave birth to three healthy boys in the central clinic of Salyan town, on 20 June. The triplets were taken to an altitude chamber (it’s a common practice, since twins and triplets usually weigh less than ordinary children).
Two out of the three infants died during the night. The Salyan District Prosecutor’s Office instituted criminal proceedings. According to one of the versions, the infants died as a result of a power failure in the hospital that night.
According to a report published on the baku.ws website, there is an extra generator in the hospital, but it does not function.
The tragedy attracted a lot of attention. It was covered in printed media, on TV and discussed on social media. However, a month later, no one showed any interest in the investigation findings anymore.
Moreover, it was hardly the first scandal in the obstetrics & gynecology sphere in Azerbaijan.
First there was indignation and then everyone forgot about the infants
For example, the case of a young lady, who gave birth to a child right on the sidewalk, in the Baku outskirts, because the out-patient department personnel refused to help her and sent her to the hospital. Of course, the woman couldn’t reach the hospital, so the child passed away before the ambulance arrived.
This story caused an uproar on social media. Countless criticism came down upon the medical personnel. People said that every out-patient facility had a gynecological room; besides that, doctors took the Hippocratic oath, and they were obligated to give her assistance. However, these posts on social media were hardly enough to hold the personnel liable; a more ‘titanic’ effort was required. Therefore everything went to naught – the case was discussed and eventually forgotten.
However, another story came out a few days later: Rauf Nagiyev, a Senior Emergency Physician, commented that the woman who had given birth to the child was a gypsy; she had delivered a healthy child in the ambulance and afterwards was taken to hospital.
The numbers
According to WHO data, 99% of mothers die in developing countries. Daily, 830 women die worldwide due to pregnancy and labour-related issues that could have been prevented. However, the overall maternal mortality rate worldwide dropped by almost 44% from 1990 till 2015. Concerning the child mortality rate, there is a special coefficient used to estimate it – the number of children who died before the age of 1 per 1,000 infants born each year. According to UN data, the average number of infant mortality deaths per 1,000 is 50.
According to Lala Imanova, a gynecologist, there also exists a coefficient for infant and mother mortality rates. This coefficient is more or less stable. “However, the facts are hushed up and, unfortunately, is quite a normal process.”
Child mortality is one of those ‘negative indices’ that Azerbaijani statisticians don’t like much. Analyzing the reasons for such mortality is a thankless task, because the causes of such a tragedy are rarely revealed and recorded.
The Healthcare Ministry is known among journalists as being one of the most ‘closed-off’ institutions around. It has its own press service which presents to the public its own press releases and official statements on issues such as viral pandemics or the recall of medication. There is a hotline on its official website, and one can address them with a complaint, which is designed ‘to serve the citizens day and night.‘ However, the number and type of those complaints still remains an internal affair at the Ministry, since no such data is available to the public.
According to the CBI statistics, the mortality rate per 1,000 infants in Azerbaijan in 2014 was 26.67 (between that of Surinam, 26.55 and Zimbabwe, 27.07). For comparison: in Ukraine this number is 8.10 and in Poland it’s 6.19.
Free and Paid Medicine
In many countries in the post-soviet area, a state-run maternity hospital is quite an unpleasant place: poor conditions, rude personnel, continuous spending of money (this does not include service costs, but rather the informal fees that will be put into the staff’s lab coat pockets).
People, who have such an opportunity, prefer to deliver in private clinics, and there are plenty of them. Labour there costs between AZN 700 and AZN 1,600 (USD 460 – 1,050). This sum includes the costs for child birth, anesthesia, postpartum care in a neat and comfortable ward with a sanitary facility, catering and the infant’s first vaccinations.
In state-run maternity hospitals, it costs AZN 500-800 for a doctor. In the best case scenario, all expenses will be covered by this amount, but usually, there are charges added for analyses, petit ‘bribes’ to nurses for changing the baby’s diaper or traditional gratuity when being discharged from hospital. In the end, the labour cost is the same as that in the private maternity hospital.
A state-run hospital is often risky and extreme. Here is a young mother’s story: “In 2012, I underwent a caesarian section, and I fled that place [the hospital] the next day. I was told there that the doctor was sleeping and he would come as soon as he woke up. They gave me an injection (anesthesia) into my back three times and I’ve been suffering since then. Later that night I had terrible shivers from 01:00 a.m. till 05:00 a.m. There was no ward for the child so they put it on a near-by bed, covered it with a blanket in a way that the child almost became asphyxiated. I was unable get an answer from the nurse, since I couldn’t speak because of my shivers.”
After that some heroines appeared – there were some experienced mothers in the ward; they helped her to take care of the child. She had to go to one end of the corridor to get water, and food was heated-up at the other end of the corridor. She applied to the public hospital, in the hope of being awarded some money, but it turned out that she was awarded only AZN 200 because she had to fork out AZN 10 each to the neuropathologist, pediatrician, nurses, and even to a ‘special woman’, who dressed the child before it was discharged. The mother was not allowed to do this.
Stories about dangerous situations are not all that rare. A young woman describes how, when she screamed from labour pains, she was ‘tied to the bed like an insane woman’. Later on, there were problems with delivering the child; a doctor said the girl would die if a Caesarian operation was not carried out in the next 15 minutes. “However, the senior doctor did not want to give permission for the Caesarian to be carried out, motivated by the fact that “…we have been forbidden to perform a Caesarian section”. Her husband argued with her for a long time, but she refused to violate the ‘law’. Fortunately, things turned out okay and permission was given for it.
Usually, women are eager to tell such stories, but they are against having the name of the hospital and their own names publicized. Perhaps they do not want to be involved in a scandal, or they still leave the door open to go to the same hospital when they get pregnant for a second or third time. Sometimes their reserve is connected to a fear of being condemned by their relatives – eastern women should not talk about child birth. It is considered an act of shame.
In this story, at least, the hospital’s name is revealed. “In 2000, I delivered a baby in Krupskaya Hospital. I have never met such low-level people in my life. The medical personnel was made up of well-dressed women wearing gold jewelery and diamonds. At the same time, they behaved like beggars. In the morning they came for breakfast, and they asked one patient to give them bread, another to give them some cheese, and a third to give them butter. And they had breakfast. Later they searched the patients’ bedside tables, “Have they brought you dolma? You are forbidden to eat dolma, I will take it. Tangerines – not allowed, I will take them.” I gave birth to my child in winter, and there was no hot water. A pot of hot water to wash my child was sold for AZN 3.”
In fairness, it must be said that this is not the case in all public maternity hospitals. There are several exemplary ones, where ‘western standards’ are applied and the services don’t differ all that much from those offered in the private clinics.
On the opposite side of the fence
Sabina Akhmedova (the name has been changed for privact reasons – author) worked as a chief nurse in the maternity hospital for 14 years and told us about the ‘inner workings’ of these institutions.
She worked as a nurse in one of the public maternity hospitals from 2000 till 2014.
“A maternity hospital’s policy depends exclusively on the senior doctor,” Sabina explained. “At first, a well-known doctor was our senior physician. Earning money was the only goal during the period of her ‘rule’. So-called money for the hospital fund was collected. These funds were to be spent on purchasing new equipment, medications, etc…But nothing was bought. The money for the ‘fund’ was collected as bribes from patients, a certain percentage of which was given to a ‘collector’, nurses, ward attendants, doctors, and the rest sent to top officials.”
“Every day I went to work with a big bag,” says Sabina. “I took bandages, syringes and emplastrum along with me. The state provides these things to our maternity hospitals, but I don’t know where this equipment and supplies disappeared to. The senior doctor and the supply manager probably took them to the shops.”
A nurses’ wages in maternity hospitals amounted to AZN 120 (USD 89). The chief nurse got AZN 160. But that’s only when they got paid in full. However, nobody was ever paid in full; many nurses received AZN 50-60. It was necessary to buy medical supplies from this sum: “We bought meters of fabric together to sew robes. It was cheaper than to buy ones that were already made.”
“You can’t imagine how insulting it is to ask for and take money from a patient, to wait while she searches her pocket and gives you her kopeks. The doctors told us, “We had to take the money quietly, otherwise it could have caused us problems.” ”
Later the senior doctor in the maternity hospital changed. “Doctor Nigyar Akhundova came from maternity hospital #6. It was then that we first learnt that things could be done in a different way, not like they had been done before,” says the nurse. “She provided us with new equipment, new tables and beds for new born infants. We got everything – new beds, linens, to say nothing about all the other necessary supplies. We even received stationary, glasses and soap. It turns out that the state allocated all of these things.”
A certain sum was allocated to nurses and ward attendants from a fund, which was created from the sums paid by the patients for child delivery, operations and treatment. It was forbidden to take money from maternity patients for small services. The staff stopped paying money to high-ranking employees. “At last we started living and working normally,” said the nurse.
Is free-of-charge labour possible in Baku?
A story of an emigrant from Europe, published in one of the local forums is one of the most highly publicized cases. At that time it was shared on social media and was seen as exotic and strange. There was a husband and a wife expecting a child, who were practicing Muslims and did not want to commit such a ‘kharam’ (a sin) as paying a bribe.
“In Azerbaijan, there was a widespread virus called ‘shirinlik’ (‘baksheesh’). It was everywhere – in kindergartens, schools, hospitals, and other institutions,” the young lady says indignantly. “However, we chose a way that we thought would allow us not just to ‘pay less’, but to ‘not pay at all’.”
The couple could not afford a private clinic and applied to a public maternity hospital.
That’s where they had to face all the negative sides of those institutions– lack of clothes, linens, pillows, ants crawling on the tables, a negligent doctor and personnel, who, as they claimed, received a salary of just AZN 50 etc. After the delivery of their baby the husband received a hint that he had to give them some money for their services, but he explained that he would not give them any money, as it was a sin. He said if something happened to his spouse and child, the whole staff would be held liable in accordance to the law. It obviously had its effect, as the new mother was taken care of and was properly attended to until the day of her discharge.
After being discharged, the parents brought a huge cake to the staff and promised to pray for them.
