Health care wake-up call

ANGUISH: Nongyao Daenmuangthaen, left, grieves after the death of her six-year-old daughter who suffered a severe stomach ache while at school.

The recent case of a six-year-old student who died after suffering an acute stomach ache at school and was delayed for four hours at a healthcare station instead of immediately being transferred to a hospital has come as a wake-up call for schools and healthcare centres nationwide to pay more attention while providing services to children.

Earlier this month, Nongyao Daenmuangthaen, 42, rushed to Bang Chalong healthcare station in Samut Prakan’s Bang Phli district after seeing a message from a friend telling her to urgently go to her daughter Namphet Udomkin.

Ms Nongyao, who works as a caddy at a golf course in Bang Phli district, was shocked to discover her daughter looking weak and off-colour at the healthcare station. The girl complained of severe pain in her stomach.

She asked the class teacher what had happened and was told her daughter had developed acute stomach pain and collapsed after finishing lunch at school.

The girl was rushed to the nearby healthcare station about 12.30pm. Medical staff there gave the girl first aid, but her condition did not improve.

The parent of another child offered to take Namphet to a nearby hospital, but permission was refused. Officials said parental permission was required before she could be moved to a hospital.

As a result, Namphet was kept at the healthcare centre for four hours.

“When my daughter saw me, she said ‘Mum, please help me. My stomach hurts so much’. I never thought that they would be her last words,” Ms Nongyao said.

The child was unconscious when they eventually arrived at Bang Phli Hospital and then she convulsed. Nurses took the girl to an emergency room, where a doctor declared her dead.

A post-mortem examination conducted by Ramabhibodi Samut Prakan Hospital concluded the girl’s passing was due to hyponatremia and gastrointestinal infections.

Ms Nongyao said she wanted justice, holding the healthcare station officials responsible for their refusal to transfer a very sick girl to hospital.

“If my daughter was transferred to hospital on time, she might be still alive,” she said.

“When someone comes to the healthcare station with a serious illness, you have to observe that person to determine if they’re going to worsen.

“Namphet clearly suffered extreme neglect.”

Ms Nongyao said she will sue officials at the healthcare station for negligence so as to set a new standard for healthcare centres and hospitals’ emergency medical services across the country.

“I hope the death of my daughter would be a wake-up call, so no one will have to suffer the same fate,” she said.

History repeats itself

Last year, a 15-year-old boy in Phetchaburi with a bad stomach ache also died after a nurse at a hospital left him waiting for hours for medical treatment.

The boy first went to the emergency room at one hospital but was later transferred to another hospital.

Once there a nurse told him to wait but he was in great pain. He fell from his chair after going into shock with his face also having swollen up.

The hospital gave him cardiopulmonary resuscitation, but it was too late.

An x-ray taken by a doctor showed his main stomach artery had ruptured.

Panel looks into case

Nond Jindavej, deputy director of Samut Prakan Provincial Public Health Office, said his office has set up a committee to find out if the school healthcare station’s staff staff were responsible for any wrongdoing in Namphet’s situation.

“The three healthcare staff working that day have been called in for questioning,” he said.

“The initial investigation found that the girl was not neglected.

“At first the girl was fully conscious and able to communicate with medical staff although she had abdominal pain and signs of dehydration.

“The staff also provided her pain killers and oral rehydration salts.”

Dr Nond said the medical staff at Bang Chalong healthcare station tried to contact the mother several times, but they could not reach her, so they asked a friend of Ms Nongyao to send her a message instead.

“When the mother arrived, one of the staff at the healthcare station used her personal car to transfer the girl to Bang Phli Hospital because it was difficult to catch a taxi from the station,” Dr Nond said.

“However the girl was moved from her car to a taxi on the way to hospital because she was not good at driving.”

When asked why the medical staff at the healthcare station had to wait so long for parental approval to move the girl to hospital, Dr Nond said the staff are only allowed to move adolescent patients if they are in critical condition, but when the girl was at the healthcare station she was still conscious, so they decided to wait for the mother.

“All medical staff at Bang Chalong healthcare station were sorry about what happened,” Dr Nond said.

“Our committee will soon conclude the result of the investigation whether the healthcare station’s staff are responsible. If they did wrong, they will face disciplinary action.”

A doctor in Bangkok, who asked not to be named, said it is sometimes difficult for medical staff to decide.

“If the student is writhing in pain, it would be against common sense if medical staff wait and keep her at the health station,” he said. On the other hand, when a patient is still conscious, it is possible that they would decide to wait.

“The history of how the student suffered the symptoms is another thing to consider. Some cases are acute. For example, in one minute, a student might be joking with his friends, but in the next minute a main blood vessel might rupture. In this case, it might still be too late even if he is sent to a hospital,” the doctor said.

Being more proactive

Thee Bhawangkanantha, head of the Office of Basic Education Commission (Obec)’s Child Protection Centre, said Obec had recently sent its guidelines for school first aid procedures to all schools under its supervision to ensure they know “what to do in an emergency”.

According to the guidelines, if a student gets sick at school, he or she will be assessed by school nurses. If the student is not acutely ill, he or she will be allowed to rest and see if their symptoms subside.

On the other hand, if student is acutely ill, the school must inform parents immediately and ask for consent to transfer the student to hospital.

If the student is acutely ill and the school cannot contact parents, the school can transfer the student to nearby hospital or medical centres.

“All Obec schools must follow these recommended procedures. In Namphet’s case, I think the school did a very good job as she was rushed to the healthcare station immediately,” he said.

Mr Thee said Obec now also has a plan to create a database of children with chronic health problems such as asthma, diabetes, and seizures that need special care.

Under the plan, teachers will have to work closer with parents to screen children considered at risk based on family history.

Teachers will also have to closely monitor the health status of children and adolescents in their classes.

Schools’ regular practice

Tanatpong Kongsai, the father of a seven-year-old student in Bangkok’s Phra Nakhon district said he believes in school staff’s judgement.

Nurses from a nearby hospital are stationed at the school. They are the ones whom the students will be sent to when they face health problems.

Whenever a student falls ill or has an accident, staff members of the school his daughter is studying would call the parents.

“When my daughter gets a fever, either a teacher or one of the nurses will call and tell me to pick her up,” he said.

“They have all the parents’ numbers and we [parents] are aware that the school might call,” he said adding that even in case the parents are not reachable, the school would make a right decision to seek suitable treatment for the safety of the child.

Likewise, Andrew Elliott, principal of Bloomsbury International School Hatyai, said that in case any of the school’s student falls ill or suffers an accident, the school follows policies and procedures based on standards and expectations set by its accrediting body, the Council for International Schools (CIS).

All teachers were trained to ensure the curricular activities meet the school’s safety requirements.

“If any teacher comes to entertain any concerns about student safety, he or she should bring these to the attention of the relevant section head before the relevant activity is next due to occur,” he said.

“We regard it as part of our duty of care to notify parents and guardians and obtain their prior consent if hospital treatment for a student were to be recommended by our nurses wherever feasible, but hypothetically if we were not able to elicit this consent, a member of our teaching or managerial staff or our nurse would accompany the child so that the recommended hospitalisation wasn’t unduly delayed as a result,” he said.

If an accident entailing any kind of injury occurs or if a student falls ill, the supervising teacher will provide immediate help and care as they are trained in the administration of first aid, and the school also maintains an in-house clinic in conjunction with a nearby hospital.

The clinic is staffed by at least two nurses throughout the school day from 7.30am until the end of classes. Nurses also take the temperatures of primary students when they first arrive at the school as a precaution each morning, he said.

The school takes care of children from nursery level to Year 13.

When a student comes to school and is known to be ill and to be taking a particular course of medicine, and is not deemed to pose a health risk to other school members, the relevant medicines are handed to the school nurse by the relevant parent or guardian at the beginning of the school day.

The nurse asks the parent to complete a form stating the child’s name and year group, instructions for administration and dosage, he said.

The accepted medicines must be prescribed by a medical practitioner, must be in their original container as dispensed and must be labelled identifying the name of the medicine, patient, instructions for administration and dosage the school principal said, adding that school class teachers will also be informed about the required medication.

If the nurse deems any injury or illness for which any student is referred to her as one whose treatment exceeds clinic treatment, the school’s Administration Office would telephone for emergency assistance from the contracted hospital, via the latter’s ambulance service if necessary, he said.

“We record in the school logbook all incidents involving injury and illness, and, in all cases, we inform parents, guardians or carers via emergency telephone numbers that we keep on file,” he said adding that the numbers are updated.

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