i agree thea, the PRIMARY reason was in the part of the doctor in which he/she should have paid attention to the condition of jyotsana, or to the very least, refer her to another facility.

There is a multitude of factors that can be attributed to Jyotsana's death. First factor would be the inadequacies in terms of the health care provided to her. The lapses in the management of her condition specially at the level of consultation with the private doctor contributed a lot with the DELAYS in treatment that she could have received if her condition is diagnosed early and early referral is made.

Accessory with this would be again traced to the capability of the doctor (the private one) in handling such cases. In the case of Jyotsana, TIME is an important element. If the doctor only have been knowledgeable with her condition, it did not take almost a day to wait for proper management.

Also, the assessment procedures implemented in that health facility is quite questionable since they are not able to detect signs of fetal distress or death through simple assessment interventions like FHR monitoring...

the causes of her death includes;
first and foremost. her condition was not detected early by the doctor who attended to her because, he was suddenly called. It's a neglect on that doctor's part for not even bothering to discuss to her about his diagnosis or the treatment that could have saved her life. There was also the delay in decison making process baout what is the best thing to do with her condition. Another factor would be the distance of the hospital from their place.

There are different underlying causes of Jyotsana’s death: First, the doctor’s negligence, it was his responsibility to tell Jyotsana and her family the real diagnosis of what had happened. Jyotsana has a right to know what’s happening to her and even her baby. But the doctor failed to do so. The doctor didn’t even discuss any treatment or safety measures regarding her pregnancy. Another factor is the accessibility of the health care facility. A 40 km hospital is not an ideal health care set up.

One of the primary factors that lead to the death of jyotsana is the patient's condition was not detected early. Note that in the situation, the health care provider was not able to examine the patient well to arrive at an accurate diagnosis. and then the patient was sent home. The lack of diagnosis and lack of health measures advise became the number one factor which lead to the death of the patient. If only the doctor paid attention and refer the condition immediately to the nearest facility, then jyotsana might have been saved.

The second most obvious factor is the delay in decision-making of the family. Knowing that the patient already has clinical signs and symptoms, the family must have consulted another doctor to examine jyotsana.

Another factor also is again, very obvious in our past cases, the proximity of the nearest health care facility to a small village like jyotsana's. The patient needed immediate and emergent care and this was delayed because the facility was 40 km away!! The delay in reaching the hospital is also another factor that adds to the death of the patient.

In contrast to out past cases, socio-economic factor was not highlight here. jyotsana came from a well-to-do family and might have afford the cost of medical care IF ONLY GIVEN IMMEDIATELY.

Good evening Classmates! I’m Angel and I will be your moderator for tonight. Our discussion will first focus on the Case 3 that we were not able to finish last time. Then we’ll move on to the next topic Case # 4 after we all agreed to each other’s posts.

Classmates, please be guided by the instructions that were posted by Miss Ara last night.

Let’s start. Good Luck!

Case Study # 3: Treating Complications in Pregnancy

Jyotsana’s Story

Jyotsana was 20 years old and had been married for one year. She came from a well-to do family, and now lived in a small village with her husband. This was her first pregnancy. She had regular antenatal check- ups at a private clinic, and her pregnancy had been uneventful. When she was eight months pregnant, however, she suddenly developed a fever and a pain in her abdomen. She was taken to a private doctor, who admitted her for observation, but he was soon called away and did not examine her very well. The doctor did not tell Jyotsana or her family what he thought her diagnosis was or discuss any treatment options with them. The next day her condition became worse, and her relatives were told to take her to the hospital, which was located more than 40 km away.

By then, Jyotsana could not speak and was unresponsive. By the time they arrived at the
hospital, she had already died. The doctor examined her and told the relatives that the baby had died earlier in her abdomen and might have poisoned her body, leading to her death.

Questions for Students
1. What were the underlying causes of Jyotsana’a death?
2. What should she have done differently?
3. What should her family have done differently?
4. What should the doctors have done differently?