Outrage grew in Tunisia this past week after 11 premature babies died in less than 24 hours from infections acquired in the same hospital as doctors and patients expressed frustration over the country’s struggling public health care system.

The babies died recently at the Rabta hospital maternity ward in central Tunis, the country’s capital, after nosocomial, or hospital-acquired, infections led to deadly septic shocks, the health ministry said.

Four more babies died later, and two of those deaths were also linked to the infection, said officials at a news conference at the health ministry on Friday.

After the deaths, Abderraouf Cherif, the health minister, who had been nominated just months ago, quickly resigned. Several top health officials were fired.
Sonia Ben Cheikh, the interim health minister, called the deaths a “national disaster” and said officials suspected a problem with the sterile room where hospital staff members prepare the premature babies’ nutrients, which were delivered intravenously.
“We have doubts on the sterilization of the room and of the tools, which may have led to the infection,” she said at a news conference on Monday, adding later on local television that the department where the newborns died was short on workers, with only three doctors for 40 beds.

The public outcry was worsened by the hospital’s handling of the deaths.

Local television showed families holding the bodies of their newborns in cardboard boxes that had been handed to them by hospital staff members, sparking indignation on social media, especially after an official from the health ministry said on television it was not an “unusual practice” because “it can be less traumatizing than giving them in a simple blanket.”
That official was fired a few days later.

Prosecutors have opened an investigation, and the health ministry has asked a committee of doctors and pharmacists to investigate the deaths and the possible human errors that led to them.

Mohamed Douagi, a doctor who is leading the investigative committee, said there was a wave of panic when the first babies died on Thursday, leading to “mouth-to-mouth resuscitation on three babies at the same time.”

“There was a medical failure but we don’t know yet at which step,” Dr. Douagi said at a news conference on Friday.
The deaths have shaken Tunisia’s government, which has been unable to reform the Tunisian health system, a recurring demand since the popular uprising of 2011 that toppled the country’s longstanding dictatorship.
Prime Minister Youssef Chahed said on Thursday during a meeting with the heads of hospitals around the country that he would “ensure there will be accountability for any fault that happened during these events.”

He also acknowledged that the health care system has been in disrepair for several years.

“The health sector is suffering from a crisis and the last reform took place more than 14 years ago,” he said, adding that since the 2011 revolution there had been “laxity,” “corruption” and a “lack of authority.”

“Nobody can deny this, and it is everybody’s responsibility,” he said, “And all together we have the duty to find solutions.”
For many doctors, the deaths are symptomatic of deeper issues with public health care. They say their working conditions have badly deteriorated, pointing to a lack of proper medical equipment, bad hygiene and rising distrust from patients.
Tunisia’s health care system had long been considered one of the best in Africa, providing free or cheap care to millions of Tunisians through a national health insurance system. But since the 2011 revolution, corruption has increased and public hospitals and insurance funds have fallen into increasing debt, making it harder to pay suppliers for equipment.

Zeineb Turki, a doctor and spokeswoman for Afek Tounes, an opposition party, noted that there had been “more than 10 ministers in less than eight years after the revolution.”
“None of them had time to reflect on the sector’s underlying issues, and all of us knew it would eventually lead to such a tragedy,” she said.

The number of young Tunisian doctors leaving to work abroad has grown significantly in recent years, according to the Tunisian medical association. In 2018, half of all the newly registered doctors left Tunisia to work in Europe or in Gulf countries, seeking better working conditions and higher wages.

After the death of the premature babies, several young doctors created a Facebook page, “Balance ton hôpital,” French for “Denounce your hospital,” where they shared pictures and testimonies of their workplace struggles.

Aymen Bettaieb, the vice-president of Tunisia’s organization of young doctors, said, “We have been speaking out for years but now the patients and the people are also with us.”

He added: “We are counting on this national wave of anger to make things change once and for all,” he said.


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