Savita Halappanavar has become an icon. Her death in Galway University Hospital a year ago has taken on mythic qualities.
Kitty Holland’s new book, Savita: The Tragedy That Shook A Nation, gives us pictures of Savita, the child dancer, the proud graduate, the devoted daughter, the loyal friend.
We see Savita’s life through the prism of her death and her death is explained by our Constitutional prohibition on abortion. Even her grieving husband, Praveen, says “maybe Savita was born to change the law here.”
But she wasn’t, of course. She was born, in all probability, to be a wife and mother and an accomplished professional. She had it all at her finger-tips. And it was ripped away by our medical service. Her death means we can’t look after people properly, particularly not pregnant women. Her legacy should certainly not be the Protection of Life during Pregnancy Bill, nor even the deletion of the Eighth Amendment. It should be a proper, safe, functioning health service that treats all our citizens equally.
The terrible story of Savita’s death is not about abortion. It is a story about medical negligence of appalling proportions.
Holland counters criticism that Savita’s story has been monopolised by the pro-choice movement: this was the context in which her death was seen by her husband and friends. It was her horrified friends who stood helplessly by as she breathed her last in that Galway hospital. The story was leaked to Holland, probably because she was known to be a pro-choice journalist and she quickly and conscientiously followed it up.
And when you think about it, for a moment it, becomes so obvious why the abortion issue loomed so large for the Indian community. It is because attitudes to abortion are a fault-line of cultural difference between our two countries. If you’ve ever been an emigrant, take a second to remember what that felt like. I remember complaining endlessly to other English speakers about everything that was different about my host country.
When something as horrific as the inexplicable death of a treasured friend occurs in a foreign hospital, the story that will make the most sense is that it could not have happened in the safe place that is home.
That may, indeed, be the case here, but in ways which have nothing to do with our abortion law. It may, indeed, be the case that no hospital in Savita’s home town of Belgaum, India, would been so ruinously negligent as to let that lovely young woman slip through its fingers when there were, says the Hiqua report, 13 different occasions on which a potentially life-saving intervention could have been made.
The issue here was never abortion. The issue is the shocking state of our health system.
It may be quite true that if Savita had had an abortion when she requested one, on Monday, Oct 21, or Tuesday, Oct 22, it would have saved her life. But the real issue is that nobody knew her life was at risk. Savita wasn’t requesting an abortion because she feared for her health. She feared psychological trauma. She also wanted to get back to her beloved parents, before they left for India.
Savita’s consultant, Dr Katherine Astbury, did not refuse to terminate a life-threatening pregnancy because she was constrained by her interpretation of our abortion law. She didn’t think there was any threat to Savita’s health. As she said in her evidence to the coroner’s inquest: “there was no suggestion that she was in any way unwell...”
No suggestion? Except that, according to the evidence of Professor Sabaratnam Arulkumaran, to the HSE enquiry, infection is the cause of a miscarriage such as Savita’s — in the second trimester of pregnancy, presenting with her membranes bulging and her baby alive — in 77% of cases.
Infection should have been suspected from the very moment she was admitted to the hospital. Arulkumaran said he would have offered to terminate the pregnancy on Sunday, Oct 21, and advised termination after Savita’s waters broke in the early hours of Monday, Oct 22.
Astbury should have intervened to terminate the pregnancy straight-away, on medical evidence alone. She would not have faced any legal obstruction in doing so.
The issue of Irish abortion law has become a smokescreen protecting Savita’s consultant and her team at Galway University Hospital.
But the smoke is clearing. The Hiqua report points its finger straight at the hospital: “The consultant, non-consultant hospital doctors and midwifery/nursing staff were responsible, and accountable, for ensuring that Savita Halappanavar received the right care at the right time. However, this did not happen.”
It calls for heads to roll, or “appropriate referral(s) to the relevant professional regulatory bodies”. And making someone take responsibility for his wife’s death is at the heart of her bereaved husband’s search for justice, as he sues the hospital for medical negligence.
We can’t have it both ways. If our abortion law were the issue, then Astbury was a prisoner of the law. If she and her team were negligent, then what we must face, instead, is the full horror of our maternity services, for which there is no national strategy and which require, according to Hiqua, “urgent” review.
Why do we not have the recommended number of obstetricians? And why don’t we use obstetricians only where they are needed? Why don’t we mainstream midwife-led care for low-risk mothers, as recommended by a KPMG report in 2008? Why do we throw consultants at mothers if they pay for them privately, even in public maternity hospitals?
The most depressing part of the Savita tragedy came home to me when a nurse friend said: “Was she a public patient? That figures.”
Savita’s death was used by our Government to grease the wheels of the Protection of Life During Pregnancy Act, although the new law would have made absolutely no difference in her case.
It is even questionable whether a law allowing abortion to protect a woman’s health, rather than her life, would have made any difference, given that her consultant didn’t see any threat to her health, before it was too late.
The story of the beautiful girl killed by the cruel law was so simple and so potent that it zipped around the world. Holland’s book reminds us of some of the headlines, from ‘Abortion flares in Ireland over death of critically ill woman denied quick termination’ (Washington Post) to ‘Ireland murders pregnant Indian dentist’ (indiatimes.com)
“Never again,” the placards read at the demonstrations following Savita’s death. But the hard truth is it will take far more than a new abortion law to make sure what happened to Savita never happens to another woman.
It will take a new culture of what Hiqua calls “ownership”, which stretches from every pregnant woman, the minute she walks into a hospital, right through the system to the consultant who is ultimately responsible for her care.
Whether she pays or not.
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