Namibia: Allegations Rife That Doctors Unduly Profiting From Caesarians

Alice Mwanaumo Si|9 January 2010| New Era.com.na

Windhoek — Whispered allegations obtained randomly from individuals that doctors and other medical personnel sometimes intentionally recommend Caesarian sections to expectant mothers for financial gain have over the years turned into an audible rumble.

A country profile of Namibia was a while ago carried out at a roundtable meeting between the World Health Organisation (WHO) then director-general and women leaders in connection with attaining Millennium Development Goal 5 (improve maternal health).

The roundtable meeting made available some of the results of surveys carried out in 1992, which included disparities in the percentage of Caesarian sections carried out in urban and rural areas, and also variations according to sub-regions.

In 1992, 7 percent of births in Namibia were delivered by Caesarian section and of this percentage, more than half occurred in urban areas; 9.6 percent of Caesarian sections were also carried out in the central/south sub-region compared to only 3.7 percent in the northeast region.

Windhoek, as a city located in the central part of the country, directly falls under the shadow of these statistics.

Caesarian section is a term derived from a centuries old belief that an ancestor of Julius Caesar was born that way and can be defined as a procedure in which incisions are made through a mother’s stomach to deliver one or more babies. This is usually performed in the event of vaginal (natural birth) delivery posing a threat to the mother or baby’s health.

The WHO stipulates that a country should strive to have not more than 15 percent prevalence rates for Caesarian sections and so with the 1992 rate of 7 percent, Namibians, and women and their families in particular, may have cause for concern.

In an interview with a mother who several months ago gave birth to her son via C-section, it was clear that she was not amused by her experience.

Although the circumstances and cause for her C-section remain unclear, she maintains that doctors today are generally lazy.

“These doctors do not want to wait eight hours or however long it takes a woman to experience and complete labour and natural birth.”

She stated, “Obviously, in such cases, doctors might feel inclined to recommend C-sections; even if they are not necessary but just as a way of quickly dealing with patients and moving on to the next ones.

“You have to bear in mind here that C-sections are costlier than natural birth.

C-sections also place the African person at a disadvantage because they limit the number of children you can have.

“Africans place strong emphasis on child bearing and having a moderately sized to large brood of children. I for one know that my operation will prevent me from having as many children as I want.”

A telephone call to Dr Bernard Haufiku of the Catholic Hospital resulted in an amiable dispute from him that doctors do sometimes authorise C-sections for financial gain.

He said, “In the past, it was alleged that doctors use caesarian sections to get money as these operations are more expensive than natural birth procedures. For example, these allegations were common about 10 years ago when I was a student in South Africa but they were later proven to be false or inaccurate.”

Haufiku explained that the very nature of C-sections makes them generally more expensive than natural births.

C-sections, for example, often require a team of a minimum of four medical personnel, including a doctor carrying out the operation, his/her assistant, a staff member in charge of administering the anaesthetic and one that actually delivers the baby.

Normal births on the other hand can be carried out under the supervision of one or two medical personnel.

He went on to explain that policy dictates that a paediatrician is always present at a natural birth to ensure the health and well-being of the new born but this does not always happen especially in far out areas where resources are scarce. Even so, the absence of a paediatrician does not seem to negatively and heavily impact on most natural births.

“What is important in this debate on whether doctors benefit financially by authorizing C-sections that the woman in question is advised to undergo, is for the public to be aware that doctors are paid the same amount to deliver babies via C-section as they are to oversee natural births. The extra financial cost of C-sections goes to the hospital as an institution and not into the personal pockets of doctors,” Haufiku explained.