North Macedonia: Investigation of death of pregnant Romani woman denied care for days despite being in labor

The European Roma Rights Centre has reported that a 37-year-old Romani woman and her baby have died in Skopje, North Macedonia after being emergency transported to the hospital from Ohrid, a city in the west of the country. The mother arrived at the hospital only to wait hours for treatment.

The woman then suffered complications that resulted in the death of her baby in utero and died later of sepsis after doctors in the emergency care unit were unable to revive her. The incident occurred on 31 March.

The woman’s water had broken days before, and she had been waiting for doctors to accept her at the gynaecological clinic in Ohrid to deliver her child. She visited the clinic several times, complaining of extreme pain and showing signs of infection, but was denied treatment and sent home.

She was finally rushed to the emergency department in Skopje only to be left outside the hospital for more than six hours while personnel waited for the results of a COVID-19 test. The Ministry of Health has since confirmed to the ERRC that her results came back negative.

The woman lived in poor conditions with her husband and two children, aged three and six. Because of her poor background she was unable to afford the cost of traveling to visit a doctor often.

She visited the gynaecological clinic at Ohrid General Hospital for the first time after her waters broke on 26 March and was told, after examination, that she was not yet ready to deliver. She returned three days later on 29 March, complaining of intense, abnormal pain and showing signs of bleeding and infection.

The same doctor told her she was not yet dilated enough for delivery and sent her home. She came back again the next day with worsened pain and was told by a different doctor that she was not yet ready to give birth.

She was again sent home without any treatment, despite begging the doctor for a caesarean section to relieve the pain. On 31 March she arrived at the clinic in the morning and asked for immediate attention as she could no longer stand the pain.

A doctor who was new to her case was on duty and told her that her baby was in bad condition and was having difficulty breathing. The doctor called for an emergency vehicle to take her to Skopje hospital at 10am because her complications were too difficult to treat in the Ohrid clinic.

Considering the time it takes to drive from Ohrid to Skopje (two hours), and the time it would have taken for the emergency services to respond, the woman could not have arrived at the hospital in Skopje any later than 1:00 PM. The doctors found her alone outside the hospital, which means the driver of the emergency vehicle left her near the doors rather than take her inside.

She had a high fever, so medical staff took a sample to test for COVID-19 and she was made to wait for treatment until the test results had returned. She was not admitted to the hospital until 7:30 PM.

It is unclear at what point the baby died, whether during the two-hour drive to Skopje, or during the six or more hours the woman was left outside the hospital doors, but the doctors at the emergency department of the hospital noted that the baby was dead on arrival. Nobody from the hospital called to tell the woman’s family or friends that she had arrived there – they only found out by contacting a Romani doctor who was working in a laboratory in Skopje and asking him to track her down.

The only official communication her family received from the hospital was at 8:30 PM, when they were told that she was being taken into surgery to remove the baby. After the operation was complete, she reportedly had further complications and a high fever as well as signs of sepsis.

The woman was intubated and medics attempted to treat her for more than two hours but were ultimately unsuccessful, and she died at around 10:00 PM. The Ministry of Health has confirmed that the State Sanitary & Health Inspectorate will begin an investigation into the woman’s death at the University Clinic of Gynaecology & Obstetrics in Skopje, the hospital she was brought to.

Additional inspections will be carried out at the General Hospital Ohrid Department of Obstetrics, Gynaecology, and Neonatology and with the family doctor. Much of the media coverage in North Macedonia has victim-blamed the woman for allegedly not regularly attending check-ups with her doctor (which she was unable to afford), or for her poor health condition and lifestyle.

In one editorial she was incorrectly described as being “morbidly obese” and as having been “immobile” for the past five months. Her friends and family say that is untrue and that she walked her eldest daughter to school every day.

Regardless of their veracity, such claims would not absolve the medical staff of their apparent negligence in failing to treat a woman in the ninth month of pregnancy complaining of severe pain and living in a vulnerable situation. While the ERRC can only speculate about some of the details until the autopsy report is completed, there is strong suspicion of negligence fuelled by institutional racism at several stages leading up to the death of this woman.

The first instance is the doctors’ repeated refusals to treat her at the gynaecological clinic, despite the severe pain, bleeding, and signs of infection she was showing. Whether she was dilated enough to deliver her baby vaginally was irrelevant to the obvious problems she had that required treatment.

The question of when her baby died is also crucial to the question of medical negligence. The baby was still alive, though in danger, when she was examined by the last doctor at the Ohrid clinic before being driven to Skopje.

The baby may well have died before arriving at the hospital, but the woman was then left for over six hours at the door, during which time the baby could also have died, and that could have been the cause of the sepsis which killed her. Additionally, the Ohrid clinic did not send her blood group information with her in the emergency vehicle when she was transferred to Skopje.

That lack of blood group information was mentioned by a representative of the Ministry of Health in the description of how the woman died. It is clear that  extra precautions do need to be taken at hospitals to slow the spread of COVID-19 and to protect frontline medical workers, as well as other patients, from possible infection, and it is also clear that during a state of emergency and a time of national panic it is also inevitable that mistakes will be made – already it is clear that human rights violations will occur more readily in this period.

There is, however, no excuse for the institutional racism and negligence that led to the death of this 37-year-old Romani woman and her unborn child. A close neighbour and family friend is now looking after the woman’s other two children so their father can work to provide for them.

It was this friend who brought the woman in labor to the clinic and witnessed the events in the days leading up to her death. She said to the ERRC: “I saw her in bad condition, she was begging the doctors for help for days. I think it happened because of how she looked to them, her appearance and her socio-economic situation.”

The neighbour also recounted how she had heard the staff at the clinic commenting that the Romani woman smelled bad, and she had witnessed them laughing and joking when they told her she was not ready for delivery and sent her home. This woman died not only because of the unprecedented public health situation around the pandemic, but because this situation coincided with her being Roma and her being poor.

The intersection between the woman’s skin colour, gender, and class meant she was treated unequally and unprofessionally by a system that institutionally discriminates against people who look like her, a system which ultimately values her life as less worthy than other citizens of the country. The pandemic has only served to stress this system and to highlight the tragic inequalities that have always existed within it.

The cause of death here is as much racism as it is negligence. The ERRC expects to receive the autopsy of this case from the hospital in approximately one month’s time and will investigate further with the Health Inspectorate and Health Ministry.