Within a week, Mubashir (name changed) headed to the graveyard twice. The first time, he was there to bury his yet-to-be-born baby. A few days later, he had to bury his wife Nazia (name changed) — whom he had been married to for a year. Nazia was suffering from Hepatitis E. She died on March 31, 2008, reportedly due to the delayed diagnosis of the disease by her obstetrician, Dr Zeenat Eva Khan, at the South City Hospital.

Nazia’s family told The News that she had been Dr Khan’s patient for six months. The latter had referred her case to the Aga Khan University Hospital (AKUH) on March 21, claiming that emergency facilities at the South City Hospital were “not sufficient.” Moreover, Nazia’s family maintains that Dr Khan “abandoned” her patient after referring her to the AKUH, and went for a brief visit abroad. Nazia’s family believes she could have survived if the doctor had diagnosed her disease at the right time and hospitalized her.

Nazia’s mother-in-law and sister-in-law (Saba) said that she had been unwell for quite a while. She had lost her appetite and was vomiting frequently. This is rare for the 24th week of pregnancy. Nazia also complained of constipation and discoloured urine. Fearing the worst, the couple visited the South City Hospital for an urgent check-up without an appointment; but no doctor was available to attend to Nazia.

The RMO (Resident Medical Officer) present then, informed the couple that constipation during pregnancy was “normal.” This was later confirmed by Dr Khan as well, over the phone. “Instead of recommending a blood test, she recommended suppositories for constipation relief and advised her to increase fluid intake,” Saba said, adding that Nazia’s condition did not improve and four days later (on March 21) she had to be rushed to the hospital again.

It was at this point Dr Khan suspected that Nazia may have been infected with Hepatitis E and recommended her case to a gynaecologist at the AKUH. “The doctor said that she was referring the case to AKUH because emergency facilities there are better than those at South City Hospital,” Saba said.

The doctor at the AKUH immediately diagnosed that Nazia had been infected with Hepatitis E and began treatment. It was too late, however, because the delayed diagnosis had caused her condition to deteriorate further. Two days later, Nazia’s six-month-old pregnancy had to be terminated and she entered a [mild] coma. After remaining unconscious for a few more days, she died due to heart, liver and kidney failure on March 31 — five days after her first wedding anniversary on March 26.

Dr Khan, in her defense, said that she had recommended Nazia’s case to the AKUH because she believed that doctors there could handle her case better. The family is not satisfied however, and is left to wonder why her doctor was unable to diagnose the disease for six months. Furthermore, after Nazia’s death, the doctor’s rude behaviour with the family (also observed by The News) has upset the family more.

It was also learnt that after a few weeks into her pregnancy, Nazia had been complaining of anorexia. Her doctor told her she could dine out if she wanted to, Saba said. This was later cited as the reason for her death by the same doctor’s assistant.

According to the WHO (World Health Organisation) website, Hepatitis E is a waterborne disease and contaminated water and food supplies have been implicated in major outbreaks. Symptoms of this virus include jaundice (yellow discolouration of the skin, dark urine and pale stools), anorexia (loss of appetite), nausea and vomiting, fever and an enlarged, tender liver. The website also states that the disease occurs mostly in developing countries, is more frequent and severe in pregnant women. Hepatitis E in the latter leads to a mortality rate of 20 percent in the third trimester and hospitalization is required for ‘fulminant hepatitis’.

“Nazia was destined to die,” says Saba. “But this is an act of medical negligence and the hospital authorities should look into the matter and make sure no other family undergoes the trauma that we went through.”