A review report compiled by the Ministry of Health on the death of Fathmath Mishka Mohamed reveals gross negligence by health emergency responders.

The ministry publicized its review report on the death of Mishka, 10 and native to Kulhudhuffushi City, on Friday.

The report revealed that the victim’s family had phoned the Health Protection Agency (HPA)’s helpline several times starting from 9pm on May 31, due to signs of breathing difficulties and other issues. However, a family member had to go to Dharubaaruge where the Health Emergency Operations Centre (HEOC) is located, for them to be finally be provided assistance.

The ministry reviewed the actions of HEOC’s service centers including the call center, Medical Response Team, Clinical Management and Advisory Team and Emergency Medical Services in responding to the case. As such, the review was made on whether or not these service centers had followed the current guideline in responding to the case.

According to the report, Mishka tested positive for Covid-19 on May 30 after having provided samples on May 28. As per procedure the family was inquired whether Mishka required a doctor’s consultation, to which the family responded by requesting a consultation. Although the contact tracing team had compiled the required information on a record sheet, Mishka was not provided a consultation.

Further the report highlighted that despite all required information being collected by the team as per the procedure, it had not been updated on the outbreak (OB) system. Under the authority’s guidelines, the care cluster team is required to check up on patients under the age of 15.

The ministry’s report cited Mishka’s family having reported that her difficulties began at 2:20pm on May 31 and that she had been unable to eat anything alongside fatigue and constant coughing. These details were shared with the call center by Mishka’s family, following which the call center’s system was updated and a sheet was filled.

A doctor from the Medical Response Team had contacted the family for a general consultation at 3:53pm the same day. The doctor was to have instructed the family to continue giving Mishka the medications she was prescribed and to contact the call center if any other difficulties arise.

Mishka’s family phoned the call center for a second time due to persisting difficulties at 9:06pm that day, where the call center was briefed that Mishka’s condition was deteriorating and she was having breathing difficulties.

The call center had updated its OB system and raised a ticket at 9:10pm, the call center sheet was updated at 9:15pm.

A doctor from the Medical Response Team had attempted to contact the family again at 9:53pm, however, they were unable to reach the family. Despite this, the Medical Response Team had updated the information sheet as “attended”.

Having seen the missed call, the family attempted to contact the call center at 10:06pm and informed them that Mishka was still struggling with breathing difficulties. The information was recorded at 10:12pm. A doctor phoned Mishka’s family at 10:33pm once more, where the family briefed him of Mishka’s condition for the previous week. As such she is to have suffered from dry coughs for two days and high temperatures for six days. The doctor was also informed that Mishka was a child with special needs. The doctor updated the system at 10:39pm and informed two relevant centers, tasked with activating ambulance services. The review report noted that ambulance services were not requested.

Mishka’s parents had contacted the call center five more times between 11:16pm and 11:33pm that night, after she collapsed and began bleeding from her nose. Despite having informed the parents that an ambulance would be dispatched, the report highlighted that ambulance services were yet to be activated.

At 11:27pm the same night, due to the long delay, a member of the family went to Dharubaaruge following which the HEOC’s facility management cluster informed EMS of the situation.

The department had then phoned Mishka’s family and informed them that an ambulance was on the way, at 11:33pm. The ambulance reached at 11:38pm, Mishka was unresponsive. Paramedics immediately provided CPR services and rushed Mishka to Indhira Gandhi Memorial Hospital (IGMH) by 11:42pm. This was a delay of two hours and 26 minutes.

The review report indicates that authorities had failed to acknowledge the situation as an emergency situation and failed to act in accordance to the set guidelines in turn having failed to trigger ambulance services to respond to the case.

Despite it being an emergency situation, DMRT and CMET had failed to follow through the procedure in requesting ambulance services. The call center had also failed to inquire the seriousness and urgency of the matter when receiving the family’s calls.

The ministry revealed that ambulance services were activated and the child was rushed to the hospital within 10 minutes after the EMS was informed.

Mishka’s death was reported at 12:10am on June 1.

The very next day the Minister of Health, Ahmed Naseem had met with press, where he admitted that relevant authorities were negligent in the delays in providing medical response to the family of the youngest Covid-19 victim in the Maldives, and assured that action will be taken against those found guilty.

While the report, which does not mention the action taken against those found negligent, was released a day later than announced, the ministry said that this was due to delays in gathering all required information.

The death is also being probed by the Human Rights Commission of the Maldives (HRCM) and the People’s Majlis.

Although Mishka did not have any underlying medical conditions, she was diagnosed with ADHD. The Ministry of Health revealed that “immediate” changes had been brought to the mechanism on deploying ambulance services following the incident. The report released on Friday also notes changes to HEOC's Medical Emergency Response Team, as well as work to strengthen emergency response services.