A medical travesty in Nara Prefecture

Last week, a woman from Kashihara, Nara Prefecture, miscarried after nine hospitals refused to admit her. In August 2006, 19 hospitals refused to admit a woman, also from Nara Prefecture, who had lost consciousness during delivery. She died eight days after she gave birth in the 20th hospital. These two incidents highlight Japan’s shortage of maternity clinics and obstetricians and the Nara prefectural government’s slowness in improving its ability to transport pregnant women in critical condition to hospitals that can admit them.

The Kashihara woman was picked up by an ambulance shortly before 3 a.m. Wednesday after complaining of a stomachache and bleeding. Her water broke at around 5 a.m. on her way to the 10th hospital. Approximately 10 minutes later the ambulance collided with a minivan. She arrived at the hospital in another ambulance around 5:50 a.m. and the fetus was pronounced dead.

The number of childbirth facilities in the nation declined from 4,200 in 1993 to 3,000 in 2005. In 2004, obstetricians and gynecologists nationwide numbered about 10,600, a 7 percent drop from 1994. The government must take urgent measures to increase the number of obstetricians and improve their working conditions.

In last week’s case, it is possible that miscommunication also contributed to the tragedy. If the ambulance workers had better explained the urgency of the situation to doctors, the woman may have been admitted earlier. In fact, the first hospital was later found to have had a vacant bed. The collision between the ambulance and the minivan also serves as a reminder that the police must work harder to make drivers aware that they must give way to emergency vehicles.

Nara Prefecture has a computerized network of hospitals to help those in an emergency find a suitable and available hospital. To do this, however, the patient’s doctor must make a request to a member hospital. Since the woman did not have a regular doctor to make the request, the ambulance team could not use the system. The prefectural government must quickly rectify this system’s absurd inflexibility.