For the past 17 years, Agnes Padan, 40, and her husband Lawrence Jayaraj, 50, have been on a mission to demand that the government improve maternal healthcare for women living in the interiors of Sarawak.
Their motivation is personal. In 2002, Agnes’s mother Kam Agong died from postpartum hemorrhage (excessive bleeding) two months after delivering her eighth child, Jordan, at the Lawas District Hospital.
“No woman should have to endure what Kam Agong went through. She was a perfectly healthy woman who, because of the negligence of the doctors who attended to her, bled to death. She was only 44,” says Lawrence.
Like many district hospitals in the state, the hospital in Lawas has been without a gynaecologist, or any specialist, for the past 55 years, denying pregnant mothers access to proper maternal care. Lawas has a population of more than 50,000 and the district hospital also serves the surrounding villages.
In 2004, Agnes and Lawrence sued the hospital, the doctors who attended to Kam and the Government for negligence. They won their medical negligence case in 2008 but it did not bring change or improve maternal healthcare for expectant mothers in the interiors of Sarawak.
“Winning the case was a big moment for us. We were devastated by her death and we wanted answers. No lawyer wanted to represent us ... most wanted to settle the case out of court because they didn’t think that we could win against the Government.
"But we refused. We wanted the case to be heard and so, we represented ourselves,” shares Agnes, who still gets emotional when talking about what her mother went through.
Although Agnes and Lawrence live in Kuala Lumpur with their four children, they spent months travelling back and forth to Sarawak to build their case.
Adds Lawrence: “When we started probing what happened to her, we found out the extent of the hospital’s negligence and the deplorable care that was given to her. The hospital even forged her consent for a Caesarean birth! How could this have happened?”
Determined not to let Kam’s death amount to naught, the couple then launched the Kam Agong Campaign, to raise awareness about the poor state of healthcare in Sarawak and put pressure on the Malaysia Baharu government for much needed improvements in the health services in the rural areas of Sarawak.
“A new district hospital in Lawas was promised under the Seventh Malaysia Plan (1996-2000). We are now at the 11th Malaysia Plan and the proposed hospital has not been built.
“Till now, pregnant women from remote settlements like Long Semadoh have to travel for five to six hours, depending on weather conditions, in a four-wheel drive to get to the district hospitals. It isn’t cheap and the roads are rough. And when they do get to the district hospital, the standard of care is poor.
“Why is this still the case? Why are poor, rural Malaysians still being deprived of proper health services?” asks Lawrence.
Last month, Agnes and Lawrence handed a petition to health minister Dr Dzulkefly Ahmad demanding that the new hospital be built and better services be provided in the state immediately. The minister pledged to look into the matter and Lawrence is hopeful that change may finally reach Sarawak. In February, Works minister Baru Bian too gave an assurance that the federal government was committed to building the Lawas hospital.
In the meantime, with a grant from the Freedom Film Festival, the duo produced a documentary titled The Story of Kam Agong to raise awareness about what happened to Kam.
The 30-minute documentary sees Agnes returning to her village of Long Semadoh to try and piece together what happened to her mother.
The story of Kam Agong
Kam Agong lived in Long Semadoh with her husband, Padan Labo and their children. She was known as a quiet and hardworking lady who loved to sing. She and her husband grew padi to earn a modest living for themselves. Their income wasn’t a lot, but it was enough to survive.
On February 8, 2002, Kam went into labour. She went to the Lawas district hospital to deliver her baby in the evening, accompanied by Padan and Lawrence.
At around 2am the next morning, doctors informed the two men that Kam was experiencing an obstructed delivery and that her baby was in distress. They said they needed to perform a caesarean section on her.
The surgery had complications, the family later discovered, and Kam experienced primary postpartum hemorrhaging – she’d lost almost two litres of blood and was extremely week.
Kam was kept in the hospital for five days and then she was discharged even though, according to Lawrence, she was still extremely weak. Not knowing what else she could do, Kam returned with her infant son to her village about 100km away.
“She accepted the doctor’s decision to discharge her and went home. On March 8, she heard that the doctor who had operated on her was in the village clinic. Kam Agong walked about 1.5 kilometers to the clinic to see the doctor because she was in severe pain and her wounds - she had two incisions made, we don’t know why – were badly infected. Her uterus was also bulky.
“She also told the doctor that she wasn’t able to urinate. The doctor told her that her uterus was bulky because of her age.
“She wasn’t referred to a gynaecologist or even told to go to the district hospital or any of the other bigger hospitals for further treatment. She was just told to go home,” explains Lawrence.
Six days after that, Kam began bleeding profusely at home.
Some villagers scrambled to hire a truck to take her to the hospital in Lawas. Kam survived the journey but at the hospital, they did very little for her, says Lawrence.
“They gave her a pad for the bleeding and admitted her. The doctor administered syncometrin (she was experiencing secondary post-partum hemorrhaging) and sent her home.
Two days later, she was discharged,” related Lawrence.
Even though he has shared the story of Kam many times, he is still visibly upset at how Kam was denied proper care.
Kam went home even though her surgical wounds were still infected and she was running a fever. She returned to her village and a day later, she died.
Kam’s death was a shock to the family.
“My father was lost. They were very close and had a loving relationship and ... he wasn’t in any state to look after Jordon. So Lawrence and I decided to take him with us to KL and we adopted him. At that time, we had two little boys of our own who were one and a half, and three years old.
“We also eventually brought my father and most of my siblings back to KL with us.
“My mother’s death was very hard for us. She was a very loving person. She was very quiet but extremely hard working. She never had any severe sickness just the usual fever now and then. She always kept any hardships she may have faced to herself. She was very strong and she did everything for us. She fought for us, always. She made sure we had enough money to go to school and to be well.
“To be honest, the past 17 years has been a struggle for us. There were times when the electricity in our house was cut because we had no money to pay the bills on time. But we have done well, I think,” says Agnes.
Voice for the voiceless
Despite their hardship, Agnes and Lawrence are steadfast in their resolve to bring change for the people living in remote settlements in Sarawak.
“These people don’t earn much and they don’t ask for much. In fact, they accept that life and death are in God’s hands and what happened to my mother and the other women who have died during childbirth as fate.
“But what happened to Kam Agong is not fate. A crime was committed against her and we don’t want other poor families to go through the same fate,” Lawrence says emphatically.
For their documentary, Agnes conducted interviews with Kam’s family and friends in Long Semadoh. There are only about 30 families living in her village. The film is entirely in the native Lun Bawang language, with English subtitles as its purpose is to give a voice to the people of Long Semadoh. Shot in Long Semadoh and Lawas, the documentary gives an idea of the journey that villagers have to go through to access medical services in the town.
Making the documentary was emotional for Agnes who shares that she burst into tears many times when she was listening to the women in her village share about how difficult it was to afford or access medical services for their family or themselves.
“Actually, at first the Lun Bawang community was confused about why we had launched the campaign. For them, we had won the case and so the issue was over. But in the course of making this documentary, I heard so many stories from villagers about how difficult it is for them to access medical healthcare.
Their stories were heartbreaking. They were talking about survival. I could relate to their stories because I grew up in the same village. I come from a poor family too.
“It is very difficult to earn (a living) in the village. My parents were padi farmers and they would get income from their harvest just twice a year. And they couldn’t earn much because everyone in the village was doing the same thing. So, to earn a little extra, my mother and father used to weave rattan baskets which they would sell for about RM25 to RM30. Income depended on demand and it never exceeded five baskets a month. Some months they didn’t sell a single basket.
“For them to go to the hospital in Lawas, it would cost them about half their monthly earnings, if not more. And that’s why I am doing this. We need to keep talking about what happened to my mother until we see some change in the delivery of healthcare in Lawas and other districts in Sarawak. We also need to raise awareness among the people in Sarawak. Unless there is change, what happened to Kam Agong could happen again,” says Agnes.
View the documentary at https://bit.ly/2EcF83w