Sarkakiyar Hadiza Bawa-Garba

**Jack Adcock**, ɗan shekaru 6, an kwantar da shi a asibitin Royal Royal Infirmary (LRI) a ranar 18 Fabrairu 2011. Ya mutu daga baya ranar, a wani ɓangare saboda gazawar da aka yi masa. Dr **Hadiza Bawa-Garba**, karamar likitar da ta kula da shi (karkashin kulawar mai ba da shawara kan aikin Dakta Stephen O 'Riordan) da kuma wata ma'aikaciyar jinya, **Isabel Amaro**, daga baya an same su da laifin kisan kai bisa ga sakaci. Dukansu daga baya an soke sunayensu na kwararru, duk da cewa Bawa-Garba ya yanke hukuncin bayan daukaka kara. Akwai muhawara mai gudana game da hukunce-hukuncen da aka yiwa Bawa-Garba,  wani bangare game da laifin na Bawa-Garba tare da mahallin gazawar tsarin, da kuma wani bangare game da yiwuwar yin amfani da bayanan nata masu yin tunani game da aikinta a matsayin shaida. 

## Asali
A shekara ta 2010, Hukumar Kula da Kiwon Lafiya ta nuna kusan kashi ɗaya bisa huɗu na ƙananan likitocin da suka bar horonsu na NHS a Ingila bayan shekara biyu, kuma a cewar ionsungiyoyi, wannan ya faru ne saboda yawan aiki. Ma'aikatar Lafiya ta ƙaryata shi, BMA ta ba da haske kan batutuwan game da 'Umurnin Lokacin Aiki na Turai', tsarin canzawa da ƙarancin ma'aikata.   

A shekara ta 2016, wani rahoto da Kwalejin Kwararrun Likitocin ta fitar ya jaddada "gibin da ke tattare da juyawa, rashin samun ingantattun kayan aiki da kuma karin aiki" ga likitoci a cikin horo. Duk da jin cewa marasa lafiyar su suna daraja su, 80% na waɗannan likitocin sun ba da rahoton damuwa mai yawa, ko dai 'wani lokacin' ko 'sau da yawa'. Rahoton ya gabatar da "mummunan hoto game da yanayin kananan likitoci a halin yanzu da kuma tasirin da hakan ke da shi kan marasa lafiyar da suke kula da su a kowace rana" kuma wannan ya kasance a "matakin cutarwa da rashin dorewa".   Matsalar gibba da manyan matakan danniya da sakamakonta ga ɗabi'un ma'aikata shima daga baya an nanata shi a taron wakilin BMA na shekara ta 2017. 

## Lokaci

### Mutuwar Jack Adcock
A 18 ga watan Fabrairu 2011, Jack Adcock, wani 6-yaro ne dan shekaru, da aka kira a Leicester Royal infirmary da ya GP kuma aka shigar da wani Yara Ƙimar Unit (gardiâ) a 10.20am. Yana da ciwon rashin lafiya na Down's syndrome kuma yana da nakasar ɓarna da aka gyara a cikin watanni 4.5 da haihuwa. Ya kasance akan angiotensin mai canza maganin enzyme, enalapril . Ya gabatar da gudawa, amai da wahalar numfashi. 

Dr Hadiza Bawa-Garba tayi mai aiki, wata **kwararriyar mai rejista** **(SpR)** a shekara ta shida na karatun ta na digiri na biyu ( **ST6** ) wanda kwanan nan ya dawo daga hutun haihuwa, ita ce ke da alhakin kula da Jack. Babu wani babban mai ba da shawara, wanda ya bar ta da ɗawainiyar ɗaukacin CAU. Rota rata ya nuna cewa Bawa-Garba dole ne ya rufe aikin wasu likitoci biyu  kuma mai ba da shawara kan kira ba ya aiki a Warwick har zuwa karfe 4:30 na yamma a wannan ranar, unda bai ankara ba an kira shi. Ba a kammala musayar safiya tsakanin ƙungiyoyi masu shigowa da masu fita ba saboda kiran kamawar zuciya.

Ba da daɗewa ba bayan shigarta, ma'aikatan jinya a CAU suka sanar da Bawa-Garba halin da Jack ke ciki. Bayan binciken asibiti, sai ta same shi da rashin ruwa. sakacin mai kulawa da iskar gas ta bayyana cikakken Metabolic acidosis tare da lactate na 11.4&nbsp;mmol / L da magani pH na 7.084. Ta gano cutar hypovolaemia daga cututtukan ciki, kuma ta sanya maye gurbin ruwa . An aika gwaje-gwajen jini don nazarin dakin gwaje-gwaje kuma an nemi x-ray a kirji.

Bawa-Garba yayi kurakurai da dama. Ba ta nemi mai ba ta shawara kan harkan lafia ba don  ta yi nazarin Jack a yayin taron mika mulki da rana da karfe 4:30 na yamma amma ta raba sakamakon binciken dakin gwaje-gwaje mara kyau tare da shi wanda ya rubuta daidai a littafinsa. Koyaya, mai ba da shawarar bai sake duba mara lafiyar ba kamar yadda ya yi tsammanin Bawa-Garba ya “matsa” waɗannan sakamakon a gare shi. Wannan shi ne karo na farko da suke aiki a kan wannan canji. Kodayake ta bar daidai enalapril din magungunan marasa lafiyar a kan jadawalin maganin, amma ba ta bayyana wa uwar yaron cewa ba za ta ba. Daga baya mahaifiyar Jack ta ba shi yaron a wannan ranar da karfe 7 na yamma wanda ya haifar da girgizawar jijiyoyin yaron da mutuwarsa.  Wannan al'ada ce da aiki a asibiti - don bawa iyaye damar gudanar da magunguna a cikin asibiti kafin a ba su.

rashin nasarar IT a asibiti na daban ya jinkirta sakamakon gwajin ana samunsa har zuwa karfe 4:30 na yamma, duk da ana aiko da jinin jini da karfe 11 na safe. Bayan sun kira dakin gwaje-gwaje, ƙungiyar ta karɓi sakamakon jini wanda ke nuna CRP 97, Urea 17.1, Creatinine 252. Anyi aikin ɗaukar hoton kirji bayan awa ɗaya daga baya zuwa 12 na rana, amma masanin radiyo bai ba da rahoton ba. Bawa-Garba ya sake nazarin rediyon da karfe 3 na yamma, ya gano cutar huhu ta sama ta hagu, kuma ya rubuta cefuroxime a cikin mahaifa. Sake maimaita iskar gas ya nuna cigaba a cikin pH zuwa 7.24. Ta sake nazarin Jack a cikin CAU, kuma ta ga cewa ya inganta, kuma yana zaune yana sha. Ma'aikatan jinyar sun fara amfani da maganin rigakafin ne da ƙarfe 4 na yamma. Amintaccen asibitin ya yarda da gazawar tsarin da ke ba da gudummawa ga al'amuran. 

A safiyar wannan ranar, Bawa-Garba ya shigar da wani yaro mai cutar ajali tare da umarnin kar a sake farfado da shi (DNAR) zuwa ɗakin gefen sashin. Wannan yaron wani mai ba shi shawara ya gan shi da rana kuma ya sallame shi da rana. Da karfe bakwai na yamma, Bawa-Garba bai sani ba, an dauke Jack daga CAU zuwa wani daki a sashen. Da misalin karfe 8 na dare Jack ya fara lalacewa, sa'ilin da likitocin likitancin da ake kira da ake kira masu sa kuzari da yara suka kasance cikin sauri-barci. Duk da kulawa ta gaggawa, ya kamu da ciwon zuciya, an fara CPR, kuma an gudanar da intubation na endotracheal. Bawa-Garba ta halarci kiran kamuwa da zuciya zuwa ɗakin gefe inda tayi imanin cewa shine yaron da ya kamu da cutar ajali wanda ta karɓe shi tun farko tare da umarnin DNAR. Ta nemi ƙungiyar da ta dakatar da sake farfadowa, amma ta fahimci cewa ba shi da haƙuri a cikin minti 2, saboda haka ya sake dawo da CPR.

Jack Adcock ya mutu sanadiyyar bugun zuciya sakamakon cutar sepsis  karfe 9.20 na dare. 

### Kararrakin Isabel Amaro
A ranar 2 ga Nuwamba, 2015, an yanke wa Amaro hukuncin daurin shekaru 3 a kurkuku, bayan an same ta da laifin kisan kai ta hanyar babban sakaci. An soki yadda take lura da yanayin Jack Adcock da kuma rikodin sa. Daga baya aka buge ta daga nas din. 

### Hadiza Bawa-Garba kararraki
A ranar 4 ga watan Nuwamba 2015, an sami Bawa-Garba da laifin kisan kai ta hanyar babban sakaci a Kotun Kotun ta Nottingham a gaban alkalin da Mai Shari'a Andrew Nicol ya jagoranta. A watan da ya biyo baya, an yanke mata hukuncin daurin shekaru 2 a gidan yari. Ta daukaka kara kan hukuncin zwa kotun qoli, amma an ki karban rokon a watan Disambar 2016. 

Hukumar Kotun Kwararrun Likitocin ta dakatar da Bawa-Garba na tsawon watanni 12 a ranar 13 ga Yunin 2017.  kungiyar general Medical Council yayi nasarar daukaka kara kuma aka buga Bawa-Garba a ranar 25 ga Janairun 2018. 

A ranar 13 ga watan Agustan 2018, Bawa-Garba ta yi nasara a karar da aka daukaka kan kada a kore ta, ta maido da dakatarwar shekara daya.  

Yawancin kwararrun likitocin sun nuna damuwa kan cewa ana hukunta Bawa-Garba ba akan hujja ba kuma ba daidai bane saboda gazawa a tsarin, musamman karancin ma'aikata a ranar.  

## E-fayil
A Jerin manyan badakalar likitanci da suka hada da badakalar zuciya ta Bristol da kuma binciken Shipman sun yi tasiri a shawarwarin neman ragin hukunci wato sake neman likitoci. An dakatar da aikin a cikin 2005, lokacin da Dame Janet Smith ta soki tsare-tsaren a matsayin wadanda ba su dace ba don gano likitoci masu haɗari. An ƙaddamar da sake tabbatarwa a ƙarshen 2012. Duk likitocin Burtaniya da ke son riƙe lasisinsu na yin aiki an sanar da su cewa ana buƙatar sake ba da izinin kowace shekara biyar, bisa ga haɗakarwa da nuna ilimin zamani ta hanyar cika CPD (ci gaba da ƙwarewar ci gaba) bukatun abubuwan. Kolejoji da bayar da ra'ayoyi da yawa daga marasa lafiya da abokan aiki. An tsara wannan don nuna cewa sun dace da zamani kuma sun dace da aiki. Revalidation, a cewar BMA majalisar GMC mai aiki jam'iyyar shugaban Brian Keighley 2012, an yi nufin "don karfafa inganci a cikin kiwon lafiya ga marasa lafiya ta hanyar kai-kai, kimantawa, ci gaba da ilimin likitanci da kuma nuna aiki." Ya kuma bayyana cewa, "A cikin shekaru 10 da suka gabata an samu rudani da tashin hankali tsakanin wadanda suka yi amannar cewa kayan bincike ne ga wadanda ba su da kwarewa, maimakon tsari, tsarin ilimantar da mutum." 

Tun daga shekra ta 2012, an nuna damuwa da yawa ciki har da a cikin 2016, cewa ga ƙaramin likitoci "Ana buƙatar yawancin likitoci da su 'yi tunani' game da Mugayen Haɗarin da ba a Warware su ba (SUIs) da Bayanin Muhimmanci (SE) a matsayin wani ɓangare na horo na musamman. Don haka wannan na iya haifar da gagarumin nauyi na gudanarwa da kuma haifar da ninkin matsaloli biyu. ” 

Kamar yadda ta saba dokan likitanci, Bawa-Garba ta ci gaba da koyar da kayan karantarwa a cikin jakar kayan kwalliya a matsayin wani bangare na karatunta, ciki har da batun kula da Jack Adcock. Anyi amfani da wannan kayan akan ta, kodayake wane irin rikici aka samu.   Kungiyar ta masu kare ta sun bayyana cewa ba a yi amfani da kundin jakar ta na intanet a shari'ar ta 2018 ba.  Ba a yi amfani da fayil ɗin e-bayyane ba a cikin shari'ar 2015, amma ƙwararrun shaidu sun gani.  

Wannan ya haifar da damuwar tsakanin likitocin cewa za su damu da kasancewa masu gaskiya a cikin karatun su.   

## Amsawa
Akwai yarjejeniya mai yawa cewa anyi kurakurai masu tsanani a cikin maganin Adcock. Koyaya, an yi mahawara ta jama'a game da asali, mahallin da matsin lambar da likitoci ke aiki, da abin da ke faruwa idan aka yi kuskure. Tattaunawar tana kan batutuwan wane tsari ne da tsari ake aiwatarwa wadanda basa iya yin kuskure, kuma suna inganta damar gano su idan sun faru. Dangane da Dr Bawa-Garba, NHS Trust da ake magana a kanta ta fahimci akwai gazawar tsarin da matsin lamba wadanda suka taimaka ga mutuwar mara lafiya. Dr Bawa-Garba yana da kyakkyawan tarihi har zuwa lokacin.  Dokta Jeeves Wijesuriya, shugaban ƙaramin kwamiti na likitocin na Medicalungiyar Likitocin Biritaniya (BMA), ya yi jayayya cewa waɗannan ƙarancin tsarin ba a kula da su yadda ya kamata ba a gwajin farko. 

A ƙarshen watan Janairu 2018, shugaban majalisar BMA, Chaand Nagpaul, ya nuna damuwa kan tsoran likitoci da ƙalubalen yin aiki cikin matsi a cikin NHS. Ya bayyana cewa ba tare da tsabta daga Babban Kwamitin Kula da Lafiya (GMC) da sauransu ba, batutuwan da ke kewaye da yin rikodin karatun na ilmantarwa zai haifar da aikin karewa da gazawar koya daga kwarewa. BMA, a cikin amsa, sabili da haka, zai ɗauki matakai don yin hulɗa tare da GMC dangane da al'adun tsoro, zargi da gazawar tsarin. Har ila yau an haɗa da jagoran likitoci kan kimantawa da yin rikodin rikodi, da ƙaddamar da tsarin ba da rahoton kan layi. 

Kungiyar Likitocin ta Burtaniya, wani kamfen da ƙungiyar neman taimako ga Doctors da NHS sun yi gangamin wayar da kan jama'a game da gazawar tsari a lamarin. 

GMC ta fitar da Tambayoyi game da batun, suna rufe batutuwa kamar abin da likitoci ya kamata su yi idan suna da damuwa game da matakan ma'aikata da aikin nunawa. 

Gwamnatin Burtaniya ta gabatar da wasu sauye-sauye don mayar da martani game da lamarin, tare da wani rahoto da aka fitar a Yunin 2018.

## Hanyoyin haɗin waje

* Rahoton bincike game da lamarin da Asibiti
* Bawa-Garba v R - Jin Karar Kotun Kisan Kisan Kisa
* GMC v Bawa-Garba - GMC tana bin sharewa daga Rajistar Kula da Lafiya
* Bawa-Garba v GMC - Kira game da Kashewa daga Rajistar Likita
* Kwamitin Gudanar da Da'a da Kwarewa na Majalisar Nursing da Midwifery Council da Kwarewa kan Isabel Amaro 
*  
* Shafi game da shari'ar Bawa-Garba a likitan likitancin Burtaniya tare da cikakkun hanyoyin sadarwa da bayanai 

## Manazarta