It’s been more than a year, but Ahmad Saleem still can’t get used to hot temperatures.
The thought of heat touching his body has become triggering, a haunting reminder of losing his wife post-childbirth.
“It takes me back to the fever she had or when I did CPR on her… I could feel the heat on her body,” he told Global News.
Saleem lost his wife Ayesha Riaz, 24, three days after she gave birth to their son Eesa in February 2018, at Markham Stouffville Hospital (MSH) in Ontario.
WATCH: Markham man seeks justice after losing wife to Strep A last year. Caryn Lieberman reports.
The healthy mom contracted a hospital-acquired aggressive group A streptococcus (GAS) bacterial infection, ultimately leading to septic shock and her death.
The last 365 days have been a reality the widower hasn’t accepted — he is depressed, in denial and trying his best to raise his son.
“I still don’t believe it,” he said. “I break down at random times… I just can’t believe that it’s something that happened to me. From when our life was to become one whole, everything was taken apart. It becomes a nightmare over and over again.”
Last month, Saleem, along with his family and friends, celebrated Eesa’s first birthday.
In the brightly-lit room adorned with gold and blue balloons, Saleem held his son and a knife in another hand, helping the one-year-old cut into his multi-tier cake. It’s milestones like these that constantly remind him of his wife.
READ MORE: ‘My whole life taken away’: Ontario father questions why 24-year-old wife died post-childbirth
The infection postpartum
Group A strep is a bacterial infection that has the potential to cause severe disease, Dr. Isaac Bogoch, a clinical researcher at the Toronto General Hospital Research Institute, who was not involved in Riaz’s care, previously told Global News.
The majority of people with GAS infections get sore throats or small skin infections and in rare cases, some go into septic shock.
Eesa. Photo courtesy of Ahmad Saleem.
“The other thing we have to remember is even if you get group A streptococcus, it doesn’t mean you’re going to get an infection,” he told Global News.
“Some people are what we say colonized with the bacteria — that just means the bacteria is on the person but not causing an infection. It is not causing any disease.”
The infection can become deadly if it enters the blood stream, causing organ failure and eventually death.
In hospitals, however, it can get trickier. You can get group A strep from direct contact with someone who has it, but it can also spread through unwashed medical tools.
READ MORE: Moms talk strep A after childbirth: ‘I was just scared that I would sleep and not wake up’
WATCH: Ontario hospital details steps taken in wake of young mother’s death. Caryn Lieberman reports.
The majority of these infections are community-acquired, meaning someone from outside the hospital passes on the infection, often without showing any symptoms when they come in.
“They could subsequently start showing symptoms, in which case the hospital would treat those symptoms if necessary,” said Lisa Joyce, former vice-president of communications and affairs at MSH told Global News in 2018.
But for postpartum women, it’s often “tough” to know why they are at higher risk.
After Global News shared Riaz’s story, several Canadian women told us their tales of contracting strep A after giving birth.
Nineesha Nigli, 37, of Pickering, Ont., developed a community-acquired strep A infection in mid-November 2017 after giving birth to her son at MSH.
Tina Hamilton also contracted a strep A infection after giving birth in October 2017 at Grand River Hospital in Kitchener, Ont.
The mother recalled being shaky and developing a high fever. For Hamilton, doctors quickly discovered the infection and treated her with antibiotics. She is unsure how she got the infection in the first place.
Calgary-based mom Jessica, whose name has been changed for privacy reasons, said she was discharged from Kelowna General Hospital four days after giving birth in 2018, but she quickly went back to her doctors after experiencing strep A symptoms.
Jessica was told she had an infection in her uterus (she was never specifically told strep A) and was put on antibiotics.
“I was getting better but I was having this pain on the left side of my body. I had given birth so I thought this probably feels normal,” she continues. “When it’s your first baby, you don’t know how you’re supposed to feel.”
One husband’s mission for change
Since Riaz’s death on Feb. 10, 2018, Saleem has been continuously trying to find answers on what exactly happened to his wife and where she may have gotten the infection. He still doesn’t have definite answers.
He has also been keeping busy raising awareness on social media around his late wife’s passion projects, as well as the dangers of strep A itself.
Last fall, he spent time in Pakistan working on water projects in his wife’s honour, following support through a GoFundMe account that almost raised $30,000 in 2018. He is still in the process of looking at his legal options.
“We’re really trying to convey a message, we’re trying to put something into health policy especially in Canada… that accountability for the women that passed away for strep A-related cases or postpartum-related cases because believe it or not, there is no such system that exists in Canada.”
The back-and-forth with MSH has also been exhausting, he added. Since last February, Saleem has been trying to get more information on his wife’s medical reports and if other women contracted the infection around the same time Riaz gave birth.
“They’ve always put this wall up for me when I was trying to get anything from them,” he said. “It just makes me lose faith in the health-care system. I’ve come to the realization now that if I have to pay for my health care to get the slightest chance of it being better than what’s provided now, I would do it.”
WATCH: Grieving father questions why 24-year-old wife died post-childbirth at Canadian hospital
In an email obtained by Global News, Saleem was sent a note in September 2018 that stated in the days before and after his wife’s death, there were three positive cases of invasive group strep A (between Feb. 1, 2018 to Feb. 14, 2018) in the childbirth unit.
Saleem was told all three cases were hospital acquired (last year, MSH told Global News there was just one hospital-acquired case), but after requests to confirm these numbers by both Saleem and Global News, the hospital admitted to making an error.
“I discovered that the information that had been provided to Saleem this [fall] was incorrect,” said Dr. Caroline Geenen, chief of staff at MSH, adding in regards to the three cases, only one was a hospital-acquired infection in 2018 — his wife’s.
“The review of the group strep A outbreak, conducted by the hospital’s infection control and prevention department, Public Health Ontario, and physicians, concluded that one case was hospital acquired, a second case was community acquired and the source of the third case could not be determined.”
In 2018, York Region Public Health investigated 49 lab-confirmed invasive GAS infections among individuals who lived in York region.
By law, physicians, health-care providers, labs, hospitals and institution administrators have to report cases to their local public health unit, a spokesperson from York Region told Global News.
“If the results of diagnostic testing from a hospital lab are positive for a disease of public health significance, this is an indication that the individual was likely tested at the hospital. However, if a positive test result is reported from a hospital, this does not necessarily mean that the infection was acquired from the hospital.”
According to Public Health Ontario (PHO), there were 1,138 cases of invasive strep A in the province in 2018, but at the provincial level, PHO does not track cases based on hospitals, a spokesperson told Global News.
Changes in hospital procedures
MSH has also made an effort to make changes within the hospital after Riaz’s death. “After Ayesha’s death, we initiated a number of steps, consistent with industry best practice when any kind of infection or outbreak is identified in a hospital,” Geenen said.
This means they’ve implemented enhanced cleaning measures, more education sessions and stepped up efforts to inform their staff on proper hand hygiene. They also now restrict visitors to the labour and delivery and postpartum unit during times of outbreak.
“These enhanced measures are designed to identify a possible source of infection and stop ongoing transmission during an outbreak,” she continued. “Once an outbreak is declared over, the enhanced measures are no longer necessary, and standard best practice infection prevention and control measures are continued.”
WATCH: Ontario father recalls wife’s death of infection at Markham Stouffville Hospital
The hospital also launched a broad review to identify the cause of Riaz’s infection — where could she have picked it up?
“We engaged Dr. Allison McGeer, from Mt. Sinai Hospital and a leading expert in infection control, to support our investigation,” Geenen continued.
“Extensive testing was conducted on equipment, as well as screening of staff members, but the cause of transmission could not be definitively identified. An additional challenge to identifying the cause was that, at the time, York Region Public Health reported the community was experiencing a high burden of group strep A infections.”
The importance of advocacy
Reviewing cases of patients picking up infectious diseases from hospitals is something Rick Lundy is used to. Founder of Open Arms Patient Advocacy Society based in Calgary, Lundy said he has worked with countless of cases like Riaz’s.
“Most people don’t know the dangers of infectious diseases in hospitals,” he told Global News, adding it’s important for patients to be advocates for themselves and their loved ones. But he argued hospitals and public health departments also need to put in the same amount of effort.
READ MORE: Strep A ‘slightly more common’ in postpartum women: specialist
“Hospitals need to do a better job in educating patients about the dangers,” he continued. “They need to have proper policies and procedures to tackle these infections… I’ve seen this over and over again.”
Eesa in 2019. Photo by Global News
The difficulty with patient advocacy (especially in a setting like a doctor’s office or hospital), is that patients put a lot of trust into health-care professionals, often listening to their every word. While the majority of health-care professionals react quickly to a patient’s symptoms, there are cases, Lundy said, where symptoms are dismissed.
Canada’s health-care system is also in a crisis, the Fraser Institute recently reported, resulting in shortages of medical resources and a lack of accessibility to medical care.
There are also countless examples of overcrowding and a lack of beds across the country. It is impossible for health-care staff to provide complete attention to just one patient.
READ MORE: Why strep throat is causing serious complications, from amputations to death
But Lundy said we know our bodies the best. “When you feel something is wrong, most of the time, it is wrong. Your best advocate is yourself.”
While medical errors are bound to happen at any institution, Lundy said health-care professionals need to listen to their patients, and patients need to look for second opinions.
A father seeks justice
While Lundy is not involved in Saleem’s case, he said families follow a typical pattern after losing someone this way. They seek out information and transparency, but they also want to make sure this incident doesn’t happen to anyone else.
“I need justice in any way or form,” Saleem said. “I don’t need a few words from [MSH]… I want to see vigorous change in policy, in method, application and procedure. This will be a good start across Canada.”
Lundy said this comes down to having cleaner hospitals and proper regulation and awareness when there are infections in a specific ward.
“We need to make sure patients have as much information as they can to make informed decisions on their health care.”
Saleem has a lot on his plate. In the eight years he knew his wife, everything was planned down to the minute.
His son’s name was chosen six years before he was born and his wife kept detailed diaries on what the family’s day would look like. His life has a lot less structure today, but all his energy flows into Eesa.
“Because of him, days go by, because of him, things happen,” he said. “I don’t know how he’s going to take the facts of what happened as he grows old — these things really concern me.”
He sees his wife in his son every day — his personality and his appearance, but even his hair. When his son doesn’t want something, he puts his foot down, just like Riaz did.
“My parents say it is Ayesha in another form and to some extent, I see it as well,” he continued. “I just hope that I can come close to how she would’ve wanted his upbringing to be.”
— with files from Caryn Lieberman
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