Wednesday, June 28, 2006

a bit of everything

Hi All,

Very short amount of time for a post...hopefully I will have more time tomorrow. Yes, I am feeling much better. Just a daytime flu on Friday. Then out for dinner that night and out to a night club with some Ugandan friends we had made through Canadian connections. The people we went out with were incredibly friendly and kept very good care of us. I would have to say that the only danger at a club in Uganda is having every man in sight wanting to talk to you and get your contact information. By the end of the night we had both lost our voice. Lots of fun. The next day we headed to Nabugabo lake near Masaka. We stayed for one and a half days at a place called Sand Beach on the lake. It was incredibly relaxing and beautiful surroundings. Apparently it is the only lake in Uganda we can swim in, but the water was we didn't risk it after all. On late Sunday afternoon we headed for Masaka. After some searching we decided to stay at Hotel Zebra. A very nice hotel with a wonderful view of most of the city. On Monday we went for our first time to Masaka hospital. This hospital is a general referral hospital for Masaka and surrounding areas. They usually have 9 births a day including 3 c-sections ( called creasers here in Uganda). Also, in labour ward an admitting room for women with any kind of pregnancy related or (possibly) gynecologically related issue. Then two post partum wards one for post c-section/premature and the other for antenatal/post vaginal delivery/genealogical issues and women suffering from malaria in pregnancy. Also, a special care nursery that has no incubators, but is kept very warm and the babies are covered with tones of blankets. Then 1st stage of labour room (very small) and a room for deliveries with the operating theatre nearby. The hospital is staffed by Nurse/Midwives and there is usually one OB/Gyn on-call . The hospital upon 1st inspection seemed much cleaner, organized and well supplied than Malago hospital in Kampala. They seem to have many more medications and instead of the women having to come with their own supplies they are supplied by the hospital. My first day on Monday was somewhat shocking (perhaps because on Friday I had missed the high risk day in Kampala). For the 1st part of the day I did rounds with the midwife, Cathy and Mickey on the post c-section ward (By the way although the c-section rate may seem high...this is because these are all the woman who transfer in in crisis from rural areas usually from an obstructed labour). Although many women we looked at were healing just fine...there were some at the end of the room in pretty awful situations. About 6 women were completely septic, some with burst c-section scars, most with extreme blood loss (in a place where blood is simply not very available here), some with malaria and others with HIV or both. Oh yah and most of these women's babies died in childbirth (from obstructed labour...or any other reason) or died very soon after. I'd say that about 3 of these women would probably die very soon and another handful were very close to their way out as well. I heard later that the two biggest things that the OR deals with is c-sections and sepsis from c-sections (ahhhhhhh!!). I think the sheer volume of it was all a bit shocking...had to have a bit of a cry that night...just to acknowledge this is hard work. Later on that afternoon Ais and I both had a delivery. Interestingly enough the woman I delivered had been admitted with an inevitable abortion (not sure why)...prior to delivery we thought we would be delivering a 28 wk preme, but when the baby delivered it looked more like a 32-34 weeker. The baby had very fast resps and some grunting and we managed to find a midwife to give it antibiotics (the mom had had an STD). Now two days later the baby is doing very well. Then Tuesday I started in the admissions room. All very interesting. No women in labour. One women with emesis and chronic pain at 8 months probably from malaria (she had 6 children and was 25...from her chart it looks like she had her 1st child at 14!). Another woman with a complete abortion and another woman with what seemed like 10-12 week inevitable abortion...with strange radiating pain down her left leg (ectopic was ruled out). Again two deliveries that day (one each) and both of us got to have our 1st Ugandan suturing experience (we used Cathy's suture kit). Also, on Tuesday there were many women in critical conditions who didn't seem to be attended to. One with a intrauterine death who had become septic, another woman with a bust abdomen from sepsis from a c-section (waiting most of the day for the OR) and another woman post delivery with full blown Aids and Malaria. Cathy has learned now how to administer the antibiotics they give for sepsis and do an IV on we can start helping out more in these critical and under staffed situations. Then today. Well it seemed from the minute we walked in the door babies were just flying out. 5 deliveries between us in 2-3 hours (I totally lost track of time). The last baby I delivered was premature and put in the SCN. Some more suturing, but difficult to co-ordinate when other babies were starting to be delivered at the same time. Today we had a woman who ended up going to section with lack of progress, previous section and some fetal distress. We are not sure if the baby was resuscitated in the OR (often not done at 1st here in Uganda), but when we saw the baby is was in special care and doing very badly. Very soon after the baby died...our (or at least my) 1st baby death in Uganda...hard to see, but somehow I wasn't very sad at all...these things just happen more here I guess!). What else. The midwives/nurses have been incredibly nice, helpful and accepting...I really like them. They even gave us our own aprons for deliveries...with our names on them...and mine is spelt 'Clowe' and gum boots for the OR with our names on as well (they did this all for sweet!). In terms of the rest of life it is good. Masaka is a beautiful little county town and we have a very lovely 20 minute country walk on the way to the hospital. On the way home many people wave, say hello and the children shout Muzungo (this means white person)...we smile and wave. Getting used to lots of meat and potatoes here. Today one of the nurse/midwifery students hung out with us. She was an excellent tour guide for finding 4L bottle of water and a good restaurant. On the weekend we are planning on going to Lake Mboro to see the lake, do some bird watching and go on a game drive...this should be lots of fun. Oh ya, since I wasn't able to post before...I'm sure Ais has described the lack of supplies and crazy busyness of Malago hospital. I think one of the things we are learning most is how to improvise and think quick (good qualities for Midwives...I'm sure). Many of the births in Malago were kind of a blurr to me...they delivered so quickly (often didn't even know their names). The things that stick out the most for me is a woman I supported in labour who was having non-stop contractions (1st baby)...she denied taking any African oxytocin (a root), but seemed as though she was not labouring normally and having a very hard time. In one hour she went from 5cm to pushing(primip!)! Delivered the baby and the midwife sutured (no equipment to suture with so we didn't do it). Later that day when we went with her to the postpartum ward her mom and sister insisted that the baby was called Chloe (it was a boy!) I suggested other boys name, but they insisted on Chloe (probably in some interesting African spelling). Also, in Malago I had my 1st know HIV positive delivery. It went very well, but was certainly a hump to get over in this African experience. Becoming a pro at trying the cord with the pieces from the end of my gloves and cutting with razors (this is how they do it in Masaka as well). Overall an incredible learning experience I am thoroughly enjoying it and looking forward to what lay ahead. Uganda has (for the most part) been such a friendly and welcoming place to be.

Until next time,


Anonymous Anonymous said...

What an experience this is for you two! Your digs sound wonderful. And the people. Thanks for keeping us posted. Wonderful to see your smiling faces in the pics!

11:22 AM  
Blogger Emily said...

I am so proud to know you, Chloe. You are amazing. I love you.

11:58 PM  
Anonymous Anonymous said...

Wow! I am in awe. You will be forever changed by this experience. Love your Blog. Great photos.

9:38 PM  

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