Thursday, June 22, 2006

Kampala

Well well, Aisia here. Here is my first posting of our trip. Chloe and I spent a few days in London with our dear friend Kate, and had lots of fun doing more everday London stuff than tourist stuff. Went to Borough Market, the Tate Modern, Hampstead Heath, and of course lots of eating good food and drinking, which is what Londoners do best. Everything costs double but if you think of prices in dollars instead of pounds, you don't feel so sick. It was a bit of a heat wave when we were there, and it was great to get over most of the jet lag. London was much cleaner and prettier than I remember it about ten years ago.
We flew out Sunday night from Heathrow, and almost got bumped, which I was pretty excited about, as we would have gotten about 600 pounds credit with British Airways for flying out the next day, but it turned out the flight had just enough room, oh well! So, after an all night flight, at 6am we stepped out of the airport at Entebbe, just about on the equator. It was very humid and lush, full of flowering trees and bushes. Cathy, our instructor from UBC, and her husband Mickey, a doctor, met us at the airport which was wonderful. THe taxi ride into Kampala, Uganda's capital city, was long due to very bad traffic congestion. I have seen bad traffic before, but here it can be faster to walk than take a taxi or minibus....it's not that there are so many vehicles, but just that it gets so congested and slow moving. The amount of exhaust you breathe in constantly is somewhat nauseating.
The people are very welcoming and gentle, they say 'you are welcome' to just about anything we say to them. We had breakfast at our guesthouse and then attended a meeting at Mulago hospital, where we are working. It is about a twenty minute walk from our guesthouse at Makere University. We met with the head of nursing who is overseeing our program here, as well as one of the midwives. Then we got to sleep into the afternoon and recover from our flight. THe temperature is pleasant, not too hot and usually breezy. Haven't seen too many mosquitoes yet, thankfully.
As for the work, well let me first say that some of you reading this will be in the midwifery crowd and will want the details, so some of the rest of you may not follow some of the clinical stuff, but I'll do my best. THe hospital is huge, and consists of several buildings built up a hillside. Easy to get lost. It is the main referral hospital for the whole country. We had a tour of the relevant areas, including high risk labour and delivery, kangaroo care for premature babies, antenatal clinics, and the low risk midwifery unit. The antenatal clinics see about 300-500 women a day, many of whom were lined up waiting. The high risk unit had about 100 births a day, and anyone who hasn't had any prenatal care will deliver there (or at home). In the midwifery unit, Ward 14, where we have been working so far, there are about 20-30 births a day. The facilities are very basic and supplies are nonexistent. ONly low risk women can deliver here, so if they have complications or have had more than 5 babies we don't see them. About 4-5 midwives are on staff at any one time. Women come in alone and get assessed (palpation, auscultate the fetal heart, get a history) and then are sent home or to the labour area. This consists of one large room with grubby and torn curtains, and bare filthy beds. The women are required to purchase supplies to bring with them: 4 pairs sterile gloves, 2 pieces of plastic to cover the bed, a roll of cotton wool (in place of sponges and pads), a razor blade to cut the cord, 2 syringes for oxytocin, and a cloth to dry and wrap the baby. These cost about $2 or so, which is quite a lot for these people. The monitoring in labour consists of vaginal exams every 4 hours or so, as at home, and once in awhile (really once in awhile, like maybe once or twice in labour) they use a metal Pinard horn to listen to the baby. There is one blood pressure cuff, which doesn't seem to get used, and I don't think they have a thermometer, nor do they take the maternal pulse. The oxygen, suction, and autoclave are all in disrepair and dont' work. They do have bag-and-masks, which sort of work. Basically the hospital has no supplies or equipment. They do not have anything other than their own uniforms to launder, no linens or anything like that.
So you could say it is pretty grim. But women seem to like having their babies here. And there are experienced midwives. When the women feel like pushing, they call for the midwife and move into the delivery room, which has 2 tables. They lay their peice of plastic out and climb up, and push out their babies. THey are encouraged to be on their backs with their knees up. So far they seem to have their babies very quickly. Oxytocin and ergot are available and are used routinely to prevent postpartum hemorrhage. We have seen a couple, and the midwives are much more laissez faire than we are, they reluctantly started an IV on one woman with our urging. THey are very optimistic about things like apgars and estimating blood loss. One woman hemorrhaged at least 750ml and the midwife charted 170ml! A woman from up north near Sudan came in yesterday, and no one was able to communicate with her. We observed her delivery and there was meconium and the baby was quite floppy (apgars 3, 7, 8). Cathy and I resuscitated her, doing PPV for ten minutes, and she didn't improve too well. We inquired whether she could go to the nursery in another part of the hospital, but they said, this baby is fine! But still had poor tone and was not very responsive. So we just put her close to mom and hoped for the best. The women are not treated with very much care or respect, and sometimes the midwives can yell at them or grab their hair. Suturing is needed occasionally, however there are no suturing instruments or local anesthetic, they just use their hands to suture. Needless to say, we won't be doing any of that! To clamp the cord we use the rims of our sterile gloves to tie it, and a razor blade to cut it (which are also used for rupturing membranes and episiotomies). About five minutes after the birth, the women get up and walk back to the labour room, and might be given a coca cola. Within a couple of hours they walk out of the ward and up the stairs to the postpartum unit, carrying their suitcase and baby! They stay there until the following day.
We are charting with partograms, and if a woman crosses the alert line, she is transferred by ambulance to Lower Mulago down the hill for specialized care. We will be working there tomorrow. For the women that access prenatal care, this consists of two or three visits, where they are screened for syphilis, hepatitis, and HIV. About 11-12% of the women here are HIV positive. We have brought lots of gloves, goggles, and aprons to wear as well as soap, which they don't have. The midwives want all of our stuff, aprons, gloves, and scrubs. They wear green dresses here. Basically we are able to do most things, they have gotten comfortable with us fairly quickly. So we can do assessments and deliveries. Many of the women speak very basic english, if not the midwives translate for us. Some of them speak it quite well. Although with the accents we often misunderstand each other. THe midwives speak English and the charting is all in English as well.
THings are definately very different. MOst of what I am learning so far is just how very different things can be. I was up all last night vomiting etcetera, so I didn't work today. I think I am on the mend though. Hopefully I sound as positive as I am about the experience so far, I know when I am sick things certainly seem a little darker.
THis weekend we will go to Masaka, a small town south west of here, and will spend three weeks in a smaller hospital. THen back to Kampala for two weeks. Chloe will post soon too, and we have some photos but aren't sure how to get them on here...keep checking back! HOpe you are all well!

3 Comments:

Anonymous Barb said...

Hi Chloe and Aisia!

This adventure should be a book! This is amazing! You're amazing! It's incredible to think how privileged we are in Canada, and that you two are experiencing the polar opposite to our medical system...I mean, no soap?!?!? God. I don't imagine you have very much time, so many thanks for getting the first posting up. Talk to you soon. Take good care. Love, Barb (Chloe's mom)

12:03 PM  
Blogger Emily said...

Holy, you guys! I am shocked. What a difficult and amazing experience.
re: photos... if you can find a way to upload them to your computer, all you have to do is click the photo icon in your blog posting window, and it will prompt you to choose and insert the photo you want. I hope that helps.
love, Emily

8:48 PM  
Anonymous Anonymous said...

Hi Aisia!
I hope you recover from your sickness soon. I can just picture Mulago... Ive been there more than once! You should meet the assistant dean to the Medical faculty Sam Luboga and tell him you know me- he will be able to help you out with anything you need. Yes, things are very different but I hope enjoy yourself nonetheless! Take care and please, please, please call my friends- they cant wait to meet you.

Maude

2:37 PM  

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