Saturday, June 24, 2006

 ONe week gone already....and so many things we have seen! Just recovering from a great night out last night, we called up one of our Ugandan contacts through a Canadian friend and he took us out to a huge nightclub, packed full of almost entirely Ugandans. Danced all night and got home at 4:30! Good to experience the middle class youth culture as well as everything else we have seen.
So yesterday I had recovered from my stomach bug and went back to work but Chloe was down...I guess it's good to get this stuff over with right away. Cathy and I spent the day in Lower Mulago high risk Labour Suite. It was absolutely crazy to say the least. Hard to even put into words or to even sort out what I think of it all. They are so maxed out that it is just so hard to deliver even basic care. They do about 60-100 births a day, there are OBs and interns,  as well as midwives doing the vaginal births. The "Caesar" rate here is about 15%, and most of these women truly need them. We started out following a troup of young doctors on their rounds. Saw a few women with severe pregnancy induced hypertension (220/110), sever anemia (Hgb 40-60), cerebral malaria, intrauterine fetal death, and various other less serious complications. At least they have a blood pressure cuff and a Pinard, although it seems each woman gets assessed with these about once or twice a day. I did one delivery, in the labour room where upwards of a dozen women labour and birth. I observed one of the midwives deliver a vaginal breech (a first for me) and she was rather rough I must say, but we did some minor resuc (down the hall with limited and poorly functioning equipment) and the baby was fine. Later in the afternoon Cathy and I found ourselves completely alone in the ward, all midwives had disappeared. THe women with cerebral malaria at 28 weeks was unconsious and had been seizing, a high untreated fever, finally given oxygen, badly needing suctioning, and breathing at about 60-70/min. The woman across from her laboured with severe anemia and malaria, weighing about 80 lbs at most, and badly needing a transfusion. THe blood was ordered and did arrive, but for some reason it sat there on her bed for hours. Finally the gravida 8 with a dead fetus at 44 weeks began second stage and we attended her. I won't get into details but after the delivery of the head we absolutely could not deliver the body. We managed to get the OB to attend her, and were about to follow it through, when in the other room there were two or three presenting parts on the perineum, and no midwives in sight. So we dashed in there, and I gloved up to help one lady, a primpip, but then I turned around and there was a woman who had just walked in and was squatting on her plastic on the floor (no empty beds) and a bum showing! I yelled for Cathy and she came in and  we kicked another woman off her bed and moved this woman up there, and Cathy did a very nice breech delivery. THe babe was great, although his mother had brought absolutely nothing with her, and the babe was wet and nothing to dry it with, we ended up using the paper wrapper from our gloves. THen I turned back to the primip and saw another bum! Cathy! So just two minutes after the first breech, third stage not yet complete, we did another breech.
This small baby needed some reseusc but was also fine. These women get up and leave to go to postpartum so fast that we don't even get there names or anything to chart. There is rarely a clock that works either to keep track of times. It was an absolutely crazy day! Sorry to leave it at that, but I must go to Masaka now! Will write more and am working on posting the photos. Love to all
ais

1 Comments:

Blogger Aleka Stobo said...

Wow, Breeches! Aisia and Chloe, I am very impressed with what you two are doing, you both rock!
I am on the edge of my seat...what will happen next?...
Much love,
Aleka
Say Hello to Cathy for me!

11:45 AM  

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