Tuesday, July 11, 2006

THe plot thickens...
Well, ever since Cathy left, things seem to have gone crazy in the delivery room! First I'll start with the rest of last week....as Chloe mentioned, our day at Lower Mulago (high risk unit in Kampala), was as crazy as the last time, with breeches flying out all over the place along with other complications and again, abandoned by the midwives! It was some good learning. I did deliver one mother who was there simply for PROM. She had been there at least 24 hours and doctors had ordered an IV with antibiotics and oxytocin, but at the time she asked me to help her she had received absolutely no care. So I carried out the orders, and she responded very quickly to the oxy and delivered without complication within a couple of hours (second baby). She spoke very good english and was very appreciative. She tried to give me some shillings to buy myself a soda! Also she thanked me for "paying attention to her." Her first delivery here she said "the African midwives are not kind." THey wouldn't help her off the floor to deliver and told her the baby would die if she didnt' get up. This woman made me realize some of the things I can offer here, when sometimes I feel like I am making no difference at all. Another interesting thing with this situation was that there seemed to be no membranes! The placenta was circumvallate, and there were a small amount of trailing membranes, not attached to the placenta, but there were absolutely no membranes attached to the placenta! Also on that day I observed a midwife slowly and without urgency, put on her gloves as a baby delivered itself. It is interesting to see that the staff do not ever seem to act with urgency. This baby was not alive and I didn't know it beforehand, I think the midwife did.
Needless to say, like Chloe said, in a mere 6 hours we witnessed almost everything in our complications manual (ALARM)!
We deserved a restfull weekend, which we had, at JInja, source of the Nile. NIce little local style resort, with a pool! OUr trip back on \Sunday night was long, took a matatu (toyota style van with 13 seats in it) to Kampala. I conclude that it is best to position myself so that I can't see the road ahead, it makes for a much less stressful experience, especially since I can do nothing to prevent many of the looming possibilities of major accidents. Then to the bus park to find a bus to Masaka. We opted for a big bus, rather than matatu, but then waited on the bus for about two hours, for it to fill up. Got into an interesting communication with a fellow seated near us. He couldn't grasp (or we did a poor job of explaining) how we communicate with God. I mentioned something about going into the forest to be alone, and he got fixated on this concept. HOw do you go there? How do you get power? The people are so deeply religious here that it is unexplainable to them how we are not Christian (or another religion). But what do you do when you get attacked by demons?, he asked....Well, have to say I haven't been attacked by any demons!
OK. so then back at Masaka hospital, without Cathy. Yesterday I caught one baby, fifth one I think, no problems. Then there was a gal with a preterm breech. I wanted to deliver it (they call it an inevitable abortion here before 30 wks or so because they have no means of helping such a young baby survive). I relied one of the senior midwives to assist and direct me....she was fully but with no contractions. Third very early baby for this 19year old mom,. this one the most mature at 26 weeks. THe presenting part was high, but Prossy told me to rupture membranes and get her to push, OK. SO I do, and then I reach in and feel a cord, and a foot. Hmm...this isn't exactly the situation we are taught to manage. The foot was so small, and the cord was prolapsed, and no contractions, I was sure this baby was dead. So I grabbed the other foot, sort of did the breech manouvres, except for very violently and with much force, as instructed by the midwife. She really just yanked on this tiny thing until the head came out. Amazingly, it was alive and they resuscitated it, it went to the preterm room. The mother looked like she had serious post traumatic stress,. totally vacant. And the midwives don't really communicate with them in this type of situation. Unfortunately (?), I found out today that the baby died during the night.
So today we went to a rural immunization clinic ( some benches underneath a grove of trees) and saw what that's all about. Women walked in with babes in arms from the surrounding area and got them vaccinated for polio, HepB, tetanus, measles, TB, etc. Vaccinations are one of the major components of health care here. And health care and education seem to be the majority of everything everywhere, so many schools and health projects.
For the afternoon we decided to pop back to the hospital for a bit. And the two medical students that were managing things were happy to be spelled off as it had been a busy morning and there were two more women fully dilated. ONe of them is having her fifth baby, but it isn't coming down, and there is quite a bit of caput (swelling on the head). The medical officer was consulted and a plan was made to try a vacuum delivery in the theatre. I am alone in the room, attending to someone else, when I hear the woman scream...she has fallen on the floor, in almost a complete splits, and is stuck on the floor, on her perineum (the head was on the perineum prior to this point). Oh my god! I try to help her up, she's pretty stuck, and the baby's head starts crowning..I yell for help, and scramble to put my gloves on (the floor is covered in countless people's body fluids and is cold, hard cement). I have two fingers in one glove finger, backwards, but manage to catch the baby, chloe rushes in and I hang onto the baby, nowhere to put it, while she ties the cord (with rims of the gloves, so it isn't exactly fast)...babe is pale and limp, with meconium staining....others respond to my appeals for help, but just stand there and watch, while chlo and I manage the situation in a panicked kind of way. We bag the baby for at least 10 minutes, apgars generously 3, 5, 7. babe ends up breathing after some time....no tone though, and a vacant look in his eyes. Yikes I wish I knew more about how to tell if brain damage has occurred. No one is concerned in the least. Oh the baby looks good. Oh ha ha ha, they think it's funny that the mom fell down splat on her perineum, probably damaging some ligaments, if not the fetal head. It is hard to describe how crazy this place is....just crazy. Babe did look somewhat Ok by the time we left. HOpefully things will be smoother from now on. Good luck. Anyways, enjoying the country nonetheless. Am excited to get back to Kampala and celebrate my birthday on Friday. And not be so busy busy busy. We are taking a long weekend. Will let you know how it goes!


Anonymous Anonymous said...

Wow...you two are having some really intense experiences. I really appreciate you sharing your day to day adventures with us and am always pleased when there's a new post to read. Looking forward to hearing more from you both when you return.

Love and light,
Heather (3rd year...soon)

3:43 PM  
Anonymous Anonymous said...

Your posts are absolutely riveting...I'm fascinated by the descriptions of the births but more particularly by the apparently laissez-faire attitude of the local midwives. Perhaps I shouldn't judge them too harshly given the conditions...
Keep up the flow of information ladies - it's great stuff!

Allison (Chloe's aunt)

8:13 PM  

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