Wednesday, July 05, 2006

so, here i am again at the internet cafe, it always seems hard to know where to start. so far this week has been good. yesterday on the walk to the hospital i said, i am ready for a busy day. cathy asked what we hoped to achieve and i said iv's and chlo said urinary catheters. well, be careful what you ask for! we walked in to a head on the perineum, and another multip at 9cm. so we each caught a baby right off the bat. And then there was another, and the midwives have some sort of course this week, so we were left to our own devices in the delivery room. we are all out of oxytocin for managing third stage and are now using ergot,. and it doesn' t seem to work as well. lots of clots. I also attended my first Caesar here, i was designated to recieve the baby. THe indication was small pelvis and big baby, which is not uncommon here, due to poor nutrition. I donned my white rubber boots and scrubs, mask etc,. and in I went. The women are put under general anesthetic here, which is somewhat traumatic to witness. ANd there is no electricity in the operating theatre, for the most part ( nor in the delivery room either). They use a vertical incision on the outside, and a lower segment cut to the uterus. and they are pretty rough with the whole thing, suturing etc. The babe did need some brief resuscitation, but came around fairly quickly, thank goodness, as i was alone in my task. the resusc table is old school slanted with the head lower (quite a lot lower), and then one of the legs is truncated so it is also slanted to the side, which makes for a rather awkward oblique type of surface. I am finding it difficult to get air into the lungs of babies. i don't know if it is the quality of bag-and-masks, or my amateur technique. then the baby's colour wasn't great, so we tried oxygen, and they assured me it was flowing, but the gauge said zero, and the eventually realized that yes, they were out of oxygen for mom and babe. The babe continued to have blue lips even after breathing well, and the staff assured me it was because this baby was very black. i wasn't convinced, and sure enough it did pink up nicely after a few more minutes. so that was the OR. I got back to the birthing room and two more women quickly delivered. one of them hemorrhaged more than i have seen so far. at least 1000ml. Had given ergot after the placenta, gave ergot IV, then oxy IV, and i did my first bimanual compression. At least i now feel competent doing it,. and could see the results. not sure why her uterus was so atonic, there were no signs. Eventually things stabilzed thank goodness. so that was a long day.
also this week we were taken to meet a traditional birth attendant here in town at her home. She is apparently 96 yrs old and has been attending births since age 14!!! she was quite a character. We were taken to meet another group of tba's out in the country today, and that was lovely. they were given transportation to the meeting place, snacks and refreshments, money for lunch, and we gave them some gloves and soap. they were quite excited and willing to share their experiences with us, and we did some practice breech deliveries with the torso and baby that Cathy has brought. The main concerns the traditional midwives have is lack of supplies, including water (which they have to pay for and carry great distances), women not being able to pay them anything, and women showing up very late in labour, or not attending for prenatal care. We had fun learning from each other.
Had supper tonight with some other Canadian students, social workers from douglas college. Tomorrow we are headed to kampala, and friday we will be back in the high risk unit. then to jinja, the source of the nile, for a relaxing weekend. cathy and mickey are leaving on sunday and chloe and i will be on our own.
Oh, cathy hosted a supper the other night, and we invited the hospital administrators, the midwives we have been working with, and some of the ugandan nursing students that have been helping us. I think they were quite pleased with the evening, and were a bit gussied up. OUr hotel put on a full african buffet, and the guests really loaded their plates! It is difficult to see how badly the midwives and students want to come to Canada to work or study. it is not fair that it is relatively easy ( and entirely possible) for us to come here, and just as relatively impossible for them to do the same in our country.
ANother thing that has been interesting to ponder is that we come over here and do things the way we have learned, for the most part. can you imagine if we had some visiting students at BC Women's hospital from sri lanka and they just managed births as they do at home? outrageous!
I am going to leave it at that for now, and hopefully next week we will be able to post some more recent photos. hope you are all enjoying the stories.
ais (ps the shift isn't working very well on the keyboard, hence the lack of capitals)

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