Monday, July 10, 2006

totally nuts then vacation

Hi all,

Well what can I say...things are always a bit of an adventure here. We left
Masaka on Thursday afternoon after working at the hospital (our first day
with no deliveries...although we did prep a woman for c-section). Arrived
in Kampala just in time to miss the rush hour (which is totally nuts here!)
and into the big city smog. On Friday we worked at lower Malago (the high
risk ward)...I was anticipating that it would be kinda crazy as I had only
heard the stories from Ais and Cathy about this ward since I had been sick
the previous time. The day started off fairly slowly. We spent most of our
time making sure that the women received the medications and other oders
that the doctors had left for them. This was a very interesting
ward...woman after women had orders from the doctor...most of which were not
carried out...and the doctors day after day would just re-write the orders!!
Interestingly enough the midwives often seemed like they were not doing
very much and often sitting down and chatting...while women had untreated
Malaria, PROM, sepsis and pre-eclampsia. And then, when it looked like we
would go home in an hour with no births...they started to pop out. Ais
delivered a woman who had been induced with PROM...and as we were still
dealing with her placenta and trailing membranes Cathy called me into the
other room for a breech delivery. And there it was...the bum and
balls...coming right out. In no time at all got ready and moved the women
around on the her bum was on the edge. Delivered the legs...and
the rest of the body came out very smoothly including the arms. Then
Morso-Smelly Vite (is that the spelling of the manuever?) and a very slow
delivery of the head guided by Cathy...and voila a healthy baby boy...thank
goodness for a straightforward first breech delivery. Then about ten
minutes later a woman came in who had had large amounts of bright red blood
and was term. She was in shock and her abdomen was hard as a rock. The
obstetricain was great...set up two IV's...and after both Cathy and I
determining there was no fetal heart oxytocin was put in one of the bags. A
definite placental abruption. The obstetritian said to Cathy that she was
worried about if the woman would survive considering how much blood she had
already lost and how much she will probably loose at the delivery and the
fact that there is no blood available in the hospital for her. Cathy
delivered this womans baby because the hand was coming first...this then
turned into a compound presentation (hand and head being delivered at the
same time)...and then a massive shoulder dystocia...finally after doing all
the manuvers...we moved her on to hands and knees and the shoulder was
finally dislodged. The baby was born dead...which Cathy did a wonderful job
of breaking the news to her. The mom was very sad...she had also last her
last baby because it was preterm. The placenta came with no problem and big
gush of blood, but her fundus firmed up quickly and she didn't blee any
more. When we left she was doing relatively ok...anemic and sad...but still
alive! Oh yah and at the same time this woman was delivering there was
another woman beside her...who started to push...and we looked over and
there were the babies balls coming out first (breech). Unfortunatly she was
a primip and in 20 minutes the breech didn't come out any further. We had
to leave before she delivered, but it looked like it would have been a very
grim delivery anyways. Then we rushed on our way to get out to Jinja. Ais
and I realized that in the six hours we were in the high risk ward we
covered our entire ALARM (emergency skills) manual...except for VBACs (that
were probably in a different section of the ward) and assisted vaginal
delivery (ie. forceps/vaccume...that they don't seem to do here
anyways)...crazy!! Oh yah, that day there was a woman with twins, but she
had chorioamnitis and very few contractions...and unfortunatly didn't
deliver when we were there.

Ahhh so off to the Nile for a little get away. Cathy and Mickey had booked
rooms in this great little retreat. Beatiful little huts with very nice
rooms...and a swimming pool!! Unfortunatly our only whole day there it was
clouded over. Lots of time to read and relax. Went for a bird watching
boat trip on the Nile...and even saw the source of the Nile (this actually
isn't as interesting as it sounds). Ais and I went into the town of Jinja.
Apparently the 2nd biggest town in Uganda...but actually very small. The
town we didn't find very impressive and not nearly as friendly as Masaka or
Kampala (people would stare at you...but not really in a nice way). That
night we had a east indian meal...and afterwards Ais and I both agreed it
could have been a dodgy meal...but yahoo we did not get sick. On Sat night
also we borrowed Cathy and Mickeys laptop to watch 'Memoirs of a
Geisha'....good movie and nice to do something different. Then on Sunday
after a nice sunny swim in the pool we left for Masaka (a long and tedious
trip back).

Then last night we watched the World Cup game with all the many folks who
came to our hotel to cheer on their favoured team. Ais and I chose (for no
particular reason) to cheer for Italy...good thing since they won!!

Then back to Masaka hospital today. Our first time since Cathy and Mickey
have been gone. It was good. Ais and I really worked as a team. One very
straightforward delivery. Then a woman was brought in with a suspected 28
week preterm baby that they hadn't found a fetal heart on. I found a fetal
heart on the baby and Ais and I wondered if the baby might be more like 30
weeks. Then on palpation I realized the baby was breech. I asked the
person who admitted her if they thought she was breech and they said yes,
but they had forgotton to writet it down....what! Ais ended up doing the
delivery because it was breech. Very complicated delivery. A footling
breech. With a prolapsed cord and the midwife who was helping Ais was
pulling very hard on the baby. A very small baby that required extensive
resus...but finally ended up breathing. The other midwife estimated the
baby was more like 26 weeks...yikes...very small.

What else. The culture here in Uganda is very interesting. Ais and I have
decided that we should take up some religion for our time here...because the
people don't seem to understand how we communicate with god if we don't go
to church. Some people are really very interested in our non-religion or
spirituality, but they just don't get it. Here are some Uganda isms:
-'mobalize'-To get going or to get ready
-'to move with someone'- To go out or hang out with someone
-'a short call'- to go pee
-'a long call'-to go number 2
Yesterday I had two strangers (men) tell me they loved me...I thought this
was rather hillarious, odd and interesting. The first one I just laughed at
and the second guy I laughed at and said...that's so funny because someone
else just told me that earlier on today!

till next time,


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