midwife adventures

2006-08-20T09:39:00.000-07:00

Emma, Nassa, and Julius, on a trip to the Zoo in Entebbe

Oooops

2006-08-11T07:10:00.000-07:00

Hi All,

I just wrote a very long blog entry about our wonderful vacation; however, as I was looking it over the computer froze and all was lost. Probably 45min to 1 hour of work totally down the tubes. So, as not to expose myself to more agony ('acunamatata'...no worries in Swahili) I will simply say that I agree with what 'that one' (Aisia) has written and would probably write a very similar update myself.

Again we have some more really great pics, but it will probably be a while before they are posted.

See you all soon,
Chloe

Pole Pole

2006-08-11T06:33:00.000-07:00

So, here we are on holidays now, after our 6 weeks of volunteering and learning. We finished a couple of fridays ago and kicked it off with a night out in kampala, before rising after only a couple of hours sleep to hit the road in a beamer with our Kampalian friend., he was most kind to drive us all the way to the coast in kenya! The road to the border took about 6 hours i think, ,and we also had another friend along who is from Nairobi, so it was great to get the low down on what was to come. passed some electric green velvety tea plantations and then after dark (unfortunately) through the Great rift Valley.

Arrived in Nairobi late and stayed with Yassir at his mother's place in the suburbs. That was nice as by all accounts, ,Nairobi is a dodgy city and we didn't have a lot of interest in navigating it ourselves. the next morning we had to replace the brake pads (which had been replaced no less than a week earlier??!!, and which also had to be redone again after the car made it back to uganda! Not sure what the deal is with brakes here, obviously not of the same quality). anyhow, left onwards past tsavo nat parks, and saw a lovely elephant just next to the road, arrived in mombasa on the coast and stayed a night there.

For the next week we made our way north, a couple of days in Watamu, and small seaside village, with a long long beach, supposedly voted in the worlds top ten beautiful beaches). the placee was full of italians, tourists as well as residents. apparently they run most big businesses and resorts, and are there to handle the traffic of cocaine etc that passes through the ports. Very strange to be sipping delicious Italian espresso, eating gelato and pastries and many of the Kenyans even speak italian! IT was lovely to relax. the beach was nice, perhaps not in my top ten, but the weather right now contributed to the seaweed and less than perfectly turquoise appearance of the water. nonetheless, it was lovely to swim in the warm ocean! We attempted a snorkelling trip in the national marine park, which i was quite excited about. Unfortunately it turned into a bit of a disaster, as the waves were huge against our small boat, ,and 3 of the five of us were green and upchucking into the sea. The snorkelling also left something to be desired, and after a few minutes of the odd fish and murky water and gray coral, that was that.

The food in Kenya is quite a bit more exciting than uganda, they use many more flavours and spices, and our favourite, vegetables! We also spent a couple of days in malindi, another Italian town, this one larger. that is where nassa, our ugandan friend turned around for the return journey.

Chlo and i decided to continue on to Lamu, an island off the north coast, which contains a town that is now a world heritage site, and wow, it was amazing. We thought we mightn't make it all the way there, but seeing as we were then only a 5 hour bus ride away, we thought we had to do it, and it was so worth it. the road (all the way from uganda, actually,) is pretty crap, mottled with gigantic potholes or lack of pavement, not to mention the nutbar drivers. We did eventually arrive, and took a little passenger ferry 15 minutes to lamu town. The island is largely a muslim swahili population, and there are arabic and portuguese influences. Lamu is an old old stone town, with winding alleys, less than the width of a car. that is one of the best parts, no vehicles, just donkeys!! so it was quiet and relaxed, far from anything. Pole pole, slowly slowly, is the operative word about Lamu. I loved just wandering the alleys, past mosques, a small market, stopping often for a fresh lime juice, or an avocado smoothie (alcohol is rare here, due to the muslim population, this was a welcome respite from our Kampala lifestyle). There is also a beautiful beach, a lovely 30 minute walk from lamu town. It winds along a seaside path, and at high tide you actually have to walk in the water. THe sea is dotted with handmade wooden dows, complete with blue painted carved decorations on their bows. We found some very cheap digs, with a rooftop terrace, actully the tallest building on the island, at a whopping three storeys. It is amazing how the conditions become less noticeable, our bathroom was actually truly atrocious, the toilet didn't flush, the shower (not warm of course) was sporadic in its water flow, and the fan also inconsistent. But we didn't mind a bit, preferring to spend our money on seafood.. I tried to eat fresh fish and prawns at least twice a day! And lobster too. DELICous. So, a few days of that, and then, lo and behold we 'stumbled' upon a reasonable flight ticket back to Nairobi. to be honest, we were scheming for weeks how we could avoid some of the long arduous bus journeys. so we were thrilled to take a mere 1.5 hr flight back to Nairobi, ,out of the cutest outdoor palm tree lined airport.

the next adventure, which i just got back from a few minutes ago, was a safari for three days to the Masaai Mara reserve, probably kenya's most famous wildlife viewing destination. We spent three days (granted much of it navigating more terrible roads) at the reserve. Two irish girls and a frenchmen in our van, along with our indispensable guide, Ken. We camped, which was so nice! Only my second campfire this summer, which i have been missing.

The reserve is absolutely amazing....the numbers of animals is just staggering, it's not like you drive for three days searching for a lion or zebra...they are so numerous! I loved the elephants, the lions, cheetah, the lepard, and we even saw a giraffe in labour! The other amazing thing is that the animals are totally unafraid of the vehicles, for the most part (probably an eco disaster I am sure, but wonderful to be able to see them up close). Lions and cheetahs literally walking in front of us. One morning we watched as a pride of lions took turns eating from their recent wildebeest kill. Right now is the annual migration of well over a million wildebeest, coming north from the serengeti in tanzania. So these comical creatures were everywhere, with their ungainly bronco gait and hairy backs and long faces. they seemed so prehistoric, reminding me of ancient paintings on the walls of caves. Many of the animals happily exist side by side, zebras and wildebeests and giraffes, gazelles, all grazing together. It was truly memorable. the landscape of the mara is also incredibly beautiful...geez,. sorry for all the predictable adjectives. Vast open plains, with african looking trees, punctuated by copses of green riverine forest, all under a dramatic sky. it was actually chilly, too, first time I've needed my fleece.

The Masaai people live all around the reserve, always dressed in red robes and carrying a long stick, as they are cattle people, subsisting mainly on the meat, milk, and blood of their animals. I find it fascinating that as a culture, they have consciously decided to retain many of their traditions, especially their dress. They often have huge elongated earlobes, with a large hole, and wear many colourful beads. It's just interesting that they seem to continue to follow these traditions, when so many other cultures get increasingly westernized. Apparently, individuals can choose to leave for a period of time, but when they return to the village, they must live in the traditional way. they are polygamous, ,like many populations in africa, with men having an average of 3-5 wives, each one living in her own house, which she builds, with her children. We did have the opportunity to visit a nearby village and see inside the homes and also they did some traditional dancing and showed us how they start fires by rubbing sticks. it always feels so corny being in that kind of situation, also we had to pay a few dollars each, which is fair enough i suppose. The money goes towards running the village school. It all did seem authentic and not contrived, but strange still. They have been at this tourist thing for less than two years, so I am curious about what impact it will have. They are a beautiful people.

NOw i sit here in Nairobi, killing a few hours before boarding a night bus (14-15 hours) back to Kampala. We will spend a final weekend there, celebrate Chloe's birthday on Monday, and then fly home wednesday morning! It has been an amazing journey in so many ways. looking forward to seeing everyone and spending the last few glorious days of summer on the coast, ,which still remains to me, the very nicest place in the world. Who knows if i will post again, probably not unless something very exciting takes place in the next few days. Will add some more photos when I get home though, so keep checking....

see you all soon,

love ais

Aisia Salo
3rd Year Midwifery Student-UBC
aisiasalo@hotmail.com
250-595-1027
mobile 250-686-7987

2006-07-28T06:11:00.000-07:00

I don't know how to put captions in the right spots, but this is us at church, dancing on the beach, immunizing children, and shopping at the market

time for holidays!

2006-07-28T06:09:00.000-07:00

Well well well, today was our last day of work....feels very good. Said goodbye and gave some final donations to Ward 14. The midwives expressed how much they enjoyed having us there. Said we were so nice and 'social' compared to some others, and they felt we were non judgemental, nice to them as well as to the women, and that we lacked the 'better than them' attitude. So I am very pleased that both sides could learn from each other and enjoyed the time we spent together. We attended a total of about 60 births here in Uganda, about half of them catches.
But anyways, I have been having all sorts of other fun lately, and have lost interest in posting to the blog! Let's see...well we have been shown a good time by our new Ugandan friends. We were invited for supper at the assistant dean of the faculty of med here, whose daughter we have also gotten to know. THat was lovely, they are the sweetest couple, and we had a great time visiting them. Doreen, their daughter took us to Owino, an absolutely crazy second hand clothing market (all from the UK)....imperative to have a local guide! We have also been checking out the many bars and clubs. Every monday night outside the national theatre, there is a big jam session, with many of the top musicians from uganda performing. Best of all., it's free, and all the locals just love it so much, and so do I. One exciting thing we did recently was go white water rafting on the Nile! We were kind of neither here nor there about the idea, plus it costs $100US, but we met a nursing student from Ontario and she convinced us to go. It was so much fun!!! What a day. It was definately the most hard core river I have rafted, lots of class 4 and 5s...the fun (and terrifying) part is there are lots of places without rocks so if you want (or sometimes without planning), the raft flips and you all go flying out into the crazy rapids, sucked under and upside down and then finally spit out onto the surface where you swim desperately towards the raft or one of the safety kayaks. Very exhilarating! It is scenically beautiful the whole length as well. We spent the whole day paddling and swimming. At one point we were pelted by a tropical downpour, and to keep warm and happy we belted out just about every song we knew the words to. It was a good bunch of people we were with, although it felt weird to be amongst whites again!
Hmmm....I have spent a couple of sunday afternoon/evenings at the 'beach' on Lake Victoria, which is what many Kampalians like to do. Have to find some bilharzia prophylaxis, as the water was too tempting and we all went in. Some of our friends had never swam before! Almost all Ugandans we have met say they fear water and they don't know how to swim.
A sister of our friend agreed to take us to church last Sunday. I wanted to go the hear some singing. It was a very large born again church, which I get is somewhat different from what we perceive as born again. Chloe and I were almost saved! It was a good pastor, the message was about idleness, 'get off your sleeping mats and work!" The first part was all about 'praise and worship' which means a full rock band and choir, belting out praise songs. ANd the crowd joins in and waves their arms. THen they had people go up and speak about how god had helped them through various hard times. You could see how people are so passionate about religion here.
We chedked out the veg market, bought some vanilla pods, as well as a whole bunch of vegetables, which we made into a huge salad in a wash basin, as we had nothing else! It was delicious to us, although some said it looked like dog food. Oh well. They are quite attached to their staple diet here.
Tonight we go to a big live show at one of the bars, and then tomorrow we are off to Kenya! Our friend is driving us there, which will be very convenient, we were dreading the 24 hr bus ride. WE have gotten so soft in our old age. Ha! SO, until the next time....
love and blessings, ais

2006-07-28T05:52:00.000-07:00

nice chubby baby at one of the rural immunization clinics

We are still on this rollercoaster

2006-07-22T02:58:00.000-07:00

Hi all,

Well it has been long time since an entry. We've kinda lost a bit of motivation about adding to the blog...and now I have found some inspiration. Where to start. Well before we left Masaka we spent one day going very far out of town to an immunization clinc (different from the one the day before). Ais was busy weighing a bunch of bambinos and I immunized (ie. made a bunch of babies scream)...the staff were really into getting us involved and teaching us Lugandan words. It was good to see that most babies were up to date on their immunizations in this area. Before we got to the immunazation place we had to wait at a rural health clinic...and we waited with all the other sick Ugandans who were waiting for the doctor to come...I think he didn't arrive till 11 or 11:30 (and he said later he usually will see 100 patients a day at this clinic). Oh yah and the time here is very random...I think there is no such thing as being on time. After we finished with the immunizations the workers wanted to take us to a Cave and then to the lake (lake Nabugabo...which we had been to before...at the other end)...and just when we thought they were going to take us home so we could be back for our dinner plans...the clinical officer (doctor) decided he wanted to take us for fried fresh fish at a fancy restaurant on the lake...we didn't get home till 7pm. Its very much all about going with the flow here. Ahh then we had plans with the owner of the hotel we were staying at and his family. It was a very nice night in a very high end house...we watched all these videos of Ugandan weddings...he really wanted to Marry us off to his younger brothers. Then at 10pm they start serving us dinner (apparently this is a usual time for dinner in Uganda)...and good thing because we had already eaten dinner at 6pm.

Then our last day in Masaka we worked in the Antenatal ward and it was totally amazing. The midwife running the show here was absolutely super. She loved her job and kept her rooms immaculately clean and organized (not really something we have seen very much in these parts). She specialized in couselling clients about results from tests and focused mostly on HIV couselling. Ais had some time with her and a client spending a very long time on how to put on a condom, the expiry date, temperature to keep it in and how to talk to your husband about using a condom...she was absoletely fabulous!! I ended up helping with a backlog of hmmm 30-40 women who needed to have palpations...kind of like a crazy assembly line. Then we were leaving Masaka hospital. Kind of sad. Had tea and juice with the midwives we had worked with and some people in administration. Even considering the crazyness of the place sometimes I think we had aquired a real liking for the place and the people who worked there. There are some of the midwives that I am already missing. Some of the Ugandan students I think we will still keep in touch with...oh yah we also worked with some Ugandan med students (men) in the last week...and they were very super and interested in making change/learning from each other. Goodbye to our sweet hotel room and the hosptil in Masaka and on a bus to Kampala.

Ais and I took a three day weekend in Kampala. It was Aisia's b-day on friday...so a good day to have off. On Friday we went out to a coffee shop that has excellent Ugandan coffee (hard to find here bc they all drink Nescafe) and a great breakfast with fruit salad and muslie. They off for a Ugandan massage. Almost a two hour massage for 20 dollars...including a foot wash and massage at the beggining...got to love the underdeveloped country thing! Then out for dinner at a very nice outdoor restaurant with a group of Ugandan friends. Then out dancing the night away. The rest of the weekend was pretty melow. A friend took us to a used clothing market...a very wild place and thank goodness we had a Ugandan to guide us through the chaos.

This week. Started off very slow. Not many births in the first couple days at Malago and there were many (4-5) Ugandan students there also...and they were doing alot of the work. Even though we have been here for a while sometimes the way things are done is still shocking. For instance they are super picky about wearing two gloves for a delivery and bleaching the beds and floors, but sharps are left everywhere and anywhere (also half the sharps are on top of the sharps container not inside)and never mind that all the beds have scraps/nicks in them...a perfect breeding ground for bacteria. The last couple days have been pretty nuts...7 births each day. Delivering women in the floor, in their rooms, and being torn between two deliveries at the same time. Watched a breech delivery by a midwife while I was helping Ais with another delivery. Then there are the women falling off their beds (head first!!). Had a hillarious 10 minutes the other day of running from one woman to another picking their upper half of their bodies up and putting them back on the bed (as they were litterally pushing babies out at the same time). By the end of this falling off the bed escapade...we got kind of firm ... "Now you turn around...you have to stay on the bed". Then yikes...the way the many of the midwives treat the women is so brutal...and by Friday I was about at then end of my rope. With the midwife pulling on the woman's head and hair as hard as she could, yelling at her and then slapping her...yikes. I just try to be as nice as I possibly can, but its hard not to show my anger at these midwives for their awful behaviour. And, the students are exactly the same was...slapping the women and telling them they are weak. Interesting management also...just a bit slow on the uptake here. A baby is struggling to breath or a woman is hemmoraging and either nothing is done or it is all done in slow motion...sometimes I wonder are we all on the same planet. Overall though all very straightforward deliveries with healthy/crying babies as soon as they are delivered. We ended our fridey observing the delivery of a second twin (cephalic...head first) by a Ugandan student...very exciting. Perhaps the most memorable thing from this week was when a woman come in with a foot coming out (footling breech)...she was 7cm and this was her second delivery. The midwives assessed her and then wrote in their notes:
"Woman assessed with a footling breech at 7cm dilitation. Plan to transfer her to New Malago (the high risk ward) by ambulance. Meanwhile the ambulance is not available!!"
Kind of hillarious (they were laughing when they wrote it) and very sad. Now Ais and I say all the time to each other " Meanwhile the ambulance is not available" Hmmmmmm.

Spending our last weekend here in Kampala again. Now staying in the Mussy hotel..we are really used to the cold water showeres now. Then our last week in Malago..although we are mostly going to be doing other things other than delivering babies. Getting ready for our trip to Kenya next weekend and to actually be on hollidays.

Other Ugandan english-
-'I feel pressed'- I have to go pee
-'Do you want an escort with your tea'- this means a cookie or cracker..
-'Are you disturbed' or 'Is it disturbing'- ie. do you not like this or something like that...we are not exactly sure (but Ais and I ask each other all the time now if we are disturbed)

Welaba (goodbye in Lugandan)

2006-07-11T11:22:00.000-07:00

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!
ais

totally nuts then vacation

2006-07-10T12:25:00.000-07:00

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 bed...so 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,
Chloe

crazy births and fun times

2006-07-10T11:15:00.000-07:00

Last week was pretty mellow. Wait, maybe that's not true. So much happens here that I can't really remember what happened an hour ago let alone last week. No births on thursday, and then that evening we went to Kampala, out for great indian food and then I went out to a few different local bars with some Ugandan friends. One was an outdoor joint with a gigantic screen showing old Fresh Prince of Belair reruns. Then on to a place called the Victoria Tavern....somewhat karaoke/mime/drag queen/performance art. Very interesting, as well as interesting discussion with my friends about homosexuality...it is a very 'new' thing here in Uganda. Anyways, after the third bar they dropped me off at the guesthouse, and as I was past the curfew (what a bad kid!) I had to get some help from the guard to wake up the owner....sorry! Must go, cafe closing...will finish later.

ais

2006-07-10T11:10:00.000-07:00

Cathy demonstrating breech delivery with TBA's looking on

2006-07-10T11:05:00.000-07:00

This is the 96 year old community midwife at her home with a handful of the babes she has brought into the world (children, grandchildren, etc)

2006-07-10T10:50:00.000-07:00

very chilled out restaurant on Lake Mburo, good Tilapia

2006-07-10T10:38:00.000-07:00

Mickey (Dr Rostoker, Cathy's husband) and Cathy, our instructor Our walk to Masaka hospital

Zebras during a morning walk at Lake Mburo

2006-07-10T10:26:00.000-07:00

LAKE nabugabo the equator, obviously

sunset at the zebra hotel

2006-07-05T12:28:00.000-07:00

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 (sorry for the lack of capitals, the shift key isn't working so well)

Variety

2006-07-05T12:13:00.000-07:00

Hi all,

The time seems to be flying by here. It has been a very good week so far...with a bit of variety. Today we went out to a rural health centre (level 3)in a town called Kitanda...40k outside of Masaka on a bumby/dusty road crammed in the back of a truck with Ais, Mickey and Cathy. We went to meet Traditional Birth Attendants (TBAs). We had about 3 hours with them. Cathy was mostly asking them questions for research she is doing. They were increadibly keen and interested and clapped for us all the time. The women had been practicing for 4 to 35 years with 3-5 births a month. They talked about the diffuclty in their work being the lack of suppplies that the women came with and how often they were not paid at all or paid enough. On the other hand all the women felt they had earned a good reputation and were very hounored for their work. All these women had underwent an organized training session in 2000 and were very proud that they were chosen for this and felt that they were now very competent practitioners. Generally they all felt as though their relationship with the hospital and/or their referal centre was very good and they were well respected. During the session we all demonstrated different possitions women would deliver in...I think they thought I looked pretty funny on my hands and knees with my purse under my shirt. At the end we did a demonstration of normal and breech (they had been wanting a breech refresher) with a plastic pelvis and doll. They did demonstrations as well as us. We talked about the things we did the same and did differently. I wonderful day. They were all so coulourful and enthusiastic (we should have good pics soon). I think they were also happy to come because we gave them food, drink, gloves, soap and some money for transportation. Talking about years of experience with midwifery. On Monday one of the Midwives from Masaka hospital took us to meet a traditional birth attendant who work in Masaka. She is 96 years old and has been practicing since she was 14...82 years of midwifery under her belt!!! When we asked her what she liked best about her work instead of answering us she said she has been trying for a long time to not practice, but people wont stop coming to her (no wonder with 82 years experience). We got a very cute picture of her in her apron with all her birthing supplies.

What else? Tonight we had dinner with some social work students from Douglas College who have been here for a couple of months (funny how we would be all in the same small town and all from BC). The night before we had dinner with a large group of staff from Masaka hospital ( Midwives, Administrators and Ugandan Student Nurse/Midwives). Cathy an Mickey hosted it and they seemed all very happy to come and socialize.

The days at labour and delivery have been good and fairly busy. On Tuesday the minute I was in the delivery room I was delivering a baby. We seem to be getting runs of things in our deliveries. A few women bleeding more than we would like them to after delivery...part of this could be due to the fact that the hospital is totally out of oxytocin for active management...so we've been using ergot after the placenta is out. More tears than we would like recently...not sure why...and not easy to suture with one totally sketchy clamp, no needle driver and no light. Generally the experience can get so busy at times that they can all blurr into one birth experience.

Tomorrow we are leaving after a half day at Malago for Kampala. Then working one day at the high risk ward in Kampala. Then to some rest and relaxation in Jinja. Pictures should be coming soon...we can't download them here in Masaka...need to wait till Kamapala.

Learning lots...having a great experience
Chloe

2006-07-05T11:40:00.000-07:00

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)

Lions and tigers and hippos, oh my! Well, not quite...

2006-07-02T11:28:00.000-07:00

Greetings again, and happy (belated) Canada Day. We just returned from a weekend at Lake Mburo National Park. It was quite the spot, a lot of firsts for me. It is about a three hour drive from here. Mickey and Cathy treated us to a hired car, which you kind of have to have for game drives. This is one of the smaller parks in Uganda, and thus not many tourists go there, also 'cause there is a lack of lions and elephants... but guess what we did see??? Lots of very funny looking hippos, huge crocodiles, many beautiful birds, vervet monkeys, zebras galore, all manner of antelopes and gazelles, African hares, warthogs (which are most hilarious creatures!), mongoose, buffalo (the most dangerous, after hippos!) and all kinds of other things. It was a very rustic place to stay, small simple 'banda's' to stay in, and a lovely stilted open air restaurant right on the lake, overlooking hippos usually. We did an early morning game drive the first morning, and then a guided walk this morning, which was wonderful to be walking quietly and coming upon herds of zebras, impalas, waterbuck, bush buck, warthogs etc. NIce sunrises and sunsets, also a fantastic boat trip. It felt somehow more authentic than a busier more touristed park might be. I have to say I loved my first African Safari! Also nice to spend time relaxing away from this work. THe stars are stunning and unfamiliar in the sky, a sure sign I am far from home.
The people here are just so lovely. They are also highly religious, mainly Christian (Pentecostal, Anglican), Muslim. Our friend Betty, a nursing student, asked us what religion we are and if we went to church. She was quite puzzled when we stated that many people in Canada, including ourselves, don't attend church. "But how do you communicate with God?" Hmmm...good question. WE have to think of an answer to that one. OUr driver this weekend, Peter, spent his spare time reading a bible and a book about Victory and the means to get there.
All the days in the hospital sort of blend into one. We are getting experience with different baby problems. Last week a woman arrived with a tiny twin, just hours old, born at home. The other one had died. SHe was not the mother but was bringing this 32 weeker in for care. NO one really was eager to help her in any kind of hurry, and it;s hard for me not to get involved with the women I encounter, so I am always getting attached and urging for prompt treatment! THis babe was actually in quite good shape, and ended up in the warm room and recieved antibiotics. A baby that we delivered ended up with a problem too....we are often abandoned by the midwives for periods of time in the delivery room, and once a babe is born it is wrapped and may be left for an hour or more while the mother is attended to (this is just how it is). Anyways, we had a baby wrapped and waiting patiently, and after some time I went to check on it and there was blood on the blanket. I hoped it was soiled from the delivery, but unwrapped it to check it out, and it was bleeding from the cut end of the cord! It had actually lost quite a lot of blood for a newborn. Here we use cotton cord ties (like a candle wick or flat shoe lace). It is hard to tighten it and it doesn't shrink with the cord as elastic glove bands do, so it was bleeding from there. Apparently this happends on occasion. THe baby was fairly ok, a little dusky perhaps (but colour here is somewhat difficult to assess). We gave it a volume expander and the next day she seemed fine, thank goodness. Another baby was brought back the day after birth burning with fever, we treated with antibiotics and fluids, I sure hope she is all right. Cathy caught the baby of an older, HIV positive (and likely active AIDS) and then was asked to name the baby. It was a Muslim family so we enquired of another mom about some good Muslim names for a boy. Cathy chose Abubaker, son of the prophet, and the mom was quite pleased with this. What else.....A couple of post partum hemmorhages, one on Friday that just wouldn't stop, and we were out of oxytocin...gave ergot, rounded up some more oxy, and only had enough IV fluid to give her one litre. Her uterus continued to be boggy, and we got some more clots out finally and used bimanual compression. Palpating her fundus, I could actually feel here spine! (like we are supposed to compress as a very last life saving resort!). ANyway, she lost about a thousand all told, and will likely be fine, but it was an interesting case for us, just figuring out what to do under the circumstances, and considering the cause.
We had a bit of a problem with some black belts too, last week. (senior midwives). They returned from being away and had not been informed that we would be working there, and were quite choked to have been left out of the loop, even though the head OB and the midwives actually working on the floor were welcoming etc. Yikes, I think things are smoothed over.

AIeeee, the internet cafe is closing, I better sign off! MOre later...
love ais

And more...

2006-07-02T11:20:00.000-07:00

Hi all,

Thursday and Friday were fairly busy days with a sufficient amount of crisis. Thursday lots of sick babies...Ais mostly dealt with them so she can tell you. I think there was 3 maybe 4 births that day. All fairly straight forward except for the last one. Was able to get some more suturing experience which was good. The last delivery of the day was one that we thought would be short and sweet before we went home (well of course it didn't work like that!). The baby needed some resus after delivery (completely flat)...after 30sec including stimulation and PPV the baby came around just fine. Meanwhile the woman who had delivered started to hemorrhage...very boggy uterous. She had already had active management and had an IV in already so we gave more oxy and Cathy did bimanual compression...this worked well and the fundus firmed up and bleeding stopped. She also had a very ragged tear that Cathy and Mickey ended up suturing...due the complexity, tiredness and time. We probably left the hospital 2 hours later than expected...oh well. Another big thing that happened on Thursday was this woman who had been in since Monday with Sepsis and a three week intrauterine death (who had been given multiple doses of misoprostol and prostaglandin)...and was extremely sick (high temp and pulse...looked on deaths door)...finally went into surgery to get a hysterotomy (a procedure that's kind of like a classical incision c-section to take out the dead baby...I know this is all very grim). Anyways we saw this woman on Friday post surgery and although she looked dreadful her friends thought she would live...I hope so!! The obstetrician said he had never seen anything quite like it..or anything so bad. It was very bad and sad. Ahhh ok. Friday we went in for a short day as we were leaving that afternoon for Lake Mburo. Friday morning there was basically nothing going on...so we just went around to woman we had delivered, babies and moms we had been concerned about to check up on them. One of the women who Cathy delivered wanted her to name her baby...a Muslim name...after talking with some other fluent English speaking Muslims Cathy came up with a name and did a little ceremony. Then...a couple hours before we were about to leave on vacation this 16 year old primip came into the delivery room. The delivery went well with a 30 min pushing phase, but then...her placenta would not come. It took 15 minutes followed by a huge gush of blood and a boggy uterous. I did bimanual compression, after inspection of the placenta we gave ergot (this did not help), set up an IV an 20 IU oxy then the bleeding stopped and the uterous was firm, but high and off to the side. Catheterized and then 10 minutes later it all started again. I expelled multiple huge clots and we did more bi-manual compression, hung another bag of fluid and oxy...then finally it stopped!! Mickey and Cathy then inspected the cervix (good to see how to do this) and looked for tears. She needed a small amount of suturing. Needless to say this was the biggest hemorrhage that Ais and I have had to actively manage. After an hour after our interventions her pulse went down to normal and all was ok. Thank goodness her baby was totally fine from the minute it popped out. We've been trying to figure out why the hemorrhage happened, but still no real answer. Having done hard work we headed out to lake Mburo. This was a wonderful little get away. A national park with a tonne of wildlife and a beautiful big lake. We stayed in Banda's with no electricity or washroom...very rustic and a nice get away. The restaurant was on stilts over looking the lake with hippos hanging out right at the edge of the water. We went on a day game drive, boat game drive and night game drive. I enjoyed the most the Warthogs, Zebras and many beautiful birds. The boat outing was magnificent. I saw my first real close ups of crocodiles...yikes! Skipped the walking game drive on Sunday and slept in and read my book (Nana..I'm reading the book you gave me..I love it). Now back again for another week...of I'm not sure what (we never seem to know). We will probably be here in Masaka till Thursday noon, then to Kampala for a day and then out with Cathy and Mickey for Safari again on the weekend.

Chloe

Masaka

2006-06-28T10:53:00.000-07:00

After the smog, traffic, and bustle of Kampala, on Saturday we hired a taxi and took to the road, crossing the equator (a first for me, took the obligatory photo and had a nice Ugandan coffee, not even so hot) and then spent the night at Lake Nabugabo. THis is one of the only lakes around here not containing bilharzia, and although there were lots of school boys swimming, we didn't partake. It was a nice relaxing place, a couple of low key local resorts, ours was 'Sand Beach." There were a few patches of sand, but they weren't on the lakeshore. SOme monkeys around, and birds and things. THen on to Masaka the following day. Although the fourth largest city in Uganda, it is actually a very small town, situated among lush and beautiful rolling hills. We got ourselves some very nice digs at the Zebra Hotel. Third floor balcony with sunset views over valley and hills. A good price with a big breakfast ( African tea, cereal, tropical fruits, eggs, wonder bread toast) and clean, safe and friendly.

One of the nicest parts is the gorgeous 15 minute walk to the hospital along tree lined lanes. The hospital here is also a referral hospital, and does about 8 births each day. It is much better stocked than Kampala, at least right now, and the midwives have more time to attend the mothers. About of the third of the women are taken to the 'theatre' for 'Caesar's' and a major problem is the sepis they often end up with, so there are many very very sick women who come back following operative births. The midwives are welcoming and seem to enjoy having us around. They are called Sister Prussy, Sister Teddy, Sister Judith, Sister Juliet, Sister Benadine, Sister Sarah. THere are also some 'Comprehensive Nursing' students who are fun and are a great help with interpreting. SO far we have had two babies with club feet, and two with extra digits, so I don't know if these things are more common here or it is just by chance. We had one lady today with a small pelvis and no progress in second stage, and the baby wasn't sounding great. She went to the theatre and her baby indeed didn't fare well, I don't think she will make it. Also two premature babes this week. There is a little 'premature' room, which is kept warmer (when there is electricity, which most of the time there isn't) and that is about all it means, no oxygen or incubators, just lots of blankets and hot water bottles. Chloe delivered a premie two days ago who was on the cement counter covered with a ton of blankets and today I went in there and heard him screaming and saw his little feet poking out over the edge, I lifted the blankets and he was about to roll himself off onto the floor!

The staff here have kindly gathered some aprons for us, which they used a marker to write our names across the front, and gum boots, also with our names, to wear in the operating theatre. Our LUganda language so far consists of push, push hard, don't push, lie on your side, where is your health card, and such things, sadly we haven't mastered the other basics like please and even hello! But we are learning. Many of the women here also speak some English. We have been working until evening usually, but today the deliveries came fast and furious earlier in the day, so we had more time to get into town and get things done today. THe food around here is simple but mostly tasty, lots of Tilapia fish, rice, beans, meat stew. We have been keeping up with the World CUp, along with everyone else in the country. Well, the power situation here is dodgy, so I best be sending this before it is lost. HOpe you're enjoying the updates!

love ais

Aisia Salo
3rd Year Midwifery Student-UBC
aisiasalo@hotmail.com
250-595-1027
mobile 250-686-7987

a bit of everything

2006-06-28T10:33:00.000-07:00

Hi All,

Very short amount of time for a post...hopefully I will have more time tomorrow. Yes, I am feeling much better. Just a daytime flu on Friday. Then out for dinner that night and out to a night club with some Ugandan friends we had made through Canadian connections. The people we went out with were incredibly friendly and kept very good care of us. I would have to say that the only danger at a club in Uganda is having every man in sight wanting to talk to you and get your contact information. By the end of the night we had both lost our voice. Lots of fun. The next day we headed to Nabugabo lake near Masaka. We stayed for one and a half days at a place called Sand Beach on the lake. It was incredibly relaxing and beautiful surroundings. Apparently it is the only lake in Uganda we can swim in, but the water was brown...so we didn't risk it after all. On late Sunday afternoon we headed for Masaka. After some searching we decided to stay at Hotel Zebra. A very nice hotel with a wonderful view of most of the city. On Monday we went for our first time to Masaka hospital. This hospital is a general referral hospital for Masaka and surrounding areas. They usually have 9 births a day including 3 c-sections ( called creasers here in Uganda). Also, in labour ward an admitting room for women with any kind of pregnancy related or (possibly) gynecologically related issue. Then two post partum wards one for post c-section/premature and the other for antenatal/post vaginal delivery/genealogical issues and women suffering from malaria in pregnancy. Also, a special care nursery that has no incubators, but is kept very warm and the babies are covered with tones of blankets. Then 1st stage of labour room (very small) and a room for deliveries with the operating theatre nearby. The hospital is staffed by Nurse/Midwives and there is usually one OB/Gyn on-call . The hospital upon 1st inspection seemed much cleaner, organized and well supplied than Malago hospital in Kampala. They seem to have many more medications and instead of the women having to come with their own supplies they are supplied by the hospital. My first day on Monday was somewhat shocking (perhaps because on Friday I had missed the high risk day in Kampala). For the 1st part of the day I did rounds with the midwife, Cathy and Mickey on the post c-section ward (By the way although the c-section rate may seem high...this is because these are all the woman who transfer in in crisis from rural areas usually from an obstructed labour). Although many women we looked at were healing just fine...there were some at the end of the room in pretty awful situations. About 6 women were completely septic, some with burst c-section scars, most with extreme blood loss (in a place where blood is simply not very available here), some with malaria and others with HIV or both. Oh yah and most of these women's babies died in childbirth (from obstructed labour...or any other reason) or died very soon after. I'd say that about 3 of these women would probably die very soon and another handful were very close to their way out as well. I heard later that the two biggest things that the OR deals with is c-sections and sepsis from c-sections (ahhhhhhh!!). I think the sheer volume of it was all a bit shocking...had to have a bit of a cry that night...just to acknowledge this is hard work. Later on that afternoon Ais and I both had a delivery. Interestingly enough the woman I delivered had been admitted with an inevitable abortion (not sure why)...prior to delivery we thought we would be delivering a 28 wk preme, but when the baby delivered it looked more like a 32-34 weeker. The baby had very fast resps and some grunting and we managed to find a midwife to give it antibiotics (the mom had had an infection...an STD). Now two days later the baby is doing very well. Then Tuesday I started in the admissions room. All very interesting. No women in labour. One women with emesis and chronic pain at 8 months probably from malaria (she had 6 children and was 25...from her chart it looks like she had her 1st child at 14!). Another woman with a complete abortion and another woman with what seemed like 10-12 week inevitable abortion...with strange radiating pain down her left leg (ectopic was ruled out). Again two deliveries that day (one each) and both of us got to have our 1st Ugandan suturing experience (we used Cathy's suture kit). Also, on Tuesday there were many women in critical conditions who didn't seem to be attended to. One with a intrauterine death who had become septic, another woman with a bust abdomen from sepsis from a c-section (waiting most of the day for the OR) and another woman post delivery with full blown Aids and Malaria. Cathy has learned now how to administer the antibiotics they give for sepsis and do an IV on babies...so we can start helping out more in these critical and under staffed situations. Then today. Well it seemed from the minute we walked in the door babies were just flying out. 5 deliveries between us in 2-3 hours (I totally lost track of time). The last baby I delivered was premature and put in the SCN. Some more suturing, but difficult to co-ordinate when other babies were starting to be delivered at the same time. Today we had a woman who ended up going to section with lack of progress, previous section and some fetal distress. We are not sure if the baby was resuscitated in the OR (often not done at 1st here in Uganda), but when we saw the baby is was in special care and doing very badly. Very soon after the baby died...our (or at least my) 1st baby death in Uganda...hard to see, but somehow I wasn't very sad at all...these things just happen more here I guess!). What else. The midwives/nurses have been incredibly nice, helpful and accepting...I really like them. They even gave us our own aprons for deliveries...with our names on them...and mine is spelt 'Clowe' and gum boots for the OR with our names on as well (they did this all for us...so sweet!). In terms of the rest of life it is good. Masaka is a beautiful little county town and we have a very lovely 20 minute country walk on the way to the hospital. On the way home many people wave, say hello and the children shout Muzungo (this means white person)...we smile and wave. Getting used to lots of meat and potatoes here. Today one of the nurse/midwifery students hung out with us. She was an excellent tour guide for finding 4L bottle of water and a good restaurant. On the weekend we are planning on going to Lake Mboro to see the lake, do some bird watching and go on a game drive...this should be lots of fun. Oh ya, since I wasn't able to post before...I'm sure Ais has described the lack of supplies and crazy busyness of Malago hospital. I think one of the things we are learning most is how to improvise and think quick (good qualities for Midwives...I'm sure). Many of the births in Malago were kind of a blurr to me...they delivered so quickly (often didn't even know their names). The things that stick out the most for me is a woman I supported in labour who was having non-stop contractions (1st baby)...she denied taking any African oxytocin (a root), but seemed as though she was not labouring normally and having a very hard time. In one hour she went from 5cm to pushing(primip!)! Delivered the baby and the midwife sutured (no equipment to suture with so we didn't do it). Later that day when we went with her to the postpartum ward her mom and sister insisted that the baby was called Chloe (it was a boy!) I suggested other boys name, but they insisted on Chloe (probably in some interesting African spelling). Also, in Malago I had my 1st know HIV positive delivery. It went very well, but was certainly a hump to get over in this African experience. Becoming a pro at trying the cord with the pieces from the end of my gloves and cutting with razors (this is how they do it in Masaka as well). Overall an incredible learning experience I am thoroughly enjoying it and looking forward to what lay ahead. Uganda has (for the most part) been such a friendly and welcoming place to be.

Until next time,
Chloe

2006-06-28T10:26:00.000-07:00

Mulago hospital

2006-06-28T10:20:00.000-07:00

Ruth and her newest baby, delivered by midwife Chloe

2006-06-28T10:15:00.000-07:00

The first lady attended by Ais in Africa, Upper Mulago Hospital. Irene was her name.

2006-06-28T09:37:00.000-07:00

more eating shots...here we are at Borough Market eating venison smokies

2006-06-28T09:27:00.000-07:00

Pancakes at Kate and Sean's flat in Parson's Green

2006-06-28T09:02:00.000-07:00

Eatin' burgies in the park in London and having an early group birthday with champagne and strawberry shortcake

2006-06-28T08:51:00.000-07:00

Hey, here we are, the Labcoat Lovers...all white for Uganda.

2006-06-24T02:41:00.000-07:00

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

Kampala

2006-06-22T10:12:00.000-07:00

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!

2006-06-04T18:41:00.000-07:00

This is the start of our new blog. Soon there will be all kinds of journal entries... and pictures!!