Uganda Midwifery 2011: Kampala and the first couple of days of Masaka

Last Thursday we went into Kampala. It was a dense, harried mish mash or cars, matatus (taxis), bota botas (mopeds). We went to a mall- ate Indian food at the foodcourt and picked up some groceries and an internet stick. The mall was quite luxurious and included a store for "Women of Substance", Bata shoes, and an authorized Mac reseller. Such a huge gap between the rich and the poor.

We noticed many little things in Kampala people dress well and there are a lot of different styles. The majority wear western cothes, but you see some traditional dress as well. Some women go sleeveless though that wasn't the norm. Many women wore wear heels. Probably 1/4 wear Muslim dress. We were astounded my how many people spoke English, and how expensive everything is, including hotel and food.

After Kampala we drove 3 hours to Masaka- on the way we stopped for a chai on the equator at the AID Child gallery. The roads and earth are red- just like in the movies and there was lots of papyrus. We saw someone driving a moped with a loveseat and armchair balanced on the back!

We are staying at the Zebra hotel. Two twin beds with mosquito nets, a tv, phone, huge bathroom with tub/toilet/sink. All the TVs in the place are stuck on the same station- BBC in the morning, American Idol and local news last night. The gardening is beautiful. Terrential rainpour thismorning. We can't sleep past 4am so far. Buffet breakfast with omlett, toast and fruit. Bought bailey's for coffee. With a good breakfast Alix feels ready for anything, and Carolyn wishes for a 2nd cup of coffee.

Friday we had a tour of the Masaka Regional Referral Hospital grounds, were introduced to key staff and then we put our uniforms on and went into the delivery room. Despite being told what to expect, despite having seen pictures, despite thinking that we knew what we would find, nothing could have prepared us for the stark reality of working in a hospital with so little resources and so much need. Walking through the children's ward, 20+ beds in each row, no privacy, no comforts, sick children with malaria...Visiting the women's health area of the hospital where they do cervical exams to detect cervical cancer, but have no money to treat the cancer itself. Being in the delivery room where women bring their own cloths, and cotton, where women who receive post-miscarriage care do so with little or no anesthetic because there is almost no medication. It is both devastating to see how little women's health is prioritized and also energizing and heart-warming to be here providing support and spending time with the Ugandan midwives.

The minute we arrived in the delivery room Cathy immediately instructed Alix to double glove and catch a baby. The cord was tightly wrapped around the neck so she got to try the somersault maneuver for the first time (needed a little help). We triple tie the umbilical cord with the edge of our gloves-just in case one tie falls off. That baby needed a few puffs of air (Carolyn's first resuscitation) to help him pink up and then Alix had to suture the mom- thankfully we had lidocaine. She was shaking with an audience of 5 Ugandan nursing students.There was no stool so her back ached and the power went out- thankfully Carolyn had her head lamp.

It was Carolyn's turn next- a 39 year old woman having her 9th baby- another somersault for a cord- a healthy baby and no tears.Well done Carolyn! Then we watched a D&C (removal of retained productss after a pregnancy loss) that had to be performed despite the lack of anesthetic. We couldn't do manual vacuum aspiration due to a lack of appropriate equiptment. After that it was off to the Danish NGO for a fresh strawberry smoothie and cinnamon bun and then pineapple, avocado and chapati dinner.

Both of us managed to sleep well last night, actually getting up at 6am. Amazing! Today was a hard day. A woman came in with a retained placenta after having delivered at home. Alix attempted to manually remove the placenta (her first time, she did great!) but unfortunately the placenta had grown into the uterus making it impossible to remove by hand. She lost a lot of blood during the attempt, and several hours (5 or 6) were spent trying to stabalize her and decide on a course of action. This was compounded by staffing shortage, a lack of banked blood, and ultimately her HIV+ status which makes surgery not the optimal option. Finally she was transfered to a mission hospital so she could receive blood and we hope that the retained products will work their way out.

Tomorrow is our day off and we need it. We look forward to going into the village and seeing what there is to see.

Alix and Carolyn