Routine

Sarah and I are starting to fall into the routine here in Mbale. Tuesday was a very quiet day, though unfortunately it started off with the news that three mothers died Monday night, two of post-partum hemorrhage, and one while waiting for surgery for her ruptured ectopic pregnancy (the operating room was in use for another cesarean). The hemorrhages were both complicated by the lack of resources -- the labour and delivery ward was out of I.V. equipment, and unfortunately it's very difficult to re-stock in the middle of the night. It was very sad to hear the news, and our hearts went out to the midwives who had been on night shift -- they did their best with what they had available, and obviously they were grieving the loss.

Wednesday made up for the slow day on Tuesday! Sarah and I were running from one woman to another all morning, not even having time to chart one birth before another baby turned up! We also did a number of resuscitations before noon, and we finished the day off with a "palpation and early labour assessment" lecture for the student clinicians -- this time 45 students turned up for our "class"! We've learned that the student clinicians have had a rough term, with their instructors going on strike for 3 months -- no wonder they're eager to catch up before their exams. One of the more hardcore clinician students has been showing up at the ward by 6:00 every morning, hoping to observe as much as possible, taking breaks only to attend class, and he still showed up to learn about palpation from the two of us at the end of the day. It was a bit funny trying to teach about pelvimetry, because in Canada we tend to assume that women have "adequate" pelvises to push out their babies, but we did our best!

One of the student clinicians was kind enough to give us a Lugandan lesson, which is fabulous for working with the 15% of women in Mbale who speak Lugandan. :) One thing we discovered is that we were mis-pronouncing the word that we thought meant "contraction" -- and the word we were using actually means "pubic hair." Whoops! No wonder we were getting some funny looks!

Some interesting things we've seen this week include:
- A face/brow presentation -- the baby was trying to come out face-first!
- Two "retained twins" -- one twin was born at home, and the woman transferred to hospital to deliver the second -- this happened twice the same day!
- A cesarean section for a woman with a "didelphic" uterus -- a heart-shaped uterus with a septum down the middle -- she had a cesarean, so we were able to see the uterus up close
- A beautiful ginger-coloured cat hanging out in the post-partum ward
- A baby with a significant hydrocele
- The "family planning" unit of the hospital -- they do really amazing work there, including screening for cervical cancer by visual inspection (because pap smears aren't available)



Things we miss:
- Friends and family (of course!)
- Soap and running water in the hospital! Hand sanitizer just isn't the same!
- Toilet paper, toilet seats, and hot showers -- did we mention that our dorm is a bit rustic? :)
- Being able to communicate with labouring women by talking. Some of the women have excellent English, but with most, we have to rely on body language and gesture, which isn't always the most effective way to get a point across or gain consent for a procedure.

Things we love:
- The rain! It's rained almost every day here, often huge, dramatic thunder storms that come on quickly and end ten minutes later. Often it means a power outage, but the rain storms are so powerful, and the lightening so dramatic, that they're really beautiful to witness
- Laundry. It's weird, but both Sarah and I have found some sort of strange zen moments through hand-washing our laundry every morning and hanging it out to dry on the line. It's possible that the novelty will wear off soon.
- The food! Cheap, delicious Indian food, 5 cent samosas, and fresh, cheap fruit for sale within a short walk of the hospital.
- The women here are incredibly strong and stoic. It's just amazing to watch them labour and birth with such grace, and they and their families are clearly very grateful for the care they receive.
- All of the beautiful, beautiful babies.

Posted by Lyanne