Imagine...
You wake up at dawn and restart the fire. There is no electricty.
You begin to heat up the water. There is no plumbing. This water comes from the well that perhaps you or your daughter went to the day before. You have most likely carried 10 Liters of water on your head, in the heat, for over a mile.
You begin to make breakfast over the fire. Everything should be ready before your husband is awake. Once he is awake you will serve him first, then your children, and yourself last. Afterwards you will clean up.
You will spend your morning and the rest of the day doing various tasks. You might go to the market to buy your food for the day. You may bring your grain to the grinding machine or if you cannot afford to,you will need to grind it yourself. You may cut some firewood as this is always needed. You will work on the crops, hoeing the field, planting seeds, harvesting vegetables or fruit. If you are crafty you might go picking banana leafs and other plants in order to make baskets.
Because you are so busy, it will take 4 days to make 1 basket, which you will sell to tourists for 4 dollars.
If you are lucky your husband has been in the field working as well; however it is likely that your husband has been to town spending the money that you have made on the baskets.
You will begin to make dinne. Once you have warmed the bread you will put it in a basket to make sure it stays warm for your husband who expects a warm meal as soon as he enters the house. Many men will come home drunk at 1am. You must get up, kneel at his feet, wash his hands, wait while he eats and then prepare warm water for him to bathe. Then you will clean up and using a kerosene lamp you will continue to work on your crafts until your hands and eyes hurt. Then you will go to bed, and the day will start anew.
If you are a girlchild, your day will start early also as it is expected that you will help your mother with the chores. You may or may not go to school depending on how money your parents have. You will go to the well and fetch the water, stunting your growth and contracting your spine. One day you will be 15 or 16 and it will be time for you to get married. Once you get married it is expected that you begin producing within 6 months. You will begin to do all the work of your mother before you in your new village as you are expected to go to your new husband's villlage once you get married. This work you will do until you go into labor, hopefully 9 months later and not earlier. Hopefully your baby is still moving inside of you. You will go into labor and most likely stay at home. If you are lucky, a traditional birth attendant will be with you, though sometimes what is thought to be helpful is harmful and she will have no supplies to help you with if there is a problem. You will know that childbirth is dangerous. Every girl born in Uganda has a one in 16 chance of dying in childbirth. Hopefully you will not labor for days and will birth a live baby. You know that the death of baby is common. The neonatal mortality rate is 30/1000. The years will go by and you willl continue to produce children. Over a decade may be spent either being pregnant or breastfeeding. The years will go by and you may decide to leave your husband because he mistreats you. If you do so, you will return to your mother's village with your children until you get married again. You will leave your children with her when that happens.
A mother's day , a woman day, never ends.
Carolyn
Uganda
Monday, 20 June 2011
Mbale: a few days late
So this post is way behind and is my post about my couple of days in Mbale. There is not a whole lot to say but I wanted to post something. It was an interesting experience to work in a different hospital. The hospital in Mbale seems to be busier what with me attending 3 births, Alix 2, and Lyanne 2. It is also way more organized with easily accesible charts for every woman which was a total pleasure. It is unbelievably exhausting to try to find missing charts. Two of the 3 births were uneventful but the third one was an intense experience. Everyone had gone to a c-section and I was left by myself in the ward. A woman began to crown just as Alix arrived. The baby needed resus and then mother began to have a massive PPH at the same time. I began to resuscitate while Alix began to deal with the PPH. Luckily Angela arrived soon after and was able to bring some medication. This was a scary experience for me and was a lesson in humility. The first two births of the day had been straightforward and because everyone was busy I basically acted as the 1st and 2nd midwife with no difficulties. This last one was not a birth that could be handled on its own and I shudder at what would have happened had Alix not come when she did. There were of course local midwives around, but they too, were busy. Lesson learnt: make sure you find someone that can act as your 2nd.
The next day I decided to take the day off and went to Mt. Elgon using public transport. Public transport here is always an adventure as the drivers will cram as many people as possible in their car and will stop every couple of minutes until the car is full. I arrived and found a guide to take me around to the falls through the little villages. It was a very pleasant day. The Mt. Elgon area is also known for its male circumcision rituals. The people there are open to tourists coming and watching, but this wasn't my cup of tea. In any case, the ritual goes something like this, the boy decides between the ages of 16 and 26 to get cirumicised. By doing this, he is announcing his intention to marry. Before the ritual begins, the villagers get together and basically have a free-for-all orgy. Seriously. Then the boys line up while others dance and get circumcised by a man using the same razor blade for everyone. It is important to not cry out as this will shame your family. It should come as no suprise that the rate of HIV increases exponentially 3 months later.
Carolyn
The next day I decided to take the day off and went to Mt. Elgon using public transport. Public transport here is always an adventure as the drivers will cram as many people as possible in their car and will stop every couple of minutes until the car is full. I arrived and found a guide to take me around to the falls through the little villages. It was a very pleasant day. The Mt. Elgon area is also known for its male circumcision rituals. The people there are open to tourists coming and watching, but this wasn't my cup of tea. In any case, the ritual goes something like this, the boy decides between the ages of 16 and 26 to get cirumicised. By doing this, he is announcing his intention to marry. Before the ritual begins, the villagers get together and basically have a free-for-all orgy. Seriously. Then the boys line up while others dance and get circumcised by a man using the same razor blade for everyone. It is important to not cry out as this will shame your family. It should come as no suprise that the rate of HIV increases exponentially 3 months later.
Carolyn
Wednesday, 15 June 2011
Full circle with postabortion care
On Saturday Caroyn and I travelled to Mbale so I could do 2 days of interviews on postaboriton care. *Just a reminder that postabortion care is usually post-miscarraige care, but may also include care after a botched illegal abortion* The trip was pretty, and when we arrived we went to an awesome Indian restaraunt for dinner with Sarah, Lyanne, Angela and two male clinical officers who then took us clubbing- you can read about this in Lyanne and Sarah's previous post.
On Sunday I worked on the wards during the day (caught 1 baby, managed 1 large postpartum hemorrhage ~3L blood loss, and obseved 1 cesearean and tubal ligation. I then did two interviews. One with the incredibly lovely Dr. Paddy, a GP who is just on his obstetrics internship. He is renowned for his boyish good looks and the compassion he shows to the labouring women. He kindly volunteered to show me around gynecology and introduce me to people I could interview.
On Monday we started off with maternity rounds- rather uneventful. We then headed to gynecology for rounds. At 10am, before rounds began, I watched a mother of 3 die at 10am after a septic abortion- there was a crowd of students watching and the nurse only did 9 chest compression then gave up- once a person requires chest compressions there is little hope of reviving them. There were no tears, no last rights. Sometime during rounds the body disappeared and by then end of rounds the bed was filled with someone new. My stomach churned.
I then met a man who's wife has a brain tumour which has resulted in paralysis of half her body and has left her in a coma for 8 weeks. She is 20 weeks pregnant. He requested a termination. The doctor explained that ending the pregnancy wouldn't help the tumour- but I couldn't help but wonder if he was requesting the termination because a child without a mother doesn't stand much of a chance here and it would be terribley hard to lose them both. However, abortion is illegal here unless it is to save a woman's life- and so the pregnancy continues.
I then interviewed a doctor about the barriers to women receing post abortion care. So many! They talk about the 3 delays
When women arrive in the morning they are alreay quite delayed in receiving treatment. Then then must wait for the doctor to complete rounds, and for the more urgent women to be triaged. When it is finally their turn there are only 2 sets of equipment for D&C- these must then be sterilized-another delay. Oh- and there is not light in the MVA room, so women can only be treated until 6:30pm when the daylight is gone. On average 5 women a day present with postabortion complications and only 2 can be treated. The untreated then leave- maybe they seek help elsewhere, maybe they don't.
Thankfully, 3 MVA sets were donated to Mbale hosptial last week and we finally got a hold of them on Monday. So after rounds were completed and triage was done Dr. Paddy set to work. He did 3 D&Cs and then a midwife quickly gave him a crash course in how to use the MVA equipment. I helped to fill in the blanks in the theory of MVA use. Halfway through the first MVA we began to lose daylight so I lent Dr. Paddy my headlamp to finish. There were 2 more women waiting. I wanted to call it quits for the day because I was emotionally exhausted after the death, already an hour late for dinner, I didn't want to walk home in the dark alone and I had to pack but Dr. Paddy insisted on helping the last two women since he had the headlamp- if he didn't- he said they would have gone home and maybe returned septic several days later. So Dr. Paddy, a student clinical officer and I attended the last two women in the dark with only a head lamp and the light of a cell phone.
Our last case was a woman who had been admitted to hospital after being bitten and beaten by her mother-in-law. The blunt abdominal trauma caused her to miscarry. It was terrifying- I was trying to draw up and give painkiller injections in the dark. The room was black, the woman was black, the procedure table was black...all I could see where the whites of her eyes, wide and glazed over with trauma and the shadow of the surgical instruments on the wall. It looked like a scene from a horror movie, Saw perhaps, like my worst nightmare- but rather than torture her the three of us were trying to help her.
That was the hardest day I've had here.
When we finally finished Dr. Paddy and I walked to the dorm where the gals are staying and we ate the rolex (rolled omlett & chappati), samosas and beers that they had bought for us hours earlier. We had worked a 12 hours shift. Afterwards everyone walked me home.
And so I have come full circle and I am reminded of why I am pro-choice and why I mustn't ever become lacadaisical in my attempts to reduce maternal mortality as a result of unsafe abortion.
Posted by Alix
On Sunday I worked on the wards during the day (caught 1 baby, managed 1 large postpartum hemorrhage ~3L blood loss, and obseved 1 cesearean and tubal ligation. I then did two interviews. One with the incredibly lovely Dr. Paddy, a GP who is just on his obstetrics internship. He is renowned for his boyish good looks and the compassion he shows to the labouring women. He kindly volunteered to show me around gynecology and introduce me to people I could interview.
On Monday we started off with maternity rounds- rather uneventful. We then headed to gynecology for rounds. At 10am, before rounds began, I watched a mother of 3 die at 10am after a septic abortion- there was a crowd of students watching and the nurse only did 9 chest compression then gave up- once a person requires chest compressions there is little hope of reviving them. There were no tears, no last rights. Sometime during rounds the body disappeared and by then end of rounds the bed was filled with someone new. My stomach churned.
I then met a man who's wife has a brain tumour which has resulted in paralysis of half her body and has left her in a coma for 8 weeks. She is 20 weeks pregnant. He requested a termination. The doctor explained that ending the pregnancy wouldn't help the tumour- but I couldn't help but wonder if he was requesting the termination because a child without a mother doesn't stand much of a chance here and it would be terribley hard to lose them both. However, abortion is illegal here unless it is to save a woman's life- and so the pregnancy continues.
I then interviewed a doctor about the barriers to women receing post abortion care. So many! They talk about the 3 delays
- Delay in the decision to obtain treatment
- Delay in transport to the hospital
- Delay in receiving care at the hospital
When women arrive in the morning they are alreay quite delayed in receiving treatment. Then then must wait for the doctor to complete rounds, and for the more urgent women to be triaged. When it is finally their turn there are only 2 sets of equipment for D&C- these must then be sterilized-another delay. Oh- and there is not light in the MVA room, so women can only be treated until 6:30pm when the daylight is gone. On average 5 women a day present with postabortion complications and only 2 can be treated. The untreated then leave- maybe they seek help elsewhere, maybe they don't.
Thankfully, 3 MVA sets were donated to Mbale hosptial last week and we finally got a hold of them on Monday. So after rounds were completed and triage was done Dr. Paddy set to work. He did 3 D&Cs and then a midwife quickly gave him a crash course in how to use the MVA equipment. I helped to fill in the blanks in the theory of MVA use. Halfway through the first MVA we began to lose daylight so I lent Dr. Paddy my headlamp to finish. There were 2 more women waiting. I wanted to call it quits for the day because I was emotionally exhausted after the death, already an hour late for dinner, I didn't want to walk home in the dark alone and I had to pack but Dr. Paddy insisted on helping the last two women since he had the headlamp- if he didn't- he said they would have gone home and maybe returned septic several days later. So Dr. Paddy, a student clinical officer and I attended the last two women in the dark with only a head lamp and the light of a cell phone.
Our last case was a woman who had been admitted to hospital after being bitten and beaten by her mother-in-law. The blunt abdominal trauma caused her to miscarry. It was terrifying- I was trying to draw up and give painkiller injections in the dark. The room was black, the woman was black, the procedure table was black...all I could see where the whites of her eyes, wide and glazed over with trauma and the shadow of the surgical instruments on the wall. It looked like a scene from a horror movie, Saw perhaps, like my worst nightmare- but rather than torture her the three of us were trying to help her.
That was the hardest day I've had here.
When we finally finished Dr. Paddy and I walked to the dorm where the gals are staying and we ate the rolex (rolled omlett & chappati), samosas and beers that they had bought for us hours earlier. We had worked a 12 hours shift. Afterwards everyone walked me home.
And so I have come full circle and I am reminded of why I am pro-choice and why I mustn't ever become lacadaisical in my attempts to reduce maternal mortality as a result of unsafe abortion.
Posted by Alix
Monday, 13 June 2011
The Turkey in Mbale
Today's blog post title is brought to you by Angela, in honour of the turkey who lives near the dorms. It seems he's a rather angry turkey -- he doesn't like when people wear red, and he lets them know that by chasing them and snapping at their heels -- so he's always tied up to various fences and trees, unlike all of the free-range turkeys who also live nearby. He always says hello when we walk by, in his turkey way.
Anyway.
Today was our last day in Mbale for a little while, before we head to Jinja for the rest of the week. We had another busy day on the ward -- Sarah and Lyanne in maternity, Alix on the gynecology ward, where she did more interviews for her research, and watched some MVAs done by Dr. Paddy (post-abortal care using manual vacuums). Sarah coached a student clinician through his very first catch, and both Sarah and Lyanne resuscitated a wee little premature baby (between 30 and 32 weeks, we think) until she was breathing on her own. When we left the ward, she was still doing very well; hopefully she will continue to improve!
We finished off the evening with a lovely rolex-and-samosa dinner with Dr Paddy, who was able to work well past dark because Alix lent him her headlamp. This meant that they were able to offer care to several women who otherwise would have had to wait until morning, so we were happy to treat Dr Paddy to dinner. He's an excellent doctor, and very hardworking, so we really enjoyed getting to know him better. For Sarah and Lyanne, the highlight of the trip so far has been working with the wonderful staff at the hospital in Mbale. The midwives, nurse-midwives, doctors, and consultant doctors (Ob/Gyns) have all been incredibly warm, friendly, and welcoming to us, and they are wonderful teachers. They obviously face many challenges (the hospital's ongoing shortage of suture materials and IV cannulas is one of the more obvious challenges, along with always being under-staffed and very busy), but they work hard, they have incredible clinical skills, and they are kind and compassionate to the mothers and babies.
Sarah and Lyanne are excited about our next adventures, but leaving is bittersweet. We look forward to returning to Mbale in July.
Anyway.
Today was our last day in Mbale for a little while, before we head to Jinja for the rest of the week. We had another busy day on the ward -- Sarah and Lyanne in maternity, Alix on the gynecology ward, where she did more interviews for her research, and watched some MVAs done by Dr. Paddy (post-abortal care using manual vacuums). Sarah coached a student clinician through his very first catch, and both Sarah and Lyanne resuscitated a wee little premature baby (between 30 and 32 weeks, we think) until she was breathing on her own. When we left the ward, she was still doing very well; hopefully she will continue to improve!
We finished off the evening with a lovely rolex-and-samosa dinner with Dr Paddy, who was able to work well past dark because Alix lent him her headlamp. This meant that they were able to offer care to several women who otherwise would have had to wait until morning, so we were happy to treat Dr Paddy to dinner. He's an excellent doctor, and very hardworking, so we really enjoyed getting to know him better. For Sarah and Lyanne, the highlight of the trip so far has been working with the wonderful staff at the hospital in Mbale. The midwives, nurse-midwives, doctors, and consultant doctors (Ob/Gyns) have all been incredibly warm, friendly, and welcoming to us, and they are wonderful teachers. They obviously face many challenges (the hospital's ongoing shortage of suture materials and IV cannulas is one of the more obvious challenges, along with always being under-staffed and very busy), but they work hard, they have incredible clinical skills, and they are kind and compassionate to the mothers and babies.
Sarah and Lyanne are excited about our next adventures, but leaving is bittersweet. We look forward to returning to Mbale in July.
Sunday, 12 June 2011
Making Friends
Alix and Carolyn arrived in Mbale yesterday, and the four of us have very much enjoyed our time being reuinted! We had arranged to meet two of the student clinicians for dinner, and Alix and Carolyn agreed to come along -- it probably didn't hurt that we were going back to our favourite Indian restaurant, which has several wonderful vegetarian options. :)
Denis and Paul, the two clinicians who were instrumental in setting up our lectures last week, braved the rainstorm to meet up with us, and they both tried Indian food for the first time. We had a lovely dinner together, and then they announced that because we had treated them, they were taking us out to say thank you. The group of us walked to a nearly empty dance club -- it turns out that 8:30 is too early to go out in Uganda, just as it is in Canada. :) Several more of the student clinicians were also at the club, and we had a lot of fun even though the place was mostly empty -- Angela, our instructor, was probably the best dancer of the lot of us! Among other things, we learned that the only Canadian musician that people in Uganda seem to know is Celine Dion. Before we parted ways, Denis and Paul asked if we would like a tour of their school, so we decided to meet Sunday (today) after work.
All five of us (four students plus Angela) spent the day on the ward. Alix was just planning on doing her interviews for her final project, but she brought along some sterile gloves "just in case" -- good thing she did, as she and Lyanne each caught two babies (another retained twin for Lyanne!), Carolyn caught three, and Sarah resuscitated three babies. Interesting things on the ward today included: a retained twin who came out crying, but deteriorated rapidly after his first few minutes of life (he had quite the heart murmer, so we suspect he has a patent ductus arteriosis, for those of you who speak midwifery); a very large PPH, that Carolyn and Alix managed expertly; a manual removal of a placenta; and a woman who spoke neither English nor Lugandan, with sickle-cell anemia, a history two previous cesarean sections and a vaginal delivery of a stillbirth, who had an obstructed labour. Sarah and Lyanne stayed with that woman through several long, frustrating hours, feeling utterly incapable of offering her any kind of comfort or reassurance, wishing we could offer her an epidural, and more than anything feeling the divisiveness of the language barrier in a more frustrating and poignant way. The woman ended up with a cesarean (and her baby needed resuscitation) and not a moment too soon, as a "Bandl's ring" appeared on her abdomen -- the dividing line between the upper and lower uterine segments, which is a sign that uterine rupture is imminent. The lady was really very sweet, and the whole situation, though heartbreaking and frustrating, certainly had its lighter moments -- as when Sarah and Lyanne had to communicate "empty your bladder" through sign language and gesture.
It was a tiring day, and we were almost late for our tour of the student clinicians' school. Like many things in Uganda, the school is in a beautiful setting -- on the lush, green hospital grounds, with a beautiful view of the mountains, lovely trees and flowers everywhere -- though as our guides pointed out, the buildings themselves are old and have not been renovated in a long time. We were invited into Paul's dorm room -- with Angela along, don't worry -- that he shares with three other students. The room has a single desk, and two sets of bunk beds with about 1m between them, and although it's small, it's remarkably clean given that it's inhabited by four men in their early 20s. It made the "bunk and loft" triple rooms at McMaster seem like the height of luxury!
All of Paul's roommates, and a few other student clinicians, dropped by, so that there were about 10 of us in the room in the end. Our hosts had thoughtfully picked up some soft drinks for us ('Stoney' -- Uganda's gingerale, and "Miss Angela"s favourite) and we discussed the differences between our medical systems, and the student clinicians' future goals. There was an aspiring obstetrician, an aspiring neural surgeon, and an aspiring cardiologist in the room -- it seems many Ugandans become clinicians so that they can work for a few years at a relatively good wage to save money for med school. They had a lot of questions about becoming a doctor in 'Canada' (by which they seemed to mean 'North America,' since one of them hoped to go to Johns Hopkins, and last I checked Baltimore hasn't defected).
It's certainly clear that medicine in Uganda is a very competitive field, and that student clinicians work very, very hard to gain the skills they need to get good jobs and build futures for themselves. Several of the clinicians also mentioned wanting to train in North America or Europe in order to bring their skills back home to their people -- certainly a noble goal, but it's not clear that they really understand how different it is to practice medicine with access to so much technology, how easy it is to become dependent on the technology, and how hard it might be to transition between the two. We certainly wish them all the best.
Denis and Paul, the two clinicians who were instrumental in setting up our lectures last week, braved the rainstorm to meet up with us, and they both tried Indian food for the first time. We had a lovely dinner together, and then they announced that because we had treated them, they were taking us out to say thank you. The group of us walked to a nearly empty dance club -- it turns out that 8:30 is too early to go out in Uganda, just as it is in Canada. :) Several more of the student clinicians were also at the club, and we had a lot of fun even though the place was mostly empty -- Angela, our instructor, was probably the best dancer of the lot of us! Among other things, we learned that the only Canadian musician that people in Uganda seem to know is Celine Dion. Before we parted ways, Denis and Paul asked if we would like a tour of their school, so we decided to meet Sunday (today) after work.
All five of us (four students plus Angela) spent the day on the ward. Alix was just planning on doing her interviews for her final project, but she brought along some sterile gloves "just in case" -- good thing she did, as she and Lyanne each caught two babies (another retained twin for Lyanne!), Carolyn caught three, and Sarah resuscitated three babies. Interesting things on the ward today included: a retained twin who came out crying, but deteriorated rapidly after his first few minutes of life (he had quite the heart murmer, so we suspect he has a patent ductus arteriosis, for those of you who speak midwifery); a very large PPH, that Carolyn and Alix managed expertly; a manual removal of a placenta; and a woman who spoke neither English nor Lugandan, with sickle-cell anemia, a history two previous cesarean sections and a vaginal delivery of a stillbirth, who had an obstructed labour. Sarah and Lyanne stayed with that woman through several long, frustrating hours, feeling utterly incapable of offering her any kind of comfort or reassurance, wishing we could offer her an epidural, and more than anything feeling the divisiveness of the language barrier in a more frustrating and poignant way. The woman ended up with a cesarean (and her baby needed resuscitation) and not a moment too soon, as a "Bandl's ring" appeared on her abdomen -- the dividing line between the upper and lower uterine segments, which is a sign that uterine rupture is imminent. The lady was really very sweet, and the whole situation, though heartbreaking and frustrating, certainly had its lighter moments -- as when Sarah and Lyanne had to communicate "empty your bladder" through sign language and gesture.
It was a tiring day, and we were almost late for our tour of the student clinicians' school. Like many things in Uganda, the school is in a beautiful setting -- on the lush, green hospital grounds, with a beautiful view of the mountains, lovely trees and flowers everywhere -- though as our guides pointed out, the buildings themselves are old and have not been renovated in a long time. We were invited into Paul's dorm room -- with Angela along, don't worry -- that he shares with three other students. The room has a single desk, and two sets of bunk beds with about 1m between them, and although it's small, it's remarkably clean given that it's inhabited by four men in their early 20s. It made the "bunk and loft" triple rooms at McMaster seem like the height of luxury!
All of Paul's roommates, and a few other student clinicians, dropped by, so that there were about 10 of us in the room in the end. Our hosts had thoughtfully picked up some soft drinks for us ('Stoney' -- Uganda's gingerale, and "Miss Angela"s favourite) and we discussed the differences between our medical systems, and the student clinicians' future goals. There was an aspiring obstetrician, an aspiring neural surgeon, and an aspiring cardiologist in the room -- it seems many Ugandans become clinicians so that they can work for a few years at a relatively good wage to save money for med school. They had a lot of questions about becoming a doctor in 'Canada' (by which they seemed to mean 'North America,' since one of them hoped to go to Johns Hopkins, and last I checked Baltimore hasn't defected).
It's certainly clear that medicine in Uganda is a very competitive field, and that student clinicians work very, very hard to gain the skills they need to get good jobs and build futures for themselves. Several of the clinicians also mentioned wanting to train in North America or Europe in order to bring their skills back home to their people -- certainly a noble goal, but it's not clear that they really understand how different it is to practice medicine with access to so much technology, how easy it is to become dependent on the technology, and how hard it might be to transition between the two. We certainly wish them all the best.
Friday, 10 June 2011
the humble and the haughty
Alix: No births today. At least not directly. The ward was quiet when we arrived. A woman was pushing with a Ugandan student attendent. After 45 min with seemingly no progress I gently inched my way in- taking blood pressure and pulse, listening to the fetal heart. I had asked the woman's history but the student just shrugged. It is delicate because I didn't want to undermine the local student. I finally did a VE to find what I had expected- the poor woman had been pushing on a lip of cervix which had begun to swell. I had her lie on her side and not push. After an hour the cervix was gone. After another 40min the head had only come down 1/2cm. I had discussed the dystocia with the student who continued to shrug- I had asked her if the pelvis was adequate, if she thought oxytocin may help, if she thought the head was low enough for a vacuum. Finally I announced I was calling the doctor for a consult because I suspected the baby's head was too big for the woman's pelvis and the student told me that the doctor had already come in early this morning and said that was the case and the woman was scheduled for cesearean. Why she had not told me earlier I don't know. When I asked he why she hadn't shared this info hours earlier or charted it, she left the room in a fit of laughter. I was so upset I missed the IV twice when preparing the woman for the OR. Thankfully the doctor came in at that moment and kindly helped me with the IV and did the catheter himself.
This was one of the most frustrating moments of my life. This isn't the first time that we have assessed women before having a chart. Its not the first time that we didn't know a woman had been obstructed for many hours before we arrived. I am not sure why this particular instance was so frustrating.
Upon closer examination of the chart I realized that at 11pm the night before a doctor had suggested a cesearean. I had written in the chart several times but found the first entry illegible and hadn't tried to decipher it, not to mention that she was pushing when I came in so I jumped into action anticipating a delivery soon. Had I read the chart I could have spared the woman the wait & see. She still would have waited just as long for the OR to be ready for her cesearean though. Thankfully, she and her baby were well in the end.
I have now learned my lesson. Handover/debriefing from one shift to another does not happen here. We always assess the supplies when we first arrive on the ward and now we will check the charts too-no matter what action is ongoing when we first enter. I now know that I mustn't give up on illegible writing on a chart. Thankfully this student was the exception, most are wonderful and we will miss the current batch, whose rotation on maternity ends tomorrow.
Carolyn: Alix mentioned an indirect delivery...I was doing some charting, I don't remember what I was charting, when someone rushed into the room to say that someone was delivering in the antepartum ward. I prepared the oxytocin and ran to the other room; when I got there, the head was already delivered, but unfortunately the baby was obviously stillborn. I gave some suggestions to the midwife who was delivering and and I also delivered the placenta. Despite the sadness, it was also a satisfying moment for me to feel that I actually knew what I was doing!
Today we heard some rather unsettling news. We have long known that Ugandans do not accept blood from foreigners and we didn't know why. It appears that many Ugandans, including educated ones, believe that blood from the Muzungu tribe is weaker than Ugandan blood, and is therefore not good for Ugandans. I'll let all of you to decide what to make of that.
Some of our days here are so positive, enriching, and inspiring. (Ie. yesterday's post) and other days are disheartening beyond belief. Disheartening, frustrating, where you want to leave the ward screaming. Today was more of the later.
We are off to Mbale tomorrow- the journey will take the whole day. Alix willl then do interviews on Sun/Monday. We are very excited to be reunited with Sarah and Lyanne. We will miss Cathy and Mickey. We are humbled.
This was one of the most frustrating moments of my life. This isn't the first time that we have assessed women before having a chart. Its not the first time that we didn't know a woman had been obstructed for many hours before we arrived. I am not sure why this particular instance was so frustrating.
Upon closer examination of the chart I realized that at 11pm the night before a doctor had suggested a cesearean. I had written in the chart several times but found the first entry illegible and hadn't tried to decipher it, not to mention that she was pushing when I came in so I jumped into action anticipating a delivery soon. Had I read the chart I could have spared the woman the wait & see. She still would have waited just as long for the OR to be ready for her cesearean though. Thankfully, she and her baby were well in the end.
I have now learned my lesson. Handover/debriefing from one shift to another does not happen here. We always assess the supplies when we first arrive on the ward and now we will check the charts too-no matter what action is ongoing when we first enter. I now know that I mustn't give up on illegible writing on a chart. Thankfully this student was the exception, most are wonderful and we will miss the current batch, whose rotation on maternity ends tomorrow.
Carolyn: Alix mentioned an indirect delivery...I was doing some charting, I don't remember what I was charting, when someone rushed into the room to say that someone was delivering in the antepartum ward. I prepared the oxytocin and ran to the other room; when I got there, the head was already delivered, but unfortunately the baby was obviously stillborn. I gave some suggestions to the midwife who was delivering and and I also delivered the placenta. Despite the sadness, it was also a satisfying moment for me to feel that I actually knew what I was doing!
Today we heard some rather unsettling news. We have long known that Ugandans do not accept blood from foreigners and we didn't know why. It appears that many Ugandans, including educated ones, believe that blood from the Muzungu tribe is weaker than Ugandan blood, and is therefore not good for Ugandans. I'll let all of you to decide what to make of that.
Some of our days here are so positive, enriching, and inspiring. (Ie. yesterday's post) and other days are disheartening beyond belief. Disheartening, frustrating, where you want to leave the ward screaming. Today was more of the later.
We are off to Mbale tomorrow- the journey will take the whole day. Alix willl then do interviews on Sun/Monday. We are very excited to be reunited with Sarah and Lyanne. We will miss Cathy and Mickey. We are humbled.
The week finishes with a bang...
Between the two of us, Lyanne and I assisted four mothers to birth their babies in two hours this morning. The first was lovely enough to name her beautiful baby daughter after us - Sarah Lillian (no one here can pronounce Lyanne's name). Unfortunately our first mother also went on to have a PPH. As Lyanne and I were working with one of the sisters to resolve the bleeding, I heard a call from the woman next door (and I should clarify that there are no doors anywhere - here in Mbale women are quite lucky actually, in that they have a half-wall partition and curtains between most of the beds which block sight, if not sound). This woman was having her second baby and was clearly well on her way to pushing baby out! I let Lyanne know what was going on and thankfully our first mom's bleeding had resolved and Lyanne was able to gather instruments and umbilical cord ties (otherwise known as the elastic cuffs off our sterile gloves). I caught baby, Lyanne arrived in time to be second attendant and I helped mom clean up. Just as I was preparing to chart, Lyanne was ready to catch yet another baby, and it was my turn to play second attendant. This baby needed some ventilation to get going, and as second that task fell to me. Thankfully baby came around with four minutes of PPV. I had just wrapped this baby up after weighing her and doing the newborn exam when YET ANOTHER woman began pushing out her baby on the bed closest to the infant warmer. This mother was having her first baby, but only took about half an hour to push out her baby. So we had:
Baby 1: born 09:30
Baby 2: born 09:50
Baby 3: born 10:30
Baby 4: born 11:20
With hardly any time to think and certainly none to chart in between! We are taking this afternoon off as well as tomorrow, and are looking forward to spending the day at the pool tomorrow, followed by seeing Alix and Carolyn tomorrow evening and sharing a meal with some of the student clinicians who we have gotten to know over the past couple weeks.
Posted by Sarah
Baby 1: born 09:30
Baby 2: born 09:50
Baby 3: born 10:30
Baby 4: born 11:20
With hardly any time to think and certainly none to chart in between! We are taking this afternoon off as well as tomorrow, and are looking forward to spending the day at the pool tomorrow, followed by seeing Alix and Carolyn tomorrow evening and sharing a meal with some of the student clinicians who we have gotten to know over the past couple weeks.
Posted by Sarah
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