The ATM has captured my card

We have decided to post with some of our favourite Ugandan uses of words and turns of phrase, as well as some of our language errors.

"The ATM has captured my card."

"The matoke refuses to leave the spoon."

Matoke is mashed plantain- a staple here.

"Alix, why have you soiled yourself?"

This is what they say when you accidentally get blood on yourself.

"I have failed to deliver this mother."

When the mother's labour is not progressing. 

"They made us go to bible study in college, Imagine!"

"You are most welcome."
A common greeting when arriving somewhere new.

"Do you like peanut butter?" response "Uh ugh"
(really nasally, said the way my 4 year old niece does)

"The woman who went for c-section had a ruptured uterus." response, "eiiiiiiii"

"Those people will have some IV cannulas."

"Could you get us some toilet paper rolls please?" response from hotel receptionist, "Yes please."

Here, someone says please not when making a request, but when granting one. 

"Is this where we catch the the costa to Kampala?" response eyebrow raise

Here, an eyebrow raise means yes- they are not making a suggestative gesture....unless they have long dreadlocks and seem to be familiar with western culture, in which case...

"That evening the wind blew up, the sky grew dark and it what? It rained."

Ugandans love to pose a question and then answer it themselves.

"In Canada, elementary and secondary school are free." response, "Sure?"

"How are youuuuuuuuu?" response "Fine" 

Carolyn and Alix had a Lugandan lesson in Vancouver. At that time they were taught that endaggala means medicine. After 6 weeks here Prossy finally informed us that endaggala actually means banana leaves...daggala is medicine. 

During our Lugandan lesson we also learnt that ebizza means contraction. However, in Lubisu (which is spoken in Mbale) ebizza means pubic hair. Imagine! We say, "To ebizza, to sindica. Ebizza-sindica." (no pubic hair, no pushing, pubic hair-push).

Woot, woot!

Yesterday Alix and I had a really good day working on the ward. We were supposed to work on antenatal, but when we arrived in the morning Prossy told us that there were 4 women who were 8 to 9cm and would deliver soon, so we quickly grabbed our supplies and headed to the delivery room.
It was a day of feeling really competent. I managed to get two IVs in successfully without any assistance at all (I often need someone to at least connect the IV because the cannulas are heavy and I am always afraid of losing it if I let go). These two IVs have also been after several successful IVs and this has been a tremendous feeling as I had decided that IVs were the bane of my existence :)
I also made a good management decision regarding one of the births, properly assessing what was wrong, and what was needed, which was reaffirmed by the OB when I spoke with him.
Alix did an amazing job suturing a 2nd degree tear without assistance. It was a work of art and looked perfect, and all in an acceptable about of time.
She also perfectly handled a shoulder dystocia and was gentle enough that the woman had no tears.
It was great to have such a positive day as it rejuvenated us and has made us be able to look at our final 3 days of work with some equanimity.

Tomorrow we are going with Prossy to visit her family in one of the villages, so it should be a good day.

Where is the key?

Yesterday Carolyn and I caught 1 baby each at the end of the day and then went for beans and rice for dinner at the Banana Chick Hunger Care Centre (sounds simple but it is such a pleasure the odd time we get beans). The lady from the grocery store we shop at treated us each to a banana for dessert. Carolyn has patiently taught Alix how to play whist and crib and we enjoy playing cards and drinking a beer on the patio of the Zebra in the evenings.

This morning all the moms were for CS but one, mom #1. The obstetric Operating Room was in use for general surgery all morning- an Ear/Nose/Throat doctor had been in surgery for several hours removing a foreign object lodged in a young boy's throat. One of the women waiting for c-section was in labour with her second baby. She had quite a bit of bleeding for 6cm and a bandal's ring was starting to form (separation of the upper and lower segments of the uterus- a warning sign of uterine rupture). Wisely Prossy advocated for her to be the first c-section noting pending rupture. She was right- by the time the c-section was done the uterus had ruptured along the scar from a previous c-section. The baby thankfully survived but the woman needed complicated surgery because her uterus had also adhered to her bladder with scar tissue. 

Another woman today had a blood pressure of 240/160- more than twice the healthy blood pressure. For some reason she hadn't received any blood pressure medication yesterday and was only being induced today. To make matters worse they are out of Magnesium Sulphate, a medication used to prevent seizures in women with pre-eclampsia. For a woman to buy her own costs 90,000 UShl ($35) -more than anyone delivering in a public hospital could afford. I hope she will be ok.

Carolyn caught baby #1- a very cute and healthy little girl and mom's perineum was intact- yay! Next a woman came in from home- she had been pushing for 4 hours and her baby's head was swollen with a blister and her vulva was swollen with a blister. The fetal heart was very fast. I didn't expect her to deliver but when I was assessing mom #3 she did. Baby #2 was born with a heart rate of 40, not breathing. Carolyn quickly began bagging the baby and then moved to chest compressions. She was about to give up when it moved its leg so she continued. Prossy told us to move to the nursery (where she could start an IV on the baby) so Carolyn and I walked carrying the baby down the hall while I listened to the heart and Carolyn bagged it- but the key to the nursery was missing so we had to stand in the hall holding the baby in a bloody blanket in between us while waiting for the key to be found. The baby never did breathe on its own and after 20 minutes we ceased our efforts and gave the news to the mom.

While we were resuscitating baby #2- mom #3 delivered in the first stage room. She had given birth to 5 previous babiess and had only been 5cm with mild contractions half an hour before. 10 min earlier when I had checked her blood pressure she still appeared to be in early labour...the is why we have a saying, "never turn your back on a multip!"

Tonight the administration has invited Carolyn and I and the group of Danish nursing students who are here to dinner to give them feedback on how they could improve. We are flattered that our humble student opinion is valued and look forward to the social time. Tomorrow we will do our mandatory shift in the antenatal ward.  We are braced to see up to 100 patients in only 8 hours!!!

Strength and Resiliency

On Monday, Lyanne and I arrived on the ward in Mbale for the first time in almost three weeks. At rounds we had heard that there were many women awaiting cesarean (seven, as it turned out - in a ward with eight beds, that's pretty significant). Five of these were emergency cesareans (as previously stated, ‘emergency’ means a woman will wait at least two hours, often much more, before going into theatre). Throughout the morning, EVERY SINGLE ONE of the women waiting for emergency cesarean section delivered vaginally, three in very quick succession (there was 15 minutes at most between each birth). Three of these babies did not require any amount of resuscitation whatsoever. Unfortunately, the remaining two babies had died in-utero (one mother had a prolapsed cord, the other a placental abruption).


Yesterday, Lyanne and I assessed a primagravida first thing when we arrived on the ward. She was 9 cm dilated, and had been very slow to progress throughout her labour. The doctor on call came in and assessed this woman an hour or two later, and determined that when her membranes ruptured, she would deliver - he did not suggest an oxytocin augment. (Perhaps I should mention that it is rare for health care providers to artificially rupture membranes here - there are no amni-hooks. When they want a woman's membranes to rupture, they get them up and walking around). Things got a bit busy on the ward, and it was several hours later before I returned to reassess this woman yet again. Her cervical dilatation was the same, and her membranes remained intact. I managed to rupture them myself, which revealed thick meconium stained fluid (for those not in the know, this can often indicate fetal distress). Throughout the day, the baby's heartrate had remained in the normal range, though we were listening only every few hours. At this point I needed to consult again, and so waited an hour for the doctor to arrive. Minutes after his arrival, Lyanne and I noticed this woman was pushing and that we could see the head coming. Lyanne did a beautiful job catching the baby, and this lovely little boy came into the world as healthy as you could wish, no resuscitation required.


So all of this makes me think - in Canada, our lady yesterday would likely have had an oxytocin augmentation, an epidural, possibly a cesarean section. Every one of the ladies for cesarean on Monday would have made it to theatre. Perhaps the babies that did not survive on Monday would have survived in Canada; it's impossible to know. I think most people would agree that doing six cesareans to save two babies is reasonable. However, I can’t help but feel we are giving women’s strength and babies’ resiliency too little credit. Birth works, so well, so much of the time, even if it doesn’t go according to our expected timeline.




Posted by Sarah

I like boots. They make my feet feel safe.

Hello from Masaka!

As with Lyanne and Sarah, we returned 'home' on Saturday, though unfortunately we wouldn't call it a pleasant trip. We got onto the bus to go to Kampala without mishap but getting in and out of Kampala is always a disaster and so it took us an hour once we arrived in Kampala to get to bus station, and another hour once we actually left the bus station, to get out of Kampala, to Masaka. Buses schedules around here are non existent, basically buses leave when they are full so we also had to spend an hour on the bus refusing water, pop, bracelets, cellphone holders, loaves of bread and meat on a stick. In any case we finally made it to Masaka in one piece 7 hours after leaving Jinja. The joys of 3rd world travelling! We should mention that we did get quite the kick from the person sitting in front of Carolyn who kept nodding off. Finally Carolyn had to put her hand in front of her own head to prevent getting headbutted which provided a nice cushion on which this man to put his head.

The wheels on the bus go round and round...

Our two days of work in Masaka have been uneventful. Carolyn's shoes got baptized by a load of meconium stained amniotic fluid at the one delivery of the day. Thankfully she was able to borrow Prossy's boots, which lead her to remark that she liked boots because they made her feet feel safe. Unfortunately this delivery was another macerated stillbirth. Today was slightly busier with two deliveries and several assessments; however overall we hope that it will pick up a bit.

6 days left of work and then it will be time to head back home.

Things we have accomplished so far this week

- We have figured out two more uses for a sterile glove package (What is that now? 25 possible uses? More?)

- Lyanne did bimanual compression of a uterus without getting blood on her clothing or her arms

- We have caught another four babies (two each)

- We have resuscitated two babies after cesarean section

- Sarah started an IV under pressure with no trouble at all

- We found our way to the Indian restaurant all by ourselves (okay, Sarah found the way, Lyanne followed)

The internet has been fairly unreliable in Mbale since we got back, so our updates will likely be less frequent. Alix and Carolyn no longer have access to a laptop, so their updates will likely be even less frequent.

"It's almost like coming home..."

After wishing our fearless instructors a fond farewell, our intrepid foursome spent one final night in Kampala, and then left for Jinja, bright and early, for one final day of adventures before returning to our respective placement sites.

We enjoyed a beautiful day by the pool, a delicious dinner, and a fabulous night of DIY karaoke (singing along to music from our computer) and a rousing game of zilch. Our plan for a late-night swim was foiled, alas, by a disembodied voice that came out of the shadows to warn us that the pool had just been treated with some heavy-duty chemicals, so we had to settle for a final morning swim instead. Our fellow guests at the resort this time was a group of about 25 female missionaries from the Southern U.S., so the stay was a little less quiet than before. Still, it made for good people-watching.

The four of us went together to the matatoo park. Matatoos are kind of a cross between a bus and a taxi -- large vans that follow set routes and pick up/drop off people at set points along the route, but the fare depends on the distance travelled and there is no set schedule. Lyanne and Sarah managed to find their way onto the matatoo headed to Mbale, and we have arrived safely after a fairly pleasant drive.

Seasoned travellers that we are, we've been pilfering saving the little bars of soap and extra rolls of toilet paper from the hotels where we've been staying these last few weeks, so we arrived at our dormitory well-armed. We're staying in the same building, but different rooms, just to maximise our potential for trying to open someone else's door. Mbale feels lovely and familiar after all our travelling, and when we headed to the supermarket to pick up some food for tomorrow's breakfast, we ran into the Ugandan midwife who is our main supervisor for our last two weeks, which made us feel a little more like we've returned to our Ugandan home-base. It's certainly strange to be navigating the city without Angela, and speedbumps have been added to the road near where we're staying, which has thrown off our whole system for crossing the road. Fortunately our favourite Rolex vendor was working tonight (no samosas for sale today, unfortunately) so we picked up a tasty, if greasy, dinner and we're settling in for a quiet night. Our plan is to spend Sunday by the pool once again to shake off any remaining Lower Mulago stress -- neither of us is particularly the "lounge by the pool" type normally, but we're both finding that spending a day swimming and reading is the perfect way to unwind from the craziness of the work here.

Monday we head back on the wards!

Posted by Lyanne and Sarah