Today was our first real day off since arriving in Uganda.
We started the morning off by heading for the local "Trade Show" with Commissionaire Monica, who heads up the nursing department at the hospital in Mbale. We had no idea, going in, what a Trade Show might be; it turns out it’s Mbale’s version of the PNE. There was a midway with ride (one of those swing rides – we didn’t ride it, mostly because we couldn’t figure out how the lineup worked), tents with vendors selling crafts, clothing, and all the same items that seem to turn up at local markets, and a food section with all the local standards for street food: fried dough, samosas, and the trusty rolex. There was also an animal exhibit. It cost an extra 1000 shillings to get in, and it featured two leopards, several monkeys, tropical birds, an ostrich, and a large snake, all in cages. There was also a hot and sleepy looking camel on a rope, and an empty cage; it seems the lion wasn’t feeling well enough to be on display today. The trade show only happens a couple of times a year, and it is clearly a highlight for local kids. The drive to the trade show was equally interesting, as we drove through a small village (subdivision?) that consisted of small, round, thatch-roofed homes surrounding a central dump; the dump was clearly the pasture for all of the local cows. Commissionaire Monica told us that the village population was mostly refugees who have been displaced by nearby wars.
After the Trade Show, we spent the afternoon relaxing in the sun at the pool at the local Fancy Expensive Hotel, and then having dinner in their restaurant. The highlight: the bathrooms featured toilet seats, running water, and soap! Pure luxury!
One of the quirky things in Mbale is that local businesses are perpetually unable to make change, especially for larger bills. This becomes problematic quickly, because bank machines only give us big bills, and any small bills we do manage to acquire end up disappearing as soon as we buy our next meal.
Tomorrow’s plan: Sipi Falls at Mount Elgon!
Posted by Lyanne and Sarah
Uganda
Saturday, 4 June 2011
Friday, 3 June 2011
Five Cent Samosas
Today was a Ugandan holiday, so we thought maybe we would have a quieter day on the wards.
Not so much.
First thing when we arrived, Sarah was the 2nd attendant for a baby caught by one of the Ugandan clinician students. These students have been on the wards every day with us, and they travel in packs of four or five. Clinicians have a scope equivalent to Nurse Practitioners in Canada, and in Uganda, their third and final year of education seems to consist of spending one week rotations on every ward of the hospital, with a break in the middle for lectures. They are all very eager learners, but labour and birth are not necessarily their area of expertise, and they aren't supervised. We’ve both taught them how to do newborn exams, and we’ll be teaching a neonatal resuscitation class to a group of them on Monday.
While Sarah was busy taking care of the baby and preparing oxytocin, Lyanne started an assessment on another lady on the ward. Her chart said that she had been fully dilated for 10 hours, which is not typical for a woman who has already had three babies, and an ultrasound report in her chart (scan done the day before) had diagnosed a live breech baby with multiple anomalies. A quick exam revealed that the baby could not, in fact, be breech, because the baby’s arm was coming first. Unfortunately, there was no fetal heartbeat, and the woman was in agony after many hours of hard labour. Two hours later, we headed into the OR to watch the cesarean section; it was clear from looking at the baby that he had been dead for some time, but that he did not have the anomalies the ultrasound had mentioned. The other day we met a lady whose ultrasound reported twins when there was only one baby present; we know ultrasound in Canada, like all tests, has a margin of error, but these examples take things to a whole new level. Once again, it made us realize how lucky we are in Canada: to have relatively accurate diagnostic tests, to have effective pain medication for labouring women who need it, and to have prompt access to surgery when there is an obstetric emergency.
We immediately went in for a second cesarean, this time for prolonged labour with an inadequate pelvis (in Uganda, many women have small pelvises, likely the result of childhood malnutrition); this time the baby came around quickly and enthusiastically with only a minimal resuscitation. For those keeping track, this is the first time we’ve had a completely successful resuscitation, so that was a bit of a relief.
Things seemed quiet, so we stepped out a quick lunch break; when we came back, a woman’s screams had Lyanne and Sarah running in to see what was happening. For the second time in three days, we walked in to find a breech delivery in progress, being attended by an inexperienced practitioner who was telling the woman to push; in both cases the body had delivered but the head was trapped behind the (not fully dilated) cervix. This is A Bad Thing, because the umbilical cord also gets trapped by the cervix, so the baby's supply of oxygen is compromised. Angela quickly came to help, and Sarah realized the woman in the next bed was about to push out her baby, so Lyanne ran back and forth between the two. Unfortunately, the breech baby died before the cervix was fully dilated. The woman’s reaction was incredibly touching and humbling; she thanked us for the care, and kept telling us that she was okay. Meanwhile, the baby that Sarah caught needed a tiny bit of help to get going, but not a full resuscitation. We certainly had our hands full.
Just as we were recovering from all of this, a woman was carried into the ward, wrapped in blankets. A different woman who had birthed 15 minutes before was told to vacate her bed to make room for the new arrival (did I mention it turned out to be a busy day?) and it was clear that the woman who had just arrived was having a severe antepartum hemorrhage, which we suspect was from a placenta previa (a low placenta that covers the cervix). Her blood pressure had tanked, her pulse was through the roof, and Angela and one of the local midwives had quite the time starting IVs to replace her blood volume. There was no fetal heartbeat, and the woman’s relatives were sent out to buy blood for transfusion. We were asked to be in the OR for resuscitation, but the surgery was delayed; the woman’s relatives had to go out to buy suture materials, alcohol (for disinfectant), and other materials, and the anesthetist had to arrive. Bleeding this severe would be in the OR within minutes in Canada, so it was very difficult to watch and wait, yet again, for necessary treatment, as a result of lack of resources. By the time we headed home, two hours later, the woman still hadn't been moved to the OR. Can you imagine delaying an emergency cesarean to send a woman’s husband or sister off to buy suture materials and disinfectant for her surgery?
While we were waiting, Lyanne had a quick catch of a healthy baby and Sarah was 2nd attendant; everything went very smoothly, except that again we had to rush the woman up and out of bed to make room for someone else. It was good to leave on a happy note after a normal birth, and we barely had time to get dinner before dark.
On another happy note, our dinner was truly spectacular. We bought lentil samosas, rolexes, and tomatoes from street vendors just outside the hospital grounds; our dinners cost less than $2.50 each for plenty of food.
We have tomorrow and Sunday off – hopefully this will give us time to finally upload some photos from our adventures. :)
Not so much.
First thing when we arrived, Sarah was the 2nd attendant for a baby caught by one of the Ugandan clinician students. These students have been on the wards every day with us, and they travel in packs of four or five. Clinicians have a scope equivalent to Nurse Practitioners in Canada, and in Uganda, their third and final year of education seems to consist of spending one week rotations on every ward of the hospital, with a break in the middle for lectures. They are all very eager learners, but labour and birth are not necessarily their area of expertise, and they aren't supervised. We’ve both taught them how to do newborn exams, and we’ll be teaching a neonatal resuscitation class to a group of them on Monday.
While Sarah was busy taking care of the baby and preparing oxytocin, Lyanne started an assessment on another lady on the ward. Her chart said that she had been fully dilated for 10 hours, which is not typical for a woman who has already had three babies, and an ultrasound report in her chart (scan done the day before) had diagnosed a live breech baby with multiple anomalies. A quick exam revealed that the baby could not, in fact, be breech, because the baby’s arm was coming first. Unfortunately, there was no fetal heartbeat, and the woman was in agony after many hours of hard labour. Two hours later, we headed into the OR to watch the cesarean section; it was clear from looking at the baby that he had been dead for some time, but that he did not have the anomalies the ultrasound had mentioned. The other day we met a lady whose ultrasound reported twins when there was only one baby present; we know ultrasound in Canada, like all tests, has a margin of error, but these examples take things to a whole new level. Once again, it made us realize how lucky we are in Canada: to have relatively accurate diagnostic tests, to have effective pain medication for labouring women who need it, and to have prompt access to surgery when there is an obstetric emergency.
We immediately went in for a second cesarean, this time for prolonged labour with an inadequate pelvis (in Uganda, many women have small pelvises, likely the result of childhood malnutrition); this time the baby came around quickly and enthusiastically with only a minimal resuscitation. For those keeping track, this is the first time we’ve had a completely successful resuscitation, so that was a bit of a relief.
Things seemed quiet, so we stepped out a quick lunch break; when we came back, a woman’s screams had Lyanne and Sarah running in to see what was happening. For the second time in three days, we walked in to find a breech delivery in progress, being attended by an inexperienced practitioner who was telling the woman to push; in both cases the body had delivered but the head was trapped behind the (not fully dilated) cervix. This is A Bad Thing, because the umbilical cord also gets trapped by the cervix, so the baby's supply of oxygen is compromised. Angela quickly came to help, and Sarah realized the woman in the next bed was about to push out her baby, so Lyanne ran back and forth between the two. Unfortunately, the breech baby died before the cervix was fully dilated. The woman’s reaction was incredibly touching and humbling; she thanked us for the care, and kept telling us that she was okay. Meanwhile, the baby that Sarah caught needed a tiny bit of help to get going, but not a full resuscitation. We certainly had our hands full.
Just as we were recovering from all of this, a woman was carried into the ward, wrapped in blankets. A different woman who had birthed 15 minutes before was told to vacate her bed to make room for the new arrival (did I mention it turned out to be a busy day?) and it was clear that the woman who had just arrived was having a severe antepartum hemorrhage, which we suspect was from a placenta previa (a low placenta that covers the cervix). Her blood pressure had tanked, her pulse was through the roof, and Angela and one of the local midwives had quite the time starting IVs to replace her blood volume. There was no fetal heartbeat, and the woman’s relatives were sent out to buy blood for transfusion. We were asked to be in the OR for resuscitation, but the surgery was delayed; the woman’s relatives had to go out to buy suture materials, alcohol (for disinfectant), and other materials, and the anesthetist had to arrive. Bleeding this severe would be in the OR within minutes in Canada, so it was very difficult to watch and wait, yet again, for necessary treatment, as a result of lack of resources. By the time we headed home, two hours later, the woman still hadn't been moved to the OR. Can you imagine delaying an emergency cesarean to send a woman’s husband or sister off to buy suture materials and disinfectant for her surgery?
While we were waiting, Lyanne had a quick catch of a healthy baby and Sarah was 2nd attendant; everything went very smoothly, except that again we had to rush the woman up and out of bed to make room for someone else. It was good to leave on a happy note after a normal birth, and we barely had time to get dinner before dark.
On another happy note, our dinner was truly spectacular. We bought lentil samosas, rolexes, and tomatoes from street vendors just outside the hospital grounds; our dinners cost less than $2.50 each for plenty of food.
We have tomorrow and Sunday off – hopefully this will give us time to finally upload some photos from our adventures. :)
TGIF!
It's Friday. We got to the hospital early, Carolyn caught the baby of one of the waiters at the Zebra. Or more precisely, Carolyn caught the rest of the body as the head was already out when she came into the room. Unfortunately, yet another still birth, a baby that had died several days earlier, and finally one healthy normal birth. We finished at 12:30 today so we could go to the weekly market.
First we stopped by the Zebra and experimented with mixing Nile beer (a barley, maize and hops beer) with Stoney (a local gingerale)- it was delicious! Then we headed into town.
We first walked around Masaka on a Sunday and it was like a ghost town. Today it was full of life and colour and sounds and smelled like dried fish! The market is a large, square walled area with shops around the perimeter and inside. People were selling sandals, shirts and pants, bras, produce, pots and pans, dried fish, gourds and pottery ware, dresses and skirts. Carolyn and I bought some fruit for our bus ride to Mpanga Eco Reserve tomorrow and we each bargained for two dresses. A little girl took Alix's hand at the fruit stand and was very curious about her white skin and the tattoo on her wrist. We took a photo of her and showed her the photo on our screen- her family explained it was the first time she has seen what her face looks like. The colours were beautiful and the choas was wonderful and comforting. Again we are surprised by the variety of greetings we receive here- one woman knelt to touch our feet today while others glare. We both made sure to kneel likewise! Our photos will probably describe the experience better than words.
Back to the hotel for a shower and to change into a dress- we were told we look very smart. Another stoney/nile and Benon, the owner of the Zebra, played a game of bananagrams with us and then we moved on the spite and malice (a card game). A bite of dinner. Tomorrow we will catch a bus out to the Mpanga Forest Eco Reserve and we will return Sunday.
First we stopped by the Zebra and experimented with mixing Nile beer (a barley, maize and hops beer) with Stoney (a local gingerale)- it was delicious! Then we headed into town.
We first walked around Masaka on a Sunday and it was like a ghost town. Today it was full of life and colour and sounds and smelled like dried fish! The market is a large, square walled area with shops around the perimeter and inside. People were selling sandals, shirts and pants, bras, produce, pots and pans, dried fish, gourds and pottery ware, dresses and skirts. Carolyn and I bought some fruit for our bus ride to Mpanga Eco Reserve tomorrow and we each bargained for two dresses. A little girl took Alix's hand at the fruit stand and was very curious about her white skin and the tattoo on her wrist. We took a photo of her and showed her the photo on our screen- her family explained it was the first time she has seen what her face looks like. The colours were beautiful and the choas was wonderful and comforting. Again we are surprised by the variety of greetings we receive here- one woman knelt to touch our feet today while others glare. We both made sure to kneel likewise! Our photos will probably describe the experience better than words.
Back to the hotel for a shower and to change into a dress- we were told we look very smart. Another stoney/nile and Benon, the owner of the Zebra, played a game of bananagrams with us and then we moved on the spite and malice (a card game). A bite of dinner. Tomorrow we will catch a bus out to the Mpanga Forest Eco Reserve and we will return Sunday.
 |
| The market, where you can get almost anything. |
 |
| She totally hammed it up for the camera :) |
 |
| Holy cow- it's as big as a horse! |
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| Glad I'm vegetarian |
Thursday, 2 June 2011
Today Carolyn was an IV Queen
Today we were grateful for a slow start and a very clean and organized delivery room. With the extra time Cathy taught us how to do pelvimitry. Pelvimitry is measuring the pelvis. It is a lost art in Canada because it is rather unnecessary and somewhat inaccurate- most Canadian woman have an adequate pelvis and a trial of labour is the best test of a pelvis. However, here in Uganda women can have small or mishapen pelvis' due to malnutrition and childhood diseases. The first woman Cathy and Carolyn examined had such a pelvis and was waiting for a cesearean.
Carolyn caught a baby born to a woman suffering from acute malaria- she was thin and feverish. She had had a retaind placenta with her first birth so we had an IV set up and a bag of oxytocin waiting- good thing because she had a hemorrhage which Carolyn managed with a calmly and efficiently.We were worried about her baby but it was well- still, we sent it to the nursery for observation.
The second birth was a teen woman, first pregnancy with symptoms of an STI and a boderline pelvis who had been stuck at 5cm for 36 hours. The doctor broke her waters and suggested a little oxytocin. Two hours later she was fully dialated. She had a nice slow crown then a massive postpartum hemorrhage (1.6L). Alix quickly checked for tears (none), removed clots, Carolyn examined the placenta (it was all there) and then Cathy put up an IV with oxytocin. Next Carolyn gave an injection of ergometrine, Prossy gave misoprostol sublingually, Prossy set up a 2nd IV and drew blood to determine blood type. All the while Alix compressed the uterus with one hand in and one hand out. She still bled. Finally Cathy remove some clots from inside the uterus and the bleeding stopped. We ran through every postpartum hemorrhage management step.
Two more deliveries- both rather straight forward and we were done!
We have learned that whatever we study or review the night or morning before happens on the next shift. This morning Alix mentioned that she had gotten the postpartum hemorrhage meds wrong on the exam and Cathy warned- "now we will have a PPH" and we did. The same thing happened with breech and resuscitation! Tonight I think we should review normal birth but Cathy just mentioned abruption...
We are planning a half day tomorrow and then we want to go check out the weekly market- hopefully it will happen beause tomorrow is martyrs' day- a national Christian holiday. Last week when we were at the Equator we saw people walking on a pilgrimage to Kampala for martyr's day. It's a long walk, and it's especially long without proper shoes and baskets on your head.
Posted by Carolyn and Alix
Carolyn caught a baby born to a woman suffering from acute malaria- she was thin and feverish. She had had a retaind placenta with her first birth so we had an IV set up and a bag of oxytocin waiting- good thing because she had a hemorrhage which Carolyn managed with a calmly and efficiently.We were worried about her baby but it was well- still, we sent it to the nursery for observation.
The second birth was a teen woman, first pregnancy with symptoms of an STI and a boderline pelvis who had been stuck at 5cm for 36 hours. The doctor broke her waters and suggested a little oxytocin. Two hours later she was fully dialated. She had a nice slow crown then a massive postpartum hemorrhage (1.6L). Alix quickly checked for tears (none), removed clots, Carolyn examined the placenta (it was all there) and then Cathy put up an IV with oxytocin. Next Carolyn gave an injection of ergometrine, Prossy gave misoprostol sublingually, Prossy set up a 2nd IV and drew blood to determine blood type. All the while Alix compressed the uterus with one hand in and one hand out. She still bled. Finally Cathy remove some clots from inside the uterus and the bleeding stopped. We ran through every postpartum hemorrhage management step.
Two more deliveries- both rather straight forward and we were done!
We have learned that whatever we study or review the night or morning before happens on the next shift. This morning Alix mentioned that she had gotten the postpartum hemorrhage meds wrong on the exam and Cathy warned- "now we will have a PPH" and we did. The same thing happened with breech and resuscitation! Tonight I think we should review normal birth but Cathy just mentioned abruption...
We are planning a half day tomorrow and then we want to go check out the weekly market- hopefully it will happen beause tomorrow is martyrs' day- a national Christian holiday. Last week when we were at the Equator we saw people walking on a pilgrimage to Kampala for martyr's day. It's a long walk, and it's especially long without proper shoes and baskets on your head.
Posted by Carolyn and Alix
Mbale continued...
Phew!
We have spent three days in Mbale now, and I’ve seen more in three shifts here than I likely would in three months in Canada. For example, today began with a review of the past 24 hours in LDR and postpartum. A representative from each ward was present, and negative outcomes were reviewed. We learned that a woman had come into labour and delivery an hour and a half before with a prolapsed cord, but as the operating theatre, and in fact, the entire hospital, had no suture material in stock, she had not been prepped and sent in for cesarean and was still labouring. Angela dashed back to our dorm, two minutes away, and brought back all the suture material that we had brought from Canada. Lyanne, Angela and I then prepared to go into the OR and resuscitate the baby. Protocol is slightly different in the ORs here – they have no booties to cover our ward shoes, so we were first directed to change into open-toed sandals (pink for me, brown for Lyanne) to wear into the OR. In the end we found enough mismatched white gumboots to go around, and entered the OR in those.
When the baby was delivered, it had no heartbeat. We went through NRP protocol and attempted to resuscitate the baby with positive pressure ventilation and chest compressions for twenty minutes, but unfortunately we were unsuccessful in bringing this baby around. As we left the OR and weighed baby and began to debrief the experience, we noticed another woman pushing. It was her third baby, so I donned my double pair of gloves and Lyanne rushed around as second attendant, finding oxytocin, blankets and instruments. Just as the baby was about to be born, however, Lyanne was called to another delivery. Angela took over as second for me, and had just enough time to do the same for Lyanne when her client delivered ten minutes later. Thankfully both women birthed easily and both babies were healthy.
Not very much longer, a woman who was having her fourth baby began to sound pushy. Although she was not fully dilated, she could not control her urge to push. Knowing the risk of cervical swelling and cervical tearing if a woman pushes on an undilated cervix, we tried all our midwife tricks to dilate the rest of the cervix and decrease her urge to push. In the end, she pushed out her baby on a cervix which was dilated only to 8cm. Baby was born followed by a big gush of blood which had us all alarmed about a potential cervical tear and PPH. Thankfully, we were able to staunch the bleeding, and on examination the cervix, while certainly not fully dilated, was not torn. Baby and mom were absolutely fine. I believe it was at this point that Angela and I looked at each other and burst into laughter – half from relief, half from incredulity. One of the student clinicians came up to me afterward and said, “Sarah, I think you are very bizarre. Also, I think you should teach us clinicians your skills.” And I thought to myself – bizarre and skilled, maybe I really am on my way to becoming a midwife!
We were to have three more deliveries that shift. Two vacuum deliveries followed, the first straightforward, the second devastating. The second mother had a placental abruption, and baby was born still. Lyanne and I attempted to resuscitate baby, but as with the baby earlier that morning this baby never had a heartbeat. Meanwhile, the mother went on to have a very serious postpartum hemorrhage, and ended up with a hysterectomy. I have no idea whether this woman had previous children, but my heart breaks for her – to lose a baby and then lose your uterus is tragic indeed. The final birth of the day occurred amid all the craziness from the second vacuum delivery. We heard someone call “masow!” (doctor) and turned to see a woman who had just birthed a crying baby girl on the bed. Once again, we saw the contrast between an incredibly straightforward, normal birth (no midwife required!) and a devastating, dangerous birth for both mom and babe. A wise woman told me before I left Canada that my trip to Africa would teach me more about death than it would about life, and I am trying to take these lessons to heart. Right now, my mantra seems to be “trust birth, but don’t take it for granted.”
Despite the craziness, the heartbreak, the tragedy, I find myself loving my work here more and more every day. I get laughed at for my ‘post-birth highs’ – the adrenaline rush is only magnified when you are at six births a day. Even better, I know that my skills are improving with every birth, and I’ve been able to pass on some small pieces of knowledge to the others who are working here – in particular the student clinicians, who seem to get little if any one-on-one instruction. I’ll be the first to admit I began this Ugandan adventure with no small amount of trepidation, but I feel more comfortable, confident and competent every day (Angela refers to me on the ward as being ‘in there like a dirty shirt’ – I’m not quite sure what that means but I’m taking it as a complement). In conclusion, life is beautiful, life is tragic, life is complicated, and here in Mbale life is anything but monotonous.
We have spent three days in Mbale now, and I’ve seen more in three shifts here than I likely would in three months in Canada. For example, today began with a review of the past 24 hours in LDR and postpartum. A representative from each ward was present, and negative outcomes were reviewed. We learned that a woman had come into labour and delivery an hour and a half before with a prolapsed cord, but as the operating theatre, and in fact, the entire hospital, had no suture material in stock, she had not been prepped and sent in for cesarean and was still labouring. Angela dashed back to our dorm, two minutes away, and brought back all the suture material that we had brought from Canada. Lyanne, Angela and I then prepared to go into the OR and resuscitate the baby. Protocol is slightly different in the ORs here – they have no booties to cover our ward shoes, so we were first directed to change into open-toed sandals (pink for me, brown for Lyanne) to wear into the OR. In the end we found enough mismatched white gumboots to go around, and entered the OR in those.
When the baby was delivered, it had no heartbeat. We went through NRP protocol and attempted to resuscitate the baby with positive pressure ventilation and chest compressions for twenty minutes, but unfortunately we were unsuccessful in bringing this baby around. As we left the OR and weighed baby and began to debrief the experience, we noticed another woman pushing. It was her third baby, so I donned my double pair of gloves and Lyanne rushed around as second attendant, finding oxytocin, blankets and instruments. Just as the baby was about to be born, however, Lyanne was called to another delivery. Angela took over as second for me, and had just enough time to do the same for Lyanne when her client delivered ten minutes later. Thankfully both women birthed easily and both babies were healthy.
Not very much longer, a woman who was having her fourth baby began to sound pushy. Although she was not fully dilated, she could not control her urge to push. Knowing the risk of cervical swelling and cervical tearing if a woman pushes on an undilated cervix, we tried all our midwife tricks to dilate the rest of the cervix and decrease her urge to push. In the end, she pushed out her baby on a cervix which was dilated only to 8cm. Baby was born followed by a big gush of blood which had us all alarmed about a potential cervical tear and PPH. Thankfully, we were able to staunch the bleeding, and on examination the cervix, while certainly not fully dilated, was not torn. Baby and mom were absolutely fine. I believe it was at this point that Angela and I looked at each other and burst into laughter – half from relief, half from incredulity. One of the student clinicians came up to me afterward and said, “Sarah, I think you are very bizarre. Also, I think you should teach us clinicians your skills.” And I thought to myself – bizarre and skilled, maybe I really am on my way to becoming a midwife!
We were to have three more deliveries that shift. Two vacuum deliveries followed, the first straightforward, the second devastating. The second mother had a placental abruption, and baby was born still. Lyanne and I attempted to resuscitate baby, but as with the baby earlier that morning this baby never had a heartbeat. Meanwhile, the mother went on to have a very serious postpartum hemorrhage, and ended up with a hysterectomy. I have no idea whether this woman had previous children, but my heart breaks for her – to lose a baby and then lose your uterus is tragic indeed. The final birth of the day occurred amid all the craziness from the second vacuum delivery. We heard someone call “masow!” (doctor) and turned to see a woman who had just birthed a crying baby girl on the bed. Once again, we saw the contrast between an incredibly straightforward, normal birth (no midwife required!) and a devastating, dangerous birth for both mom and babe. A wise woman told me before I left Canada that my trip to Africa would teach me more about death than it would about life, and I am trying to take these lessons to heart. Right now, my mantra seems to be “trust birth, but don’t take it for granted.”
Despite the craziness, the heartbreak, the tragedy, I find myself loving my work here more and more every day. I get laughed at for my ‘post-birth highs’ – the adrenaline rush is only magnified when you are at six births a day. Even better, I know that my skills are improving with every birth, and I’ve been able to pass on some small pieces of knowledge to the others who are working here – in particular the student clinicians, who seem to get little if any one-on-one instruction. I’ll be the first to admit I began this Ugandan adventure with no small amount of trepidation, but I feel more comfortable, confident and competent every day (Angela refers to me on the ward as being ‘in there like a dirty shirt’ – I’m not quite sure what that means but I’m taking it as a complement). In conclusion, life is beautiful, life is tragic, life is complicated, and here in Mbale life is anything but monotonous.
Wednesday, 1 June 2011
We're tired too.
Everyone here speaks Lugandan to one another.
And yet,
All of the signs
and all of the paperwork
are in English.
Posted by Lyanne
And yet,
All of the signs
and all of the paperwork
are in English.
Posted by Lyanne
Questionning
We left work feeling so drained today. Every woman on the ward today was birthing for the first time, and aside from one of them, they all had difficulties: 3 babies needed resuscitations, one woman needed a vacuum, another needed an episiotomy (that baby is in the nursery) and unfortunately, there was another stillbirth that had died in utero days before. This baby delivered breech, feet first, and Alix had to be very careful when catching this baby as stillbirths are very fragile. The mom didn't know that the baby had died and Cathy had to tell her. Her grief was hard to watch.
Yet, other days have been equally challenging and so we wondered, why was today so difficult. After some reflection, we think that it is a growing awareness of what are roles are here, and how we impact and don't impact others. Yes, our presence here is making a difference, but only while we are here. We most certainly get more out of being here than they get out of us being here. As students, this is just the reality, we're not putting ourselves down. And we think that even as practicing midwives, this wouldn't be any different unless we did what Cathy and Micky do: educate and provide training to local midwives so that these midwives can teach others in their community. That is what creates long-lasting change.
And then there is the lack of resources. This was never so obvious than today. We worked all day with no sterile instruments. We had to use razor blades to cut the cord, and no clamps before tying off the cord. A woman had to wait for hours to get sutured because there were no sterilized instruments.
The charming owner of the Zebra jokes with us that we should marry his brother- he says that engagements can be broken and marriages don't count until a heir is produced. And apparently we appear to be between the ages of 17-22. His humour is welcome at the end of the day.
Yet, other days have been equally challenging and so we wondered, why was today so difficult. After some reflection, we think that it is a growing awareness of what are roles are here, and how we impact and don't impact others. Yes, our presence here is making a difference, but only while we are here. We most certainly get more out of being here than they get out of us being here. As students, this is just the reality, we're not putting ourselves down. And we think that even as practicing midwives, this wouldn't be any different unless we did what Cathy and Micky do: educate and provide training to local midwives so that these midwives can teach others in their community. That is what creates long-lasting change.
And then there is the lack of resources. This was never so obvious than today. We worked all day with no sterile instruments. We had to use razor blades to cut the cord, and no clamps before tying off the cord. A woman had to wait for hours to get sutured because there were no sterilized instruments.
The charming owner of the Zebra jokes with us that we should marry his brother- he says that engagements can be broken and marriages don't count until a heir is produced. And apparently we appear to be between the ages of 17-22. His humour is welcome at the end of the day.
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