One month in, our thoughts so far...

So we have been in Uganda for one month, which is hard to believe. Between the four of us we have caught 99 babies. We have experienced:
-8 sets of twins, one face presentation, one shoulder presentation and seven breeches (not to mention lots of post-partum hemorrhages, shoulder dystocias and resuscitations)
-babies with cleft lip and palate, ambiguous genitalia, spina bifida and polydactyl (more than 10 fingers and toes)
-moms who seized from high blood pressure
-and mostly, we have had moms who have birthed their babies without ANY complications

Our favorite moments have been (besides talking with our families):

-a mom with a baby with cleft palate who we worried wouldn’t bond with her baby and she loved that baby so much
-when Grace (our preceptor) had her finger sucked by a baby in utero (inside the mom) which made her scream
-working for 2.5 hours and delivering 12 babies in that time
-walking into a room to catch a baby, deliver a placenta and chart (while standing up, holding a b.p. cuff and other supplies) without even thinking about it


Our hardest moments (besides missing our families):

-unnecessary episiotomies (cuts to the woman’s perineum) for 4 out of 5 births in one day (not done by us of course)
- being unable to get the arms down for a breech baby that when he was finally born never had a heartbeat and wouldn’t come around no matter what we tried
-a 15 year old GIRL labouring in a blue flowered dress, scared and alone
- anytime I found a baby who didn’t make it (or a row of them on a cart)
- every mom trying to get through childbirth with malaria and/ or HIV


Our funniest moments:

-almost missing the plane in London because we needed “one last glass of wine”
-loading 11 bags, 5 carry-ons and 6 people into one “rickety van”
-discovering a breech by the preceptor pointing out the meconium (baby pooh) on my glove
-a breech that literally “flew out”


Favorite food:
-the first night of buffet at the Zebra

Worst food:
- the last night of the buffet at the Zebra

... see you in 2 weeks... xoxoxox

Carole, Jody, Sarah and Tina

African Directions - From the Zebra to the Danish NGO

From the top of the hill, look down across the pasture and over the road. See the big building with all the scaffolding. Look past it to the building with the red roof (most of the buildings have red roofs). Turn right onto the path where you see the long horned brown cow with 2 white birds. Walk down that path until you see the wall covered with the beautiful bouganvillea (most of the walls have bouganvillea). The Danish NGO is right across from that wall. Stand outside the gap in the fence and read the sign that says "Uganda Child Care", decide it's not the right place, return to your hotel and try again. Oh and by the way, it's not actually called the Danish NGO. Hope to see you there!

Tina and Jody

Two funny posts: I am so sorry and "hair" conditioning

I am so sorry

This may be the main catch phrase that we pick up from our time in Uganda.
The Ugandan people are so empathetic to clumsy people.

Like me, who missed a step entering a room and the Ugandan women who watched me spectactularly arrive, said, “oh, I am SO sorry.” They seem very very very sorry. Not just sorry that I am so clumsy, but like they are apologizing on behalf of the shoddy construction or that the architect that could have designed such a dangerous step. [Carole told me she missed the same step entering the same room]

Or, like the time that our uniforms weren’t ready in the morning for us to go to the hospital and the “concierge” guy at the hotel looked completely stricken and went “oh, I AM SO sorry. It has rained.” ....looking totally stricken..... “It must have rained on them on the line.” .....looks like he might cry.... “Oh, sorry, so sorry.” [exactly in the tone that you might use if someone’s gramma died].

The response from us is always. “Oh, it’s okay. Really. It’s okay. We’ll figure it out...” [please don’t cry].

Getting –hair- conditioned

So, my hair is getting really out of hand in Kampala. Surprise, surprise. Note to any strangers: I have (the potential for) CRAZY hair. My hair also hated Prince George. Kampala and Prince George. GO figure.

So Carole and I walked to the Mulago Hospital in Kampala one morning and I swear my shadow looked like Animal from the Muppets! Seriously. Boing boing boing.

Which I was okay with, as on the wards I wear my blue bandana. It calms the hair and absorbs the copious sweat. Bonus!

Carole and I had long talks making fun of my hair. She gave me professional advice.
Then, the funny thing was when Cathy spontaneously told me that she had hair conditioner that I could borrow. Poor Cathy, as Carole and I broke down into gales of laughter. Then, the next morning, I opened the door and the hair conditioner was perched perkily on our stoop.

So, I did actually condition my hair on separate days with both Cathy and Carole`s conditioner.
Then Carole looks at me, sighs and says ``you know what, I actually think you need hair products!``

In The Eye of the Storm

Jody, Grace and I left Masaka today to return to Kampala. Grace and I decided to spend a late afternoon shift on Lower Mulago in Kampala. We arrived on the Ward at about 3:30 pm, changed into our white uniforms, loaded up our pockets with gloves and supplies and headed to the labour room. We arrived in time to see one baby lying on a bed in a pool of amniotic fluid. There was a first year medical student, Paul, standing there. It was the first birth he had seen. The Sister was cleaning up and welcomed us. Twenty minutes later, we had our first birth. Twenty-five minutes later, we had our second birth. In the next thirty minutes, we had 3 more births. There are only 6 beds in this ward. We had forced one mom off a bed to put another mom on it who was actively pushing her baby out. The mom we had asked to move was now standing at the base of the bed, delivering her baby. We barely caught that baby. We were ripping the tops off our gloves to try to tie umbilical cords and rushing for oxytocin to prevent post partum haemorrhage. Barely ten minutes after the mom birthed standing, another mom called us from the door. Before we could reach her, with a sickening thud, her baby was expelled onto the floor. The cord tore. I grabbed onto the placenta end of the cord while Grace grabbed the baby and Paul ripped the top off his gloves so Grace could tie off the little bit of cord left attached to the baby. Then, I delivered another baby while Grace caught the first of a set of twins. I caught the second twin, a footling breech ( feet coming first) baby. Another mom was birthing in the hall. Two moms needed suturing. Another mom was bleeding. I caught a little preemie that only weighed 1.9 grams. We barely got him breathing when we were called to another bedside. We finally had to leave. It was getting dark outside, 6:50 pm. There had been 12 babies born in under 2 1/2 hours. We knew no mothers' names. We left with more babies coming. It was a storm.

Tina

A week in Kampala

Carole and I had a good week in Kampala. We worked at the Emergency Skills Workshop Monday and Tuesday. It was fun to be involved in the teaching and PPH demonstration with plastic torsos and water and red colouring. It is amazing how many people underestimate blood loss, which is profound in what could be an unhealthy, anaemic mother.


We attended 9 births this week. Carole and I alternate births whenever possible, being the super awesome 2nd attendant for each other. It is amazing how quickly your mind organizes and prioritizes. We are both getting fast at anticipating each others needs.

I am "improving" my IV skills and Carole is getting super duper awesomely quick and speedy. And I am hardly jealous at all because she just slides that IV in on my PPH mama.

We have met. again, more lovely Ugandan moms and bright eyed babes. Cathy could be a hockey goalie with her sliding in to catch the babes coming on the floor.

We are all together now in Kampala. So more adventures to come.

xo

One Moment of Pain

Jody and I arrived on the ward at Masaka Hospital Tuesday morning. There on the shelf were the wrapped bodies of 3 babies that had died. One was wrapped in paper, a tiny premature infant that had been there since the weekend. The other 2 babies were wrapped in beautiful cloths. One mother was sitting in absolute silence on her bed. Two young dads quietly entered. They had each come for their wife and their baby. They were both so very thin, their clothes hanging on them. They each took their wrapped bundle, tenderly placed their baby in a suitcase and zipped it closed. I felt an overwhelming moment of absolute sadness at the personal tragedy happening in front of me. I carefully opened the door so they could leave the ward. They thanked me for opening the door. I nearly cried.


Tina

There's a hippo outside our tent!

Jody, Grace (our preceptor) and I were camping on the shoreline of Lkae Mburu, the smallest National Park in Uganda. We had come for a 2 day, 1 night mini safari. We had already had a game drive and seen zebras, antelopes, impalas, Cape buffalo (mean nasty beasts that charge you if you get too close), monkeys and bush bucks. And oh yes, wart hogs. Think The Lion King and Pumba and you have it. So ugly they are cute, many needing a hairdressing appointment, warthogs. Hundreds. Loved them. We had also been on a boat trip and seen dozens of hippos and 2 five metre long crocodiles. We were wakened Sunday morning by an animal of some kind snorting, snuffling and booming outside of our tent. "That's a wart hog isn't it?" we asked each other. "Yeah" we agreed and drifted back to sleep. Minutes later Grace hollered "Get up, there are hippos!" Sure enough, a herd of young male hippos had been grazing around our tents and were currently in the water playing with each other. It is hard to describe what it is like watching giant beasts play with each other, but playing they were!

Tina

A day in our life in Uganda

Tina and I have spent all of our time together in Uganda so Carole and Sarah may have a different take on their average day. But to give you a sense of what we are up to with our time, here is a typical day for midwifery students volunteering in Uganda.

0645 – the alarm on Cathy’s cell phone, which we borrowed to call home, rings. We curse the alarm that won’t stop ringing. We vow, as we do each morning, to get Grace to fix it and lay there listening to the sound of the broom sweeping outside our window.

0715 – get dressed and bags packed, head outside to breakfast – white toast (no butter), bananas and a boiled egg. In Masaka, subsitute scrambled eggs and potatoes with green peppers and onions plus Matooke (cooked green banana) with last nights leftover beef mixed in. Instant coffee is available, we opt for African tea and add an extra tea bag.

0745 – enjoy the fresh pineapple and remember to take malaria prevention medication but sip African Tea instead.

0815 – leave for the hospital, arrive very sweaty and start in the ward at 0845 for ‘handover’, hope there are no major complications that day and no stillbirths in the night. Greet our fellow students and the midwives with 'Wasu zo tya Nyabo' - make them laugh at us with our funny words.

0845 – look in the supply cupboard to see what they have for the day, clean up the sharps left in the beds, on the floors, in the sink. Wash the beds and get ready for whatever will come, usually one or two births by noon.

1145 – clean up after the births by dumping the heavy black plastic from the bed into the garbage, clean the plastic for the mom to reuse with bleach called Jik with a tiny piece of cotton or if we can find one - a luxury most days - a rag. Dump Jik on the floor and sweep it into the gutters that line the room. Send our moms to post partum and hope they don’t ‘escape’ and go home instead.

1200 – check in the early labour room to see how many mothers are waiting and what stage they are at, chart assessments and get ready for more births.

1400 – bathroom break and a few sips of water (sometimes).

1500 – start thinking about leaving, make a plan to leave but get caught up in another birth.

1700 – leave the hospital, walk ‘home’ and either stop at the internet place hoping it will be working or just go home to eat dinner (since we never get to eat lunch), one of us can call home.

1900 – have 1 beer on the deck (Tina won’t let me have a 2nd) talk about the day and then go back to our rooms to shower, hand wash our clothes from the day and hang them to dry. Try not to slip on the wet floor.

2000 – sort and pack the supplies for the next day, write in our journals and record our births. Tina wonders if she took her anti-malarials. Reflect on the day, the babies that needed our help, the strength of the mothers and the differences between here and home.

2015 – read our books with our headlamps on (I am in LOVE with my headlamp), the music starts outside, complain that we’ll never sleep. Fall asleep two minutes later to dream of the next day…

Jody

What to talk about

Sometimes it is hard to think of what to blog or to journal or what to talk about on the phone.
This is because there are so many wonderous and painful and heartbreaking and joyful and funny and colourful moments in every second of time here.

In my almost 3 weeks here (and less than 3 weeks on the wards) I have attended 29 births. I have almost passed my Canada birth numbers.

More than that, we have used almost all our emergency skills (except for that one that will not be named because we don’t want to jinx ourselves). We have dealt with severe PPH, each done bimanual compression, removed clots, assisted/observed manual removal of the placenta, delivered stillbirths, done PPV, dealt with shoulder dystocia, delivered breeches, delivered twins, supported moms who are HIV + , have malaria, gone to “theatre” (the operating room) to do rescusitation, and we have sutured a few tears (while learning great ways to reduce the risk of tears!!).

I have assisted with surgery for an ectopic pregnancy, I have taken complex health histories cross-culturally (with translation from the Jinja midwifery students), and I have kept cool in the intensity of dealing with loss. I have also experienced very sweet moments of connection with moms and babes.

I have worked with 3 awesome classmates, 4 amazing Canadian preceptors and many, many amazing Ugandan Doctors and midwives and students. They have all taken time to teach and share and learn and laugh and sometimes cry. But also, have taken the time to connect. I feel like the reality of this placement forces you to step up and take on your role, as midwife, to safely and respectfully and carefully support each mom through labour and through a time that she fears in a very profound way. Because she knows that taking this journey could mean she could die or her baby could die. And to see, first hand, that lack of resources means loss of life, in a very real way, everyday for women in Uganda. And to see, first hand, how hard they try to save lives with very little.
I am in awe of the health care professionals that do this everyday here. I am in awe of the women who carry themselves with such grace through the pain of labour and childbirth and poverty.

Thank you.

A rare and lovely day.... off

Carole and I are having a rare and lovely day off. So we slept in – ish – although carole was up at 6:00am!

I ate a quick breakfast (Carole and I got an offer by the hotel owner to be fixed up with his brothers and had to disappoint him with our unmarriagable status) and then I hand washed my laundry. We walked to town and to the bank. We love the bank because it has a “sindica” sign on the door, translating to “push” and this is the lugandan word we are quite familiar with in our work. (along with “to sindica” [don’t push] and “wega wega” [pant])

The bank was packed on a Saturday morning, so we decided to just head onto the internet cafe to wait for Cathy and Prossy (our Ugandan midwife friend) and Irene (our Zambian nurse-midwife friend). We paid $1000 shillings for 22 minutes of internet time (about .50 cents US) and checked our e-mail.

Then, Cathy, Irene and Prossy arrived and we CROSSED THE BUSY STREET (which we have never done) and went down crumbling concrete stairs and through a narrow alley to the market area. We have been here almost 2 weeks and had never ventured in that area. It was full of colours and so many stores selling cloth and caftans and scarves and sandals and many, many places selling very frilly little girl dresses. Prossy helped with the prices, because no prices are actually attached to anything. There was much negotiation . Prossy also held my hand to cross the streets, taught me how to hide my money and took Carole’s pulse when we commented on how tired Carole seemed.

A little girl (about 3) came running up to me with total delight on her face and I thought she was going to jump in my arms. She was so happy to see me, it was kind of like when my daughter Hannah sees the A&W Rootbear Mascot at the Billy Barker Day’s parade. This was somewhat more fun of an experience than yesterday evening (we were so tired after our day at the hospital), when a group of school children pointed and laughed at us trudging up the hill to the hotel and the guys on bicycles at the top applauded when we made it to the top. Har har. But like I said to Jody, we are funny looking.

You have soiled yourself.

So - yes - I have soiled myself. Did a crazy delivery and you get the baby out and you get the sharps put safely away and you give a healthy baby to a relieved mom. And then, as I run to chart, a sister says to me 'ah, you have soiled yourself! You clean up!' - meaning I had a speck of blood on my knee.

Never, never soil yourself. Very frowned upon. As are panty lines! I thought the baby delivery was an accomplishment, but the true, TRUE accomplishment is a usual human messy delivery where you magically retain a spotless white uniform. So, today, I delivered a breech first twin and then Carole delivered the 2nd breech twin, and I delivered-ish the twin placentas. and was spotless!!! Yay. A good day. I did not 'fail.'

Busy Day's

This week in Masaka has been crazy. Not busy with lots of births but busy with multiple births. Monday this week I had a mom deliver her baby, and lucky Cathy noticed that the baby was smaller than expected, and she said "Dont give the oxytocin!" There was a twin! So I got to deliver my first set of twins. First was a lovely little boy weighing around 2.3kg and the second was a girl weighing about 2.8kg, both cephalic. Both were in good condition.
Then the next day (Tuesday) we had a mom transfer in who had travelled in from 1.5hrs away and the first twin had delivered in the taxi (who did not make it) then the second was retained, when she arrived at the hospital. We attended to her quickly. She was breech. So Sarah and I helped Prossy deliver the breech, which then need Neonatal rescesitation, PPV for 15 min, that I and Prossy did together. Finally the baby came around and breathed on its own. Thank God!!
Yesterday, we had a mom come in that I was attending to she was a Gravida 8, Para 7 I thought the baby would fall out when she sneezed. It did not, strange. On my first vaginal exam I felt a head, on the next a few hours later I felt lots of lumpy bits. So I asked Grace to come check because I could not figure out the presenation. She checked and checked and checked and could not be sure. So we let her go for a little while longer and then Grace checked again and while she was doing the vaginal exam, she jumped, pulled her hand out and squealed. I was shocked thinking what the heck did she do that for and the mom was somewhat shocked. Then Grace explained the baby just sucked her finger through the amniotic sac! It was a face presentation. So we got one of Sarah's mini textbooks that she brings to the hospital (we love Sarah) and found out there was a chance the baby could be turned. So Grace searched for the OB to turn it. He told her to do it. So she did. It worked!!! We had to leave before the mom delivered but we found out today that she birth vaginaly, and Grace saved her from a C/S.
Today Thursday, I cut my first episiotomy, it was necessary. A 17 year old prima gravida, the baby was not fitting well, and it was a tight fit. We tried everything else. The episiotomy did the trick, and she had a SVD of a baby boy.
Then Sarah was attending to a mom who was HIV positive, and was a gravida 5. She was in a lot of pain, and needed a lot of support. Sarah did a vaginal exam and was not sure of what she was feeling. Grace looked at Sarah's glove and it had fresh meconium on it (very fresh). Grace say's that is a breech baby. So Sarah prepares for the delivery, while going over all the manuvers for the breech. The baby starts to deliver, and just falls out, plop! Grace say's wait...there is a second baby. We check and the second is also a breech. So I was able to deliver the second. The second did need the manuvers and we delivered two healthy babies, one girl and one boy. No rescess or anything. Wow, what an experience!
Carole

Escaping the Riot in Kampala!

So – we escaped from the riot in Kampala! It was the real thing – burning buildings, police, riot gear, people running, road blocks, thick black smoke. What was really crazy is that we actually missed the whole thing. Yup. Went to the hospital, did our usual catch a few babies thing, walked back home (we are actually calling the Modest Inn – home), packed up and hopped into our Matatu (big van that can seat around 14 people) for our trip to Masaka with our preceptors Angela and Grace. That is when we found out about the riot happening in the city. The most exciting thing about the riot for us is that we got to do this crazy detour. Our driver and our personal-door-opener took handfuls of change. Then they took us to this new, just finished road. It had about 7 different road blocks on its length. The road blocks consisted of logs with big spikes driven into them. Different people manned these road blocks. They each had to be bribed. Some with the coins, some with the information that the Matatu was carrying “white doctors that deliver babies”. Then Angela would gracefully stick her head with its lovely white hair out the window, wave elegantly like Queen Elizabeth and yell “Webale” (thank-you) at the road blockers. She got so carried away with her role that at one point she forgot what country she was in and yelled “Gracias”! We ended up detouring the riot and had a wonderful drive to Masaka. We stopped at the Equator so we could straddle the north and south hemispheres! I know it seems kinda silly, but it was actually pretty amazing! Now we help with the Emergency Obstetrical Skills Course (that teaches emergency obstetrics like haemorrhage, breech birth, neonatal resuscitation, etc) here in Masaka for the next 2 days before we start going to the Labour and Delivery ward here. Still can't believe that WE ARE IN AFRICA!!!

Jody and Tina

Last Day on Ward 14

We had our last day in Kampala on Tuesday because we are heading for Masaka to join the rest of the UBC group. We got a very special send-off. Two of the senior Ugandan midwives, Sisters Sarah and Florence, came to meet us when we finished changing. They called us “A-one professional midwives” and said we were "the liveliest” group they had ever had. Then they took our measurements (we guess they are making something for us). Then they took all our backpacks, bags and paraphernalia and insisted on carrying everything for us. They said that by carrying all our things it showed their respect for us and that it meant that we would come back! We are so very touched by what they did for us. We definitely plan to come back and spend our last week with them!


Jody and Tina

Water birth in Uganda

Yesterday we had a mom who was pregnant for the 7th time and had already birthed 6 children. In assessment she had been 6cm dilated and she proceeded to the labour ward where Sarah and I were waiting. I did my usual assessment, but I did not do a vaginal exam because she had just had one. I was later informed that she had HIV and she was very ill with some other illness that we were unsure of. Cathy did not want me to get too close because she was concerned she may hav Tuberculosis. So as I sat behind the curtain discussing TB with Micky I heard a grunt, so I got up and so did Sarah. I looked over Sarah's shoulder and saw the baby's head already born, and I pushed Sarah out of the way and yelled the baby is almost out and I have NO GLOVES ON!!! Cathy came running and helped pluck the baby out of the pool of amniotic fluid. Learning moment: don't leave a gravida 7 alone for a second!!!!!

Everyday is an adventure

Sarah and I have come to Masaka. Everyday we get up and head off to the hospital we wonder what we will encounter. So far we have attended to women living with HIV who are in labour. Many of these women are sick with other sicknesses as well. One mom also had Maleria and when the baby was born it was maserated, it was very sad. We have had 2 postpartum hemorrhages where we had to do bimanual compressions. Thank God Micky arrived with medications to help stop the bleeding. Some of these women may have died at home if they experienced the same amount of blood loss while being sick. We had the opportunity today to go to one of the local villages to meet some of the traditional birth attenants. They run a medical center with no gloves, no medications and no nomal saline or IV equiptment. These people need supplies. But they work without. It is unbelievale. Sarah and I have been resuscitating babies almost every day. Many midwives here have not been able to be trained in NRP, but things are slowly changing. We were on the ward in the hospital and there was no normal saline available to start an IV, we were thankful that no one was bleeding at that moment, otherwise things would have gotten scary. I am so impressed how the midwives here can work with so few supplies. They have about 2 maternal deaths a month in the hospital we are working in. We feel like we have been learning more in 2 weeks than we could learn in 1 year in Canada.

Our first week in Masaka

First of all, Masaka is BEAUTIFUL!!! Carole and I are good roomies, I think, and seem to work togther very well. I would have Carole as my 2nd attendant for life, if I could.

I am in charge of shushing loud people drinking late into the night, and Carole is in charge of organizing bags. That sounds about right.

I have been to 19 births in my 11 days here. I honestly feel like the experiences you have here are like a super condensed 2nd and 3rd and probably 4th year of midwifery school all in a week. This week we experienced all the grief and joy that pregnancy and birth brings. We attended two women who were losing their babies (24 and 28 week stillbirths). One of those moms was very, very sick with TRR (aka HIV +) and malaria.

We had a mom with TRR who had a severe post-partum hemorrhage so I was feeling the adrenaline and Cathy handed off the bimanual compression to me. So, double gloved and manual compression of the uterus. We had a bit of a sticky shoulder, but no shoulder dystocia this week (although I had that in Kampala, and it resolved with the disimpaction of the anterior shoulder). So we figure next week will bring some new emergency skill.

We had a baby with ambigious genitalia and some IUGR or preterm or "what exactly are your dates?" babies. We have been here to help some very young mothers deliver some very, very cute babies! And Carole had an exciting Gravida 7 that delivered very rapidly, but maybe I'll let her tell that one.

The midwives are very kind here, and let you be. Sometimes they think our slow delivery of the head is a problem and they want us to get the moms to blast the baby out. But we reassure that the heart rate is good and we slowly deliver the head. I am getting some amazing hands on training on slow slow slow delivery of the head and am VERY grateful to have it. Cathy and Mickey are very good teachers, generous with their time, patient and fun.

We are getting used to being Mzungus (non-africans) and Carole and I have each now made small children cry with our unexpected and scary pale faces.

I am so grateful to be here with these women and these teachers and these Ugandan health care professionals. I feel like I have grown and blossomed even in the short, short time I have been part of this world.

I will post when I can. I have taken like 500 photos but am having trouble with the time to post.

Yours,
Sarah

Hard Moments - Lovely Moments

As everybody already knows, birth can be quite a paradox, really hard stuff coupled with unbelievably joyous moments. On Ward 14 this week, we have had lots of both.

Yesterday, I walked into the same room where Jody had her undiagnosed twin birth the day before. This day there were 3 women on the 3 beds squeezed into a room that is about 5 feet wide by 10 feet long. The sun was pouring into the window. The woman on the farthest bed was pushing. I wasn't too sure what I was seeing, then realized it was a very swollen testicle - an undiagnosed breech baby (baby coming bum first). In Canada, with a first time mom, that usually means a caesarean section. Here it meant that the woman had to get up, make her way down the length of the ward and get to a bed where we could deliver the breech. The first part of the breech, came easily. With Angela's help I got the legs out and most of the torso. Then I couldn't deliver the arms. Jody was calling the time for us. You have 4 minutes to deliver a breech. Angela took over, and the Ugandan Midwives tried. But we couldn't get the arms out. For 6 minutes. Despite doing all the "right things". When we finally got the arms down, the head delivered easily. But the baby never took a breath, never had a heartbeat. Despite over 10 minutes of resuscitation by me and Jody including positive pressure ventilation and chest compressions, repositioning, checking equipment, repositioning, checking, checking, PPV, checking again. When we told the Mom, she wailed and wailed. Grief is the same everywhere. You just have to be there, keep holding on. We wrapped the baby and placed him where you place FSB (fresh still birth) babies. He was the second baby to be placed there since midnight. It was one of the hard moments.

And then today. Again, we arrived at Ward 14 and were changing when we heard the unmistakable sounds of women birthing their babies. We looked out our door and realized that two women were delivering in the hallway, with no one with them. Jody, Angela and I got our gloves on and went out. My mom pushed out her lovely daughter within 5 minutes. Baby breathed immediately, cried immediately. Mom cried too. Her first baby, last year, a daughter, had been one of the FSB babies. Today she got to snuggle down with her new little one, smiling her gratitude, the baby dressed in one of the beautiful sweaters someone in Canada knitted, swaddled in one of the lovely receiving blankets, holding onto a little doll that someone created. It was one of the lovely moments.


Tina

Where are we in Kampala?

So, it has taken me a little while, but I finally realized that we are actually living in a poorer area of Kampala. I figured that out when our driver - yes we have our own driver - took us to the post office, past the really fancy hotels and big beautiful homes. Hmmm. Maybe all the barbed wire and cooking fires - and just plain fires burning garbage on the corners - should have been a give away. Seriously, we do have barbed wire. But most of the barbed wire has absolutely gorgeous flowers growing all over it. And if the flowers are not enough, there are usually broken beer bottles artfully arranged and cemented down on top of the high fences. We do have a security guard (aka 17 year old with a rifle) at our iron gate. But, he has a great smile and has let us take his picture! The houses are mostly corrugated iron or brick. There are alot of people around, especially alot of young men on their boda-boda's (aka motorcycles) because there is a really high unemployment rate here - 80%, and they really stare at us when we walk by - not alot of white people here. HOWEVER!!!

Africa is a place of colour. Beautiful bold colours. Bright blue, yellow, pink, red, green. People wear amazing clothing. They paint their buildings amazing colours. There are wonderful animals everywhere. Dogs in the street, goats in the street, cows in the street, rats in the street. Some alive, some dead. And did I mention - people everywhere. And everyone we meet usually smiles at us. They laugh at our attempts to speak Lugandan. They encourage us to speak with them. They try to speak English back.

Jody and I usually wake up to clear skies, the sun rising and chanting from the large Mosque on the distant hill. Then the sky gets hazy as everyone starts their morning cooking fires. And it usually clears by the time we start our walk to the hospital. The scary young guys sitting on their boda-boda's now usually say hello and ask how things are at the hospital. We are getting more adept at leaping over the open sewage stream on our trek. Women at Ward 14 (Labour ward) smile and nod at us. They are happy to see us. We are happy to see them.

Africa is good!!!


From Tina

New blog with pictures for our kids

hey - make sure to check out http://ourmomisinuganda.blogspot.com/


We wanted to make a page where we could post more pictures for our kids. Between us we have 16 children!

So, check out our other page to see more of your mom's adventures not as related to birth.

Missing you,

Your moms

Surprise twin birth with almost no supplies

A week ago I could hardly believe I could attend a woman in labour without at least some medical supplies. What about the linens we use in Canada, the blue pads which we throw out mindlessly, the fancy doppler we use to hear the heartbeat every 5 minutes when pushing? But today I caught one of a set of twins (a girl) using nothing more than two pairs of gloves on, some cotton (think of a roll of cotton balls), one needle and syringe with Oxytocin and a razor blade to cut the umbilical cords. Oh and a fabulous preceptor who when I said : 'Angela the placenta is right there, I know I feel it but it won't come' she simply replied 'oh that because its a bum not a placenta' --- right then--- and calmly delivered the breech (bum first) baby boy.

We used, as we do for every birth, the edges of our gloves to tie the umbilical cords and mom's cloths for drying the baby. Mom was fine, fed the babies minutes later was up eating and walking within 30 minutes. We gave her some donatedblankets, lovely hand knit sweaters and dolls which she seemed to love.

The sad side of not having access to any medical supplies is that of course there are more deaths here than we have in Canada and I don't want to downplay the significance of seeing babies wrapped in their mother's cloths after passing away. I don't wish for us to celebrate using nothing at the expense of mothers and babies but to simply say birth is normal and happens. With or without a doppler and blue pads.

Margaret's birth and more

I had my first catch in Uganda yesterday. It was a lovely quick birth of a fourth baby for a Ugandan woman. His mom was Margaret and I was so pleased to be at her birth. The baby was a healthy 3.7 kgs! I was given the honour of naming the baby so I chose Francis after my dad who passed away over 10 years ago. I will post a picture as soon as I can.

Since yesterday I have also attended the delivery of very preterm twins and another healthy baby girl (4.0 kgs). These births were on the low -risk part of the high risk ward which does about 80 births a day. There is so much to write that I simply can not describe here but will carry with me for years to come.

Thank-you to all who donated hats and booties and baby blankets and other donations. The moms appreciate them greatly. They are particularly helpful when the mom has nothing with her. The supplies for the hospital have been essential to us being able to do our work. Thank-you to all!

Sarah's first birth

So - Jody and I went to Ward 14 with Cathy first thing in the morning. Wouldn't you know it - a woman was delivering right away. So I had a pretty quick orientation before gloving up! The woman was a first time mom and was so focussed and very sweet. Although pushing very hard, she always had a big smile in between contractions. We found very quickly that the language difference was a challenge. Although she spoke excellent English, it was hard to find the right words for coaching with your hands gloved up and sterile/non-sterile and the handy pocket card of terms ... in your pocket!

Cathy and Angela were AMAZING preceptors and very good at being there for you while letting you just do it! And I sutured!

A lovely baby girl arrived and was named "Jody" as the mom requested I name the baby with a "J" name for a girl. We came up with Josephine or Jody and she picked "Jody." So baby girl Jody goes off to her life in Uganda and we get ready for tomorrow's adventure.

In appreciation,
Sarah

My first Day

Today was pretty incredible. I attended my first birth on ward 14. Mom was expected to go down to the high risk ward for failure to progress, a multip, that we did not expect. She was 8 cm and not progressing and the head midwife decided to try to let the mom push and push the cervix back and the same time. Thank goodness it worked and I was able to catch the baby, and suture a small second degree tear. It was incredible.
Carole Miceli

Mulago Hospital

We did an introductory tour of Mulago Hospital. It is a huge hospital, taking about 20 minutes to walk from one end to another. We put on our white lab coats. It was quite a sight - 6 white women wearing white lab coats - we didn't pass another white person on our tour. There are two places in Mulago Hospital where women can give birth. One place is called Ward 14. This is for low risk women and averages 20-30 births a day. The other place is called Lower Mulago, is for high risk women and averages 80 births a day. When we passed this ward, there were women sitting on benches, women lying on the floor, women lying on beds and women waiting on the stairs. The nurses on Lower Mulago are very committed, but lack the numbers and resources to provide the care they want to. Women in both areas dont face the choices women in Canada do. There are no "choices" around childbirth. There is no entenox, morphine, fentanyl or epidurals to help with pain. There aren't even showers or baths or support people. It is simply women labouring, on their own, in beds, side by side. There is not a choice around "what to wear". Instead, women are wrapped in an amazing variety of colour and fabric, but definitely not in a hospital gown. So, we start attending births now, learning what we can, providing hands as we can. There is so much to do.

Tina from Kampala