The Other Side of Working in Uganda

Many of you tell us you have been keeping up with our posts so for those of you who have, you will know we have tried to mix up the things we've posted. We have funny posts, descriptions of Ugandan life and lots of birth stories. It is only now that I feel like I can post on my reflections on the harder side of working in the free hospital in an undeveloped country (if you like that term)in a major city.

Birth here for the most part happens well, narcotic free, and both mother and baby are okay - particularly in Ward 14 where we work. This ward is considered low risk and it is staffed exclusively by midwives. There is no obstetrician, no operating room and no pain medication. We have worked for 6 weeks without instruments and often we do not have supplies first thing in the morning (with shift change). But since we travel with our basic supplies (gloves, medication etc...) it is rare that the what we need is not available at all (its more likely they are in safe keeping for a "real" emergency).

Sometime though, this isn't the case. Like the day we walked in to the high risk labour room and a mother, who had bled for hours after delivery, took her last breaths. Sarah and Cathy had the same blood type and offered to do a transfusion but it was too late. I wrapped her baby while the rest of our team helped with the mom. Minutes later we could hear the yells of the family outside - which continued for what felt like hours. Someone commented that luckily the baby was a boy - if not the family might have chosen not to take the baby home.

The next day Tina and I went to rounds and both of us felt the impact of hearing that the mother's death could have been prevented. Perhaps earlier action? but at the very least just getting her a blood transfusion (the hospital was out of her blood type). This would not have happened at home.

The other part of our work that I find most troubling is seeing babies born to ill (e.g. malaria in pregnancy) or malnourished moms. In our country again this normally doesn't happen. Where it does, a care provider often will have "caught" the problem and supports can be put in place. Here there is no one who is consistently able to help other than family, if they can afford it, and it seems most women coming to the busy free hospital are from families who are not able to help.

One recent example is Fatima's baby. He was born earlier this week and Tina and I happened to be hanging around for the birth - another medical student was catching. When he was delivered he needed to be resucitated and had many other problems. The next day we found out he needed an ultrasound that the mother could not afford. So Tina and I paid 10,000 shillings ($5 USD) and he is now being referred to a specialist. If the specialist recommends follow-up tests or surgery what will happen to that baby? Will the family be able to afford to get him care?

The reality here is much different in many ways and yet the experience of birth in Uganda has touched me not only in these ways but in the same way birth does at home. The strength of the women and their resilience is truly inspiring. Each birth brings learning to my life, joy to my heart and peace to my soul. I hope in some way the moms and midwives I worked with in my time here understand how much they have given me and I hope I have helped in some little way to make their journey better.

Jody