Suck it up Buttercup

One of our new favorite sayings on our trip has been Suck it up Buttercup - which has now just been shortened to using Buttercup as a nick name anytime one of us starts whining about our "troubles" in Uganda. Read this post and then our next one and you will see why there has been little sympathy for our "tough" times.

Here are the Buttercup moments we've had so far:

- eating white toast and a boiled egg for 39 days in a row;
- white shirts, shoes and our feet permamently stained an odd orange/brown colour;
- random sewage (and other) smells and leaping an open sewer every day en route to the hospital;
- soaping up to discover there isn't enough water to wash the shampoo from our hair;
- not having a toilet seat for almost 3 weeks;
- working in Labour & Delivery, with lots of bodily fluids, and no running water; and
- almost being run over by a Boda-Boda (again).

Perspective

One of the things I noticed when I first arrived in Uganda was the scarcity of people around my own age, early 50's. Cathy Ellis explained that many people of that generation were wiped out in the original AIDS epidemic. Uganda today is a leader in Africa for actually reducing the rate of people with AIDS. On the wards, we are all acutely aware of the risk of infection. We are taught how to protect ourselves: double gloving, careful disposal of sharps, awareness of all body fluids, eye protection, rubber aprons for delivery, hand washing, anti-bacterial gels. One of the first things we check on a chart is the woman's "TR" status - "TR" means tested negative for HIV, "TRR" means tested positive for HIV. One day last week, we attended 6 young women. Two were having their first baby, 1 was having her second baby, and 3 were having their third baby. All were between the ages of 19 and 23. Five out of the 6 were positive for HIV. As I tended to these women, I wasn't thinking anymore about my risk. I was protected from head to toe. Instead I was thinking about those 5 young women, infected with HIV, their newborn child and their families at home. That is the real tragedy.

Tina

Blue flowered dress Girl

On one of our crazy days on lower mulago, we were running off our feet and trying to triage all the labouring women. This girl in a blue flowered dress was labouring away, alone, all day in a middle bed. We kept asking, each of us, what is the deal with the blue flowered dress?

"PG (primagravida), 4 cms"

and we would have to move past her to deal with the 9cms with bulging membranes that continually come through the door. Over and over.

At the end of the day, Carole was finally able to look at her chart and read that she was 15 yrs old. And "single." Carole was so moved, as the mother of a 15 year old boy, to think of her child being in that situation.

Sarah for Carole.

Remember blue flowered dress girl. We will.

Hand-washing our big girl panties...in the dark

So, Carole and I are back in Masaka for our last week of catching those babies. We had a nice 4 day adventure to see some animals, and are now working hard. The hotel has had frequent power outages, so that makes our evenings exciting! Sigh.

For some reason, the birth gods are kicking our butt and there have been lots of mamas and babies to attend to. We were very busy on Monday and Tuesday, but only 1 birth today. Lots of c-sections for failed trial of scar.

We had some sadness. Yesterday afternoon, a fresh still birth was carried in from a uterine rupture that was transferred in. This morning we found out that the mother had died. The baby was unclaimed all day. Sad sad sad.

We made friends with a sweet little 4 day old baby with Vit K deficiency bleeding. He was very unwell but quite a scrappy little guy. Carole nicknamed him "Spike" because there was a bulldog on the little hat we gave him. So, think of Spike tonight and we hope and pray he is okay tomorrow.

Sarah

Big Girl Panties

On Monday Tina and I put on our “big girl panties” and made our way to the hospital for the start of our time without preceptors. It was a tough experience with 4 out of 5 births including unnecessary episiotomies (cuts to the woman’s perineum) done by the hospital staff (not us!). We were worried to say the least. But by the end of the week we are pleased to be conducting the births on our own and even managing problems like post partum haemorrhage and shoulder dystocia.

We’ve been asked to talk to the staff about how we chart and why – the head Midwife likes what we’ve been taught (thanks UBC and our various preceptors). They are also interested in us demonstrating sterile water injections for women with back labour (I’m injecting Tina of course). We’ve moved from the role of students to colleagues. The midwives are even calling us “Sister” – a term of respect. We are both very excited about our final week here in the hospital and in Kampala.

We are much more comfortable in the city, on the streets and at the markets. We’ve even found our own short cuts and have walked at least half of the city. We even bargained for a pineapple from a guy on the road with a wheelbarrow full (saved twenty cents at least). Now we are counting down - 9 sleeps (and who knows how many babies) until we are home.

Jody and Tina

Ugandan Road Hierarchy

(in increasing order of importance)

Pedestrians - Lowest of the low. Step onto road at your own peril. Even if you are halfway across, whatever is approaching you at top speed has the right of way.

Bicycles – Low. Must give way to everything except a pedestrian, including flinging self and bicycle into bushes on the side of the road to avoid impact.

Boda-Boda – Actually 2 designations. Lowest of all motorized vehicles. Highest of all non-motorized users. Will actively run pedestrians off paths, leap unbidden between rows of traffic, run the wrong way on the streets, use sidewalks instead of roads, carry treacherously wide loads of sugar cane, swerve endlessly directly at the mzungo (foreigner) from any direction to offer a ride.

Cars – Medium. Have to be vigilant for bigger vehicles.

Trucks/Matatu (small buses). Medium-high. By dint of their heavy exhaust and slow uphill speeds they can cause road chaos behind them.

Big Buses. High. These vehicles go at high speeds wherever and whenever they want to, including passing up hills, around curves, when there is no room, when there is oncoming traffic, forcing everyone else below them on the hierarchy to GET-OUT-OF-THE-WAY.

Chickens. Highest. Will bring even the biggest buses to a halt to give the poor chickens time to get across the road.

Sharp Sharp, Where’s the Sharp?

One of the first things we learn as health care providers is to properly dispose of your sharp. A sharp is defined as anything that could cut skin. Examples include a needle, a broken vial of medication, the top off a broken vial or even used razors. Here in hospital things are a bit different. We quickly learned to play the game “Sharp Sharp, Where’s the Sharp?” For reasons we don’t understand, disposal of sharps here is very casual, and therefore, incredibly dangerous. It could be here, it could be there, in fact it could be anywhere. Underfoot, underhand, on windowsill or hiding in with clean supplies. So we remain ever vigilant and have learned to start our day with a quick round of the game and have repeated rounds throughout the day as necessary.

Tina and Jody