labour ward experiences in Masaka

So we are now in Masaka, which is quieter and less polluted though I would not call it rural. The walk to work is much more enjoyable and we are less likely to be run over by cars or boda-bodas (scooters). On Monday's walk there we stopped to watch curious monkeys swinging in the tress-both adults and baby monkeys. It was very sweet. And besides, how often can you say you see monkeys on your way to work.

So once we arrived at the hospital and began our day we were in for even more of a rude awakening. It happened to be a holiday after a weekend and there was lots going on. So much that it is difficult to keep track of all that happens through the day. The facility is even older and more basic than at Mulago Hospital in Kampala. Here the window screens are broken as are some of the windows, so shooing away flies is now part of our care for women in labour. The delivery ward has three beds and as there is no high risk ward, so all cases are brought to this room. It is somewhat disorganized, and unfortunately there is no method to the madness here. Assessments on women appear to be somewhat sporadic. There is no partogram used. And so there can be women in labour for days before someone realizes they have an obstructed labour and need a consult or help. There is no such luxury as 1 to 1 care in the public hospitals in Uganda. Here you get what you get and it depends on how busy things are, how many directions the staff are pulled in and whether the supplies you need are available when you need them. Although basic supplies such as urinary catheters, IV cannulas, oxytocin for active management, IV fluids, disinfectant wash and other such supplies should be readily available, it is amazing how often they are not. It is also exhausting and incredibly frustrating trying to track them down when you need them ASAP. At times, we have ran back to our packs to grab a few of these supplies we brought with us just in case. Thank goodness we have them with us. Although we do not have an endless supply and we have already run out of the oxytocin we brought with us.

Such is the reality of working in an under-resourced public hospital here in Uganda. It makes everyone's work so much more complicated and what contributes to the increased infant and mortality rate here. On Monday when we toured the ward, on a small concrete shelf lay wrapped bodies of babes and fetuses that had died the night before. Thankfully we have not witnessed a death of a mom or a babe yet ourselves although there have been a few that we were not sure would make it.
Today I went to the "theatre" (OR) with Cathy (instructor) to receive the infants of two of the mothers we had attended in labour who had an obstructed labour. It was such a contrast to what the ORs are like at home. My heart was pounding as I watched the procedure, just hoping all would be fine with the mom and babes. We set up our resuscitation area in anticipation of the newborns needing assistance breathing. We fund a bag with a mask attached that was more suitable for a toddler. The table we were working with was significantly slanted and we decided if the babies needed assistance we would place them across the table to avoid the incline. That still made for an uneven work surface for us, which made the resuscitation that was needed for both babes a challenge. However, Cathy has been here many times and resuscitated many a baby and so she knows the ropes and works with what we've got and then we just hope for the best.

Here after a baby is pulled out of the incision (feet first, not head first as as home) he or she is hung upside down, held by the ankles and bounced a few times, until its cord is cut. Perhaps this is done because it is believed it will expel some of the amniotic fluid--I am not certain but it is difficult to watch. Although Cathy asked for them not to do this for the first baby, it was still done for the second. Change takes time, I suppose, as well as education. So anyway, the amniotic fluid of the second baby was filled with a pea-soup like meconium and as I received the baby on a towel in my arms I smelled a foul odour. In addition to the meconium, this baby had an infection. Although in Canada we would have intubated and suctioned the meconium, there are no such supplies here. So we used the bag and mask on the babe and eventually, after a long 7 minutes, he took his first breath. Apgars were 2, 4 and 7 on this little one. He was still rather limp but at least he was breathing. He would certainly need antibiotics if he was going to stand a chance. Cathy advocated for this although the staff in the OR were not on board for Cathy to bring this baby to get treated immediately, they said they would do this in time.

So that is just a snip-it of some of the adventures and obstetric culture shock I have been experiencing. There is so much to share but so little time. I will do what I can over e-mail and fill in the rest upon my return home.