silver lining and birth on the wards at Masaka Regional Referral Hospital

So it has definitely been a busy week in Masaka. There is so much to say and share, where to begin...

So one of the things I wanted to add, is about my ray of hope with regard to the birthing practices here. Jan and I met two fabulous students who are doing their nurse-midwifery training. They are only just beginning the midwifery stage of their training and so they have been popping in on their spare time to the ward trying to absorb as much as they can. There have been a few students but Winnie and Carol are our favourites and so we've tried to take them under our wing to teach them what we know in exchange for them translating for us for the women who only speak Lugandan. I have found spending time with them and teaching them what I know to be so incredibly rewarding. Also, they are so keen and impressionable. This is where I feel there is the greatest hope for impressing upon them that treating a woman warmly, compassionately and respectfully in labour can accomplish so much more in a labour and delivery than being unkind. It has already been so amazing and rewarding watching them with women. I have turned around many a time from something I am doing in another part of the ward to see them holding a woman's hand, speaking kindly and gently to them or wiping their brow. I was attending a woman with Winnie earlier in the week and the labouring mama was in a fair bit of distress. At one point I saw Winnie holding her hand on woman's belly and rubbing it gently. Later Winnie told me the woman had asked her to do so. It was truly heartwarming to see. I have decided that besides modeling respect towards labouring women on the ward in general, I want to work with these students as much as I can as I feel this is where there is great potential to plant seeds that will most likely germinate and flourish.

So besides the silver lining of these students, I wanted to share what life of the ward can be like. I will do my best to describe it although it may be difficult to believe as it is so far from the reality that I have come to know in Canada.

To begin with,as some women travel from far away villages to come birth their babies here and they may be in labour for days before they deliver, they bring at least one female attendant with them who can look after them by bringing them food and drink (as neither is provided by the hospital) doing their laundry, helping them wash etc. The attendants and other family members "camp out" on the hospital grounds awaiting the delivery of the baby. It can be days before that happens or up to a week or longer at times before this happens. As a result, there is often some washing to be done in the meantime and so walking on the grounds we'll see clothing and sheets strewn about out on the grass, drying in the sun.

So the labour ward had 3 beds. There are green curtains strung up on thicker wire that is attached at each end of the room in between the beds. There is and another curtain strung behind the desk (which is literally a desk, not a nursing station) and this is virtually the extent of the privacy women get. As I mentioned in an earlier blog, some of the windows have broken glass and others broken screens. As the building in ground level, I often how much people on the outside can see in, particularly at night when the lights are on. Anyway, this ward is an all-in one type of ward. There are no toilets or showers perse, however, the women either squat directly on the floor to do their business or use a basin that then gets poured into the floors drains that line the perimeter of the room.

The matresses in labour and delivery are covered with a thick canvas and on top of that sits another piece of canvas that covers the bed. Women are supposed to bring another long piece of plastic with them that covers the bed. They labour and birth their babies on this plastic. They are also supposed to bring cloths that we use to dry the babes off with when they are born and then to wrap them into to keep them warm. In terms of supplies for a straightforward birth, we use 2 pairs of gloves (which in Kampala women are expected to bring with them), 3 ends of latex gloves (the rolled rim at the wrist) to tie off the cord and a razor blade to cut the cord with. We often scurry around trying to find oxytocin and a syringe so we can do active management for the placental delivery. We use paper left over from glove wrappers to wipe away any bowel movements that are passed during birth. Cotton that comes of a big roll is used to wipe the baby's face if need be, to inspect the perineum for tears and a larger piece is torn off and rolled to be used as a pad for the women postpartum. After women birth their babies we pour cool water (because that's all we have) into plastic basins, give them some soap if they haven't brought any with them and they wash themselves on one side of the room by the drain (no curtain) either on their own or with the assistance of their attendant on one side of the room beside the drain. We then accompany them to the postpartum ward where there are 40 beds, where we settle them in and check on their vitals and bleeding before we leave them in the care of the staff (and their attendants) there.

For labours that are more complicated and require and IV or a urinary catheter, we are often running around trying to find all that we need. This is particularly frustrating when time is of the essence. Sometimes, the supplies we need are not available and so attendants are asked to go and buy IVs, saline solution, administration sets, urinary catheters or even medication! When we feel we don't have the time to wait, or know that fa miles cannot afford the supplies we run to our stash and use some of the emergency back-up supplies we brought.


In terms of wards, there are 2 wards of 40 beds each (one if early labour/antenatal, the other is postpartum) and then the first stage room and labour and delivery room. These are more often then not full and, on some days they are staffed with as few as 2 nurse-midwives to cover all these areas. It's wild! No wonder so many of them are burned out. At times it seems like assembly line work with all the women there are to care for--because the wards aren't staffed adequately. It sure brings different meaning to staffing shortages. Oh and if I have heard correctly the midwives here get 150 USD per month!