Random Update and Thoughts

Well, to fill in a gap or two....following the last week Ashley and I spent in Mbale, all 6 travellers met up to go on safari for a weekend in Queen Elizabeth Park. Then Ashley headed back to Canada the Tuesday following and I went to Masaka with Tamara and Tracy for the final week before we left Uganda.

I was reminded today, now that I am in Scotland, that in Africa, nothing got thrown away easily. Ask us to tell you all the possible uses of sterile glove wrappers. There is quite an exhaustive list.

I made many mental 'notes to self' while I was in Africa and the only one I can remember now is 'why does obstructed labour cause bloody urine?' which is one of the cardinal signs? Still haven't looked it up and I'm open to information!

the last week in Mbale

Well, the twins I caught in Mulago were a harbinger for the week to come! Ashley and I had a good final week in Mbale, and there were two sets of twins born. The first set started off with a cord prolapse for the first baby who was coming breech. Ashley acted quickly to hold the baby up off the cord after we literally manhandled the woman over onto elbows and knees (the language barrier was a challenge, and also the fact that local staff had no idea what we were doing). The baby seemed to be in a hurry to be born but Ashley held her ground (that is, her whole hand up inside the mom) and would not let anybody move until it was decided whether we were going to theatre or getting the mom to push like stink. The decision was made to have her push since Ashley could feel the baby making its way down. So we flipped the mom back over and she pushed like a trooper! The baby was born within a minute, thank goodness. For those non-midwives reading, cord prolapse is an emergency that can kill a baby in a very short time. We have seen at least two fetal demises due to cord prolapse in our time here.

So, the first baby was born, a little boy and I raced off with him to resuscitate. I had located one of our very few cord clamps so we did not have to fuss around with tying the cord, thank goodness. It took a few minutes of PPV but he did come around. I really feel like his was a life our presence saved!

Meanwhile the second baby was on its way out, head first luckily. A little girl was born, vigorous and healthy. The family was overjoyed, especially the dad who was actually watching the birth (an unusual thing here). He was most thrilled to have twins. And he named them Alexander (the Great) and Rhonda. Though he likely spelled it Ruanda....I get that a lot.

And then the very next day, since Ashley didn't actually end up catching the above babies, we had a replay! Another mom came in with undiagnosed twins and the first one coming breech. Ashley got to catch this one herself, and it was a little girl weighing 2.6 kg. She was vigorous so I was able to leave her on the infant warmer and get back quickly when Ashley announced that there was another baby coming! The second one was also a girl, head-first but only half the size of her sister...1.3 kg. One of these babies was also called Ruanda....a great honour for me! Ashley's name is not easily understood here so she didn't get in on this honour, unfortunately.

Today, the five remaining travellers are in Kampala and soon to leave for Entebbe. Our flight is tomorrow, and my classmates assure me they will be posting things on the blog soon! Someone will write about our safari soon!

I've been rubbed by a lot of bums and penises today

....that's the downside of choosing the aisle seat on the buses. My arm was quite chafed! None of the rubbing was intentional but the aisles are skinnier than the people.

Also, I caught my first set of TWINS yesterday....undiagnosed until the first one popped out rather smaller than expected. I said 'wait, I think there's another one!' And the second one came breech so I got do a simple breech catch as well! So COOL! They were a boy and a girl, in that order. The mom is a twin also. Pretty nice way to end my week in Kampala!

Ashley and I are back in Mbale now and hoping to catch a bunch of babies in what will be our final week here. TTYL

Hi all....we have all arrived in Kampala together this week to work on Lower Mulago (higher risk) with Cathy, Mickey and Angela before they leave the country next Tuesday. It is nice to have their support as we get more practice with resus and lots of other things.

Everyone was in Mbale for a few days to teach Emergency Skills for the first time there. It was HUGELY well-attended and appreciated and Ashley and I are looking forward to going back and having people understand the crazy things we are doing for shoulder dystocia etc! They have looked at us askance a few times!

Update from Masaka

Our friends in Masaka have been having troubles posting, so hopefully this will work.

Greetings from Masaka!

Tamara and I finally have some time to tell you a bit about our adventures in Uganda. We are currently in Masaka having travelled across the equator to get here from Kampala after a few exciting days in the big smoke. In Kampala I had my first catch in Mulago hospital in the midst of a thunderous rain storm. The rain pounded on the corrugated roof so hard that I could hardly hear myself think never mind listen to babys’ heart rates. It was a perfect dramatic start to my birthing adventures in Uganda! In the meantime in another part of that hospital Tamara delivered a baby in the hall way which was lined with about 20 women sitting on mats on the floor in varying stages of labor. The woman next to the woman delivering was in early labor and seemed pleased to provide translating services. There was no privacy and conditions were crude but it was a beautiful birth none the less and the woman was thrilled and happy with her birth.

Masaka itself is much more laid back than Kampala. We stay in a hotel on a hill with beautiful views of rolling hills with lush greenery and fertile clay colored soil. We wake up to the sound of children happily singing with all their might at the primary school across the road and our walk to work involves saying hello to just about everyone we meet plus our efforts to speak Lugandan keep everyone well amused.

Despite the calming surroundings our first few days here were quite overwhelming. There was getting used to a new hospital where the labor ward was brimming with moms and babies waiting to deliver and there was the cold reality of watching women manage without any of the comforts that we take for granted back home. We weren’t really sure what our place was amidst the chaos and what we could do to help. We’re still trying to work that out and learning lots in the process. The people here are so friendly. When we are introduced to staff our hands are warmly grasped and we are greeted with the words “you are welcome”.

Today was particularly exciting for us student midwife types because there was a woman in labor with a breech baby. Breech babies typically present with bum first instead of head first. However, with this baby we could feel some feet presenting when she was examined which is an indication for a cesarean delivery. However in the time it took for her to be collected for surgery the baby was ready to come. We all got ourselves ready and after a couple of nail biting minutes out it came. It was just a little baby, quite a bit smaller than we’d expect (1.9kg) and it needed some resuscitation. With just a couple of puffs with the resuscitator it was ready to take its first breaths in the outside world. We were about to give some oxytocin which is a drug to help the uterus contract when our instructor Cathy noticed that the moms uterus wasn’t quite empty yet. In no time at all out came a twin!! Head first this time and crying immediately.

The babies were both quite feisty, the smaller of the two looked keen on breastfeeding from the get go so we got baby skin to skin and that baby latched onto the breast beautifully. That was the highlight of my day - a perky little twin who likes a good feed…Someone after my own heart.

Who knows what tomorrow will bring. There are moments of joy and moments of despair. It’s a bit of a rollercoaster but Tamara and I signed up for the full meal deal. Bring it on we say! We’ll keep you posted.

Tracy.

Sick as a dog on the banks of the Nile

It seems the theme of our time here is a study in contrasts.

A first-time mom pushing out her perfect, chubby, crying boy surrounded by four clapping, cheering sisters. The desparation of a new grandmother searching for life in her new baby granddaughter who not live through her first day. Each day is a roller coaster of extreme emotions. Life, death; joy, pain. It is no wonder that we collapse under our nets at 8:30 each night.

Given the journey thus far, I should not have been surprised to find myself surrounded by a tropical paradise of birds and flowers on our first weekend off, purging my guts out. The gastrointestinal upset lasted only 24 hours and I was nursed by 5 loving midwifery student attendants who just wished they had supplies to start up some IV fluids.

The learning here is only partly about midwifery skills - it is also about this balancing, tipping of the scales...the inequity in the world, the precariousness of life, the strength of women birthing while struggling with malaria, the perseverance of midwives working with extremely inadequate resources. I am awed every day.

Jinja

Ok, clearly that did not work. Hopefully we will get to be able to put up pictures eventually. If anyone has a tip on how to make the picture files smaller on my macbook, let me know.

Ashley and I are now on our way back to Mbale from the Kingfisher Safaris Resort in Jinja. We took a chicken-bus to get here, and it was ^%&^**%*% hot!! The system here is to wait until the bus is completely full before it goes, so you get on and you have no idea how long you will sit in the bus. We sat for one hour. Which apparently was not too bad. We did in fact have chickens right behind us, and while the lady assured us they were tied, their wings reached under our seats and tickled our ankles from time to time. We were the only mzungus on the bus. All kinds of little kids yell out 'Hello Mzungus, how are you?' wherever we go. It is quite cute. Some of them come up and curtsy as well.

We have had a nice refreshing break and I did in fact put my feet into the Nile River, though I did not have a Nile beer in my hand at the time. It was great to see my fellow students who have been elsewhere and there was a lot of talking the first night as we all got caught up. Ashley and I have the sad distinction of seeing the most stillbirths so far. This has been very hard and we spend a lot of time talking about what we can possibly do to make this better in Mbale during our short stay there.

On our way out of Mbale, we stopped to visit TASO (The Aids Support Organization), who are doing some wonderful work to support HIV-positive people. They have four main goals: counselling, medication, socioeconomic support, and research. Look them up. They are a part of the reason that Uganda has reduced the spread of HIV more than many other countries so far.

We will be catching another chicken bus soon and hope to be in Mbale before supper time (it's noon now).