This morning, Sarah-Jane and I went on the maternity ward round with Dr Moses, the medical superintendent. This was a really interesting learning experience for both of us; here are a few of my reflections:
-The first woman we saw was in active labour, delivering her 10th child at the age of 29! This is not uncommon here - women have so many babies and have very little choice with regards to family planning. It strikes me that until effective contraception is widely available here, the status and opportunities for women here are unlikely to improve. As I mentioned in a previous post, the Catholic attitude towards only 'natural contraceptive methods' only here is pervasive...
-Whilst reviewing this patient there was a commotion in the courtyard outside, and half the midwives and nurses ran out. Sarah-Jane and I followed to see a woman on the back of a moped who had just that minute delivered her baby! There was absolute chaos as people gathered closer to see what had happened. The nurses brought around green screens in an attempt to cover her, and the cord was clamped. The baby and mother were well and were taken in to the ward to recover from their ordeal!
-The ante-natal, post-natal and gynaecology wards are all mixed. This means that women who have had miscarriages (called 'abortions' here as what we refer to as an abortion is illegal) are in beds next to mothers with newborn babies. The attitude to miscarriage here is very matter-of-fact and it is accepted as a fact of life.
-Here, once the babies are born they sleep in bed with their mothers, and lie covered in 4-5 blankets from head to toe so you wouldn't even know there was a baby in there (see pictures below!). I asked Dr Moses if he was concerned by this but he stated that it is a cultural practice and they haven't had any neonatal deaths from this here... This is in stark contrast to the advice in the UK and 'back to sleep' campaign to reduce rates of cot death.
Above: this 2 day old baby was hidden under 5 blankets.
-Obstructed labour is a terrible problem here. We saw one 18 year old woman who had an obstructed labour and sadly her baby died. She has now developed a vesico-vaginal fistula, so that she is constantly leaking urine. As well as being desperately unpleasant for her, there is a significant social stigma for these women. Apparently, at Kitovu hospital approx 17km away there is a programme for fistula repair, but I'm not sure what the cost to the women would be.
-The majority of the caesarean sections in patients here are done using longitudinal scars (much more visible than the usual low transverse scar seen in the UK as the incision goes up above the belly-button). Dr Moses said that the transverse incisions have only been practised here for about 4 years, and many of the women have had previous c-sections using the longitudinal scars so they use the same scar again. Women are kept in for 7 days after a c-section here (in contrast to the UK!)
-Interestingly, we saw a baby who had been born yesterday weighing just 1.4kg (approx 4.5 pounds). The age of the baby was approx 28-29 weeks (there are no routine dating scans here so it is difficult to assess the gestation of the baby accurately). I was amazed that this baby would survive here (at home, babies can survive from as little as 23-24 weeks, but we have all the invasive technology, monitoring, breathing support etc). Dr Moses explained that as long as the babies can suckle and reach >1.5kg they can be discharged home.
-Affordability of medical care is a big problem here, as I mentioned in a previous post. We saw one woman who was thought to have had a miscarriage, but the team were uncertain as to whether the miscarriage had been complete or if there were any retained products in the uterus. She could not afford an ultrasound scan so was taken to theatre for a vacuum evacuation, a potentially unnecessary procedure...
Later on today I went to the paediatrics ward to check on the young girl I mentioned in an earlier post. She had been in a road traffic accident and had extensive wounds on her head that need daily dressings. On Monday, we witnessed the dressings being pulled off and she was clearly in extreme discomfort, crying and calling out. I went to the ward and again saw this awful process of the bandages being taken off whilst she cried in agony. I went and spoke to the nurse and asked about whether she had been given analgesia beforehand and whether this was routinely done. She stated that it wasn't, so I decided to talk to Dr Alfred, the paediatrics doctor.
I was concerned that it might seem as though I was interfering, but I tried to say things in a tactful way and he was happy to talk to me about it. I said that in England we often give analgesia approx 1/2 hour or so before a procedure, to make it more comfortable for the patient. They have paracetamol and morphine readily available here, so this would be entirely manageable. He asked me, "are you afraid of pain?", and stated that he thought the child "could probably tolerate it". This is reminiscent of the conversation I had with the midwives about analgesia in labour that I mentioned in a previous post. I agreed with him that she probably could tolerate it, but that I didn't think she needed to given there is plenty of analgesia available here and it would alleviate her suffering. He has promised me that he will "think about it" which I hope he will.
In many ways, resources are scarce here and this limits the services and care that can be provided to patients. However it is so frustrating when simple things can be done and resources are available but they just aren't used...
This afternoon we went to a local school for the students to ask their questionnaires; this was really fun and we were so impressed by the students' knowledge.
Tomorrow I am going to Kitovu hospital (17km away) to visit my friend Sarah from England and see the hospital's facilities. I am intrigued to see what the hospital will be like and meet the staff to see whether next year we might be able to expand the SSC programme to include both Kitovu and Villa Maria hospitals. I will keep you posted!
Anyway, it is getting dark so I had better go inside to escape the mosquitoes!
Here is a photo of us from this morning on the hospital site at Villa Maria:
Another update to follow soon,
Amy
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