The Masaka Experience – By Kati McGeorge
In mid May, I and 6 other UBC midwifery students arrived in
Uganda with 5 UBC instructors. Our purpose is to work with pregnant and
birthing women in Ugandan hospitals alongside of the Ugandan midwives, doctors
and other care providers, as well as with other students, both from Uganda and
other countries.
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| The Masaka Market |
My destination was the Masaka Regional Referral Hospital. It
is a large hospital covering the city of Masaka as well as the surrounding
villages. It also takes in women referred from smaller hospitals and clinics in
the area, especially on the weekends when these facilities are often closed.
When first arriving at the hospital, before even entering
the building, I noticed the women and their families sitting on the grass,
picnic style, waiting for their labour to be active enough to be admitted, or
waiting for their woman to give birth. Each woman has an attendant with them, whose
job it is to manage their birthing supplies and to help them to shower and move
to the postpartum ward after the birth.
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| Arriving at the hospital |
My second impression was of the smells and sounds in the
dimly lit hallways, crowded with women and men, waiting to be admitted, waiting
for their loved one to give birth. The smell was strong, musty, organic and not
particularly pleasant, and there was a babble of voices speaking in Lugandan,
the main dialect spoken in that part of Uganda . I thought of how this scene differed from
what I knew as the norm in hospitals at home in BC where the smells would be
more chemical and medicinal and the hallways bright, clean, quiet and
predominantly empty.
On a typical day we arrive on the labour and delivery ward by
9:30 after having changed into scrubs and a heavy plastic full length apron. We
are ready for action and all geared up, having stuffed our pockets and fanny
packs with supplies, such as gloves, IV cannulas, urinary catheters, packets of
gel, alcohol swabs, and many other necessary items. The hospital supplies are
limited and often doled out a little at a time so they will last throughout the
day. We brought our own supplies from Canada and purchase more from local
pharmacies to augment those supplies lacking in the hospital. There is nothing
more frustrating than urgently needing to site an IV and having to search
through empty drawers or go ask a Sister midwife to find us the missing pieces.
When working on the ward, our UBC preceptor is always by our
side or within calling distance to give a hand when needed. Often we also
search out the Ugandan Sister midwife who is working that day to ask for advice
or assistance. We also consult with the Ugandan doctors and obstetrician, who
come to assess the situation and write orders in the chart. There are many 3rd
year medical students, nursing students and interns on the ward as well. Some of these students are knowledgeable and
can give us a hand, while others still have large gaps in their experience and
knowledge and we can often give them pointers and help them with an assessment.
This is one of the ways in which we give back for all the learning opportunities
we have experienced.
Very early on we learned that the Ugandan culture requires a
different approach than what we are used to in Canada. In Uganda it is
important to be socially warm, greeting a person and asking how they are doing,
then commenting on your own wellbeing, before getting down to the business of why
you need to talk to them. This is especially challenging when seeking
information (such as what a woman’s name is or when looking for a chart) or when
needing assistance (with a woman with an obstructed labour for instance). In
the maternity ward rapid paced atmosphere this back and forth play of
cordiality can be frustrating and feel like a slow motion dance, but we soon
got used to it and even learned to appreciate these moments of social exchanges
as pearls of calm amongst the chaos of the ward.
Once on the ward we do a quick scan of the work area,
removing stray needles, razor blades and other sharp items and cleaning the
surfaces. Then we restock the cupboards and check that the resuscitation
equipment is clean and available. With that accomplished, the first task of the
day is to meet the labouring women, learn their names and find their charts.
When asked their name, women give their names in a near whisper, last name then
first, and if we are lucky we recognize the first name and enough of the last
name to identify their chart. Charts may be in the Admissions room if they were
recently admitted, or on Ward 9 at the end of the hall if they arrived in early
labour the day before or if they have some further complication. More often
than we like we can’t find the chart and must make notes on a scrap of paper
until the chart is located or a new one started.
We assess women to see how far along they are and what their
specific needs are, making plans for their care. We monitor vital signs and
fetal heart rate, start IVs, give antibiotics, insert urinary catheters, and give
care as the need arises. We birth the baby, using a slow controlled technique
when possible, check for the presence of a twin, give oxytocin prophylactically
to prevent post partum hemorrhage, deliver the placenta, assess the vagina and
perineum for tears and suture when needed.
We assess the newborn, weigh it, and
treat it with eye antibiotics and a vitamin K injection.
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| Catching a baby |
When needed, and with the assistance of our preceptor as
well as a Sister midwife, we manage
emergent cases such as labour obstruction, shoulder dystocia, post partum
hemorrhage, newborn resuscitation and other more complex issues, like twin and
breech birth, cord prolapse, or uterine rupture.
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| Twin brothers |
Ugandan women are strong and stoic, often labouring silently
with no pain medication options. Births can occur suddenly and unexpectedly,
especially with women who have given birth many times before. This year it
seems there are more first time mothers than in previous years and we try to
give them a slow birth of the baby’s head to diminish tears and trauma to their
tissue.
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| A happy new mother whom I helped birth her baby |
The number of births managed by students in one day can vary
from zero to 4 or more. One memorable day, 3 students and 1 instructor assisted
with 9 births, a nice even 3 each per student, and on at least one occasion I
caught 4 babies in one day!
My time here is flying by, and I am so thankful for this
amazing opportunity and all the learning that comes with it. I have learned so
much! My clinical skills, assessment skills and ability to look at the bigger
picture have solidified, my confidence has increased, and I have gained a valuable
understanding of how to manage labour and birth with minimal resources in
conditions well below what we experience at births in Canada. This will help me
to be more capable and effective when working in remote and rural settings or
when other problems arise. This truly is a once in a lifetime trip.
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| We often walk home in the twilight. Notice the crescent moon laying on it's back. Seeing the stars and moon behave differently really exentuated that we were far from Canada! |
