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.
|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.
|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.
|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.
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.
|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.
|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!|