Thursday, 16 August 2018

Tragedy today in Uganda

I'm in Uganda for a month, helping to mentor some midwives who are leading palliative care services in Mbale (Eastern Uganda, near the Kenyan border) and furthering the RCM's twinning partnership with the Uganda Private Midwives Association.  I'm currently up-county in Mbale - 6 hours away from Kampala - seeing where my mentees work and getting a flavour of the challenges they face on a daily basis.
A bit old - of course Zaire is now Congo
Today we went out on a field visit to a remote district reachable only on a bumpy dirt road - to see Esther in action mentoring health professionals she had previously trained in palliative care.   On arrival we were told by the Nurse-in Charge that unfortunately one of their nurses was gravely ill with eclampsia and an ante-partum haemorrhage.
With the Nurse-in-Charge and the Hospital Administrator, District Hospital - at the foot of Mount Elgon
The nurse, 7 months pregnant, was found to have proteinurea last week and had been placed on sick leave.  Today, she arrived at the hospital in the morning with seizures and vaginal bleeding.  They sited an IV with difficulty and gave magnesium sulphate but were unable to perform a Caesarean Section (despite having an operating theatre) because the only doctor was absent.  She was therefore transferred to Mbale, an hour away on that bumpy road.  The hospital has an ambulance but it had no fuel, so they had to find other transport - not easy in the middle of nowhere.

A reasonably good section of the road
On reaching the Regional Referral Hospital she experienced a further delay, joining a queue of women waiting for life-saving surgery.  We heard later that the baby was stillborn and the mother died within half an hour of finally accessing a caesarean section.  She leaves two other small children and a grieving husband and father.

We then visited the labour ward at the district hospital.  Four staff were supposedly on duty but only two were insitu, both very junior.  A woman was in labour with her 5th baby, naked with no privacy, constrained to the bed and lying flat.  She had received no fluid or food for over 6 hours and was not being monitored in any way.  Her contractions had fizzled out, unsurprisingly.  We encouraged the staff to mobilise her, feed her, offer comfort and respectful care.  We phoned throughout the day to see how she was doing - eventually we heard that she too had been referred to the regional referral hospital.  Those staff did not have the skills, support or infrastructure to provide quality maternity care, a problem sadly all to common across Uganda.  Despite the presence of several sinks and taps, there was no access to water - running or otherwise - on the labour ward. This is why the mentorship programme the RCM developed with its partners from 2015-2017 is so vital, allowing midwives to qualify having had good quality learning experiences and effective mentorship as students.  Unfortunately this hospital had no such intervention.

the labour ward
I weep for the woman and baby who lost their lives, for the children left motherless, for the women who missed out on receiving high quality care and for the midwives who experience poor quality training and little support.  We hope, through our long term twinning project, to be able to make a difference.
Another labour ward visited on our way home


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