So my second week at Mulago wasn't as harrowing as my first. I'm starting to settle in and the staff are starting to get to know me. I have still been dividing my time up between the different Obs and Gynae wards (there are many). One thing I have really been impressed with is the determination and hard work of the doctors and midwives. I have learnt that the SHOs (doctors of my grade) do not get paid for the work they do because technically they are 'students' studying for their postgrad qualification in Obs and Gynae. These doctors work so hard, I am truly shocked that they don't get a penny! I have no idea how they have the motivation to carry on.

I spent some time on the gynae oncology ward. This was depressing. Cervical cancer accounts for about 80% of all of the gynae cancers in Uganda. The woman are often young and present with advanced disease as there is no cervical cancer screening programme and HPV is very prevalent in HIV positive women. If the women are operable they often have to wait several weeks for surgery as only one oncology patient is operated on a week! The majority of the women are waiting for radiotherapy and palliative care.

Unfortunately there were two maternal deaths last week. One of which has upset me and really driven me to try to improve the care of women in obstructed labour. Again this girl was young, only 19, she was fully dilated for over 16 hours, she had an emergency caesarean and developed septicaemia (sorry for the jargon!). The patient needed to be transferred to intensive care but the family could not afford it, so she died. However I truly doubt that she would have survived had she gone to ITU. Obstructed labour is a massive problem here. Many woman are young and malnourished or have diseases that distort the shape of their pelvis, making vaginal delivery impossible. So women often wait many hours in labour developing fistulas, infections or rupturing their uterus and often end up with a dead baby.

On a lighter note I had a great weekend! I sampled one of Uganda's finest night clubs which was an experience I wont forget for a while! On Saturday we had a house warming party and slaughtered a goat for the occasion! We butchered it outside our house and roasted it on the BBQ, it was tough as old boots but it went down well!

What an interesting first week I've had..

So my first week in Kampala has been really good. I've settled into my house and I'm living with 4 other people, 3 of them from the USA and a girl from South Korea. There's plenty going on in and around Kampala, there's always a house party to go to, some really good markets, nice restaurants. I've spent the day in a lovely resort with a 50m outdoor pool chilling and relaxing in the sun after my first few days at Mulago!

I started at Mulago hospital on Wednesday and to say it is different would be an understatement. The hospital is massive and so is the O&G department, with over 30,000 deliveries a year! My first day was tough. The day stared with a morning meeting, we were informed about two maternal deaths that occurred over night, both women were very young, the first a 19 year old girl died from a massive haemorrhage and the second, a 23 year old woman died from sepsis. This was shocking to me as I have not encountered a direct maternal death in the UK in my fours years working as a doctor. Their bodies were left in full view the corridor by theatres, god knows what the women going for their caesareans thought as they walked by. My second day was a little better, but could have been a nightmare. I decided to attend the labour ward ward round, which proved to be very frustrating. I watched while approximately 40-50 women in one massive room (all naked, in labour and with no privacy) were examined by young male doctors with awful bedside manner. I was so shocked at the conditions these women had to give birth in with absolutely no respect for their dignity and autonomy. Midwives are few in number and very busy, running between women giving birth. One particularly shocking moment was when a woman was delivering breech, and the SHO didn't know what to do. So I was left to do the delivery by myself, and luckily it was an easy delivery. The baby almost died, it needed urgent resuscitation, only to find there wasn't any resuscitation equipment that worked. A medical student finally found some equipment that worked and I managed to resuscitate the baby. I fear though that if I was not there that baby would have died. The midwives and junior doctors have very limited newborn resuscitation skills. On my 3rd day I decided to attend the general gynae ward round. This was a new experience for me, I felt like a medical student again. Every other patient either had malaria, HIV or TB, something that we very rarely see in the UK. There were many really ill patients waiting for urgent surgery but the hospital had run out of sutures. This meant none of them could go to theatre. I am beginning to imagine that this will not be an infrequent occurrence at Mulago. The powers who be would prefer the additional cost of keeping sick patients in hospital waiting for surgery, rather than find money to buy sutures.

Arriving in Uganda

Hello everyone,

Hopefully this blog will be interesting and not boring! So i'm going to keep things short and sweet. I'm living in a large house with 4 other people, all working for NGOs. The area seems really nice with a slum down the road! Everyone is friendly and you don't get hassled!

I'm going to head down to the hospital tomorrow and get started! So I guess I'll let you know how things go...