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!