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.