Sorry it's been a while since I last wrote, I've been really busy working on guidelines and teaching, so I haven't really had much to write about. I just completed a new guideline on the management of obstructed labour that I presented to the department on Friday. I received really good feedback so fingers crossed it will actually make a difference to the way women are managed.

I spent a couple of days at a conference for the Association of Obstetricians and Gynaecologist of Uganda, which was an eye opener. The theme of the conference was improving family planning as the average Ugandan woman has 6.7 children and 52% of the Ugandan population are under the age of 15. Access to contraception is a big problem here and abortion is illegal which means it still significantly contributes to maternal mortality.

I had a tough couple of days last week. I spent some time on the gynaecology admissions ward, and managed a pregnant woman with severe malaria, something I haven't done before, thankfully she improved with some basic treatment. What I found most frustrating about this case was that this women had actually been seen on the ward round but nobody had made sure she was given any treatment and consequently she deteriorated!  Lots of women present with complications of miscarriages and illegal abortions. These women  often have surgery to evacuate their uterus while they are awake and if they are lucky they get a small dose of pethidine. When I questioned why the women weren't given more analgesia or an anaesthetic the response was 'Ugandan women are used to pain'. Unbelievable.

Unfortunately babies are still dying. I found a baby a few minutes old whose umbilical cord clamp had come off and had lost a lot of blood. I managed to resuscitate the baby by giving chest compressions but it was still not breathing on it's own. I knew the baby needed a blood transfusion and respiratory support, so I picked the baby up and ran to the special care baby unit were we manged to give the baby some blood and it started to breath spontaneously, it was really hard to hold back the tears, and such a relief that I could tell the mum that her baby was still alive.