Wednesday 19 October 2011

The past few weeks have been really busy. I had a break from Mulago for a few days (I really needed it) and went to a village health centre just north of Kampala, in a place called Kabubbu. It's funded by a UK charity, which has built a primary and secondary school that provides free education to children who have been sponsored by families in the UK. It also has as a health centre that focuses on HIV and maternal health. My main reason for going was to evaluate reasons why mothers weren't having their babies at the health centre. This was a fantastic opportunity to visit women in their homes. The conditions people live in are truly shocking, the majority don't have electricity and you can forget about running water. The women were so welcoming and their children amazing, even if I did scare the hell out the smaller ones (I've never seen kids run so fast in true fear! I guess I must have been the first white person a lot of these children have seen). We managed to get some really good information on how to improve the services at Kabubbu. I've devised a training programme for the midwives, hoping to improve their clinical skills, address issues such as patient confidentiality and implement a community health education scheme. Especially trying to dispel some of the myths surrounding birth control, such as it causing cancer and birth defects.

Back in Mulago things continue as they always do-slowly! I've spent a lot of time on the labour ward and I've actually managed to do some operating, mainly second stage caesareans. I'm also surprised at the number of vacuum deliveries I've been able to do, I was under the impression that vacuum deliveries weren't something that were practiced at Mulago. Most recently I had to do a vacuum delivery on a second twin with cord prolapse, luckily the baby was born in good condition (phew!)

One of the main issues at Mulago is the lack of senior support. I think this is two fold. Firstly the seniors aren't easy to get hold of and secondly the junior doctors don't seem to ask for help and tend to just get on with things, which clearly isn't safe practice. For instance I was left to deliver a 14 year old girl, her first pregnancy and it was breech (she should of had a caesarean). The head became entrapped and there were no forceps available. I asked for help but no seniors came, luckily a midwife helped me and we eventually managed to deliver the baby. Thankfully the baby survived but the mother sustained a 4th degree tear (a tear through her vagina and rectum).

Many women suffer from eclampsia (seizures due to high blood pressure). This is a complication of pre- eclampsia that we rarely see in the UK. My first experience of eclampsia was with a women in obstructed labour. After rushing round frantically trying to find magnesium sulphate and hydralazine, I managed to stabilise her (thank god for all of my emergency skills training in the UK!) I wheeled her round to theatre and  the baby was delivered by caesarean. The mother did well after a short stay on the high dependency unit.

Over the next few weeks, I'll be mainly working with a Consultant and a nurse from the Liverpool Women's Hospital looking at the gynae oncology service at Mulago. This should be really interesting as there is a lot of scope for making some much needed improvements.