Much of the work I have been doing over the past few weeks has been concentrating on getting the operating theatre in Kawempe health centre up and running. This has been a slow and slightly frustrating process. The main problem has been with the generator. It hadn't been wired up to the theatre so in the case of a power cut (a daily occurrence) there was no alternative power source. It has taken about 8 weeks but the generator is finally wired up and the theatre is ready to go! As of yet there hasn't been any caesareans, mainly because of the lack of doctors at the clinic. I am currently spending one day a week there but this isn't enough, there really needs to be a doctor present 24 hours a day for the theatre to have the intended impact on Mulago. This has been the biggest challenge and is a problem reflected throughout all health centres in Uganda. The government is aware that there should be a doctor at Kawemepe and despite asking the health authority to help they still haven't appointed a medical officer.


I've been continuing with the community health education at Kabubbu health centre, concentrating on contraception and antenatal issues. We are currently planning a 'one stop shop' for women to have any gynaecological issues dealt with and to get the contraception of their choice. We have just appointed two new members of staff, a very experienced midwife and a nurse who will help push Kabubbu in the right direction. The number of women attending for antenatal care and the number of deliveries has started to increase, which means less women are delivering at home (either alone or with traditional birth attendants).


Work at Mulago goes on and I'm really enjoying it at the moment, partly because I am getting small breaks when I go to the other clinics. I've been splitting my time between the main labour ward, the admissions area and the high dependency unit. Post partum haemorrhage kills many women at Mulago. Partly because it isn't managed well. Slow decision making and the chronic shortage of blood means that these women often die. For example a woman had an emergency caesarean section because of a placenta praevia (low lying placenta), she started to bleed and was taken back to theatre. However the bleeding continued. She arrived in the high dependency unit but I couldn't control the bleeding and her condition was deteriorating. She needed to go back to theatre. Getting blood was a nightmare.The intern had to find the blood and cross match it herself because the lab technician was nowhere to be found!  The woman was taken to theatre for a second time and had a hysterectomy, fortunately for her she had completed her family.