Monday 9 January 2012

Sorry it's been a while!

I hope everyone had a great Christmas. It’s been a while since I wrote my last blog, so it’s going to be a long one!
The 2 weeks leading up to Christmas were perhaps the most intense two weeks that I’ve had at Mulago. Over these two weeks all of the SHOs were on exam leave and to make matters worse the interns were on strike because they hadn’t been paid. During this period I was the only junior doctor on the rota to cover labour ward, theatre and admissions (there would normally be 3-4 SHO’s and 4 interns)! Two seniors were supposed to be covering labour ward during the exam period, however often only one would turn up and would go to theatre leaving me alone. On one day no specialists turned up at all, so I wasn’t able to open theatre when there were 8 women waiting for caesareans. A woman presented with cord prolapse so I had to take her to theatre but she was the only caesarean that got done. We had 2 days with no IV fluids in the whole department, this meant no caesareans, and keeping fingers crossed that no women had a PPH. To say I felt vulnerable would be an understatement, and in true Mulago style everything you could imagine happened: Eclampsia, twins, breech deliveries, abruptions, ruptured uteri. One particular incident happened when I was alone in admissions. A woman arrived in a semi-conscious state following an eclamptic seizure, and was now having an abruption (premature separation of the placenta leading to heavy vaginal bleeding). It was very hard to auscultate a fetal heart beat and I feared the baby was dead, after delivering the baby with a vacuum it needed urgent resuscitation. I attempted to resuscitate the baby but it was futile, I didn’t have a towel to dry the baby and the resuscitation equipment was broken. A very frustrating and upsetting day.
Another incident that I believe could have been prevented represents some of the struggles we have at Mulago. A woman with obstructed labour had a caesarean section during the night and was found to be bleeding in recovery. She was not taken back to theatre, but instead admitted to the high dependency unit (HDU) where she continued to bleed. In the morning meeting she was reported as a maternal death until one of the nurses informed us that she was still alive! I went to HDU to find her in a peri-arrest condition. Two units of blood were rapidly transfused while I tried to locate the specialist who could take her back to theatre. She was eventually taken back to theatre for a hysterectomy but desperately needed more blood. After madly running around the hospital I was able to get another 2 units of blood but unfortunately she died a few hours later. If there had been more staff and no shortage of blood this woman’s life could have been saved.
In my last entry I mentioned a health centre called Kawempe and I’m pleased to report that the operating theatre will be up and running at the end of the week, ready to start doing caesareans! And hopefully start to reduce the burden on Mulago.
The other health centre I have been working at is Kabubbu. I have been really trying to promote health education and improve access to family planning, and this week I had a session with 30 local women about contraception. It is unbelievable how many myths there are about contraception such as causing cancer, birth defects and infertility. It was brilliant to be able to dispel these myths and give the women more options. Hopefully we’ll be expanding the contraception provided at Kabubbu to include the IUD and implanon, which the women seemed really keen on. Just a small step in the right direction!
Finally I would like to say a BIG thank you to everybody who sponsored me to run the Kampala half marathon. I have raised over £600 for the Liverpool Mulago partnership. We are still deciding how to best spend the money but I will keep you all informed.

1 comment:

  1. It's terrible that you have to watch those lives slip away, especially when it's just a matter of reliable equipment. I'm glad you're publishing what goes on in medical facilities out here. So much aid money come's this way but it just never seems to trickle down far enough...

    ReplyDelete