Moving forward...

I have been really impressed with the progress made at all three of the health centres I have been working at (Kawempe, Kabubbu and Kasangati). I visited Kawempe today to find the postnatal ward full of mothers who have had emergency caesarean sections! This is great for the local woman as they no longer have to make the difficult journey to Mulago and face the long waits to be seen by a doctor. Word is spreading that Kawempe is now doing caesarean sections and more women are attending for delivery. However Kawempe is still struggling, their budget has not been increased now that they are performing caesareans and shortages of drugs and equipment remains a daily challenge.

The new postnatal ward

The building of the new postnatal ward at Kasangati is now complete. However a walkway still needs to be built connecting the operating theatre to the ward and then hopefully caesarean sections will commence.

The number of deliveries at Kabubbu has more than doubled over the past 6 months and more women are continuing to attend for antenatal care.

The past week at Mulago has been hectic. The registrars have been away for their exams, so it leaves doctors very thin on the ground. On one occasion a woman had been found having an eclamptic seizure and was bought in by the police. She was very unwell, agitated and confused and her baby needed urgent delivery. The wait for theatre was too long so I had to deliver her baby by vacuum. It took heavy sedation and four nurses and doctors to restrain her. I can't imagine ever having to do this in the UK, but when the wait for theatre is hours you're often forced to make really difficult decisions.

I recently spent a week on the emergency gynaecology admissions ward. I had no idea of the scale of the problem caused by unsafe illegal abortions. These women are desperate and manage to buy misoprostol or use local herbs to induce an abortion. Women risk their lives trying to have abortions. I removed a stick from a woman's cervix, she was lucky that she hadn't perforated her uterus, haemorrhaged or developed sepsis. Unlike a young woman who was referred from a hospital in northern Uganda with septicaemia following an illegal abortion, who unfortunately died a few hours after admission. With no social welfare system or assistance for women who have large families, women simply cannot afford to look after the children they have let alone any more children. With additional barriers accessing contraception women will continue to have unwanted pregnancies and seek illegal abortions. This is a very sensitive political and religious issue with fierce condemnation of any woman who seeks an abortion. Unfortunately I'm not sure how this situation will change.