A Weekend Away

Hello all...it's been a few days since my last post and I'm typing away on one of the slowest computers I've yet come across in Masaka, so I'm unsure as to how much I'll get written this evening.

To start from where I left off - a few more thoughts about visiting the TBAs:
-most of these women had learned their skills from their mothers or grandmothers; in fact there was a mother-daughter duo present at the workshop!
-each TBA attended between 2 and 5 births per month.
-despite having good skills and training, and knowledge about when they should refer women to a health centre or hospital, the lack of transport is a major risk factor when there is an emergency during a birth. As well, these women are not trained in, nor do they have access to, some of the basic medications and supplies we would use at a home birth in Canada. It was interesting to learn that some of them buy ergometrine of their own volition to use in the case of postpartum hemorrhage. The district health nurse-midwife who attended the workshop with us was trying to discourage the TBAs from using medications at the births they attend as they are not trained in the correct usage - it's not considered within their scope. As well, we expressed some concern that if they were going to be giving meds, ergometrine is not a good first line treatment for hemorrhage - oxytocin is a much better choice. I can understand the desire of the TBAs to have some other way to manage a postpartum hemorrage - I find it scary to think about attending a homebirth and not having any options for treating a hemorrhage. Add to that really sketchy transport situation and it certainly puts into perspective the work that these women do out in the rural areas of Uganda.

On Thursday we were back at Masaka Hospital. It was an interesting day, upsetting in some ways. Very slow in terms of births, in fact, the only term vaginal delivery occurred after Anne-Marie and I had left. But Brynne and Cathy were still there, which was great, as Brynne caught the first baby of a 15 year old woman who had a very traumatic labour. She was so young, and incredibly distressed throughout most of her labour. It was hard to know what was going on for her, she was requesting a C-section from the moment she arrived, and she spent a lot of time crying and screaming, both with contractions and in between. Again the language barrier was distressing. In the end though, she pushed her baby out with no complications, Brynne caught this little girl, over an intact perineum, despite directives from the Ugandan midwives to cut an episiotomy. I think we're gaining a reputation for prevention of tears - some of the Ugandan students (and even one of the interns) have been requesting to attend births with us so that they can learn how we manage second stage (the pushing stage).

We had a long weekend, taking Friday off. Cathy, Mickey, Brynne and family, and myself headed to Queen Elizabeth National Park to see some Ugandan wildlife. We met Cathy and Mickey's daughter-in-law Lindsey and her friend Andrea there. It was a great weekend. Cathy generously hired and payed for a vehicle and driver to take us from Masaka to QENP, where we stayed at the lovely Kingfisher Lodge just outside the park. We had a great mix of relaxation and exploration, spending some time at the lodge lounging, reading, enjoying the view. The kids played in the wading pool much of Saturday. We also saw lots of animals - elephants, hippos, crocodiles, antelope (Water Buck and Kob), lions, a leopard!, many birds, warthogs, mongoose (mongeese?), water buffalo...it was great. We took lots of pictures and just enjoyed the scenery and landscape. A real treat.

I'm feeling ready to head back to the hospital tomorrow. Cathy, Mickey, Anne-Marie, and I only have 3 days left here in Masaka. We head up to Kampala on Thursday morning to spend a day and half working on the high risk ward. Then Cathy and Mickey fly off to Zambia to meet Inna and Elaine. A-M and I will spend two more weeks working in the low-risk ward in Kampala while Brynne will remain with her family in Masaka and continue working at the hospital here. It will be a sad parting of ways but I'm looking forward to the change and hoping that we will get a few more births in Kampala as none of us have attended as many as anticipated yet and I would like to attend a good number more before I finish my placement here.

Well, time to post this entry. I'll write again soon. Sending love and light from Uganda to you all.

Heather