last day here in Kampala. sad to be leaving

Early breakfast and then lots of waiting around for 9am meeting. We should know by now that 9 means 1030ish
Anyway very successful end to our work here. Professor Ann managed to bring together midwives from the Ugandan private midwives association and midwifery educators for a successful discussion about mentorship.
Then this afternoon we gave our feedback before heading to the airport to await our delayed flight.
Sad to be leaving Uganda but hopefully our efforts will begin to make a difference.

travelled over the equator almost to Tanzanian border

A long drive on very bumpy roads across the Equator to visit a private midwifery centre and a government hospital.
It took several hours to get to Masaka then we left the tarmaced road and went for over another hour before we reached St Mary maternity and general nursing home. Its the only one for miles around so is quite busy. The midwife that runs it is qualified in the UK some years ago when they did parts 1 and 2. But she is the only qualified member of the team other than a general medicine doctor. There are a team of so called midwives which are in fact TBAs . I wasn't able to spend too much time there but I can show you some pictures and say that it seemed like a happy place.

this is Bonny our driver at the equator

St Mary's maternity home

wicker baby scales

labour room

After leaving here we went just 30 mins down the road, bumpety bump!! to find a level 1V health centre that mean they have a maternity unit with theatre and are able to perform C/S and offer a full range of A/N P/N care.
Well ..... on arrival we found no one to show us round other than the care taker, maternity did have 5 p/n women and babies but not a member of staff in sight.   We had a chat with the women and checked on there babies, had a look at the labour room and ventured off to see if we could find anyone else. The general ward was just the same, full of patients with IVIs and some looking quite poorly but not a member of staff apart from the caretaker.

maternity building level 1V health centre

labour room

We did find out from the care taker that a doctor lived on site and he could contact him if he thought he was needed.

My lunch today was

23rd September 2014. Makindye Maternity Home

I met midwife Ruth today who has been qualified for over 40 years and runs her maternity home from a building in her garden. As well as being a midwife and mother she also keeps pigs and hundreds of chickens. I have a feeling that my lunch was pork.
It was really home from home at the clinic, everyone got a warm welcome as they arrived and the care was delivered with kindness and respect.

This afternoon Ruth got together with another local midwife to do some training. We have done a mini skill drill day. Resuscitation of the newborn, Shoulder dystocia, PPH. We had lots of fun and I think they learnt something.

I have learnt lots about contraception and how to pray. Very important on your own as a midwife out here.

faith restored

22/9/14
I have spent the day at Maama Maria's maternity clinic today a private clinic which is where I was based last year. It was good to see the changes that have been made especially when you know that the twinning project has helped.
They have moved there Labour room and have loads more space a tiled floor and well organised emergency equipment. There is now space for women to be off the bed and the midwives told me of a delivery Mary had done with the women on a stool.
Mary wishes to thank all at Queens Hospital Burton for the fantastic New equipment you have sent. I was also able to meet two of the women we are providing complete maternity care for.

This is Carol and Molly

Both of these women come from a community that wouldn't normally seek any A/N care and would only go to the clinic if they had a problem. They were identified by Mary's outreach worker who chose them because of there circumstances. Your donations have payed for both women to have HiV screening, 4 A/N assessments, a mama pack, containing everything needed for delivery and care at delivery and the 1st 24h P/N.

The New Labour room at maama. Maria's 

the placenta pit and midwife Nuruh

Sunday 21/9/14

After meeting with the Ugandan Private Midwives Association, our partners in this project, We are able to see what they want from us next week.
My remit for the following 5 days is to visit several private clinics one of them Mama Maria's which I was at last year and audit the impact that the volunteers have had.
I need to find the reports from last years volunteers and devise an audit tool to try and capture as much information as I can and try to show the positives and negatives of the volunteer visits.
Easy really!

the meeting

 Prior to the meeting we had a lovely afternoon at Kampala golf club

Ann Patricia Me and Sue

I have also talked with Mary midwife and president of the UPMA from Mama Maria's clinic about using the donations which the midwives and staff at Burton Queens Hospital have given for helping some women who would not normally seek medical help from the midwives. One of the women delivered yesterday and I will tell you about it in the next blog when I have been to the clinic to meet with the midwives and hopefully the mums.

well earned days off

Today we have visited Uganda's National Mosque, The Gaddafi Mosque. Interesting history told to us by our guide. The foundations were laid by Idi Amin who never completed it.
Later money was provided by Colonel Gaddafi as a gift to Uganda and the mosque was finally completed in 2006. it covers 12 acres and is made of reinforced concrete

Myself Sue and Patricia in our hijabs

climbing the minaret 50.5 m

the stairs

veiw from the top

the Arab world represented by the patterns on the ceiling

the wood paneling represents the mother land, Uganda 

the stained glass represents Europe

Successful end to 2nd week here at Wakiso

My last day at the health centre was helping out at the busy HIV clinic. Before I got started I hunted out Sister Betty and Sister Robina to give them my report for the time I have been here. I was able to tell them that I had seen some improvements over the last 8 days. The new desk in reception had helped women see who they needed to report to and freed up space for clinical use in the midwives room. There were some new trash cans in all the public places helping to keep the place clean and tidy and this morning I had seen the midwives on duty start their shift with a daily clean of labour room and office. This made such a difference.
I didn't want to sound too critical so gave a list of 5 things I thought the maternity department could start to work on to make difference.

1. Use the 5S document to improve organisation and encourage staff to take responsibility for the overall tidiness of the department.
2. Stop the dangerous use of Sharpe's for ARM. This procedure and Sharpe's weather it be a clean needle or a broken vial puts midwives at risk of a needle stick injury and mothers and babies at risk. 
3. The clinic works on a curative basis, reacting to problems, when midwifery can have greater impact working in a preventative way. Proactive not reactive. eg: Screen for pre-eclampsia, anaemia , infections and IUGR at every opportunity.You have made a good start by performing and recording BP on every A/N visit. Keep it up.  
4. Encourage midwife Regina to disseminate her skills for resuscitation of the newborn.
5. Regarding dangerous practise during the 3rd stage of labour, my 1st concern is that midwives are performing active management without administering an oxytocin. I recommend that the health centre look closely at the way the 3rd stage is managed and perhaps draw up some guidelines. 

Lastly I would like to say a big thank-you to all the staff at Wakiso maternity unit for making me feel welcome. I have learnt a lot from them, I now feel expert in using a pinard and I shall never throw anything away as there is always another use for it. Except empty vials!

cleaned up midwives room

17/9/14 Too tired to write so just put some pics up for you to see.

advice in mother and child passport

happy family

mother and child passport

epilepsy poster

going home. new mum was the 3rd passenger after posing for the photo, dad walked with the suitcase

16/9/14 department meeting

Well today I went early to attend the department meeting, true to form I need not have got up early as it started late.
I was able to meet Sister Robina a very nice midwife who was keen to implement some of my suggestions.

• The 1st was that every women coming for A/N check should have a BP checked and recorded and a follow up by a doctor if it wasn't normal. This mornings clinic had 3 follow ups organised and I saw a doctor for the 1st time since I have been here.
• The 2nd was that the midwives take responsibility for their emergency packs. There are 3 bags under the delivery trolley for PPH Pre-eclampsia and NN resus. so this afternoon we have cleaned and restocked them. They're now in a fit state to use.
• The 3rd was to ban the use of needle's or broken vials to perform ARM. this was more difficult to get them to understand how dangerous it was to both midwives and mums and babies.
• I have also discussed the use of a Ugandan document called the 5 S's. which talks about organisation and cleaning as well as other things.
• They have blown up the birthing ball and were keen for someone in labour to arrive to use it.

I think these small changes will make a difference to the women coming for care at the health centre. I just hope it all continues after I leave.
I did want every women to have a urinalysis. but that was pushing it too far. One thing at a time, small steps.
Didn't get time for lunch today but made up for it with a nice meal at posh restaurant in Kampala and a bottle of wine.

1st success of the week

Managed to convince the midwives that a young 1st time mum didn't need an episiotomy.  Intact pereneum , no razor blade required and everyone happy.

Lazy Sunday

14/9/14

This mornings news, as well as the terrible incident in Syria, shows a terrorist threat in Kampala. Advice from the British Embassy is to stay in the hotel don't visit any shopping malls or restaurants that attract westerners. The threat is from Somalia Shebab who it appears have a terrorist cell set up here in Kampala.  They say there will be updates later today, but for now we are trapped in the hotel again.

weekend

Didn't write yesterday as a bit upset. It was a long day at the health centre at Wakiso, very busy HIV clinic seeing both antenatal patients and new mums and babies. There where only 2 members of staff to run the clinic and deal with admissions in labour and postnatal women and babies. As you can imagine something had to give. There just wasn't enough of us to help everyone. The midwife I was working with started her shift at 7am and didn't take a break for a drink until after 4pm and her shift wasn't over until after 6pm.

We dealt with many mums and babies for the HIV clinic and booked several who had just found out their status. As well as this we had 2 deliveries and several more admissions in labour as well as post natal patients.

At the very end of my day a car arrived outside the clinic and a very distress man came in shouting I couldn't understand what was being said and thought initially that he was complaining about something. The midwife just seemed to ignore him then she wrote something on a scrap of paper and the man after some pleading rushed back out to the  car. I followed him to see if i could tell what was going on. The passengers seat was flat and as the car drove off, I could see a women covered with blankets lying down. On questioning the midwife I  found that the man had come into the clinic saying he had got a women who was 6 months pregnant in his car who was dying! she was bleeding. I am afraid I was unable to keep my cool and regret my reaction. I questioned the midwife's lack of interest in the mans requests for help. The midwife didn't even get up from her seat to see if there was anything she could do. I had seen this midwife throughout the day site venflons and set up iv fluids so knew she was competent. It is 12 miles through congested traffic to the main hospital in Kampala.

I have since found out that in Uganda midwives have been imprisoned after maternal deaths until investigations have been completed which sometimes takes months even years. So I now understand that things aren't always how they appear.

This was the end of a very stressful 3 days and has left me with much to reflect upon.

water collection point

Today Saturday has been a much better day. We have visited Ziwa Rhino Sanctuary about 3h drive from Kampala but well worth it. Along the way we witnessed the daily chore for most people here of collecting water and carrying it home.

robert Ziwa ranger

The Rhino sanctuary is home to 15 wild Rhinos which they have been protecting and enhancing a breeding program since 1997 following the violent demise in the species, ending in their extinction in Uganda in 1983. Our ranger guide Robert walked us really close to a mum and baby rhino fantastic day

mum and baby sleeping in the shade

2nd day at Wakiso health centre

There are lots of things to deal with here, from dead dogs on the road to the terrible way women are treated.  I hoped that midwives would be more respectful to women but it seems I hoped for too much. I think I will just post some nice pictures as its not appropriate to blog some of my thoughts about today.

family support

there's a baby in there somewhere

transport in labour

postnatal room

mum Rosie with baby Peace 1st bf

1st day at Wakiso health centre

Well what can I say there's plenty of work for me to do but, where should I start.
I was met by sister Betty who only spent 5-10 minutes with me  not really knowing who I was or who had sent me. I was then taken to the maternity department which was in the middle of a busy ANC. I met with 5 midwives and just mucked in to see about 40 women. Once clinic was over things calmed down and I was introduced to everyone. Eventually there was just one midwife, Jennifer left alone in the department to attend to what ever came in. We saw another 2 patients before I went home at 1730.

The clinic is small it has a labour room with 2 beds, a USS room, a room for the midwives, a post/antenatal room with 6 beds and a coach and a waiting room. Over the last 10 days there have been 34 deliveries at the clinic and 6 transfers out to the main hospital 2 were p/n transfers the others in labour. The health centre has a theatre but that was locked up. the midwives told me they can perform c/s but the doctors are very busy so usually transfer people. There is no transport for transfers the women have to get there under their own steam. Its 12 miles away! and once at the hospital in Kampala and seen by a doctor there is a 4 hour wait for an emergency c/s!?

As you can tell its challenging and hard to see how you can help change some things.

One women and her husband did arrive in labour only to be told that she hadn't with her the compulsory pack containing gloves and things for delivery. The mw didn't assess her in any way just turned her away to go and buy the pack. They walked away and returned about 2 hours later with gloves and pack. This women was G4P3 and HIV + . All women in Uganda are entitled to the birthing pack free of charge.

midwife Jennifer

sent away

poverty

You may not think as yourself as being rich

Think again

I read an old midwifery today issue from 2010 which struck home with me being here in Africa

mum and daughter collect water

watching people get on with their everyday lives. It said, “You may not consider yourself as being rich yet only 10% of the world’s population own a car so if you do own a car that puts you in the top 10% of riches people in the world. It’s the same if you have access to clean drinking water, education or a trained midwife.” So next time your feeling poor remember what poverty really is. 

9/9/14 Still waiting to start work

I feel like there's not much to tell you about as my placement at the health centre in Wakiso has not yet been organised. I am waiting for clearance to go and observe there. They tell me it is a sensitive situation what ever that means? This morning I had an email stating the program I will follow, as usual it is very scanty information but basically I will be picked up to start work for 9am tomorrow, only 4 days after my arrival!  Sister Betty will be ready to receive me and is happy to continue the good work done by  the volunteers who preceded me. Hope I live up to her expectations.

So what have Ann and me been up to today :- Well we decided to venture out of the hotel as it was beginning to feel like a prison. We located a driver Godfrey and he took us into town and dropped us of near to a craft market. Had a nice wonder around there bought a unusual metal basket thing made out of recycled coke bottle tops and some post cards. Had lunch in town before coming back to the hotel.
We have organised ourselves a trip out on the Gulu road about 3 hours away to a Rhino Sanctuary called Ziwa. Its home to Uganda's only rhinos. They are wild and protected in the sanctuary and we should be able to track the 9 rhinos on foot through the Savannah and swamps with a guide sounds really good so fingers crossed it all works out.

Hopefully the next instalment will be about the health centre 

SAFE ARRIVAL

Arrived safely here in Kampala at midnight last night. Just one little hitch no one was at the airport to collect us so thank goodness I wasn't alone Ann and myself made our own way to the hotel in a taxi.

view from my door

not so peaceful outside the hotel gate

think this guy may come by with the finished 3 piece suite on his push bike by the end of the week