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