Today, the meaning of boomu was lost....(by Tanya)

Boomu-means together, the purpose of a group: to work together for our mutual benefit and the benefit of our communities.

We arrive on the ward this morning to find a very tiny premature baby in the nursery struggling to breathe. The mother is there, we try to resuscitate the baby, but the heartbeat is too weak and despite our efforts, the baby passes.  A mother and her family leave the hospital empty and heartbroken...

I wonder how long this baby was in the nursery struggling to breathe. Would this baby have survived if there was enough staff to adequately care for these fragile babies in a nursery that at times has two babies sharing one cot?

The day continues…

A woman, gives birth to beautiful baby girl, and then suddenly starts to hemorrhage. We act quickly: we give her oxytocin, a shot of ergometrine, rule out perineal  lacerations, empty her bladder, check for retained products, insure her fundus is firm, consider bi-manual compression,  but still the bleeding continues….we estimate 800 mls of blood loss at this time. When we attempt to put in an IV of normal saline, the Ugandan midwives do not feel the woman is hemorrhaging, and putting up an IV is seen as wasting valuable resources. Despite the scrutiny we decide to do it anyways…

The dynamics of the team effort suddenly shift  in our differences of opinion and ways in which we manage emergencies and the atmosphere becomes uncomfortably tense and divided….

The day continues…

A woman, who had come to see us earlier with two scars from previous caesarean sections, goes to the theatre to have her third baby. It appears to be an uncomplicated operation.  Later that day, while recovering in a long room lined with women recovering from post-operative procedures, she quietly passes away, unnoticed.  A member of a generation suddenly gone, a grandma is left to raise her daughter’s three children, grief is again present...

Why did she die? How did someone not notice that she was critically ill? Which of the 40 women and babies, divided between 2 separate postpartum rooms was the ONE and only postpartum nurse attending to at the time of her death?

And still the day continues…

A woman is rushed in from a village far away. She is barely conscious. Pregnant with her 7^th child, she has never been to a hospital until today. Her uterus has ruptured and she needs an immediate caesarean section.  We rush to put up an IV and catheterize her bladder in prep for the theatre. A litre of blood is ordered for a transfusion. It arrives quickly. The intern doctor prepares for delivery, but the Obstetrician has not yet arrived. We wait impatiently, knowing that every minute lost is crucial.  When he casually saunters in, he finds that there are no operating scrubs available, and declares that he will be unable to proceed with the operation…

I watch this woman, unconscious on a metal stretcher. Her sarong is covering her tired, limp body. Her baby is no longer alive, and I wonder how long she will be able to live?  Who is in charge of washing and re-stocking the scrubs and will the scrubs be found? Is there time to transfer her to another healthcare facility? Is the lack of scrubs really coming between the possibility of infection and her life? Will the worried mother of this woman standing outside the theatre doors be left to raise her 6 grandchildren?

For us the day ends here.

We change out of our soiled clothes and gather up our bags that contain: sterile gloves, lubricating jelly, antiseptic wipes, fetoscopes and stethoscopes’, hand sanitizer, sterile gauze, our catheters, and IV cannulas, our delivery sets, our suture material and headlamps and our plastic goggles that we bring each day in order for us to feel as if we are doing our job “properly.” 

As the sun sets we walk back up the grassy field to our hotel on the hill (of all places). We pass a little boy, with no shoes herding his two cows and oodles of happy school children who try out their English phrases on us. We are greeted with warm smiles and friendly, sincere “welcome backs” from the staff at our hotel.

But what becomes of the woman, their families, and their children- those living and left behind?

With unanswered questions, heavy hearts, and a feeling of frustration and powerlessness, we order a cold Stoney and sit down to dinner…

In a hospital with limited resources,  a divide in philosophies and management of care, and a hierarchal chain of command, I can’t help but wonder, "What would have happened today if the meaning of  Boomu was able to be embraced by all?".