Come for a fun evening and fundraise!

Thanks to all of you who have read our blog throughout the summer!

If you'd like to come hear about our experiences in person, hang out with our midwifery community, have a drink, come to our get together/fundraiser on September 6th!

We're all going to get together on Thursday, September 6th at the Pint (455 Abbott Street, Vancouver)). It's a casual evening to have a drink, eat some things, we'll talk about our experiences and have some pictures and videos in the background. There will also be a silent auction filled with lots of handmade local items donated by BC artisans. There will also be a fabulous door prize of a basket filled with goodies from Uganda!

You can see all the details, and pictures of all the silent auction items here:
http://www.facebook.com/groups/456782147676093/

Tickets will be $10 for students, and $15 for non-students.
Everyone is welcome to come!

Looking forward to seeing you there....

Webale Nnyo

(by Natalie)

First and foremost, sincere apologies for the huge delay in a post - after we left from our last day in the hospital, we left on a safari and were left without internet connection everywhere we went.
As they say, time flies when you’re having fun, and boy, did time fly.
Our last week on the wards was quiet, and the last baby I caught was a perfect way to end the placement. It was a mom having a VBAC (vaginal birth after cesarean). She was getting into lots of positions of her choice, supported by her two sisters. One of the sister called me to come back as the mom started to push. The baby is barely out before it starts crying, and has the sweetest facial expression that we all can’t help but start laughing as the baby is born. It’s a moment I won’t forget, a baby being brought into the world filled with laughter.
After our placement ended in the hospital a week and a half ago, I travelled Uganda a little with Quinn, Jo, Tanya, and Clare, bringing us to today.
Today is my final night in Uganda, and it is so surreal to think that 8 weeks ago I was starting. I had been waiting to come here since I was accepted into midwifery, and I couldn’t quite believe that the moment to be here had finally come. On my first night here I kept wondering about what I would do and see, would I live up to my expectations of myself, would I be able to do it?
And, I feel so proud to say that coming to Uganda met everything I hoped for and more.
I feel so much more confident in my knowledge and skills as a midwife. It is incredible to look back and see how much I have grown in 8 weeks.
I am incredibly grateful to have met all the mothers and babies that I did, to have known their openness and kindness, to feel connected with only our eyes and hands.
Despite some tough days and difficult births, I am so glad that when I look back at this experience I am filled with a deep trust in women’s ability to give birth, their incredible strength, and the wonderful resilience of their babies...

Amina and Sarah -Part 2 !

-from Joanne

(See Hatching Babies posting for Part 1)

Amina's tiny daughter Sarah had been discharged from the nursery shortly before I finished my placement at the hospital. I was very skeptical about how this preemie would do outside of the nursery. She had been in the nursery for over a month, but still only weighed 1.2kg (up from her birthweight of 1kg). She looked tiny and gaunt and I couldn’t imagine that she would be okay at home without a feeding tube to nourish her. On the other hand, I convinced myself that at least she would be away from other babies that could make her sick. I emphasized to Amina the importance of returning to the hospital if her baby showed any signs of illness.

After two weeks away, I returned to Masaka with my mom.  It was with trepidation that I phoned Amina to see how things were going. To my relief she reported that they were both doing well. Sarah was up to 1.4kg, was seeing a doctor weekly, and was feeding on breastmilk exclusively. With her invitation, we headed to her village to have a visit and see this lovely pair! It was the first time I had seen Sarah alert, and although there is still a long road ahead, Sarah was in good health and Amina was relaxed and positive. It was such a delight to get to see these two again!

Amina with baby Sarah -7 wks old.

Sarah alert and checking out a Canadian JaJa (grandmother)!

Teaching and Learning.

-from Joanne

As we have mentioned, the UBC Student for Global Citizenship program includes both planned and spontaneous opportunities for exchanges of knowledge of expertise. In one moment I would be asking advice from a senior Ugandan midwife, in the next I was teaching a young nursing student who would then assist with the delivery and provide invaluable language help. Over our time here, Cathy and the other faculty had coordinated and delivered workshops for Ugandan staff in Masaka, Jinja, and Kampala. Some of the topics included: Postpartum hemorrhage, shoulder dystocia, neonatal resuscitation, antepartum hemorrhage, charting, delayed cord clamping, etc. As students we were also able to assist with teaching to hone our own knowledge and skills, and assist other learners.

Our placements here provided an abundance of opportunities to be both a teacher and a learner. With gratitude to all of those who contributed to our learning in Uganda, here’s some photos from a few of those moments.

Angela teaching breech delivery to midwives in Jinja. 

Cathy teaching Neonatal Resuscitation to rural midwives who had come to Masaka for training. 

Clare, medical anthropology student, helped staff midwives deliver a CME workshop at Masaka hospital on HIV Exposed Infants.

Cathy delivering workshop for midwives in Jinja.

Babil teaching an attentive nursing student in Masaka.

Cathy frequently facilitated our learning with her excellent sense of humour!

Lorna taught and supervised us in Masaka.

Cathy demonstrating maneuvers for shoulder dystocia at a workshop for midwives in Jinja.

Prossy, one of our amazing supervising midwives in Masaka, teaching Joanne counseling and medications for HIV+ mothers and newborns. 

 Quinn in Jinja : teaching a station on active management and postpartum hemmorhage.

Dr Mickey and Prossy, two of our instructors, keeping it light and fun!

Tanya teaching enthusiastic nursing students how to use a fetoscope and count fetal heart rates.

 Natalie delivered a presentation on Delayed Cord Clamping to a group in Jinja.

Tanya facilitating a station on 
Shoulder Dystocia in Jinja.

Participants estimating blood loss at our fake hemorrhage station.

Grace Jolly (right), a Ugandan midwife and trainer, teaching neonatal resuscitation to participants.

Impossible Is Nothing... (by Tanya)

We leave Murchison Falls and the dry grasslands where we spent the day watching elephants, giraffes, and herds of water buffalo, thousands of colorful birds, baboons and their babies and crocodiles sunbathing along the Nile River.

 The sun is rising and the streets are already lined with children, dressed in different colored uniforms walking the miles to school with no shoes on.  Some carry bundles of dried long grass tied together in a bunch to use a broom for their chores at school, others carry yellow plastic jugs full of water balanced effortlessly on their heads.  The older brothers and sisters hold the hands of their younger siblings. They see our white truck approach and break out into fits of giggles, wide grins flashing bright white teeth against their dark little faces, and wave frantically, yelling out “Muzungo, Muzungo!”, and I can’t help but laugh every time.

Making red bricks

The womn are home with babies tied to their backs while they work all day long. The men are found burning wood to make charcoal for cooking, packing wet red mud into triangles that will dry into bricks, carry loads of millet and plantains they have gathered in the fields on their old rusty bikes . Those not working are seen gathered together, talking amongst themselves, playing a game of pool outside, or sleeping in patches of shade. The houses vary in style depending on family income; some are made with mud with dried palm leaves for roofs, others are made of wood or red bricks with a tin roof.  

A schoolyard with uprights off in the distance

We pass hundreds of little schools, some consist of one room lined with benches that are packed with kids of all ages, others are larger, and more established schools with soccer fields. The uprights are made of logs that give them a lopsided look. Every so often I see a group of children kicking a soccer ball made of layers upon layers of plastic bags that have been rolled into a ball, but mostly the fields are empty…


A ball made of plastic bags

We come across a small building.  It is a school that educates 130 children, ages 3 to 13. As our Muzungo truck pulls in, I see a young boy who spots us and starts to jump up and down with excitement. Within seconds we are surrounded by kids who are curious as to why a truck full of Muzungos pulled into their school this morning. I get out and look for their teacher. I find her in classroom, packed with kids.  Her name is Beatrice-she has been teaching here since 1972. I tell her that we are student midwives from Canada and she cups my hands in both of her hands and with a look of sincere gratitudesays,  "Thank you for the work you do". It is a phrase we have heard often here, which seems to catch me by surprise because the work we have done feels insignificant in comparison to the work the majority of Ugandan people do every day, just to survive…

I ask her if we can give her children a couple of soccer balls; one for the small children to share and a larger one for the older children. At once she breaks into a huge smile and starts shaking my hands again and again and says “Yes, yes, yes madame, we would be forever grateful, come, please will you sign the guest book?”


We are now surrounded by 130 anxious little faces, so when I a hold up the balls and ask “Would you like a football today?” they break into screams of laughter and shout out in sweet, excitable voices “Yes please!”

One little boy stretches his arms to the sky and thanks God.

The teacher throws the balls onto the grassy field and then joins them.  The children go wild; screaming and chasing the balls around the field, kicking it to each other and throwing the ball into the air, laughing and piling onto each other as they dive onto the ball to get at it first.

130 kids go crazy over balls!

 As we stand back and witness PURE JOY, I conclude that I have never in my life seen a group of children have so much fun!

Experiencing the pure joy in giving here in Uganda is a feeling I will never forget and I thank all of you who gave me the opportunity to have this experience.


As I prepare to leave Africa, I think about the women and their families I have been allowed to care for, the student nurses,  interns, doctors and midwives I have interacted with, and I have a sense that  “Impossible Is Nothing.”

Wei Be Lei Uganda
With much love, Tanya

Boxes......

According to Wikipedia: Compartmentalization is an unconscious psychological defense mechanism used to avoid cognitive dissonance or the mental discomfort and anxiety caused by a person's having conflicting values, cognitions, emotions, beliefs, etc. within themselves.

Compartmentalization allows these conflicting ideas to co-exist by inhibiting direct or explicit acknowledgement and interaction between separate compartmentalized self states.

Although we are  making connections and memories we will remember for a lifetime, we cannot ignore that fact that our days here are filled with interactions, sights, and experiences that have a profound impact on us. Out of respect to the women we are serving and to avoid traumatizing some of you, there are some days and stories we opt to not share.

 Jo and I have been practicing the art of "compartmentalizing" some of these moments by putting our emotions in a box to re-visit at a later time......

So...here's an example of our box...

(By Tanya and Jo)

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?".

Cherishing the PostPartum Smiles

Cherishing the Postpartum Smiles

Hi! It’s Shannon from Jinja. It has been an incredibly interesting, rich and humbling week on our own since the preceptors left.  There have been many sad stories and many rich and poignant experiences. All the stories from our time here are beginning to weave together into an incredibly rich tapestry, full of many colors and textures. Now, while supporting a mom in labour and watching out the window at the families waiting for their loved ones with chai or mattokke; when I give the thumbs up sign to a dad or sister whose head is lingering just outside the window waiting for news and they grin back at me; or when walking through the post partum ward at the end of the day and giving hats to all the new babies; when witnessing a labouring mom of seven reach out to support a first time mom who is struggling through her contractions- my heart is full of Uganda. I know that when I leave here I will wrap the beautiful tapestry of stories around me and carry it home where it will always be a part of who I am as a midwife. 

This week has been very, very busy. The ward has been full. Some days it has been very noisy with many moms in active labor. Liz and I run from one mom to the next, supporting each other when we can, thinking quick on our feet and constantly being thankful for the tight team we have developed. I am very thankful when Liz brings me a plate of excellent food from the TASO. We just stop for a few minutes and then jump back into the action!  There are some moms that needed more attention, time and support, and then many other moms just push their babies out.  We have coined a new term.  “The GreenMorris Maneuver” is a skilled trick to catch a baby who is flying out with only enough time to glove one hand.  A complete “GreenMorris” means that two or three fingers may be in one finger of one glove.  Incomplete? Glove is fully on. However, the baby is safely and gently supported and does not hit the floor or bed.

My favorite time of day is on our way out of the ward when we stop to visit everyone in the postpartum ward. The evening sun streams in through the tall windows and lights up all of the families in the large room. The room is long and skinny; this week every evening has been full to capacity. Bright colors of fabric spill everywhere, children of all ages with wide eyes staring, several generations of women gathered on mats to celebrate the mother and newborn, providing care and food, newborns crying, mothers resting.  As we walk through the ward we look for the faces of the women who we have supported through their birth.  This is my absolute favorite part of the day because when I see the women smile in recognition I know it has all been worth it.  It fills me right up to know that despite language, cultural, economic and social differences we have been on a journey together. As they brought their child into the world, despite all challenges and barriers, we had the opportunity to witness and support.  Even though the labors can be hard and long and the women have very little, even though sometimes the babies do not survive or spend many days in the special care nursery, even though we are challenged by the treatment and struggle with finding supplies to help them, with sometimes only our hearts and our hands, we can still let compassion and empathy guide our work. They look at us through the pain of labor that is universal. Our touch, gentle care and soothing words have no language barriers. So, at the end of the day, we stop to sit with them, hold their babies, learn the names they have given them, meet the other family members and give a hat or blanket. Even the mothers whose babies have passed often still smile at us as we stop to check on them.  Then we wander out the door into the sunshine, a few more threads added to the tapestry, grateful for the day. 

A big shout out to all the people who supported my trip to Uganda.  Also, big love to my amazing family at home on Haida Gwaii whom I miss so much.

Shannon

A Shout Out to some of our sponsors!!

As we start to near the end of our placements here, we are thinking about all of the people that helped make this placement in Uganda happen. We’d like to give a big shout out to a group of people that donated items and services for our fundraising. Please check out all of these generous artists and professionals who donated items for a silent auction - great stuff that will be available at our Students for Global Citizenship fundraising event this fall that will boost the program and support the students who will follow in our foot steps next year! (We will post the event info here on the blog once confirmed.)

 
     







      Ø  Masha Tikhonova Human Anatomy Art:  http://www.imagience.com/

Ø  Soma Studios:  http://www.somastudio.net/

Ø  April Lacheur (Painter) www.yapespaints.com

Ø  Vicandalbie:  http://www.vicandalbie.com/

Ø   Mellon Glass:   http://www.mellonglass.ca

Ø  Heyday Design http://www.heydaydesign.ca/

Ø   Meiku Designs:   http://www.meikudesigns.com/

Ø   Lulidesign:   http://www.lulidesigns.etsy.com

Ø   Shrpixieland: http://www.shprixieland.com/

Ø   Sandpiper studios:   http://www.sandpiperstudio.ca/

Ø   Superfly lullabies:   http://superflylullabies.com/

Ø  These Gray days :   http://thesegraydays.com/

Ø   Printing center   http://www.vehicle-graphics.ca/

Ø   Sugarandcandy:   http://www.sugarandcandy.etsy.com

Ø   Dirty Girl Clay Works:    http://www.dirtygirlclayworks.blogspot.ca/

Ø   Vanprint:   http://www.vanprint.com/

In addition, we’d like to thank the Victoria Midwifery Department for donating a digital baby scale to a hospital here. Accurate baby weights are even more critical here as they are used to quickly determine medication dosages for babies exposed to HIV, infections, malaria, or born prematurely. 

Our gratitude to all of you from us!

  - Joanne, Tanya, Babil, Natalie, Quinn, Liz, Shannon

Sorting medical donations in Entebbe

Want to support the program for next year?

Each year personal donations are used to purchase medical supplies that students bring as donations to the hospitals here, and to deliver workshops to local midwives. Program costs also include ensuring UBC instructors are able to supervise students during their placements – a component on international midwifery/medical placements that is considered essential for sustainable and ethical international partnerships. 

Some of the girls en route to Uganda with bags of supplies & donations

Tax receipts are available for monetary donations made directly to:

Students for Global Citizenship

Dept of Midwifery

B54-2194 Health Sciences Mall,

Vancouver, British Columbia, V6T 1Z3, Canada

Tel: 604-822-0352
Email: info@midwifery.ubc.ca

  

A tour

I have been struggling to find words to describe how one moment I am overjoyed and the next completely overwhelmed. Happiness filters through our day: a new mama smiles shyly at her infant; our nurse friends giggle at our spirited attempts at Lugandan; I stare out the window to waiting families turning the hospital grounds into a colourful spring picnic of grass mats, toddlers, yellow thermoses, and coke bottles. Yet, I am surprised to experience such frustration. Essential birth supplies are here one day, and missing the next. Women arrive to the hospital too late or too sick for us to help. We struggle with differences in practice, and in building space for labouring women to find autonomy in a hospital culture of rounds, rounds, rounds, and vaginal exams, vaginal exams, vaginal exams. I can't ever find charts, even when I had them five minutes earlier. With this said, there is something amazing about working here, in forming connections across vast cultural divides, in how the soda seller at the hospital canteen saves a mango juice box for me each morning. I love that Shannon and I feel like a smooth team as we care for our women- regardless of outcome-as best we can. For now, I am holding close these moments and hope that later, I will begin to find some understanding. I think what I will remember is that this was beautiful.

So, in lieu of specific birth stories for you today, here is a mini-tour of our beloved hospital so you can get a sense of where we spend our days. I hope you enjoy them!

-Elizabeth (Jinja)

The Labour Ward:

 Our Resuscitation Area:

 Delivery Room #1:

 Curtains between beds:

 Our little kitchen, with a favourite nurse:

 A beautiful mother and her new babe:

Who's Who in the Zoo..

Because we landed running in our respective hospital sites, we haven't done a great job of introducing ourselves. In case it hasn't been clear, there are three regional hospital sites we are split between while here in Uganda. Each site has at least two students and one BC Registered Midwife (who have also been registered locally to practice here in Uganda during our placements).

Our three sites are cities in the southern half of the country: Masaka, Jinja, & Mbale. The country of Uganda is said to be a similar size to the state of Oregon, and has a population of ~33 million. Each of the hospitals we are at are referral hospitals. This means that not only do we see women from that particular city, but we also receive women who have traveled from a rural area -usually due to complications they have encountered in labour. This partially explains the high number of complex or emergency births that we have been involved in. Other factors leading to complications include malaria, anemia, HIV, malnutrition, poverty, distance and cost of traveling to the hospital, and usually a combination of these factors.

One other potential complication that we are learning about here is women with contracted, or very small, pelvises. This can be due to malnutrition in childhood and adolescence that then prevents proper bone growth in women. For some women, this can be so extreme that they require cesareans in order to give birth as their pelvis is too narrow to deliver vaginally. This is something we consider when a woman arrives from a rural area and has been in labour for multiple days without progress. Although not overly common, for at least some women who have this situation, a cesarean delivery is what can save the life of both the mother and baby.

So, here's who's who in the zoo:

Lorna, Cathy, Grace, Shannon, Joanne, Angela, Natalie, Babil
Elizabeth, Tanya, Quinn, Claire

Masaka-Joanne, Tanya, Babil and Claire (medical anthropology student) with Cathy RM, Lorna RM, and Mickey MD.

Jinja-Elizabeth and Shannon with Grace RM

Mbale-Quinn and Natalie with Angela RM