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

Maternal Mortality and Women's Rights in Uganda

"Feminism is the radical notion that women are people."  (Author unknown)

 A powerful and timely article from the Boston Globe:   

“Ugandan women go to court over maternal mortality”

By Rodney Muhumuza, Associated Press  

 June 14, 2012

KAMPALA, Uganda - More than 100 women die in childbirth each week in Uganda, a heartbreaking statistic that has energized activists to go to the Supreme Court in an effort to force the government to put more resources toward maternal health care to prevent the wave of deaths.

The activists say they want the country’s top judges to declare that women’s rights are violated when they die in childbirth, the kind of statement a lower court declined to give last week. In rejecting the petition, the Constitutional Court said the issue was one for the country’s political leaders.

The country’s top judges have a serious role to play: A declaration favoring the women activists would shame the government into action that drastically reduces mortality among childbearing women in Uganda, activists say.

“All we want is a declaration that when women die during childbirth it is a violation of their rights,’’ said Noor Musisi of the Center for Health, Human Rights and Development, a Kampala-based group that is championing the legal push. The groups presented the case to the Supreme Court on Tuesday.

Uganda loses 16 women in childbirth daily, a figure some activists emphasize on placards during regular marches in the streets of the Ugandan capital. Most of these deaths occur in villages where bad roads and poverty make it difficult for women to reach health centers. Even when they get there, some say, the available care is poor.

Health centers have been built in villages across Uganda, but the structures are usually devoid of equipment and medicine. Ugandan newspapers frequently tell of midwives and nurses who treat women in labor with a lack of compassion. And at times, when the caregivers are overwhelmed, some women are left to die.

Valente Inziku, a Ugandan man who lost his wife and baby in 2010, blamed the government. The hospital in northern Uganda where his wife went had no delivery kit that Sunday morning, and the midwives were greatly outnumbered by the patients, he said. The nurses asked him to buy gloves that were never used.

“She was not attended to,’’ Inziku said. “She waved her hands the whole day but no one responded. Then she started bleeding. She bled and bled and then she died in my hands.’’

http://bostonglobe.com/news/world/2012/06/13/ugandan-women-court-over-maternal-mortality/0qs36uXae26qwk6XcgOAdK/story.html

The other side of midwifery (by Natalie)

Sadly Angela left us last Wednesday to do a workshop in Kampala, so we had a few days off. Yesterday was our first day back on the wards, and I was wondering how it would go without her. What would I get today? Would I be able to manage on my own? As I have learned already, sometimes the world has a funny way of listening.

As soon as Quinn and I stepped into the ward, the head nurse tells us, “Gloves on! We have two women in second stage!” Thankfully, they are side by side, so Quinn and I can be close together if we need each other. As my 16 year old mom is getting close to crowning, Quinn lets me know she is a first time mom who has been in labour for many days. I also notice by the shape of her stomach something that looks like a fibroid - both of which are risks for extra bleeding postpartum. Many mothers here have differently shaped pelvises from having babies young (their pelvises have not fully developed) or from inadequate nutrition (their pelvises don’t develop in a normal way). I can see this baby needs some help coming out, likely from a differently shaped pelvis, and it’s a very tight fit. I do what I can, and the head comes out...but the shoulders do not.

I am doing all the maneuvers I have learned and practiced at school, but I now have many students looking at me, and two senior midwives telling me to do fundal pressure and pull on the head, and if I just pulled on the head, the baby would be out by now (we don’t do these technique anymore). Quinn backs me up while we stick to our guns and try to quickly explain we don’t pull on the baby’s head; the baby comes out in 3 minutes (you have 5-7 minutes) and needs some resuscitation. As Quinn does the resuscitation (and is still monitoring her other mom!) my mom starts to have a postpartum hemorrhage. I get the bleeding under control with wonderful help from the Ugandan medical students. Her baby is now breathing, but clearly needs further monitoring. Minutes later, Quinn’s mom has her baby, and then her baby needs resuscitation too. Her baby comes around well, and I really begin to appreciate how hard the nurses work - often one nurse to six patients; and I am running off my feet to keep good care of my mother and her baby as well as Quinn’s recent baby, while Quinn is finishing up. We take the baby to acute care, and from within, I sadly hear the unmistakable cry of a mother who had recently lost her child.

I then follow one of the interns as he reviews a mother having her fourth baby. She is “nearly” (means almost fully dilated) when the senior obstetrician has advised that she should have her waters broken to help with the head coming down. As the interns break her waters, he discovers a cord prolapse (when the cord comes down first - you need to lift the head off the cord so blood can continue to flow to the baby instead of getting squished by the head). I change places with him to keep the head elevated so he can prepare for surgery, and they are able to get in quickly. Thankfully, the baby comes out crying and doesn’t need any help.

The day is filled with more moms to assess. As more senior students, Quinn and I have lots of Ugandan nursing students and two medical students following us around. In some ways it is wonderful, because it really tests my own knowledge, and makes me so proud of all that I have learned. And in other ways, it really(!!) makes me admire my preceptors, because teaching is incredibly hard work.

It starts to get late, but after a chaotic day, all I really want is a non-dramatic catch and without a million pairs of eyes staring at me. There are a few moms labouring, and the mom’s labouring voices sound like puppies crying out to each other. I am monitoring two in particular: one who is a 16 year old first time mom and in the bed beside her, a 32 year old mom of 6. Very sweetly, as the night progresses, I noticed the 16 year old steal glances at the more experienced mom, and begin to echo her noises and movements, as if she is learning the art of coping with labour. Quinn and I both finish the night with straightforward catches and beautiful babies.

I swing by acute to see how the baby from earlier is doing - and when we look at the baby, we see that it is having seizures. We ask the nurses what will be done for the baby, to which they explained they will have to wait for the doctor to come in order for the baby to be assessed. Unlike home, acute care is just a room full of mothers holding their babies. No monitors, no one-to-one nursing, no doctors right away when you call them, no immediate diagnostic tests to tell us what is happening to the baby. Often all you can do is hold the mothers hand and give a tender squeeze, a smile, and just hope for the best. Today when I went by, the mother had left with her baby, so I don’t know how the baby will do.

Today was the first time I really missed home. First, it is extremely challenging to have to manage complications while defending yourself. I have so much to learn from these women and midwives; but it is so difficult to go up to a midwife who has been practicing since I was born to gently explain why their management technique is not right. Second, the condition of the first baby I caught really hit me hard. I know that I did all that I could and I delivered the baby in a reasonable amount of time, and I have no idea how this baby had coped with many days of labour or if there had been any underlying conditions. I hate the lack of resources to find out why and not understanding why some babies have a harder time than others. I hate that a doctor will likely not see the baby for many hours, and no one will be able to monitor the baby closely. I hate knowing that the difference between life and death for this baby could be so simple, but is so far out of reach in a health care system that is so under supported and under valued. And even with all the resources, tests, and care, the outcome may be the same and I still may never know the answers. But I guess that this is also what it means to grow into myself as a midwife - to come to terms with the other side of life, and all that it means.

3 Beds, 3 Babies, 3 Hemorrhages...(by Tanya)

After a wonderful relaxing weekend at the King Fisher Resort with our classmates in Jinja, we were bound for a busy day back at work…..

The morning and afternoon felt evenly paced and semi- organized, and we actually felt like we were getting a system down…the labour ward was quiet and tidy so we considered leaving early…

Our labour room: beds #1, 2, 3....

Babil charting the chaos!

but as quickly as we thought it, our beds filled up. Babil had bed number one, Jo had bed number two, and I was going to second assist both of them (second assistant assists the primary birth attendant, she monitors fetal heart rate during labour, administers the oxytocin injection after delivery,  notes time of delivery, and ensures baby transitions well etc. The primary birth attendant directs the management of the labour, delivery of baby and placenta).

Babil’s mom delivered slowly and gently and the baby was fine. As she was delivering the placenta the woman began to hemorrhage. As Cathy rushed to insert an IV into a tiny little vein to start a bag of normal saline, Babil did bi-manual compression of the uterus, and I drew up and injected ergometrine…. a few minutes later the uterus regained tone and bleeding stopped….

Just as this was happening, Jo was called to bed number three as a woman came in from our first stage labour room with a baby who was suddenly crowning….

Jo putting in an IV

And as fast as she could catch that baby, the mom in bed number two, pulled back her legs and began to push her baby out. I grabbed the closest pair gloves to put on just as her water broke with a big splash; baby’s head was also crowning. The baby’s head was large for an African baby and didn’t restitute. I felt a big shoulder wedged behind the pubic bone. I called Cathy for help with the shoulder dystocia, and after a couple of maneuvers (that we just finished teaching at the workshop in Jinja) the baby came….but not without another postpartum hemorrhage! So Cathy and I performed the same steps that we had just finished with Babil’s mom….

Just in time for Jo’s mom (who appeared to be recovering well with baby on her chest) begin to have a hemorrhage as well, which was brought under control by putting up an IV with another 10 units of oxy and suturing her perineum…

Our tidy, organized, quiet labour ward was no more, and we definitely didn’t leave early, but despite the chaos and litres of blood lost, our moms and babes were all fine.



Making a fake PPH at a workshop

Postpartum hemorrhage (PPH):  Defined as a blood loss of more than 500 mls of blood is an obstetrical emergency that can follow vaginal or caesarean delivery and is a major cause of maternal morbidity. According to the World Health Organization, PPH accounts for 25% of maternal deaths per year.  Anemia can be one of the contributing factors in postpartum hemorrhages, and is extremely prevalent here in Africa. With a diet low in iron, limited access to prenatal care, lack of iron supplements, high rate of malaria,  HIV, and short intervals between pregnancies, anemia is hard to avoid. The physiological increase in blood volume throughout a woman’s pregnancy enables most woman to handle this loss during delivery, however, woman with anemia in Sub Saharan Africa can become hemodynamically unstable with a blood loss  less than 500mls.  Detecting anemia in our moms is a skill we mastered quickly. And as a result, we have learned to be prepared for a PPH and to act quickly!