Obstetrics, Ugandan style...

Time for some obstetrics! I am working at Mbarara National Referral Hospital in south-western Uganda. The 600-bed facility is one of four teaching hospitals nationwide and is affiliated to the Mbarara University of Science and Technology. It has a large obstetrics and gynaecology department with 24 doctors and 20 midwives, and is the first place I've worked where the former outnumber the latter. The hospital has approximately 8000 births a year (a similar number to Liverpool Women’s Hospital, my former workplace) but has only three beds on the ‘labour ward’. The literacy rate in Uganda is improving at 73%, but for the less fortunate there is a handy clue at the entrance to the department that they are heading in the right direction for their obstetric and gynaecological services (see photo below).

Dr Kim outside the Obs and Gynae ward

The first few days were certainly eye-opening. There is a general air of chaos on the wards which takes a little getting used to, but I’m beginning to acclimatise to the mayhem. I delivered someone at the foot of a tree on the way to work one morning which is not something I’d experienced in the UK! Quite why the patient was not occupying their bed that was only 50 yards away is anyone’s guess, but I have never left the house without a pair of latex gloves since that occasion.

The staff are incredibly friendly and helpful and I’m getting used to ‘Ugandan Time’. If you add at least an hour to the length of time within which something might be expected to occur, then you’ll be well on your way to getting to grips with the local timekeeping. Unfortunately ‘Ugandan Time' also applies to emergency situations, which has led to some hairy moments. 

The patients themselves tend to be extremely appreciative of any treatment provided, however minor, although this sometimes becomes embarrassing as they try to give you money following their Caesarean section.

 

I’m beginning to formulate tentative plans of what I’m hoping to achieve here. It remains a challenge to work in a clinical environment devoid of guidelines and information whiteboards so I’m hoping to be able to introduce these soon.  The Royal College of Obstetrics and Gynaecology in London have raised charitable donations for Mbarara which I am helping to allocate, so I’m hopeful that basic facilities can be improved. I’m hoping to install curtains around the beds on the antenatal ward to give the women some much needed privacy.  We also need a better way of transferring patients from the operating table to the trolley following surgery as a patient recently fell after her Caesarean section. We use PatSlides routinely in UK and they could be something we could consider introducing here.

Outside of the hospital I’m pleased to report I’ve just attended my first Ugandan aerobics class, which takes place in a nightclub, bizarrely. My anxiety levels were raised as we assembled in the middle of a male sauna, prior to the session, but fortunately this was the place of payment rather than exercise and we were soon able to flee to the dance floor for the exercises to begin. Working out beside fridges full of beer and with people playing pool in the background may seem distracting but it was most enjoyable and I’m guessing this will turn into a regular Wednesday night trip, though whether Dave decides to dig out his sweatbands remains a moot point.