Altitude, sickness.

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I have now been working in Mbarara Regional Referral Hospital (MRRH) for just over 5 months.  My primary aim is to improve maternal services in Mbarara and this is a brief update on what I have achieved so far and my plan for the future.

The organisation of the unit has frequently been chaotic, particularly on the antenatal ward where 25 admissions a day is commonplace. For its size, the unit also has an extremely high number of deliveries per year (around 9,000).  I have introduced a white board to facilitate order, to enable better quality handover and to act as a reminder to perform timely examinations. Although there was initial resistance (and for the first 2 weeks there was only myself and one of the fourteen residents updating it regularly) it is now being used effectively. 

Kilimanjaro, elephant.

There are no curtains and very little privacy for those patients who require intimate examination on the antenatal ward. There is also a lack of bed nets to protect patients from mosquitoes and subsequent malaria.  With money raised from the Global Gateway Challenge I have ordered bed nets and curtains to improve patient care on the antenatal ward so we are excitedly awaiting delivery.

One of my main roles in MRRH is teaching, which can sometimes prove difficult, partly due to the lack of available space close to the clinical areas.  I am pleased to report we were recently granted permission to renovate a storage room adjacent to the ward area.  This renovation was only made possible by funds raised from generous fellows and members of the RCOG. The room is a more appropriate teaching environment and makes it easier for staff to attend sessions whilst remaining easily accessible in the event of an emergency. This area has already been used by midwives, medical students and doctors. 

Before...

...after

Along with this refurbishment, and with the collaboration of my Ugandan colleagues, I have managed to pilot a cervical cancer screening project for HIV-positive patients using visual inspection with acetic acid (VIA).  This has now been running for 10 weeks and we have already screened 350 women. We hope to expand this programme through collaboration with Mulago-Mbarara Teaching Hospitals’ Joint AIDS Program, who are instrumental in the funding and functionality of the HIV clinic in Mbarara, and who we hope will provide the means to train more nurses in VIA technique.

I currently sit on a maternal mortality committee. We have identified one of the main problems, namely that a significant contributor to maternal death is the lack of appropriate antenatal care women are receiving in this region. In the future, along with help from other committee members, I hope to improve these services by providing necessary equipment to establish a high risk antenatal clinic and by producing referral criteria for distribution among other health units to improve antenatal care.

Although these changes are small, change in Uganda begins and is sustained by changes in attitude. I hope that by taking an interest in teaching and by providing dedicated teaching areas, residents’ enthusiasm for post-graduate learning will increase.  Although our HIV / cervical cancer screening programme is in its infancy, I hope that the number of screened patients will continue to rise. Single lifetime screening has been associated with reductions in cervical cancer of as much as 31%.  Furthermore, if we can improve our antenatal care, there may be a subsequent fall in maternal and perinatal mortality.  I believe that these small changes can make a big difference to the health of women and babies in Mbarara.

Kim has promised to do it without legs (surgically removed by Dave) if anyone is willing to donate £10,000.

Small changes still require funds.  Dave and I are climbing Kilimanjaro on the 28^th June and we would appreciate any support you can give us.  Your donations will be used to improve the care of mothers and their babies in Mbarara Regional Referral Hospital.