Update from the Field: Obstetrics at Mulago Hospital

Emily Rosen '15 and fellow students at the equator at midnight, traveling from Kigali to Kampala. Emily is fourth from the right.
Emily Rosen ’15 and fellow students at the equator at midnight, traveling from Kigali to Kampala. Emily is fourth from the right.

July 24, 2014: Emily Rosen ’15

After four flights, two delays, and a sweaty sprint through Amsterdam airport to catch a flight, I arrived at Entebbe airport in Kampala, Uganda. It was 2:00 am and I was greeted by a driver to take me to the Luboga household. I deliriously opened the door and sat in the driver’s seat realizing for the first time that things are backwards in Africa. When I got to Mpererwe village, where the house is located, I was oriented me to my room (a mosquito net was provided), my bathroom, and to the silver pot that held the clean boiled water.

I woke up on Sunday morning completely unsure of where I was or who was in the house with me. I walked out of my room to find two “ssabos” (means sir and is the proper way to greet a man) and quickly befriended them. Throughout the day the Lubogas had around 50 visitors: people from the church, the community, family, and friends. It was overwhelming but surprisingly comfortable. Here in Uganda, there is a saying that “it takes a village to raise a child.” They believe that the children of the community will one day be your children’s neighbors and therefore it is the responsibility and privilege of the community to support each other. It is easy to think that the lives we lead at home are filled with support and a sense of communal well-being, but what I see here is beyond words. For example, Ugandan weddings have 2,000 people attend. They don’t worry about renting tents, picking a popular band, or how to seat people so they aren’t offended. Tents are supplied by neighbors, music is played by the church, and hundreds of their closest friends come together without judgment or jealousy. I learned a lot in my first day, but the most important was that no matter who you are, what color your skin is, or where you grew up that you are welcomed here.

Monday morning was my first day at Mulago hospital. The campus is on a large hill with “Old Mulago”at the top, the Ugandan Cancer Institute in the middle, and “New Mulago” at the bottom. New Mulago is the newest part of the hospital…meaning that the last renovation was in 1962. Before I attempt to describe my experience thus far it is important to realize that in Uganda there is one OB/GYN doctor for 10,000 patients. A normal U.S. hospital has a few thousand deliveries a year whereas Mulago has 90 per day or 35,000 per year. The overwhelming amount of patients and profoundly under-resourced facilities make for a completely chaotic experience.

The first thing you notice when you walk into the labor suite is the smell: a mix of feces, blood, and sweat. It is a bare room with beds lined up on either side with no more than a foot between each patient. Each woman gets a piece of plastic to put on the mattress (there are no sheets at the hospital) and a role of cotton for cleaning. Whoever screams the loudest gets the most attention. There are no epidurals and all that we offer for pain management during labor is our apologies and support. Although the labor ward is disordered, the doctors are working hard to manage such a complex situation.

One woman came in screaming so I took her to a bed. She sat on the uncovered mattress giving me just enough time to put on gloves before I delivered her baby. I then began yelling for help because I didn’t have anything to tie or cut the cord. I ripped the top of my gloves off to use to tie the cord. To say resources are lacking is a profound understatement. The average wait for a c-section is six hours during which patients may have uterine rupture and die. The only fetal monitoring is something called a “peanut” which is tool that is placed on the women’s abdomen and against your ear to try to hear the heart rate.

In regards to Ugandan culture, I am absorbing as much as I can. On my third day I took a “matato” (local bus) alone through the city. I navigated two different buses to travel the hour distance home from the hospital. I’ve met students from Russia, Italy, and Holland. I have taking Lugandan lessons, watched a traditional African dance, gone white water rafting, and visited Rwanda to see the genocide museum.

My love for the people and culture here is hard to explain. I think next time I come, you should all join me and see for yourselves.

Location: Kampala, Uganda
Length of Stay: 6 weeks
Name of Program: Global Health Elective with Dr. Majid Sadigh (UVM College of Medicine/Western Connecticut Health Network)

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