When I arrived in Uganda, I was worried that I would not be able to do anything as a first year medical student. However, in the high risk labor and delivery suite, I found that there were many things I could do. I soon realized that at Mulago Hospital, the simplest things can make the biggest difference.
One afternoon I was in the admissions room where a 25-year-old woman was initially assessed and then directed to the Preeclampsia/Eclampsia Unit. (PET), labor and delivery or Maternal-Fetal Medicine (MFM). She had been rushed in on a stretcher accompanied by a tall, thin, barefoot man while her husband waited outside. She was semi-conscious and 37 weeks pregnant with her third child. The tall man said she had taken rat poison. After a few minutes she sat up and vomited. We started an IV which she fought. Her body shook as she cried and explained that she attempted suicide after discovering her husband had taken up with another woman.
Rat poison is usually an anticoagulant like warfarin with vitamin K as the antidote. The problem was that this particular day there was no vitamin K. Her husband had purchased some which a nurse brought in. She had settled down and her friend was asked to leave to give privacy to the other women in the admissions room.
Two days later, her friend approached me with an enthusiastic hug. He told me that his friend, the patient, was going to be having the baby that day. I continued on to the ward and heard her voice call out, “Musawo Alex.” I greeted her and reminded her that I was not a musawo (doctor) but in school to become one, and asked how she was doing. She told me she was being induced. I read her chart which revealed that she had had a membrane sweep – the first step in induction.
I told two senior residents from Canada that the patient had taken rat poisoning two days previously and was now being induced. They both agreed that this was not a good idea. Although she had received the vitamin K as an antidote to the poison, vitamin K does not cross the placenta barrier. Therefore, the baby has an increased risk of hemorrhaging and should be delivered by C-section to avoid any cranial trauma during a vaginal delivery. This was discussed with the attending and the patient was placed on the surgical list. Perhaps her case had gone unnoticed as there had been a far more dramatic attempt of suicide the previous day, because no one on the ward except me had known about her rat poison ingestion.
My last patient encounter at Mulago was with her. I said goodbye and wished her well. She told me she knew she was having a girl and wanted to name her Alexandra. I was touched, but there had to be someone more worthy than I to be her namesake. I told her I preferred her own name, and that most Ugandans only know Alex as a boy’s name. She told me she had one last request- could I find her friend and tell him that she was hungry? “Sure,” I said, and left.
I walked past security and was faced with the daunting task of finding her friend among the masses of family and friends gathered in the hallways, stairs, and courtyard. I did not see him anywhere. I almost shrugged it off – I had tried, hadn’t I?
But I couldn’t leave Mulago knowing she would be waiting and hungry. I walked through the courtyard and looked at all the tired faces. How many days and nights had some of these people spent here? I wanted to hug everyone I saw and say thank you and tell them just how extraordinary they are. The patients might not have much at Mulago, but the love and resilience of their loved ones surely makes up for a lot. At last I found him – her tall, thin, barefoot friend. I gave him the message, climbed back up the five flights of stairs and got him through security (they seem to oblige to my requests) and the last I saw of him he was embracing her and asking what he could cook for her.
Until next time Mulago – and thank you to all the wonderful resilient people that make this such a special place.