After our weekend settling into Kampala it was time to finally hit the ward of Mulago Hospital for some more substantial time. During our first month in Uganda, while based in Entebbe, Cally, Ibby and I had visited the labour ward and special care baby unit on numerous occasions but I was yet to really get a feel for how things worked here and I was eager, if not slightly nervous about what I would be faced with. Without going into the gory details, visiting the labour ward for the first time was definitely not the kind of start I was hoping for. Poor Ibby, who is not medical and had never actually seen a baby being born (why would she at the grand old age of 23!), handled it amazingly. On walking into a room with maybe 30 women scattered amongst those delivering on beds and those waiting their turn on the floor and noticing that there was a woman about to give birth on the floor beside me (she made it onto a bed thank goodness) I realised that this was not the place for birthing partners, soft ocean music (yes some mothers bring this) and lovely cute baby balloons. Yes, the indignity of delivering in front of at least 29 other people out in the open is still quite confronting to me and for that reason as well as the fact that I have to walk around in there in my flipflops, I try to limit the need to head over to the labour ward if I don't absolutely need to! As for the baby unit, we were still getting things prepared for the study and had not actually started recruiting any babies yet so I decided to join the staff on the unit and chip in for some ward work.
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Mulago Hospital main entrance
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The first thing that strikes any first time visitor to this ward I think, is probably the sheer number of babies there and it is easy to look around and wonder how anyone truly knows what is going on and who is doing what which each and every baby. It is sometimes the case of either freeze and feel overwhelmed by the apparent chaos or just crack on and get on with the work. During that first day, I definitely found myself at times doing both! For a Doctor trained elsewhere where resources like thermometers, scans, nasogastric tubes and even warm blankets are completely taken for granted, it takes quite the adjustment to realise what is feasible here and what you just have to do without. On starting to see some of these babies early on, I think I spent half my time examining them and the other half wrapping them up and trying to keep them warm! It has become a little bit of an obsession of mine here and perhaps in a way its because it feels good sometimes to do something simple like wrapping up a cold baby when you know that some of the more complex treatments are not going to be accessible for them.
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A section of the baby unit - busy day!
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To say that first day on the ward was the worst day in my career to date is definitely not an understatement but it is also not meant as a criticism of the staff or the ward itself. In the last 6 weeks, I have not even come close to experiencing another day like it so as bad luck would have had it it just didn't seem to be my day and definitely turned out to be a true baptism of fire! The feeling of helplessness was not something I am used to and something which now serves to remind me of exactly how lucky we are in the UK and Australia. I won't go into the awful details but lets just say it felt like life was somewhat cheaper here and the loss of one or on that day, multiple, felt all the more tragic because you knew that only a flight away, it needn't have happened. At times what made it worse too was that I could see the morale of the staff was affected. It has taken me a while to differentiate what can appear as indifference at times from perhaps just the belief that sometimes it is better not to go on trying when you feel a situation is hopeless. This I am sure is the case here at times for the very sick babies where all the treatments available have been exhausted and the only thing left to do is wait and see.
There are some lovely times on the ward too though! I would hate to give the impression that it is all doom and gloom as this is definitely not the case. Getting to know some of the staff here has made my time so memorable and I will definitely miss them a lot. Sister Margaret who runs the ward deserves a medal for the way she manages to control and steer what can sometimes only be described as utter chaos when the rate of babies coming into the unit far exceeds the ones discharging out of it. With babies literally sticking out into the aisles, on bench tops and on more than one occasion, in my arms due to lack of space, she seems to keep order and ensure the important things get done with the sort of calm that the sisters in charge at home could only imagine! The parents here too are amongst the most stoic that I have ever met. I am sure this is mostly to do with the fact that medicine here is still very much practised in a paternalistic way with the doctors and nurses telling the parents what they need to do, where they need to go and only occasionally, what is actually wrong with their baby. The priority is definitely not on easing the parents' fears and anxieties and for that reason I think parents just realise that they have to get on with it and do what they are told. The mothers, most of which hobble into the unit hours after giving birth are often expected to hang around the corridors all day without a bed of their own until their baby is ready for discharge. They never complain and seem so accepting of their circumstances. I was actually quite taken aback the first time I saw a mum openly weeping on the ward and I realised that mums and dads back home are really lucky for the support they get.
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Dr Flavia and I on the ward
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As my time here is almost over and in just a few weeks I will be back on the wards of London with equipment coming out of my ears, I know that having this experience will definitely change the way I look at my own job. I can't say I have come over here and learnt a huge amount of new clinical skills, except the ones related to the study that is, but i have definitely learnt a new appreciation for the way in which people practise medicine and manage with far less than we do. Despite the ward working really hard under often difficult circumstances and limited resources, I do hope our time here has managed to have some positive influences and I hope that as I have learnt things from the staff and babies here, I hope that I have brought something positive in return, at worst it will be that babies need to be dry and warm warm warm!!!
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