Quinet's Ugandan Adventure

At the weekly clinic we saw around 30-40 pregnant women per day, who were coming in to get pregnancy tests, HIV tests, immunisation or other antenatal care and check-ups. I’d heard about a number of home births taking place without medical staff in the village, but despite this I was impressed to see such turnout of women at the centre. All of the women were happy to get a HIV test and I counselled the very few who were positive.

The messages around HIV testing and follow-up for pregnant women were well adhered to. Mothers had the option of not breastfeeding at all or to exclusively breastfeed for the first six months, followed by a further six months of mixed feeding after the child was weaned. Mother-to-child transmission of HIV has significantly reduced but you still get a few women whom find it difficult to adhere to this feeding plan, resulting in the child later testing positive for HIV.

I was able to provide mini workshops to the women as the waiting room was more private (within a building) and I had the support of an interpreter. The women said they had never had a group session or benefited from sharing their experiences in a space where they were assured the information was correct.

One experience I will never forget was returning from break and being asked to go into the labour suite. I have always wanted to witness or be a part of a birthing process, but I was in for a shock.

The lady was laid naked on a bed covered with a thick black plastic bag. She not only had to bring a hospital bag, she had to bring her own basin, cotton wool, gloves and razor blade. Her waters were broken and despite been fully dilated, the baby’s head was not engaged.

She was in a lot of pain but no pain relief was available for her because the clinic was out of stock. Windows were ajar and passers by within the centre could look in, so that’s probably why she made no sound at all. All I could do was fan her, as she could not understand English and I did not want to irritate her or make her any more uncomfortable than she already was.

It came to the end of my shift and still no baby. A few days later I heard the baby was born and mother and child were healthy. I needed to confirm my suspicion of what the razor blade was used for, and the nurse confirmed it was used to cut the umbilical cord!

This was an experience with one woman, but to think that this woman had experienced this before or that other women experienced the same is disheartening. I later spoke to one of the nurses about the standard of care and she admitted that it can be the case, depending on the nurses on duty or the resources available at the time of delivery. She said that the situation was improving and that the government is working to improve the quality of care in such village centres.

I also had the opportunity of visiting the maternity ward of a regional government hospital near Muyenga in the city, and was glad to see how different and how much better the service and care was. However people still had to pay for their care and not many can afford to do so.

Equally impressive was Kampala International Health Centre. It was only a year old, with modern facilities and equipment.

Visiting three different types of hospital gave me a general overview of how the system works and the hope that it was possible for improvements to happen.