Olyotya Nyabo

Today was our first official day in the hospital. I'm starting off in the "low-risk" labor and delivery ward but the Northwestern kids are scattered all over (infectious disease, pediatrics, cardiology, emergency medicine). Because we had an abbreviated day due to orientation and the low risk ward is well... low risk... I didn't see anything too crazy in the way of medical conditions. The other students had lots of stories to share about their experiences though: In infectious disease a patient with bacterial meningitis had grand mal seizures during rounds. It took 15 minutes to get IM diazepam and most of the rounding team wasn't too phased by the experience.. in fact they continued rounding leaving a resident and the student to deal with the situation. In pediatrics students saw patients with severe malnutrition, disseminated tuberculosis, meningitis, etc. In the emergency room a  man was carried in by four police men, each carrying one of his limbs. They set him on the ED floor and left without explanation. He had multiple lacerations to his face and limbs and blood pooled around him as the doctors discussed what to do. In cadiology an attending did a blind paracentesis for post-MI pericardial effusion. In another bed a patient was actively having a heart attack with only aspirin and plavix to treat.

For me it was more of a culture shock. The women at the low-risk ward start off seated on rows of wooden benches. They're examined by a nurse and triaged to latent or active labor. The active labor area consists of stretchers with plastic mattresses lined up row by row. No visitors are allowed and the women bring everything with them including their cavela (a plastic sheet they put on the beds to lie on... the beds are otherwise not cleaned or wiped with bleach), their own cotton for cleaning, sterile gloves, etc. They have to purchase all these things themselves. Here there are no doulas, no comforting husbands, no ice chips, no fluffy socks, or lake views. Furthermore, no fetal heart monitoring, ultrasounds, epidurals...not even antibiotics. We assess fetal heart rate with a Pinard Horn that you essentially place on the woman's abdomen and listen with your ear. Looks like something from the middle ages to me but the Swedish midwife student told me these are used in Sweden, too!

The first woman I met was 20 and a primagravida. She was having contractions every 10 minutes but you could hardly tell from the steady look on her face. (Lauren, one of the nurses, told me that sometimes the women are so quiet about their pain, they deliver their baby without anyone noticing). She was 8 cm dilated (the max is 10 cm) and we lead her to the active labor ward. Before we could help, she picks up her 30 lb suitcase and walks steadily 20ft over to her bed. The whole time I was just imagining the labor ward at Prentice. Two Prentice rooms are probably bigger than the entire clinic. The difference in how women are treated here is so drastically different. Apparently the Ugandan midwifes tend to be stern so Ugandan women sometimes turn to foreigners for comfort by grabbing your arms and hands... However, Lauren said that once a woman grabbed her hair with her hands and splattered blood all over her. I'm not sure how I'm going to handle a situation like this.. but definitely with caution. The way pain is defined here compared to the States is just so drastic. Seeing the standard of living here makes me think that maybe the people here are just used to more pain in all aspects of their life and thus handle it better. None of these women have any kind of anesthetic. 

We had a Luganda lesson today-- it's the major language spoken here other than English. I learned a few useful phrases that will hopefully help me connect with patients. For example: Olyotya Nyabo is a greeting that essentially means: "Hello, Madam".

Suffice to say, the experience in Mulago has been an interesting one so far...!