Happy Friday! It’s crazy to think that I have already been here five days. It seems like both a short and a long time as the days are very full. I worked in maternity today which is the US equivalent of labor and delivery. It is a very active part of this hospital as there are approximately 3000 deliveries per year. Patients are self referred and referred from outside facilities for the services here because of the excellent NICU (see earlier post). Again, I saw mothers with diseases that we do not usually see including malaria and HIV. Uncomplicated vaginal deliveries are managed by midwives and noticeably there are no repairs of perennial lacerations. Many healthcare practitioners in Uganda are able to perform cesarean sections as all medical officers and of course OB/GYN doctors know how to perform them. Medical officers are trained in cesarean sections as it is one of the most needed surgeries in the country and a life-saving procedure for mothers and babies.
During my shift we admitted a patient with vaginal bleeding who was about 26 weeks along (although this is hard to know as there is no routine prenatal care here and ultrasounds that date pregnancies are only performed when problems arise). This patient’s ultrasound was performed today and showed placenta previa. She was found to be actively bleeding (probably from the previa or from abruption) and in preterm labor thus was taken for C-section, and I assisted the obstetrician in the operating room. This was a very different experience than I have had before. For one, the attire in the operating room (called “theater” here) includes a reusable head covering, a rubber apron over scrubs, a washable cotton gown over the apron, and knee-high white garden boots. Eyewear consisted of plastic goggles that are typically disposed of after one use in the US but instead were placed in a basin for cleaning after each surgery. Scrubbing (a.k.a. washing your hands super carefully before surgery) included using a reusable soap bar that had a Pepsi bottle cap embedded in it so that it was magnetically attached to the sink and a reusable sponge and nail cleaner. During the surgery, unlike in the US where there is a surgeon’s first assistant as well as a scrub technician to hand instruments to the surgeon, the first assistant is expected to also operate as the scrub technician. Suffice it to say, it was a very unique and new experience for me. The baby was born just shy of 1 kg in weight and at the end of the day was doing well all things considered. Can’t wait to see what Kiwoko has in store for me tomorrow!
Lugandan word of the day: okulabula (verb, “oh-coo-lab-u-luh”, take caution)
Medical learning point of the day: Obstetric fistula remains a very serious and stigmatizing complication of labor and delivery in Uganda. Fistula‘s are open tracks that form between most commonly vagina and bladder but possibly between vagina and rectum after a prolonged, obstructed labor. Women who attempt to deliver their babies at home could be in the stage of labor where baby’s head is pushing on all the pelvic organs for more hours than recommended. This pressure then causes slight ischemic injury to the areas of the vagina and bladder/rectum. This tissue then necroses and an opening forms. As it heals, liquid from the rectum or the bladder follows the path of least resistance through these openings and a fistula is formed as the tissue heels. Access to cesarean sections has reduced this but not completely eliminated the occurrence of obstetric fistulas, and Uganda has taken steps to improve access to C-sections (see above).
