Birth and Death

I spent Friday morning at the Mbarara University of Science & Technology (MUST) visiting the antenatal, postnatal, gynecological, and labour wards. As part of our DE program, we're using four Friday mornings to alternate visits between two different hospitals--MUST, which is public and is usually extremely busy, and Mayanja Memorial Hospital (MMHF, our local partner, is the non-profit branch of MMH), which is private and has nicer facilities but fewer patients due to the higher cost.

We were first taken around to the different wards by an extremely informative first-year resident, who explained the types of patients admitted to each ward, common cases seen and complications encountered, and the challenges faced by the staff in dealing with patients (only having one operating theatre at MUST, for example). Afterward, we observed in the labour ward, where we witnessed a live delivery!

More from our visit:

-MUST handles 15-25 deliveries a day. Of those, 6-10 will be Caesareans, a higher number than I expected. However, there is also a huge fear of infections spreading in the postnatal ward. Because beds or cots are all kept together in one room 2-3 feet apart (no separated rooms), a woman who becomes septic is always placed in the back corner, while those newly out of surgery are kept at the front of the ward, as far away as possible. Sidenote: Those who visited MUST the first week saw some of the C-section wounds, and they all said it was not a pretty sight--large incisions and jagged stitches. MMH patients, we're told, fared better with neater handiwork. Yet another dichotomy between private and public facilities.

-The gynecology ward sees many complications from botched abortions. Abortions are illegal here, save for medical reasons, but many women don't want more children at all or specifically don't want girls. A perforated uterus is often just removed--it's easier to prevent infections this way than attempting to repair it.

-Some women actually want their tubes tied as a means of preventing future pregnancies, but since there's only one theatre, such operations are low on the priority list. Women frequently get pregnant again before they can have the procedure done.

-The last case we saw was a woman who had attempted an abortion at 24 weeks. The fetus had been decapitated (to try to remove the rest of the body from the woman), but the rest of the extraction had been unsuccessful and the woman had come to MUST. The resident told us he could feel bones sticking out of her cervix and that these abortions could also result in a perforated uterus if the rest of the body was not removed promptly. She was given pills to induce contractions and dilation and was then sent outside to wait for the drugs to take effect in approximately two hours.

It is heartbreaking to hear about and see some of these women who suffer so much. They often don't want any more children (on average, a Ugandan woman will bear 7 children), but husbands are often resistant to using condoms or other family planning methods, leading to these drastic measures.