Tuesday, 15 September 2009


Had a really interesting few days at work. I'm spending the week in the materno-fetal department, which covers all the high risk obstetrics. What is most interesting is that the majority of the stuff on the wards is the same as at home. The difference is that geography, and to a lesser extent social status, determine which women are admitted. Women often travel huge distances to get here or in some instances getting back to the hospital can be impossible due to money etc. The wards were relatively quiet, probably due to the riots more than anything else, so there were a significant number of women in the latent phase, false labour or women who had had previous sections awaiting elective caesarean. Other cases included HIV with extensive genital warts (by far the worst I've ever seen), malaria in pregnancy and a severe exacerbation of asthma.

I slept really badly on account of my sunburn (I know, I know) and then couldn't get a minibus so had to catch a boda-boda to work, which I despise because the guys are crazy and I hate motorbikes at the best of times. Too much excitement before work is more than the average girl needs, and boda-boda hair is not a good look!

Today I spent the morning in antenatal clinic. There is no true appointment system. Women turn up first thing in the morning and wiat their turn. The system actually runs fairly efficiently. They attend, their files are pulled, they have HIV screening if it has not already been done, they are then seen by a midwife or a doctor depending on whether they are high or low risk. Bloods and scans are arranged where appropriate. I saw a good case mix of twins, HIV in pregnancy, follow-up of women who have had malaria, cervical carcinoma and cervical incompetence. It's certainly a more interesting case mix than at home! The challenge of the language barrier is massive. Already I'm adapting my English to the African syntax, even down to how I ask people what time it is ('how do you make it?'). I am also trying to adapt my practice to the population. In Mulago women are admitted for things that aren't an issue at home, simply because of the difficulties with accessing healthcare, concerns for example about obstructed labour, that would potentially result in a disastrous outcome. I know that my mindset is beginning to change, but also that now my face is becoming familiar to the doctors and midwives here we can discuss things more easily. When I am asked about how we do things at home, this is sometimes a good springboard to talk about differences in management, and explore the evidence base. I am already questioning my own practice more than ever, I realise that some things are just taken for granted in Western obstetrics and that we don't always question the minutiae of what we do.

This afternoon I had a successful meeting with Interpol, got my letter of good conduct, so I'm ready for round 3 of the Immigration Title Match. I've also made enquiries about gorilla tracking in January when my Mam is coming over to visit! I'm SO excited! Tonight, I'll be working on a guideline, having a glass of wine and getting some sleep.

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