I have started the teaching sessions for the midwives. The first session was last Thursday, talking about Antepartum haemorrhage, which was not so well attended - they are optional sessions - as the hospital was ridiculously busy (even by Mulago's standards) and it was difficult for the staff to get away from their clinical committments. This week we did postpartum haemorrhage, 17 midwives attended and we talked for around 3 hours about issues surrounding PPH and its management. I really felt like people went away from the session having had the opportunity to ask questions and clear up confusion about such an important obstetric emergency. Some of them now want to look at a better system of measuring blood loss so that they can pick up PPH and manage it earlier. We're going to explore the idea in a bit more detail and maybe get a small study going. Next week we're going to try and run a practical drills session on shoulder dystocia.
I've been spending more time on labour ward, starting to get directly involved in patient management. In one afternoon in the admission room alone I saw so much; an eclamptic fit, 2 women with severe PET, footling breech in labour at term (NVD), 2 women with HIV and ruptured membranes, an acute severe exacerbation of asthma, twins, a handful of women in latent labour, 2 women who delivered in the admission room and also got involved in a PPH. I didn't even set foot into the labour ward proper. Buzzing - and knackered - when I left. There's so much other stuff that I'm witnessing, and I'm really beginning to see things that you tend to only read about, for example, breech delivery with entrapped head. I also spent a bit of time in the general gynaecology ward.
We're trying to set up an audit looking at stillbirth rates at Mulago, to try and see if there are any preventable factors that we can identify and work to improve. It will hopefully be a useful and fruitful exercise.
We had midwife of the month again this week, which was a resounding success. We have begun to rotate it around the wards, so that all the staff have a chance of becoming the midwife of the month, and hopefully this recognition will help to improve morale.
I've spent some time this week working with one of our specialists and two midwives who are going to Liverpool Women's as part of the Liverpool Mulago Partnership programme. They're really excited and now they have their visas are raring to go. One of the midwives who was due to go in June, but had visa problems, tells me she can't believe it's real, and won't until she actually arrives. Let's hope there are no other hitches. I'm really looking forward to wroking on the ideas that they bring back from Liverpool with them, I think they're people who have an immense amount of drive and energy to push things forward here.
Socially, still having a ball. Two of our housemates have gone back to Germany and the States, and a new guy, Michael has moved in. Seems like a nice guy. Met up with a couple of lads from the UK, friends of a friend, Elliott and Jake. Went out for a fab curry at Khana Khazana in Kampala, and a few beers, but we were too full to go dancing. Our now weekly Muzungu Barbecue party the following day was fun, although Sunday was wiped out, although I spent a bit of time at the hospital working on a guideline for normal labour.
This week was occupied by coming fourth in the pub quiz, more grilling stuff on coals and then yesterday visiting the Baha'i Temple in Kampala. It's a really pretty, simple temple set in stunning ground on one of Kampala's hills. The butterflies are stunning and there are hundreds of them - of many different species. Learned a bit about the religion and then wandered through the gardens for a bit.
Had a slightly unnerving boda ride where a taxi driver leaned out of the window of his cab, looked me square in the face and shouted
"Muzungu, they are going to kill you!"Not really sure what that was all about, and who 'they' are... Any ideas?
We're going to organise a big house adventure to the Ssesse Islands next weekend to relax a bit. Going to spend this week on gynae oncology, which will be interesting as there's a high incidence of cervical cancer here in Uganda.
Sorry about the technical, businesslike entry - feel like 10 days is too long to leave between one entry and the next, must update more often!
Happy 26th Birthday to Ben - hope you enjoyed your surprise party!
I'm off for a pedicure - feet are trashed!