Tuesday, 6 July 2010

How Many Ugandans Does It Take To Get a Midwife Down a Mountain?

Heather Nunnen and Lorraine Dinardo arrived from Liverpool one drizzly Saturday afternoon at the beginning of June, which seems such a long time ago.  I was excited about them arriving and about working with them at Mulago, but also nervous about what they would think of Mulago, and also about how I have adapted to the environment here and how that reflects in my clinical practice.  We had a very action packed 2 weeks at the hospital, and an equally action packed social calendar.  Which started almost immediately on arrival, with several beers and a curry, and confirmed my suspicion that we would be working hard, and playing hard too.

We spent Sunday doing the leisurely tourist intro to Kampala, including an obligatory trip to the craft shop 'Banana Boat' and met up with Alice Alum, who is the manager of the midwifery led labour ward here at the hospital.  Sunday evening kicked off with 7 of us piling into a car made for far fewer people, and as the resident hobbit, I drew the short straw, sprawling myself across the girls in the back seat, wedging my head up against the window and bracing myself for the potholes.  We arrived at the Ndere Cultural centre for a night of traditional dancing and entertainment.  We went on a cultural journey around Uganda, with most areas being represented in varying forms of colourful hip shaking, bum wiggling dance.  A number of staff from Mulago joined us, as well as a team from Canada and my housemates.  It was a fantastic show.

Monday started in earnest with the morning meeting, introductions to notable people within the department and a tour of the hospital.  The labour ward was fortunately quite quiet, although at the end of our tour round, we came across a flat baby that needed quite a lot of resuscitation, taking him to special care and commencing CPAP.  He recovered reasonably well, but it highlighted some of the problems that we face here.  We debriefed over a few beers and an Ethiopian in the evening.

Tuesday was a day of bureaucracy, and Heather and I trudged to the Nursing and Midwifery Council in the searing heat, to collect her registration certificate.  And got sunburnt.  We wandered back to Mulago, stopping to buy grilled sweet potatoes, and taking in the scenery of Wandegeya - coffin makers, cabinet makers, stalls selling everything from shoes to bath taps - before returning to the hospital.  I hosted a barbecue in the evening for everyone involved in the partnership, which went down well.  The star of the evening, however, was Alice's one-year-old daughter Anneke, who caught and held Heather and Lorraine's attention for much of the night.

Wednesday was a national holiday - Heroes Day - and so after some craft shopping at the National Theatre we went out to visit Enid at the orphanage in Buddo.  It's some time since I visited Enid last so it was nice to go back there and see how she and the children are doing.  Enid prepared a simple lunch of matoke with g-nut sauce, greens and beans, which we ate in her home with her mother. At Enid'e request, Agnostic Alldred, managed to stumble through something resembling a prayer, dragged from the back of my catholic educated mind, and we were then able to share our meal.  It was delicious.
After lunch we met the children, and Heather and Lorraine gave the stickers, books, pens, crayons, balls, parachuting men and a whole other selection of goodies to Enid for the children.  It was less of a free-for-all than the last time we went.  Enid told us a bit about her life, and how she got to where she is now, what life at the orphanage means to her and about her family.  We mucked around with the kids for a while before they migrated to their rooms, or towards the TV, and after a farewell prayer we headed back to Kampala and settled down for a Ghanaian meal.  It had been an emotional afternoon, which manifested itself as a need to have 'just one more beer'.  And for once, it was not me doing the encouraging!  We met my housemates at the casino - Avner was due to leave town and was having a blow out - which made for a late night.

On Thursday I pottered onto labour ward at precisely the wrong moment.  In the space of an hour we delivered 3 stillborn babies and dealt with a woman who had what we thought to be an eclamptic fit.  It was total chaos and by the time it started to settle we were knackered!  The day continued in the same sort of vein.  On Thursday, Norfolk Enchants hosted the best/worst pub quiz (delete as appropriate) ever conducted in the history of the world, at Bubbles O'Leary.  The major advantage to having to write and present the quiz is a free bar all night.  Which we took advantage of, since it would have been rude not to.  Friday was an admin (hangover) day for me, Lorraine stayed on labour ward and Heather went up to ward 14 for the day.  I arranged for the carpenter to return to measure up for the mosquito grilles on HDU. On Friday night, we had a leaving party for Avner, who has finished his time in Uganda.  Was gutting to see him leave, but we have many fond memories of the hairy Mexican/Egyptian/Israeli/Khazakstani Jew wandering round the house in nothing but pornographis moustache and a small towel.  I can hear him say 'Antisemite' at that sentence.  It was drunken, and ended at some ungodly hour of the morning.  And then we got up to drive to Sipi Falls the next morning.

Fast Eddie arrived at the house at some horrifically early time after the party.  Chi had slept in so we were a bit late staring out but Adam, Chi, Mbarara Mike and I piled into the van and picked up Heather, Lorraine and a random dude called Jason, from the guest house.  Eddie lived up to his name and before we knew it we were in Jinja, eating rolex for breakfast.  On the road out of Jinja, we were leafleted through the van window, much to Adam's annoyance.  The leaflets were advertising a Dr Brown and Professor JK, and claimed to be able to cure diabetes, improve your sex drive and get rid of the Tokoloshe (a dwarf-like water sprite or zombie), amongst 26 other wild claims.  I kept the phone number, just in case...  The journey was otherwise uneventful, apart from a torrential rain storm breaking just as the mountains came over the horizon.  We reached the Sipi River Lodge at around 2pm, and had lunch of sandwiches and locally grown, roasted and ground coffee.  After sorting out who was sleeping in which banda, we decided to go for a hike to the top two falls out of the three that make up Sipi Falls.

And so the fun began.  It was steep and it was slippy, and our guide didn't quite know what he'd let himself in for.  We got to the top of the first waterfall, before we started collecting people.  A number of children began to crowd around Heather, one or two at first and then a whole throng.  We heard lots of giggling, and at each corner when she caught up with us, she had more flowers about her person - in her hair, shirt, behind her ears - than before, and seemingly more kids.  We were almost stampeded by a crazed cow that came hurtling down the track, but veered off into a field and crashed through a farmer's fence instead.  We reached the base of the second fall, by now with around 12 children in tow.  We spent a few minutes taking photos in ridiculous poses before starting the trek down hill.  It turns out that our newly found troupe of children came in handy for steadying 'Grandma' as they had affectionately named H,  on her descent, as the track was slippy.  Ahead of the group this time, slips were usually preceded and followed by a loud 'AaaghAAAghArgh!', from Heather, and the accompanying infectious cackle of one of the kids, with or without a crash through  the undergrowth.  Naturally this set the rest of us off laughing and in some instances a domino of slips too.  We made it down from the mountain as night fell, covered in mud and soaked through from falling.  A welcome beer and a home cooked meal awaited us, and after a hearty feed and more coffee, we stumbled back to our banda and fell asleep to the sound of rushing water from the falls, and the creaks of the bunk beds as people shifted around.

The next morning we had a leisurely breakfast and then set off to tackle the lowest and largest of the three falls.  Heather elected to stay behind at the lodge and write postcards.  She definitely chose the sensible option, and I envied her choice as we slipped and slid down to the bottom of the falls only to get absolutley soaked on the way back up.  The views were spectacular though, and it was a great way to work off the previous night's dinner.  We had lunch before departing, getting 5 minutes down the road before Mike declared he had left his watch in the dorm.  We turned back to pick it up, I got paranoid and decided I had left my ipod - which I hadn't, it was in my bag all along - so frantically rummaged through my bags and the dorm only to find it in the last place I could possibloy have looked.  Chi jumped out of the van declaring that she had left her brain behind, at which point we realised we were all being ridiculous, and we set off back to Kampala for the second time.

We reached Kampala late, had dinner and headed home, ready for another week at Mulago, refreshed after a fantastic weekend in the great outdoors...

Photos are here

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