WARNING: This post contains some graphic details and images from my visit to Mulago Hospital.
You might remember from my first post that after only three days on the job, I visited (and almost fainted in) Uganda’s national referral hospital. More specifically, Mary and I were shadowing Dr. Eve Nakabembe, an OB/GYN and consultant doctor in the maternity ward at Mulago Hospital in Kampala, where over 30,000 babies are delivered annually.
The trip was supposed to sensitize us (mainly, me) to the issues that mothers face once they actually arrive at a health facility (never mind all of the obstacles they face just getting to the hospital), so that I can write about this stuff in grants, proposals, and the like.
For Mary, who has worked as a nurse in Uganda’s health care system, the visit was just another day at the office. But I am not a clinician, I’m pretty squeamish around blood, and I’ve definitely never been into the operating theater of a hospital. So I was already feeling pretty uncomfortable when Dr. Nakabembe invited us into the operating room to consult with a mother who had given birth at home and was now hemorrhaging.
Postpartum hemorrhage – basically rapid loss of blood following delivery – is the number one killer of mothers worldwide, with the highest rates in African countries. This mama had delivered by herself at home, but had not delivered the placenta, which urgently needed to be removed in order to prevent her from losing too much blood.
Before I continue with what actually happened, I think I need to give you a picture of this operating theater. You’re probably picturing a sterile room with white lights and a cadre of health professionals – including an anesthetist –fluttering around this woman, preparing her for a relatively painless procedure.
This woman was lying on a metal table covered with what looked like a black plastic bag, undressed from the waist down, with her knees bent, feet on the table, completely exposed to the many other patients and staff in the room. She was moaning in pain, tears streaming down her face, no one there to comfort her (until Mary joined her bedside and placed a compassionate hand on her shoulder). There was some unknown liquid substance spilled on the floor beneath the table, mixed with a small pool of her blood.
As soon as Dr. Nakabembe approached, she noticed that the IV drip hooked up by one of the interns had been done wrong and was leaking air bubbles into the mama’s blood stream. This is super dangerous, as it can cause an embolism. This mama was then given a shot of some kind of pain killer, and before it had any chance to begin working, Dr. Nakabembe began the process of extracting her placenta.
This is about the point where I started to feel really queasy. I could see how much pain this mama was in and hear her fighting back screams as Dr. Nakabembe continued the painful procedure. When I turned clammy, felt like vomiting, and started to get tunnel vision I knew I needed to leave before I passed out – hard – on the cement floor, possibly in a pool of someone else’s blood.
Reflecting back on the experience now, it seems nothing can quite prepare you for a visit to the maternity ward at Mulago Hospital. The smells, sights, and sounds almost immediately overwhelm your senses. Words can’t possibly do justice to the visceral experience of it all. Seeing mothers laboring on the unclean floors, enduring painful emergency obstetrical procedures in full view of others, and being surrounded by unsanitary conditions, one wonders if these women have been forgotten by society.
There exists an utter lack of dignity within these walls.
Patients and staff aren’t even given the most basic amenities, such as a functioning toilet. Seriously.
The day we visited, the hospital had run out of gynecological gloves, so patients were forced to purchase and bring their own. This seems unimaginable to an American like me; even with our cracked and flawed health care system, this would never happen.
I’m not going to say I was completely surprised at what I saw. It’s not that I hadn’t heard about the plight of women in the developing world, the lack of basic resources at health facilities, the challenges faced by health workers (horror stories about Mulago, specifically, aren’t difficult to find). I had even spoken with Mary and other health care professionals from east and southern Africa who revealed that they have worked for months without pay, endured 24+ hour shifts without a sip of water or a bathroom break, and witnessed countless patient deaths without a moment to process the experience.
But, it’s different to see it with your own eyes. It reminds you why you care and why your heart aches and your soul feels drawn to do something.
So what can we do about the poor conditions at health facilities and the myriad social, political, and economic factors that contribute to them? And how can we ensure that that we address the root causes and many faces of the problem? How can we get beyond a ‘band-aid’ approach?
From what I’ve learned here so far, a huge part of the solution lies in educating leaders across sectors – from law, to government, to education and beyond – in how to advocate for improvements in maternal and child health. In other words, building the capacity of local leadership to engage in systemic change within their communities and spheres of influence (and yes, that is what one of the Save the Mothers programs does). Here’s one small example of how this can change things:
Less than a year after she enrolled in Save the Mothers’ Master of Public Health Leadership program, Sylvia Ssinabulya, a member of parliament for Mityana district in central Uganda, introduced new national maternal care legislation. The bill proposed compulsory registration of maternal deaths, with the aim of targeting remedial action (like establishing blood banks or obstetrical care) where most needed. It passed; and also influenced the national budget, which added stand-alone line items for the provision of emergency obstetrical care and access to family planning – for the first time in Ugandan history. Ms. Ssinabulya also established the Association of Ugandan Women Parliamentarians, a group of 37 other members of parliament focused on improving maternal health in Uganda.
And this is just one of many, many stories from program graduates, who are changing things at the local, national, and even global levels.
As a policy person, this approach to systemic change totally resonates with me. It’s a powerful thing, as it creates a ripple effect, that (however hard it may be to measure, especially to donor standards) filters out into society, ensuring that these women are not in fact forgotten.
Stay tuned for more on Save the Mothers’ other key program, which is working to change things specifically at the health facility and community levels. But for now, despite the scene described above, I hope this post leaves you feeling hopeful that the issue of preventable maternal death is being relentlessly attacked from many angles and levels here in East Africa. Also, let me offer you a final sliver a hope with this update: a new “state-of-the-art” maternity ward is currently under construction at Mulago and slated to open in May 2017.