Today is day four of working in the operating theater for labor and delivery. We’ve averaged six cesarean sections per day while we’ve been on the floor, but there are actually 15-20 per day and this is usually with two obstetricians (one early shift, one late) doing the surgeries. In Uganda, it is culturally favorable to have a normal vaginal delivery and to my knowledge they don’t induce, so each c-section – or Caesar as they’re called here – is an emergency. The need is so great and resources are so limited that moms could wait for their turn as much as 18 hours or longer.

Views on the walk home from Mulago Hospital

Mulago is a tertiary referral hospital and, while there is a private pay floor, the majority of the hospital services including the theatre that I’m working in are government-supported so supplies are limited. For example, there is a set amount of suture that can be used, so surgeons improvise and close the abdominal incision in three layers versus six, doubling the number of Caesars that can be performed with what’s available. The hospital can’t provide bedding so mothers bring their own bed sheets, cotton wool, nursery sheets and receiving blankets. Monitors are non-existent and IV flow rates are a guesstimate controlled with a clamp and by poking hollow needles through the top of the saline bottle to relieve pressure and increase flow.

Smoke from burning trash mixed with diesel exhaust, grill smoke, and humidity equals a hazy Kampala.

This part of the rotation I’m working with a classmate, Susan Slycord, and today there were two surgeons working with the support staff sufficient for one OR, so we received babies. This includes brief exams (APGAR scores, weight, gender and time of birth); showing mom the baby, being sure to show its gender, cord trimming and identity labeling of each baby. Today was a little tougher than earlier in the week. We really have had pretty healthy babies for most of the week yet today we did three (successful) resuscitations. Overall, two-thirds of our babies delivered cesarean survived. Pathology and complications that I saw here in one day I would imagine that obstetricians might practice for 20 years in the States before they see each once. I was ready to receive one of our babies and the doctor told me it might not survive. I asked how I would I know if resuscitation should be attempted and she said, “Well, if you think it will survive.” For me, that was actually a little ambiguous and I really don’t think that I should be the one making that call, but we did. Fortunately for me, the decision whether or not to do each resuscitation was very obvious so I didn’t have to navigate the grey zone – it very black and white. At one point, both Susan and I were performing separate resuscitations. When my baby was stable, I went to see how her baby was doing and she was very calmly performing CPR on a baby boy. Nothing was sweeter than watching the pink color come into his face and hearing him cry. A baby crying in the operating theatre is a welcomed sound! Cry, babies, cry!!

A dress store along a strip in Wandegaya on the walk back to Makerere University and NUFU House

After the day in the theater, we had our second Luganda language lesson. This has been very helpful because almost none of our patients speak English. Can you imagine waiting 18 hours for a caesar, being in excruciating pain, and having to interpret sign language and trust the mzungo* in the room? Thus, I pay attention and ask questions in Luganda class. After work, Susan and I walked to take care of some errands and had rolex sandwiches** from a street vendor on the way home. We also probably needed to get out and see some life in Uganda. That’s what the pictures are from – my walk home every day. I think you can see that there is much poverty here. It’s so honest and constantly present here, whereas in America (my frame of reference is middle-class Des Moines), it seems you have to make a special trip to be visually aware of it. But I want to make sure that I’m clear, this isn’t all of Kampala – it’s a developing country and there are growing businesses and there are people that have wealth. But here, it’s just all twisted together. Here you can’t get away from it – it’s right in front of you.

The rolex stand: the griddle is in front of the man in the peach shirt.

*mzungo = anyone with white or light skin

**the BEST and probably healthiest fast food I know. For 50 cents you get chipati bread and a two-egg omelet with onion and tomato. The chipati and omelet are plate-sized, shaped like pancakes and rolled up wrap-style.

Beth with her rolex

I hope I have time to walk around with a camera because it’s so frustrating to write this all down but not really having the words to capture what I’m seeing. But that seems to be the resonating theme for me here: It is something that you can learn SO much about a place before arriving and that knowledge has nothing on the actual experience of it. No matter how prepared I was, no matter how much research I did, no matter how good of a traveler I might be, nothing could accurately describe the experience here, and I’m assuming that tomorrow’s day at work will be no different.

As for tomorrow, I’ll be on the labor and delivery floor unless things change (which is also common here…you have to go with the flow or you’re bound to be frustrated). I naively thought it was an error in my information packet that 27,000 babies are born here each year. It was not a typo: I’m told 80-100 deliveries per day.

Click here if you’d like to read more about the hospital.

My plane landed in Entebbe and I can’t think of any airport arrival more breathtaking. We walked down the stairs onto the tarmac in the middle of the green hills dotted with terra cotta roofs. After immigrations and customs, I found James, the driver sent to pick up students, and we headed to Kampala. On a two lane road, you have three or four modes of transportation in one lane each way and congestion is an understatement – cars and trucks, bota botas (motorcycle drivers that rent the extra one or two seats), bicyclists and pedestrians all in one lane and the shoulder. The colors and smells overwhelmed me. Tiny eight-foot by eight-foot rooms with a roof line both sides of the road and house the businesses of tailors, sandals being fashioned from old tires, airtime card sales, chipati bread  (tasty local take-away sandwich), Rolexes, auto oil sales – you name it. If you can sell it, there is a small building for it. There are also lots of brick buildings being built that are two or three stories and, if you look into the city centers, taller 20-30 story shiny buildings live among the banks and ground level vendors.

The road from Entebbe blends into the road to Kampala – it was hard to tell where Entebbe ended and Kampala began. After dropping off my suitcase at NUFU House on Makerere’s campus, James took me to the medical school offices on Mulago Hospital grounds. NUFU is a five-bedroom house on university grounds. We each have a room with a desk and bed with mosquito net. We share three bathrooms, and the NUFU caretaker/office manager Margaret serves toast, coffee and fresh mango or watermelon juice every morning for breakfast. Depending on the day, samosas, banana bread or boiled eggs are also served. It’s a nice way to get to know my house mates.

I was able to take in a little bit of Kampala on Saturday and tagged along with a housemate to a coffee shop that ended up not having wifi but did have the most wonderful coffees and smoothies. We had lunch out and it was the most amazing Indian food I’ve ever had. After that we trekked to the Baha’i Temple and I learned a lot about their faith It’s a very beautiful and peaceful belief system. There is one temple on each continent and the African Temple is here. On the walk home, we stocked up on water and some fruits and veggies – jack fruit is the strangest fruit I’ve come across and it’s a delicious flavor blend of slight banana and mango. Saturday was certainly a day of acclimation and soaking in the city.