Monday, August 3, 2009

Maternity Ward

I was impressed by the labor ward at Tororo District Hospital.
At Mbarara, I rememeber chaos. Patients packed in, many cringing and rolling in pain on the floor, waiting to become fully dilated. Once ready to deliver, they are given 1 of 3 delivery beds, quickly delivered, cleaned up and sent over to postpartum for 2 hours, at which point they were sent home.

L&D at TDH was clean, calm and organized. (It helped that there was no one in labor the first day I went. But even the second time, there was yelling from pain, but everyone had a bed and a modicum of privacy (effective curtains).
The walls are painted white, and there are specific instruction on what to do in case of pre-eclampsia.

I was very impressed with those instructions, and I told the nurses. Later, they told me that they are writing up similar ones for postpartum hemorrhage. I got the impression that the leadership of the maternity ward was forward-thinking and interested in improvement.

Patients stay 24 hours after a vaginal delivery (longer than the 2 hours in Mbarara) and 7 days after a cesarean (so that the sutures can be removed before they go). I saw the antepartum and postpartum wards, and while there were many women there, it was not full, and definitely not overflowing like in Mbarara (where vaginal delivery patients all lay on the floor because the beds were filled with cesarean patients).

One problem that TDH does have is that there are only 2 doctors for the entire hospital (general practitioners), so if neither is available to do the cesarean, the patient is referred to another hospital, and presumably she or the baby (or both) could die on the way. (I am applying for a Ugandan medical license and hopefully will be able to do some clinical work and operating there. The nurses and administrators seemed very receptive.)

The delivery beds were spartan like the ones in Mbarara (all the birth-plan, doula, water-pool-delivery types would be shocked), but newer, nicer and cleaner-looking.

There was even a very fancy one with leg rests and foot rests, but apparently it's rarely used because many of the nurses are not comfortable using all the movable parts.

When women come to deliver, they bring large printed cloths and a plastic garbage bag - these are used to deliver her on and clean up the blood. Sometimes they even bring supplies like latex gloves, plastic wash basins, and cotton wool (although TDH seems better-stocked than Mbarara). Here, a birth plan is not deciding what you want your "experience" to be - it's determining what you need to do to survive it.

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