Je bekijkt de reis...
Reisverslag Munu bye!
13 april 2018
After a really short dry season this year for six weeks it started raining again. I loved the dry weeks, no rain, no mud, nice and hot temperature. Ok, also some disadvantages like dust everywhere...so after mopping the floor, 5 minutes later you don’t see that you did it....maybe just leave it for a couple of weeks? Your skin looks brown and teinted, but it’s just the dust, so no rubbing because than you can tell.. if you move or even lie still on the couch your sweating profusely. When you sit on a plastic chair for a while, hopefully you don’t wear grey pants, because you’re soaking wet from behind like you pied your pants.... sleeping in the night is difficult because it is too hot (lucky I’m not in a relationship, because that would be unbearably hot) when the first raindrops felt, I stood with my arms wide open to catch the drops and smelt the fresh rain. I think my guard thought I was going to be mad or hit by a heatstroke...
They burn the grass, so new fresh green grass will follow. The disadvantage of that is that the air is filled with black dust what makes your skin black like ‘zwarte piet’. Little boys around 4 years old are walking around with a burning stick in their hands to burn the sides of the roads.
The bad part of the rain is that also a lot of flying animals are appearing, flying ants, but worse an invasion of ants in the garden. The whole yard is black of ants. They even attacked the guard during the night... I always thought it was a fairytale that ants can kill a person, but now I see the amount and the size I believe! So in the evening we are spreading paraffin to kill the ants and to make a barrier for the guards house and my house so they will not attack me in the night...brrrrr
Here in town you see street children wandering around, intoxicated by alcohol when they don’t reach the age of 10 years yet. A funny culture difference here is when you brings some sweets or so. If you offer people a sack to pick one so everyone can have some, they want to take the whole sack for themselves. So a good lesson is just to give it separate to them. Or am I now the cheapy Dutchie? We are familiar of giving a cookie from a box and after everyone has one, you close the box.... During lunch everybody is putting a pile of food on their plate, not looking at the people behind them if there will be enough food. As a result the last ones in the row don’t have any food.
After a week of training I start (on time) at the hospital. None of my colleagues is showing up, and they don’t know that I’m coming, because I don’t have a fixed schedule on purpose so they can’t rely on me... A mom comes in, waiting in the corridor. Before I see her standing and waiting time is already past. I ask her to come in. The students are around so I explain them how to examine a mother, what do you ask her...she only speaks Acholi, and I only speak it ‘manok’ (a little bit). One of the students is translating and when I ask her if she lost fluids, she confirms that she lost this morning and that something is hanging out...! What??? Oh no, I pull the ‘ketenge’ away and there it is, a big piece of umbilical cord hanging out. She came by boda (on the back of the motobike) and it is already for hours that the cord is out. This baby is a miracle, because I hear a good stable heartbeat! Amazing! Luckily the gynecologist is around (also a miracle, because lots of times he is in his private clinic in Kampala) Eh....doctor....emergency! And then it goes fast, we are like a well oiled machine...never been so quick in theatre! We push the head of the baby up, fill the bladder, let the mother sit on her hands and knees, and still the baby is alive. Unfortunately the theatre is not ready, it takes more than 30 minutes before the anesthetist nurse is ready and they forgot to turn off the air-condition, so the moment the cold is touching the umbilical cord the baby died.... so sad...It could be saved, but no....when I come hours later in the postnatal room, and I ask the mom if she knows what happened to the baby, she doesn’t...nobody told her yet, and she isn’t asking...so again with the same student who is translating I tell her what happened, that we tried, but that the surgery didn’t work out and we were too late. It is the sixth baby, but still you see the pain. She tries to hide her tears. The grandma comes in and we explain it again, I ask her if she want to see her baby (that’s not common) but she really want. So I take the baby in a blanket and show her. She doesn’t touch it, because that brings bad spirits upon her according to the tradition. So sad, to walk with a dead baby in your arms which could have survived.... I put it in an old paper box and the family will take it for burial. But the day is not over yet. A mother is lying there saying she is in a lot of pain. I don’t see it from her face that she is in pain, and definitely she is not having the baby soon...so I tell her that she needs to experience lots more pain before the baby comes. I shouldn’t say that, because after that she is screaming and making lots of noise, just to show how serious the pain is... the next mom coming in. When I feel inside I shake hands with the baby...the baby pulls the hand back, it is shy until I can’t reach it anymore. Not a good sign, the baby is in a wrong position and it will never come out like this. She needs an operation, but we have to wait because there is no sterile equipment, so they first have to sterilize materials. Patience, patience, patience...in the mean time I have a nice, normal delivery of a big baby boy, named after me, Mario. The next mom is not progressing and when I check position after one of my colleagues checked I feel a hand next to the head of the baby, cheeky one! It is not fitting like that! So also this one in line for cesarean section. The in charge nurse comes in and tells me proudly that she was changing wound bandage! Wow, pooh, hardworking..... The evening duty don’t show up, and I’m exhausted... around 5 pm the in charge says we will leave, without leaving anyone behind. Crazy! I can’t leave the ward and the moms unattended. I know I’m not responsible, but I feel like that. And that is the big difference, nobody feels responsible, even not the in charge! So I make her to call people, because I will not leave, and finally a colleague arrives and takes over. Unfortunately it doesn’t get better with dying babies. When I come back after a night or a weekend off, still babies died. And sometimes it also happens with me. I take over from the nightshift, the mother delivers quickly without any problems, the baby is crying and I explain to the students about delayed cord clamping and the advantages. In the meanwhile I look at the baby which is quiet, the baby stops breathing. Whatever I try, stimulation, ventilation, resuscitation, the baby doesn’t pick up...come on little one! But the baby died...what happened!? What did I miss? I’m so confused, what went wrong? A healthy looking baby which was crying....! Later on I go to the mother to tell her that her baby passed away, a student is translating. I ask her about the pregnancy, if there were any complications, if she had unhealthy babies before. And what do I hear...? The membranes ruptured already two weeks before but she didn’t tell her husband. After a week she told her husband, but there was no money for transport. So it took another week to arrange money for transport to the hospital. My colleagues of the night duty didn’t ask any question and forgot to give her antibiotics because they didn’t know. Maybe, the baby could have survived if we had given the mom antibiotics on time? Now probably the baby died of an infection. In the meantime when I was busy with the resuscitation of the baby, my colleague is not very active and she let students do a delivery unattended. A few hours later the family comes with a pale and non-reactive baby, bleeding from the cord. They didn’t tie the cord well, so the baby was bleeding profusely. I rush to the NICU to put an IV line and try to give blood transfusion, but nobody succeed to catch a vein, this baby is dying. We are desperate. Than one of the new colleagues, a young guy, comes in to take some papers for administration, and he succeed to put the line in! The baby survives and I see a totally unrecognizable baby after two weeks, healthy and dark brown and not mzungu color anymore!
This is not a nice and happy blog. A mother died just when she came in to the hospital after an abortion where she left the hospital without notice. She comes back after two weeks of bleeding, and she collapsed. The doctors tell me that they resuscitated the mother. When I ask them how they did it, it seems it is not really an accurate resuscitation, so I ask if there is any need for resuscitation training. At the end of the week I give a resuscitation training for people in the hospital, and it is most needed. The way how they did it is just some nice touching of the body around the shoulder, but not really stimulating the heart.
In the morning I put on my professional uniform and I can handle everything, after work I’m taking it off, and I feel differently...
Because of all the dead babies, I arrange another training about neonatal care and resuscitation. When we start, it’s just 10 people. But after a while the whole conference room fills up. I even see the face of the hospital director in the midst of them. Off course he disappears before the practice part. But he is enthusiastic and even offers me a job to teach in university.
I’m very sad and disappointed because my colleague and friend, our great gynecologist Lierka Rodriguez, left the country due to visa and registration complications. So now I have to finish and continue the project without her. We had so many plans for training and she was a big support. It is too much work for one person, I can’t be everywhere at the same time, teach the midwives, students and the doctors. But we have to try to survive without her, but it is a big loss, I miss you dearly my friend and buddy! I miss the banana and chapati she brought every morning as breakfast, because she knew I didn’t take care of myself...
During the last training the people were very enthusiastic and stimulating. Although I sometimes have the feeling I’m teaching primary school kids. If you don’t do an energizer they fall asleep or wander off. Our training is very interactive but probably still not enough. So every hour I let them dance, pick fruits from an imaginary basket or Ali Baba with following gestures.
But there is a lot to be positive about. During the refresher training and the follow up visits we ask how they did the previous months after the training. And so many inspiring stories. Off course it is possible that they just tell us to be nice, but it looks that those are genuine stories. Immaculate always referred difficult cases to the hospital, but after the training she is more confident and she gained so many skills that she now delivered a triplet on her own, she resuscitated babies with good results, she managed to solve a big bleeding of a mother following the steps she learned during the training. And at the same time she teach other colleagues how to do it! Irene, a midwife in a very remote health center close to the border of South Sudan resuscitated a baby for more than an hour on her own, and the baby survived. Before the training she didn’t know how to do it and just was blowing some air in the face of the baby. Christine, a big mama in a big health center, always laughing told me that she doesn’t do routine suctioning anymore and she noticed the difference and that ventilation works better! Raymond, a young guy in a small health center is telling the story that one of his colleagues wanted to refer a mother because of no progress, but he first emptied the bladder and the baby was born normally. It saved the family money for transport and he also give training about all the things he learned on the training. Sarah, a beautiful woman, just delivered her own third baby is telling that lots of colleagues call her when there is a complication, because she followed the training and knows a lot. At the same time she teach the other colleagues how to do it. Kia, a smart girl, saved a mother with a big bleeding by watching the mother the whole night, didn’t leave her sight and following all the steps of the training. And the nice part is that she came with the question if it is possible to use the bakriballoon(for stopping a bleeding) if you don’t have a urinecatheter. So they think about things and ask questions, and that’s how I came up with the idea that it is also possible to use an IV line instead of the catheter, so even in the smallest health centers they can use this method now! So what we see is the butterfly effect, we teach 10 people, but if they teach 4 or more other colleagues, see how fast it will spread! There is hope for Uganda! They only need support...
The project is almost ending, and we urgently need more funding to continue....so if someone knows a big sponsor, please help the people in Uganda! If no other funding will come, I will leave Uganda at the beginning of June...
So much to be grateful for: living in a country of peace, freedom of speech, drinking water everywhere (even to flush the toilet, what a waste actually) nice seasons: spring with lots of flowers, summer with sometimes nice sunny days, autumn with lots of rain, and wintertime sometimes with a surprise of snow and ice-skating. Democracy, safe public transport, jobs, no poverty, enough food and a wide range of food, good education available for everyone, freedom of religion, fast Wi-Fi, delivering services for food, your own car, bicycle, motorbike, nice restaurants, cinema, washing machine, dish washing machine, vacuum cleaner, your own private delivery room with clean and safe deliveries, shopping malls, good shoes, quality cloths, a good healthcare system available for everyone, conversations with your parents, friends and family, electricity in your home, no power cuts, running water everywhere, fresh milk without mad cow disease, with your mouth wide open standing under a shower brushing your teeth and after swallowing the water, nice brown, salty bread, cheese, a well filled fridge, a freezer always working, not counting your money at the end of the month if you’re still able to buy that package of milk, nice apples, good roads where you can drive a 120km/hour and not worried if you will kill a goat, cow or little child, traffic lights, and organized traffic where almost everyone is following the rules, special paths for walking or cycling, hot water to warm up after a cold and rainy day, hot water from the tap so you don’t have to cook water before washing the dishes, oven, microwave, dryer for cloths so you have soft towels and nicely smelling pyama, everywhere ‘working’ sockets, kids not crying if they see you because you’re so scary white... and it all seems so normal!
On the other hand I will miss the fresh fruits, sunriped, nice mango’s, passionfruit, pineapple (5 for 5000ush) avocado, not an extra tomato when you buy 4 for 1000ush, sunny hot weather where always the sun comes after rain, no gamepark an hour drive from town, no waterfalls where you can swim in a hidden pool, not a big garden with a guard who welcomes you home every day, no corn at the side of the road, fresh roasted above a charcoal fire, no rolex, no pork on a stick when you take the bus, No goats, chicken, cows, pigs at the roadside, a different world! no kids greeting you every day when you pass: Munu bye, munu bye!
16 april 2018 10:37 | Door: Janine Bontenbal
Hoi Marian, heftig man allemaal. Wat je schrijft raakt me echt. Ik vind het echt tof wat je doet, je kunt heel trots op jezelf zijn. Ook al is het moeilijk soms, je maakt wel echt een verschil.
Succes met alles, veel respect voor je!