Je bekijkt de reis...
Reisverslag Another report
2 juli 2017
Everything has to be a bit slower than normal....I'm adjusting to this culture....
Women have a special figure. Small waist, tin legs but big behind, really big! If they don't have it naturally they use implants, yes, butimplants! The first thing they say: you're fat! Apparently its a good sign here.
In the evening I'm not always in the mood to do groceries and cook, so sometimes we go out for diner. At 7:00 p.m. Its dark outside. To go home you have to call for a boda, so you shout, whizzle or clap your hands. Than a guy on a motobike comes, you jump at the back, and hopefully they bring you home. It's pitchdark, the roads are dirty and bad and full of holes. I hold them tight. The lights of the bodadrivers are not always working so well, so I'm always glad when I'm safely home. After a few weeks a lot of bodadrivers know me. If I tell them where to go, they respond by saying: I know where you live, no worries.... problem is that I don't recognise them, they are dark, and it is dark....so no difference in appearance for me. Off course they recognise me because of my white and lightening skin! No problems to transport two persons at the same time, squeezed together, spooning, they bring you home. No half price unfortunately!
When I'm walking to the hospital in the morning the bodadrivers are waving, it feels a bit home.
If you go to a restaurant and you order food, first ask what they have.... a big menu, but most of the times not available.
So what do you have? Eggs, vegetables and chicken....
If you order it can happen that after two hours they come to tell you that what you ordered is not available....even if everybody has their food. Maybe they still try to catch a fish if you ordered it...
On thursday it is quiznight at BJZ, a local bar. With all the VSO volunteers we go... having a drink, listening to music and trying to win.....we are 4th out of 40 groups....not bad!
Everywhere you look its green, because of rainy season, sometimes a part of red dusty area. It looks clean on the street, in the morning you see older people sweeping the streets. Most people live in round huts of clay. On the rooftop the laundry for drying. A piece of fabric to close the entrance. Women sitting in front of the house, one kid wrapped in a ketenge on the back, other children playing around them. Two little kids are playing at the edge of some water, throwing rocks in it. Everywhere kids are the same. They preparing food. On the street you can buy food: roasted pork(like bbq) cassave, rolex(chapati with egg) Most people are busy, carrying big loads on their head. Boda drivers standing together, waiting for customers. The area around Gulu is flat, no mountains. It looks like a fruitful country, avocadotrees, mango, lemon, papayatrees, cornfields, Irish potatoes, people(mostly women) working at the gardens. Termitehills sometimes 2 metres high next to the roads. In every village there is a 'healthcenter' a pharmacy and a phonecompany. One watersupply for the whole village where women and children are waiting with jerrycans to pick up some water, never men! Imagine that you live in a house where you don't have running water....no toilet... so if you use the tap today again, using fresh cold or hot water, drinkable, think about that privilige!
Again a twindelivery. The second baby isn't coming, the first baby was delivered at home. So it took already a lot of time before they got to the hospital. The baby is still alive, but not for long. Midwives are a bit lazy, they are not in the mood to hurry up for theatre, discussing which one will go for theatre, time, time time.... after one hour one midwife goes slowly to theatre, when they deliver the baby, there is no heartbeat anymore.....unfortunately
The baby lies on the table where they normally do resuscitations, wrapped in cloths. Next to the death baby lies a healthy lively baby, just born. The grandmother of the dead baby comes, and thinks that the living baby is theirs. She is send away in a very rude way. No mercy, no compassion.
The next mother is a young one, only 17 years old. A student wants to do the delivery, so I will assist her. It looks like the pregnancy is premature. The delivery is difficult, and takes long. Now I really can use a vacuumdevice, but unfortunately they don't have it, and the interns don't know how to perform. But after some maneuvers the baby comes out. No reaction, so we give stimulation and ventilation. I ask someone to call my colleague who is working at the neonatal ICU for assistance. After a while the baby is breathing and we give the baby back to the mother in skin to skin contact. In the meanwhile the student delivered the placenta, so well done! She is a quick learner: seen one, done one!
The local staff is nowhere to found, they disappear without saying. Three mothers in labour and only students available who never performed a delivery. One of them thinks she can do it without assistance, she is pulling the head of the baby, I'm glad its not getting off. I tell her not to do anything she doesn't know how to do it. Not in my shift! Women here are no practice material! They are human beings, very precious! I explain a lot what I'm doing, how and the background of actions. When I start talking to one of them, suddenly there are like 20 students around me. I think thats a good sound, they want to learn. The only thing is privacy of patients, but.....there is none....people are used to have a big crowd around them when they deliver....its a teaching hospital is what I'm hearing all the time.
Students are very stubborn, they just do things without any knowledge. They don't know how to check fetal heartbeat, if you ask them to count they just guess(well, all the midwives do that actually) When I'm for 5 minutes in postnatal ward, a mother delivered a baby. When I come back, the two students are standing at the resuscitation table with the baby. Nothing wrong with the baby, and I already explained them several times not to put the baby away but leave it on the moms chest. At the same time the mother is bleeding heavy. Nobody of the students noticed that. I call them, give medication to the mother, deliver the placenta and start suturing fast to stop the bleeding. In the meanwhile I explain them that this is one of the reasons not take the baby somewhere else. You don't have vision on mother and baby.
When your on your own at the ward, only students, or totally nobody, its very busy. 5 deliveries a day is normal, sometimes more, suturing, checking fetal heartbeats(with an iron doptone) doing vaginal exams ( no possibility to check BP because there is no equipment) and also checking the postnatal and antenatal ward and giving treatment there. Almost impossible most of the times. Women come in without notice, carrying a plastic sheet, a antenatal card and sterile gloves, sometimes very much in labour, so you have to be quick. Sometimes someone is too late, just as last week, the cleaner calls me that some lady delivered in the corridor. She is holding the baby between her legs, the placenta already delivered. The baby not breathing. Action, action, action....luckely children are very strong, most of them survive! If you need the beds, you tell women who are not immediately delivering to go out and wait till they feel the urge to push. The autoclave is broke, so no sterile equipments, always lack of gloves. Sometimes water is not running, and lots of times powercuts and no working generator. Medication is frequently not available, so treatment is just given when it is available. Not so strange that a lot of women suffer from infections.
A woman comes in, already 8 cm dilatation. The student is doing the exam and tells me that she thinks she felt an umbilical cord, so I'm checking, and yes....umbilical cord prolaps. No catheter available, the head of the baby already descented. So I push the head up, let the doctor come to prepare for an operation. I can't let go, I have to hold my hand inside of the woman to push the head up, otherwise the baby will die because of the pressure on the umbilical cord and loss of blood/oxygensupply. Its actually funny if you see it from a distance: a mzungu(white) inserted with her hand inside a woman who is sitting on hands and knees, on a trolley outside to go to theatre. Outside a lot of a family is sitting and watching. But most important thing is that the baby survived!
Sometimes mothers collaps when they start walking after a delivery. Big panic and they always think that the women are psychotic because they are a bit confused just after falling down. They don't know that its a normal reaction after passing out.
After one of the shifts a woman walks towards me, I saw her the day before and couldn't find a fetal heartbeat. But the lady is a bit fat, so maybe thats why I couldn't hear it. The ultrasound scan was not available anymore, so she did do the ultrasound the next morning. Now she shows me the result: no pregnancy! She ask me how it is possible? She had 3 times antenatal checks where they wrote that there was a fetal heartbeat, her belly is growing, but no baby inside! She is confused...I understand. the scanresults says that there is a enlarged liver and splene. Here in Uganda alcohol is a big problem. A bottle of gin or whiskey is very cheap... maybe thats the problem? I send her to emergency for a check up.
If someone is sick they have to get a boda to come to the hospital, no 911, no ambulances...well, they have....but no fuel most of the time... so you see a bodadriver coming with two people. The one in the middle can hardly sit straight. Women from healthcenters have to wait sometimes for hours before the driver of the ambulance is in the mood to drive them to the hospital. Most of the time they use a boda, but lots of people don't have the money for a boda, so sometimes the midwives give their own money to pay for it so they can save the woman. Than a woman sits on a motobike, bleeding, with an umbilical cord and clamps hanging outside....not so comfortable...
When its raining, nobody comes to the hospital...well, no staff....after the rain stops then they come in...when its not raining they are always late. Shifts start at 8:00am, they not come before 9:00 and sometimes later. They really don't care! Nobody is checking them, they write in a registration book that they came at 8:10am...
Registrations, a different story, everything had to be registrated: skin to skin: check(even if they don't do it) vitamin K: check( its not available for weeks) breastfeeding within one hour:check( the baby is not with the mom) apgarscore: 9( even if they gave ventilation---- well, not really adequate ventilation, so maybe the're right....) partograph: they fill it in after the birth, fetal heartbeat registrated every 30 minutes( I never see them listening, strange..)
Together with a pediatric nurse we give trainings: Basic emergency obstetric and neonatal care. The goal is to train a few midwives, after that pick one or two, who is really good and train them to be a trainer themselves. Also we try to encourage them to make changes at the ward and teach other colleagues and give feedback. Our first training we gave to the midwives, some interns and clinical officers of the hospital. It is always waiting if people come, when they come and how many. We've planned for 10 people...
I asked one of the students with lots of potential to join the course. She arrived at first, slowly more and more people are coming in. Around 11:00 there are 9 people and finally we can start. Not bad...we begin with a baseline. So we let some of them do a normal delivery, to see how they do it and what can be improved. The first day is about normal deliveries, maternal mortality rate and what we can improve to reduce the rates. Get to know each other and do some practice.
Always when you give a training here you have to trick them with something. Most NGO's give a lot of money to join trainings, our NGO doesn't give money, and I'm glad. It's really wrong to give money so people come, they are not interested in knowledge, only money...
We provide them with breakfast and lunch and soda's, and for them that's already luxurious. Also we give them compensation for transport, and if they come from far we arrange accomodation. I think that is fair.
The second day more and more people are coming in, I don't know if its about the food or the training, but the news is spread that we give training. Even a cleaner comes in, write her name at the registration list. My colleague explains her that this is not really a training for cleaners, but we promise her to give a training special for them....(we have to figure something out, infectionprevention is really important, so maybe start with the cleaners!?)
The participants become more and more enthousiastic and really want to learn and change. Today is about resuscitation of newborns. Knowledge is really bad and practice even worse. They can't perform proper stimulation and ventilation. They don't know when to start massage and when to stop. The only thing they always do: suction(with a dirty bulb) and hold the baby upside down, slap the baby on the buttocks..) and sometimes that helps....they are used to clamp the cords immediately, take the baby away from the mother, put it on a table, just under an open window, so most babies are cold and because of that in a very bad condition. That so many babies survive is a miracle! In the meantime they are busy with the baby, they don't notice if the mother is bleeding....
We try to act as real mothers, and we do roleplay to make it as real as possible. In uganda they really like roleplay! So a lot of laughing and fun. At the end of the day most people know now how to ventilate and resuscitate a baby.
3th day of training the conference room we hired for the whole week is taken. The medical director and all headnurses have a weekly meeting. We are less important, so we have to move to a small room, but off course we are flexible and we try to make it possible. There is a powercut the whole morning, so powerpoints and movies are not available, so we do it by head and with flipcharts. It's about hygiene, infectionprevention. The participants have to write something on flipcharts: what is going well, what is going wrong, what will I teach someone else? Really exciting outcomes! The funny part is that they mention several times: being on time.......LAUGHING OUT LOUD.... nobody is ever on time! Only we, the mzungu's! And now they are mention that! So, they are annoyed by that.....so funny....! We told them to change it, talk to your colleagues to be on time, but first: start to be on time yourself! So we expect that tomorrow everybody will be on time at the training........we will see....
The afternoon is about post partum hemorrhage and pre eclampsia. To be active after lunch my colleague goes outside when nobody notice and than she started screaming while she is holding a small baby and a lot of blood around her on the ground. The reactions are hilarious! One is running outside to take care of her, one is running inside to pick up cloths for the baby to dry and warm, another one runs inside to pick up equipments to clamp the cord, two are just sitting at their seats inside, and the rest are watching and laughing loud. The whole hospital and patients are watching and laughing.... at first everybody thought it was someting real. Well, everybody is awake now! No afterlunch dip! At this moment we definitely found our champion who can be a trainer! After this we act like we are a couple coming in with pre eclampsia. When they examine her she started shocking and having convulsions, lots of chaos, panic and also a lot of laughter.
The last day is about twindeliveries, breech, shoulderdystocia, cord prolaps, vacuum and forcepsdelivery. A lot of practice combined with theory. Everybody thinks its useful. We have a good feeling about it.
The next week we give the same training for midwives from healthcenters around Gulu.
The training for the healthcenters is really good, they have more skills and experience. They work with less staff, no doctors, less equipments. One of the participants brought her twin babies and a nanny. So they are sitting in a corner of the room.
Also in this group there is a really good one, we ask her to become a trainer. So she will join us the next time we give a training, so she can practice....
Public holiday on friday and a weekend off. Together with Renee( a girl from Holland, started at the same time) who lives in Arua, I'm doing a trip to one of the gameparcs. We met at the entrance together with a group of Canadians and Austrians. Groups of elephants, hippo's outside of the water, very impressive and big! Not the small ones we have in our zoo. We have a female ranger who is coming with us for protection. It's big and beautiful parc, we drive for hours and see so many animals: buffalo's, giraffes, monkeys, warthogs, antilopes different species... and than at the end..... yes! Finally Lions! They are just lying beside the road. Renee and me sitting in a close van, so I really want to make pictures and see the lions and open the door....at one metre distance two lions...I think they just eat, because they are lazy and not interested. At one moment one of the lions turns her head, at that moment I slamped the door, too risky....the lions cuddling each other and than they walk away....amazing! For the night we are sleeping at a restcamp in dorms. If you want to go to the toilet you have to bring a light, because if you meet a hippo you can shine in their eyes and that will scare them(they say...) one of the girls comes back from the toilet, shaking....one metre distance she almost walked against a hippo! I think I will pee in my bed this night....
We're making a bonfire, have a bbq with roasted goat and some salad, and we sit and talk till late in the night. Hopefully the bonfire will scare the animals...the next morning we drive early to see more animals. We spotting a hyena and see the sunset, so impressive and so quiet!
After that we are doing a boatsafari on the Nile to the waterfalls. At the end we have to climb to the top of the falls. It is very hot today, Tse Tse flies are flying around us, trying to catch us. On top of the fall is a beautiful view, the falls are so powerful, almost scary.
When we drive out of the parc we still see elephants and hippo's, they don't care about borders...
They sometimes destroy villages and try to find some food. Monkeys are everywhere, and they are agressive! The jump into cars, on the rooftops and steel everything also when you holding it.... the only thing what works is to pick up a stone and the movement throwing a stone....
On saturdaymorning I wake up by the sound of the guard who is cutting the grass. I make some tea, have some breakfast sitting on my porch in the sun. After that doing laundry, cleaning the house, doing groceries at the market. Sometimes going to a internetcafe to do some work. On sunday when there is time, we go to the pool for chilling and I try to reach my family trough skype.
Or after work lying in the hammock, looking at the palmtree above my head and the lizards playing with each other, eating popcorn from the market(500shilling) and a cold soda from the nabor across the street just to have some sugar after a day of work, no eating and drinking... fireflies in the evening and a lot of mosquito's. In the morning after rain the garden is filled with wings of flying white antz. Its a specialty here! (I tasted it....not nice)
If you're living in Africa don't be afraid of animals.... cockroadges, spiders, antz as big as spiders, bats, lizards which are hiding in your shoes, or in your bed.
A legion of antz are marching into my house....noooooo, really big antz.....hot water, the only solution to kill and stop them. Or does anybody has another solution?
The mosquito's are even worse, they bite you even if you put on repellent and wear long trousers...
We have a new guard. The old one had a drinking problem. Lots of time he was not responding if we knocked at the gate. One day I stood in the rain, screaming, knocking, bouncing the gate, didn't hear me because he was too drunk. Another time I came back in the evening and than he couldn't find the key, and the keyhole. After the weekend the other guard came to me, telling that the drunk guard told him that I didn't pay him. Also that he was harrassing women across the street... so for me that was the end, I called the landlady and we fired the guard. Finding a new one was a bit difficult, and our other guard had to stay until we found a new one. Luckely we found a good one. The landlady told him to be nice to us, smile if we come home after a long day hard working, asking how we are....well, he is doing his job: every day when I come home he is smiling, greeting me and asking me how I am....
Home is where your heart is.....
2 juli 2017 20:14 | Door: Angelique
Meis wat een verhaal !!
Zoveel respect voor wat je doet!
Wat een hoop ellende zie.je daar, maar ook wat een frustraties waar je tegen tegen aan loopt!
Veel succes verder! Xxx
3 juli 2017 21:55 | Door: Leen
Wat een verhaal en helemaal in 't Engelands
3 juli 2017 21:58 | Door: Leen
' t lijkt alsof de helft van mn verhaal is weggevallen. Ik wens je alle kracht wijsheid en verstand toe en pas goed op jezelf!
Respect voor je!