Uganda Day 8...

 I woke up with somewhat of a brainwave....

Why not rope /bribe the kids to pick up the plastic. The field whete the party was, was still strewn with rubbish, mainly plastic bottles. Perhaps if the kids got a bit of a reward for picking up the plastic as well as a well done and a thank you, maybe they would see the value in continuing to pick it up when we are no longer here. So I poked my head out of the door and summoned the army of kids that I had built up... I explained that if they filled the plastic bags I had with bottles they would get a reward....

Within 10 minutes 3 bags had been filled as well as a wahing basket. They had dome a fantastic job! I gave them all pencils and bubbles and gave them. high fives and said thank you in Ateso.. yalla ma noi!

We put the bags and the washing bin in our rooms until we could work out what to do with them. Here it seems as though there is no facility for recycling. In Kampala we saw people collecting and weighing bags of plastic bottles which then wentbto a local plastic factory where they made stuff out of it, that was what we were told. Here in Ngora, it seemed as though there wasn't even a collection of the plastic.

Margaret was coming again this morning. Today we were teaching the community nurses and midwives and hopefully some of the traditional birth attendants. This meant, that after introductions, we had a couple of free hours whilst Margaret had the class.

Grace first took us to the antenatal clinic area. Claire and Sam had a lot of questions about monitoring of the mother in pregnancy and particularly interesting was the work they did and the set up for HIV affected mothers.

I asked whether they have a child health record like they do in England and Grace showed us a card with growth charts on, HIV statis, immunisations and other useful things.

We went back to the labour ward. It was quite quiet there. There was one baby who had been born yesterday who was very cute.. we gave the mother a hat for him.

Grace then said that the doctor had called asking if I could go and see a baby who had just come in. So we went back to the emergency room.

There lying on the trolley was a baby with a cleft lip and palate.  She looked listless and quiet and was working hard with her breathing. Temp was 34C and her oxygen saturations were low. She did not look well at all. 

They were very concerned about the cleft lip and palate, I was more concerned about the low temperature. They picked up the baby and carried her across the hospital to the paediatric bit where they have a radiant heater and placed her under it. To do that they first had to take out another baby from under the heater, who was on some respiratory support and transfer that baby to a cot. The baby they moved was all swaddled up and I never got a good look at that one. The baby with the cleft was then moved to the heater and with some marvellous ingenious practicality, they rigged up the one CPAP machine and split the tubing so that it could deliver oxygen to 2 babies at the same time. Baby with the cleft had a cannula so Dextrose fluids were started and antibiotics given.

By the time I left them to it, the baby had warmed up a bit and I went out of the room to find the others talking to a mother who I thought was that babys mother. Turns out she was the mother of twins, one was lying on the bed, wrapped up and looking very well, the other was the swaddled baby that had been moved to make way for the baby with the cleft.

It had been absolutely fascinating to see this baby come in and the first steps in her care here and how they did things. I was worried about the baby amd resolved to check on it later.

We also checked in on the small baby that had been under 1kg at birth. His mother was very happy to see us and proudly showed us her boy who now had no oxygen... probably because the other babies were using it... but he looked good and wasn't breathing fast like he had been the other day. She said thank you again for the blanket and hat that we had given her. She was so sweet!

The girl with the pneumonia looked slightly better today, was sitting up in the bed and her legs didn't look quite so swollen. She even managed a little smile. Whilst I was busy with the baby with the cleft, sam and Claire had handed out balloons and pens and pencils to the children and they were all wandering around the ward clutching and waving their  balloons.

We made our way back where we found Margaret in full swing and all the class making their own sanitary pads. It looked really involved, firstly cutting a paper pattern then sewing the cloth shape, then making the pad out of cotton cloth folded over and then putting it all together. Far too complicated for my sewing skills! I sat and watched and chatted to different people.

One of the traditional birth attendant was resplendant in a purple dress and furiously sewing away... even the boys were getting into it. Samson (who Claire had met last time and was going to act as our translator later in the day, when it was our turn to teach) was making a valiant effort and many of the others were concentrating hard.

It was the most animated class I had seen with everyone involved.

Whilst we waited for Margaret to finish, myself, Claire and Sam tripped off to get a quick. bite to eat and stock up on water. Once again it was an unbearably hot day with not a cloud in the sky and we were suffering a bit. We quickly cooked a bit of pasta, chopped up a salad and gulped it down.

We had found a green bin at the front of the hospital so decided to take all the platic bottles up and dump them in the bin in the hope that they would be recycled somehow.

The class had decided to go straight through the teaching and not have lunch so Gillain kindly bought them all a drink and then Margaret wrapped up her teaching and we gathered togather all the cloth cuttings, needles and pins and tidied up.

It was then our turn. I sat on the back wall with Sam whilst Gillian did a talk about malaria and maternal infection. Whilst I was sitting on the wall, I got joined by various kids that had been following me around all week... sometimes I felt like the pied piper. They all sat next to me quietly on the wall, as good as gold. Even the youngest ones sat and listened. I took some photos of them sitting on the wall and playing behind me.

Once Gillian was done I stood up and did a little talk on recognising a sick baby, when to bring them into Freda Carr. I started with my few words of Ateso... Yoga.... beyebo asi.... e kakiro Lydia... which brought laughter and a bit of clapping. I kept the talk simple as out in the community there was no monitoring equipment so the it focused on changes in the baby, well versus not so well. At the end I had a few questions from the group, which prompted a bit of discussion... all of this was done with Samson translating into Ateso.

Then sam's turn with PPH followed by Claire with feeding... all the talks went down well and it was clear that there was a lot of knowledge in the group, particularly from the traditional birth attendants who had a wealth of experience.

Gillian tried to tease out of them about traditional pracrices but possibly because Grace was there, they stuck to the party line of 'as soon as the woman is in labour, we bring them to hospital.'

The traditional birth attendants are now not allowed to help the women give birth but must support them in making their way into hospital. That said, I'm sure that many of them give birth at home in the mud huts as they cannot afford to come into the hospital.

It was fascinating. Some of the answers the women gave, gave a window of insight into the lives they lead and have led. I felt privileged to be a part of this.

When Claire gave her talk, Samson, as the translator ended up stuffing 2 knitted boobs down his top to demonstrate the expressing of milk.... that had the class in fits of giggles.

We finished up and everyone in the class got paid for their attendance. Many of them walked a long way to get here, some as much as 10km and they had a long walk home... hopefully they felt it was worth it. It seemed like we gained more from them than they gained from us but everyone seemed happy and we high fived everyone as they made their way out.

Many of them asked to have photos with is all and one of the traditional birth attendants grabbed us and was telling us how she had started out as a midwife many years ago (she was 75 years old) and then her father had sold her for marriage for 10 cows or something like that so she wasnt able to continue with working as a midwife. She said we were lucky to be able to choose what we did and wished she was from the UK and have the choices we had. It was quite sad. That said she seemed to have such a wealth of knowledge and had helped so many people not just the mothers but also doing HIV advice clinic and much more.

Once the teaching was done,  we went over to. check on the new cleft baby. Oxygenation was better, breathing was marginally better... temperature was much better.  We did however learn that the twin, who had been switched with the cleft baby, had died that morning... probably not long after we had left for the teaching. The parents had taken the other baby home already and presumably taken the body of the one that had died. I felt bad that I hadn't seen the condition of the other one as it had been taken out from the resuscitaire... it had been all bundled up in blankets.  Unfortunately these things happen and overnight the electricity had gone off... leaving the twin without any oxygen or respiratory support. It makes things difficult for sure. 

We all felt a bit down at that news but slightly buoyed by the fact the cleft baby was doing better. The small 1.4kg baby was also doing well and his mum was so happy to see us and showed us her baby everytime we came round, whilst thanking us profusely for our negligable gifts of hats and blankets. That bit was heart warming for sure! 

We had a plan to head into Kumi this afternoon, so had a quick change and refresh and then waited for james to come and pick us up. Meanwhile the kids had bought more plastic for us and we started filling the bags and washbasket for a second time! 

Kumi was an interesting place... a fairly busy town with a bustling market. We went to get some money out to put into motion a plan of ours and then wandered round the market. As usual the stalls were filled with massive fruit and veg and we got a few bits for lunches and dinners but I also negotiated a price for some spices and then got conned (happily) into buying some other type of powder... that sounds bad.... for cooking with... essentially it gets mixed with water to make a sauce. Another massive watermelon and lots of bottles of water later and we hopped back into the minibus and headed back to Freda Carr.

We cooked dinner over the gas stove, thankfully now with electricity available and then went for a quick night walk where we found the usual frogs and a couple of well camouflaged geckos on a tree.

Sleep came quickly, it had been a long long day!