Arriving and first day

Where do I even begin…The flight?  I left Burlington September 19^th and arrived in Entebbe, Uganda 24 hours later.  It was fine, exhausting, 20 hours in the air and very interesting people.  They had made a mistake with my reservation and I did not get a window seat during the day flying over Africa.  I got up and walked around and tried to peak out other’s windows unobtrusively to see my first viewing of this amazing Continent. Finally, one man who kept waking up when I would try to sneak a peak while he appeared to be sleeping invited me to have his seat and he took the one next to it.  It turns out he was a 22year old man who goes to school in Burlington Vermont and lives a few blocks away from Wolfie. He was delightful and heading to Sudan to teach English for a few months.  I enjoyed his company and his stories and it felt good to give him my phone so he could call his mother when he arrived.

I wasn’t sure who was going to meet me or if indeed they would. For some reason I felt really calm about it. I had met two people heading to Western Uganda and then the Congo – one was a meteorologist and one was a medical anthropologist. Both were working for the CDC studying the plague and weather influences. It was decided that if no one was there for me I would go to their hotel and figure it out in the morning. At the very least I could hire a driver to take me up north.  As it was I walked off the plane to the most amazing crescent moon – I don’t know why it seemed different but it was.  After getting my visa I was pleasantly surprised to find I did not have to go through customs – that definitely relieved a lot of my worries about all the medications and herbs I was bringing.  Then, there he was, a wonderful man holding a sign with my name.  I immediately liked him and his brother.

Ali, the driver was gentle and kind and Suma his brother, a medical doctor, were sweet and helpful and very polite and concerned about my comfort.  They asked if we could please stop at the hospital – their cousin who is 21 weeks pregnant was being discharged (at midnight – she had been waiting for a ride all day) after being treated for a bladder infection.  Charity waddled to the car and immediately I could tell she was very very sick.  After trying to get information about her symptoms and treatment I rummaged through my bag and got her the best antibiotics I could spare that may hopefully help.  I feared she had a true kidney infection, not a UTI, and needed IV antibiotics.  The good news, 2 days later she is doing much better.  So, I wasn’t even in the country for 1 hour and already I was being put to work!

Going to her home was fascinating. In the dark on these wild streets, the shacks, the noise, the parties, the fires, the children, the police stops. Tired as I was I just took it all in. Then we arrived on a road so rural it made Vermont’s mud season roads seem like new highways.  She lived right on Lake Victoria surrounded by banana trees and I could only get glimpses in the dark.

I made it to my hotel in Kampala, one close to where Ali “sleeps” and was surprised at how calm I was. No running water, very hot, I couldn’t find an electric outlet, the most beautiful views and the nicest people. So, at around 1:30 am I tried to go to sleep.

September 21, 2012

The next day I awoke and went and had breakfast – samosas and hot milk with sugar.  It was so delicious and simple.  We left on the long journey and again I took in the sights, this time during the day.  Ali and his cousin drove me the 7 ½ hours to Atiak and told me much of Uganda’s recent history and their views on politics and religion and everything we could think of. They introduced me to “yellow.”  They are bananas in all ways except the taste – oh my, the aftertaste was the most delicious orangey yumminess ever.  We lunched on them as we drove up.  As we passed the Nile River (I couldn’t take photos as guards were there and it was forbidden) there were lots of baboons on the side of the road.  They stopped so I could just watch and laugh.  

As we got further north the infrastructure changed to smaller villages and again, roads that were shocking even to me.  The 40 mile ride from Gulu to Atiak takes 3 hours you have to go so slow. I loved watching all the schools and children and naked boys trying to cool off in streams.

When I arrived in the birthing center compound I felt immediately at home. I was in awe and a bit overwhelmed, but at home all at the same time. It is very beautiful and so primitive and simple and yet so intricate in the details.  I met everyone who was here and all were very welcoming.  I took a tour of the grounds and wished I had brought my boys – children are everywhere and very welcome.  I decided to do my nebulizer and had my adapter handy and then proceeded to blow it up. I didn’t realize I needed an inverter (which for some reason I think is blown up it self now but that is another day and story).  Not a good start but I was able to order one from Kampala which would be driven to Gulu then brought up by boda boda (motorcycle taxi) hopefully the next evening.  Then, after a delicious meal of rice and beans the work began.  1 labor came in then 3 calls within 1 minute.  I hadn’t unpacked and I was busy and happy. 

The first woman I cared for was having her 8^th baby. She just arrived in labor and was struggling.  She was scarred deeply on her chest and I was told it was from the LRA.  At a young age she had been abducted and had her first children with them.  It was heartbreaking at my core, I cannot imagine such suffering.  She had a difficult birth but the most beautiful little (big!) girl.  She wanted to name her Laureli but I felt so unworthy and overwhelmed I laughed and said “no no no!”  She kept insisting but then I said, name the baby in the morning.  In the morning she asked me to name the baby Laureli or give her a name and I chose Beatrice. I was told it was an honor for them for us to name the baby. In retrospect, maybe I should have agreed to Laureli but it felt just too big and I had only been there a few hours. 

Lillian and baby Beatrice:

Within 30 minutes of her birth another woman had a lovely baby boy in the caul.  He had the thickest bag I had ever experienced and at first I couldn’t even imagine what it was.  The next morning a woman on her 7^th baby walked in and delivered within minutes, another boy, another beautiful baby and mama. Midwife Amy caught that baby and we helped lift her off the floor as she was practically sitting on his head it happened so fast.

Each woman hopefully has an attendant, usually her mother or a family member – someone to help feed them then wash all the laundry after.  The woman are not given much support and indeed it is hard to support them the way we do in the States – they are very quiet and do not make eye contact and they do not speak English and they appear uncomfortable around us.  The attendant is in the room for the birth and is very helpful. After, they go to the fire and boil water and wash all the sheets and towels from the birth and prepare food.

I had only a few hours sleep and was tired.  Soon another woman walked in, alone.  She was 15 years old and had no prenatal care. She was obviously very very sick and was delirious. With the limited interpreter we had we determined she was almost 38 weeks and was contracting. She was terrified and traumatized and we later learned she had been raped. Her family had kicked her out of her home and the father’s family did not want the responsibility but now it was a police matter – not about the rape but about if they would have to take care of her.  But her vital signs were not good and her blood pressure was scary  (at one point 225/110) and we had no urine sticks to test for protein.  Was it preeclampsia or HELLP?  Was it an infection (UTI or kidney, chorioamnitis)? Was it malaria?  Was it rabies (she actually did start foaming at the mouth)?  She clearly needed to go to the hospital but she did not have an attendant and they will not allow you in without one as the attendant feeds and cares for you.  OK, so one of us 4 could go but we were very busy and 2 are students and one was very sick herself.   We really couldn’t spare anyone yet we were worried she would die soon.  Truly that is what was going on with her condition.

How to get the blood pressure down even temporarily?  We got meds from the local pharmacy which did help initially but she was still sick and delirious and scared and her labor was getting stronger.  But, first problem hopefully solved until we could work out the rest.  Next the attendant issue.  As a miracle someone found her grandfather in town who was at the police with the father of the baby’s family.  They agreed to set aside all differences to hopefully save her and the baby’s life and one of them became an attendant. Again, no regard to her emotional state regarding this family or the conception of her child, but I was grateful someone would go. Just in time.  Midwife Rachael agreed to go on the transport even though she was ill and of course the truck broke down and then Consey’s blood pressure started to get even higher and then Rachael started vomiting.  Yikes!  But they finally made it and dropped her off and hopefully she will be ok.  They don’t always have physicians or medication at the hospitals, but this one was better than most.

That concludes my first 24 hours at the birthing center.