It’s been over a month in beautiful Mutungo and my time here is short. I’ve been working as a nurse at Kajjansi health center, a cluster of community clinics settled on hilly terrain in the outskirts of Kampala. The clinics at Kajjansi serve the outlying villages of rural Kampala and other vulnerable populations residing in the slums and deep countryside. This center works hard to connect with under accessed populations through outreach projects, providing screening & treatment for communicable disease(s). All people, including young mothers and children are given access to medical services, family planning, and provided with basic medical care & access to costly medications when appropriate. Expecting mothers in the surrounding communities are DEPENDENT on this center for maternal care; the other option being childbirth under less sanitary or unsafe conditions at home. Often, the transport alone to major hospitals in Entebbe and surrounding cities is unaffordable for these mothers/ families. Newborns receive pediatric care/ monitoring up to their first 2 years of life and all pregnant mothers are screened for HIV & malaria. Medications for treatment are delivered at no cost when disease is confirmed. HIV positive babies and/or babies born to HIV positive mothers also receive treatment/ prophylaxis and referrals to specialized clinics via this center. The antepartum clinic and labor and delivery have become my focus here; an experience that has moved me to start this fundraiser.
The clinic is DESPERATELY under resourced and remains a safety project in need of obvious attention and greater financial funding. I DID not and DO not expect to save any financial crisis during my short work life here... I am however, deeply inspired to create a safer space for the mothers and newborns through a few simple additions. Hopefully with the help of some friends, family and all the people I’ve met along the way, I can make this happen sooner rather than later.
First, I will share some details of the clinic and my experience here so far (trying my best to keep this short)...
In general, financial resources are directed towards medications (antibiotics, antivirals, vaccinations), materials for HIV and malarial screening, and necessary supplies needed to deliver these treatments effectively. There is NO alcohol available, NO masks, protective gowns or eyewear; gloves are rationed and used between multiple patients (for the protection of staff), there is NO hand sanitizer/ sterile wipes, and rare opportunity for sterile procedure for injections, catheterizations, and/or wound care. Pregnant mothers are asked to collect basic materials (see picture: loose cotton, plastic tarp, razor blade (in case in need of episiotomy), plastic basin for water) prior to delivery. Loose, dry cotton is used for “cleaning” sites prior to injection/ insertion and during “clean up” during labor and delivery. This cotton is often visibly dirty and I have even found it to be a home to a small insect(s) at times. In addition to lack of materials, many of the local staff working here are unpaid or grossly under paid - I have witnessed their passion to reach those in need and their efforts remain steadfast. The community is fortunate to have their energy and devotion.
Mothers birth children and recover here post delivery. There are 8 postpartum beds (cots) situated with mosquito nets and one small trash barrel for waste for all. In this space, there are NO pillows, NO sheets, NO available running water for washing (or for drinking) and NO toilets in the building for new mothers. Access to clean water is a MAJOR problem - not just in our clinic but throughout much of Uganda. I’ve witnessed mothers urinate and/or drink from the same basin they use to wash as they were in too much pain to do anything else. Paracetemol (Tylenol) is rationed to new mothers in severe pain (FYI -generally ineffective for postpartum pain related to swelling). I’ve also watched expecting or new mothers have syncopal (fainting) episodes related to dehydration in which I've needed to make trips to the market or the nearest stand pipe for clean water. New mothers (or their families, if present) must make a 30-40 ft. downhill trek (very slippery when raining - see video) to obtain both water for washing/ drinking or if they need to use the latrines. The latrines are dirt/ cement latrines (a hole is the ground), many times swarming with flies and other insects; they are also shared with other patients, including those with communicable diseases being seen in other buildings throughout the center. Newborns must sleep with their mothers on a raised cot (NO bassinets) after delivery (okay) and must be left on the cot unattended (not okay) or attended by a neighboring family of another mother/ another child (common) if the mother must obtain water or leave the room for any reason. There is no rail or barrier and the floors are concrete. This may be scarier to embrace in real time... but in any event, the safety concern is legitimate and it has been difficult to watch/ tolerate in my daily routine.
Labor and delivery is nested in tight corner of our building, a small space with zero privacy.. housing a small water vessel for hand washing and the only water source in the building. Tools are sterilized in minimalist fashion and improvisations are frequent. There is one midwife present (NO DOCTOR) during birth(s) who tends as best she can to the mother or both mothers as they deliver. As mentioned before, mothers bring a plastic tarp from home for collection of blood and waste during labor... this is placed on a plastic mattress on which they give birth and wiped down after delivery/ departure. Though rare, HIV positive mothers may give birth next to HIV negative mothers. There are only two beds in the labor and delivery room. These beds are placed 5 ft. apart, with no curtain for separation between mothers (or separate work stations) to prevent cross contamination or exchange of fluids (there is a lot of fluid(s) during childbirth). The strategy per staff is to “be careful” in this situation; a protocol that needs work.
There are a lot of cultural practices during birthing that have been eye opening as well... I will spare you the details around this as it doesn’t seem relevant at the moment; but, know that misconceptions and misinformation absolutely exist.
I have not endured the experience of labor and I am not a mother... but I feel deeply for these young women. I am overwhelmed and humbled watching their strength and resilience as they enter motherhood under hard conditions. Though childbirth being a beautiful, natural process... natural childbirth is undeniably a painful and demanding experience on a woman’s body and mind. That being said, I think there is something in their experience that can be improved - both for safety and for comfort by providing some or all of the following:
*2 locked medical bassinets available for when a mother must leave the building
*2 commodes for toileting, for new mothers in pain
*1 stand pipe installed for running, clean water to labor and delivery/ postpartum area
*1 plastic curtain line between labor beds to be used (when appropriate) for infectious disease issue(s)
Through providing these MOST BASIC additions, we will create a sustainably safer environment for these new mothers and their newborns. It remains true that the dollar stretches far here. Any loose change, 1$, 5$, etc. will make a difference in this effort. I think this goes without saying, but to lift any doubts... All funds raised go directly to the clinic... and any money unspent on the materials above (or additional funding) will go towards essential materials such as alcohol, cotton, and gloves.
Whether you have the means to donate or not, THANK YOU for taking time to read this.. Your energy and time spent means something in itself.
With love and gratitude,
PLEASE pass this along to your fellow mothers and children :-)
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