A condom, an orphan and a bearded “lady” – all in a day’s work

The internet has been awful so I am writing with a very vague hope that I will be able to post this, but here goes… We had a patient with a placenta praevia yesterday (when the placenta is sited low in the uterus, reaching or covering the cervical opening). Babies with a placenta like this have to be delivered by caesarean because they can’t get out through the placenta, so when the patient appeared on the ward after having had a substantial bleed at home I decided it would be best to get on with the operation that day rather than waiting and running the risk of her bleeding again in the middle of the night. As is sometimes the case, the placental bed on the wall of the uterus was very oozy so I tried a technique we often use, putting a balloon inside the uterus to apply pressure from within and stop the bleeding. The difference is that in the UK we have custom made balloons all in a nice sterile pack. Here I had to resort to getting a condom and tying it on to the end of a bladder catheter. I must say I was really pleased with how well it worked. I deflated it and took it out this morning and she is doing really well. It is amazing how much saline you can get into a condom! We (as in Kisiizi Partners) have just funded a diathermy machine for the maternity theatre and it should arrive in about three weeks. I can’t wait for it to come, it is just such a pain having to tie off every little blood vessel and caesareans will become much quicker with diathermy. It would be unthinkable in UK to be doing a caesarean without this machine.

It was great to see hundreds of the orphans from our project gathering here today to collect their exercise books, pens, soap and other requirements from the orphan project workers ready for the new school term. Many of the younger children were not even born when the project began. One of our orphan graduates, Elliott, who now works at Kisiizi as a qualified nurse, gave the children a motivational talk. He has a real heart for the project, having benefitted from it himself as a child. He brought me a present the other day, a chicken (live of course). It was horrible today when a man with a big knife came to do the necessary. I just couldn’t look, I felt so guilty. If it hadn’t been a present I really don’t think I could have eaten it! Anyway we invited Elliott to dinner to share the chicken with us, and very good it was too, after the attentions of our lovely house girl Clemency, who is a fantastic cook.

My campaign to teach the interns about obstetrics began today in earnest, with Alan lying on the floor role playing a collapsed pregnant woman! Credibility required suspension of disbelief about bearded ladies as this particular “female” proceeded to have a mock eclamptic fit! Tomorrow I will be using models for the teaching as delivering Alan of a baby by vacuum extraction would be a step too far!

The mother’s waiting home opening ceremony is on Friday. I am sorry to say I had to get very cross with the man who is supposed to be painting the new beds when I found him and his side-kick lounging around on the beds doing nothing. They were apparently waiting for the “right” type of sandpaper, which had to be brought from Mbarara, a town some two hours distant. Why would he start spray-painting the beds without assembling all the right equipment first I ask myself? There is no answer, this is just how things happen here. He had disappeared for most of yesterday as it was. Having left him under no illusion as to my opinion of his painting efficiency I then turned my attention to the man who was “washing” the mattresses outside in the dust with a filthy cloth. I am afraid he got rather short shrift as I instructed him to take the mattresses inside, get some clean water and soap and a clean cloth and start again. I am determined we will have mothers in the home by Friday even if I have to spend the next 48 hours with a paintbrush, mop and duster doing it myself!