Mbuya Nehanda Maternity Hospital.

We were both looking forward to our day in Maternity Services and had pink fluffy visions of cuddling babies and marvelling at the miracle of new life.  Things were slightly different...

We told Matron we wanted to get in the thick of things so she sent us up to the Labour Ward.  Our whistlestop tour ended in the final delivery room where a woman stuck her head out from underneath the blanket and said it was time to push.  After some persuasion from the Matron, the midwife who insisted she was only 6cm dilated gowned up just in time to welcome an 8lb 2oz baby boy.  At this point, having not made a sound during the whole process, the new mother stuck her head back up with a disappointed face to declare she had wanted a girl.  Baby boy was quickly cleaned, measured, weighed and wrapped and put under a warming unit to keep him toasty whilst his mom was seen to.  The placenta appeared to be taking it's time to make an appearance but after some almighty tugging by the midwife (which caused the woman to make significantly more noise than she did during the entire birth) it finally showed.  A first degree tear was anaesthetised and stitched and the woman was left to recover.  During the delivery Kerrie nudged me and pointed out a tiny baby under the warming unit peeking out from a mass of blankets.  Convinced that we had already missed the event and this was all a fuss over nothing we pointed this out to the midwife who didn't seem to concerned and said it probably was someone elses baby. 
We followed the midwife off to the sluice where we had a good look at the placenta and were talked through the points to take note of and then wandered off to the office to make the new arrival official and put his name in the myriad of books, lists and registers.  We noted with interest that if the child had received a single-dose Nevirapine prophylaxis (if they had been exposed to HIV from the mother) it was recorded as a matter of course in the register which further emphasised to us the enormity of the HIV pandemic here.
The afternoon was a little less dramatic and we joined the student nurses in the twice daily damp dusting of the ward while they quizzed us about life in the UK.
We were both struck by the conditions that the women gave birth in in comparison to what we know as the norm in England.  Handwashing does not have the same emphasis that it does in the UK, in fact, we are yet to find a sink that can offer us soap, running water and paper towels all at the same time but we are told that they do not have problems we have with things like MRSA and C-Diff so that may be part of the reason that perfunctory infection control precautions are considered sufficient.  Communication in this setting seemed to differ from what we knew as well.  Patients in this setting were less involved in decisions made about them and seemed happy to accept whatever the professional wanted to do.
 
Conditions here are sparse and the people are very grateful for any help that they receive and we cannot but help draw comparisons to some of our experiences that we have had in the UK where we have so much but frequently fail to appreciate our good fortunes.

Opportunistic Infections Clinic

Happily the Sister in the Opportunistic Infections Clinic did not send us on our way this morning.  We arrived bright and early to watch the hall full of patients being led in song and prayer.  What a lovely way to start the day and uplift the spirits!

Our first visit of the day was to join in a group counselling session for adolescents with HIV.  The counsellors and the children very kindly agreed to conduct the session in English for our benefit.  We tried to sneak in quietly and perch in the corner to observe but the children moved around and gave us their seats at the main table.  We protested that we were fine but the counsellor explained that this was the children showing respect for their elders so we took our seats.  All the children greeted us in unison as 'Auntie Natalie and Auntie Kerrie'  All the children then stood up in turn to introduce themselves - they told us their grade at school, the current medication regime and timings and what they wanted to be when they grew up.  Much emphasis was placed on encouraging them to think about their future and where their lives were going and the fact that their HIV status should not inhibit them.  In fact. if they sat down without telling us what their dreams were, the counsellor made them get up again to tell us.  We were sat in a room of future teachers, doctors, accountants and lawyers.  Sadly though, only 1 wanted to be a nurse!  After introductions they discussed issues around compliance and adherence with regimes and how the non-disclosure of status could affect this.  The children then all had a 1 to 1 session with a counsellor.  We were both amazed and moved by the bravery of these brave children in the face of the burden that they carried.

We then tagged onto a Dr's training session on the assessment of the newly diagnosed patient.  We found this so informative and useful and then sat in on a few consultations afterwards and gave our opinions with our newfound knowledge!

We left our teaching session to go and join the nurses in the assessment hall but found everyone gone.  Things seem to come to a grinding halt at lunchtime so we wandered about for a little while until we found the end of an adolescent clinic that the Dr kindly allowed us to join.  We heard some stories from patients that brought tears to our eyes and again were humbled by the bravery of the patients. One of the patients, a young lady of 20, has a dream on running her own business, which is to help other children with HIV with things like providiing clothes and toys to orphaned children. However her compliance with her medication was erratic due to her chaotic life. The Dr said that if she were to become more compliant he would help her acheive her dream by funding her business!! Such acts of kindness once again made us feel humble. She would not be able to help others if she didn't look after herself. The Dr and patient had known each other since 2004.

The clinic wrapped up and what seemed like the never ending lunch hour was still going on so we were released for the day to go and arrange the rest of our week.

First Real Day of Work!

After a sleepless night we were up bright and early on Friday morning for our first day at the OI Clinic.  Despite our beaming scrubbed faces the Matron declined our services for the day because they were doing bookings and our time would be better spent on another day.  Feeling slightly deflated we wandered over to Casualty to offer our help.  A somewhat unsmiling Sister also decided that she could also do without us.  Fast running out of places to go we went over to Annexe to see if they would have us.  Matron was very pleased to see us and talked us through the running of his department with vigor and enthusiasm that was infectious!  But by 9:30 we were yet to clap eyes on a patient so we were very excited when we left for the unit.
We were somewhat unprepared for what awaited us on Ward 12.  The unit is a secure unit catering for 36 patients though we were told that this quota was frequently exceeded due to lack of space.  The unit also mixed all of the patients admitted (juveniles, females/males, those in criminal custody, those dealing with addiction etc) which the Matron admitted was not conducive to the treatment and rehabilitation of the patients but it was an issue that he was working hard to rectify.
Immediately upon entering the unit we were amongst the patients who seemed to find us very interesting!  The nurses station was behind metal grates and we were encouraged to enter the garden and meet with the patients.  We both found this somewhat intimidating as even with our limited mental health experience it was clear to us that the majority of the patients were disturbed in some way or another.  Patients came up to talk to us and ask us questions.  We found a lot of the patients to have little awareness of our personal space and much interest in our badges and pens and had no problems with touching us without warning and for want of a better word we felt 'snuck up' on several times by several patients.  On the whole we were a little intimidated and stuck together like glue!
We saw 2 concrete cells with mattresses on the floor where violent patients were contained 'for their safety and that of others.'  There was a small hole was in the centre of the door for observation purposes.  In the 3rd cell a lady was frequently beat on the door screaming which did not serve to quell our nerves.
Student nurses seemed to do the majority of the patient interaction.  15 minute observations were carried out on patients at risk of suicide.
The patients were a little bit unhappy that we had not brought oranges and apples so we will certainly be bearing fruit on our next visit.

The beginning...

Our adventure has been off to something of a slow start.  We decided to do a courtesy visit on Monday to the lady that had been co-ordinating our placement.  This turned out to be a jolly good idea because no one knew who we were and the planning started from scratch again...  Enter Mrs Saburi who has been most helpful but had to start getting permissions etc for us to be let loose on their patients.  This was all arranged by Thursday which involved an awful lot of hand shaking and unpronounceable names and an epic walk about the hospital.  So, during our time here we will be visiting:

Opportunistic Infections Clinic:  An outpatients clinic serving 300-400 patients per day (run by 4 nurses!).  HIV +ve patients come from far and wide on a 3 monthly basis to receive their antiretrovirals and counselling where needed.  We were so overwhelmed during our short time there on Thursday by the sheer volume of people waiting to be seen and their patient and smiling demeanour.  We were also surprised by the number of children attending the clinic.
Mbuya Nehanda Maternity Clinic:  Natalie was quite excited to return to where it all began!  She was born here 28 (ha ha) years ago.  It does exactly what it says on the box and the we were welcomed by the Matron  who agreed to meet us on Tuesday after we agreed to wear sensible shoes.
Annexe: Psychiatric Inpatients and Outpatient Clinic.  We met a very enthusiastic and newly appointed Matron Muroiwa who was very keen to show us around but we were ushered away by Mrs Saburi!
Casualty: We were a little overwhelmed by this one too.  Again silent people sat in endless rows just waiting.  We noted several patients in the waiting room that in the UK would have been rushed right through but were left on stretchers and chairs in corridors.  Matron will be expecting us next week.
Medical/Surgical Ward: Yet to be decided which ones we will visit.

We anticipated our little walk about to take an hour at most but it soon became apparent that the pace is somewhat different here.  We waited...a lot.  For Matrons, for Sisters, for Co-ordinator's...  but it seems to be the way so we happily fitted in and our visits took 4 hours.
The day had many pleasant aspects.  We were surprised by the cleanliness of the hospital, at one point having to trod carefully as the polished floors presented something of a slip hazard and the enthusiasm with which the staff welcomed us to their departments.