On my recent trip to Uganda I joined members of the Twezimbe Development Foundation to visit a number of health clinics in Mawokota North District west of Kampala. I don’t know what I expected to see – I had seen pictures of the drab wards and knew there were challenges with lighting, drug supply, and lack of equipment – and yes, all of these challenges were strikingly obvious and frustrating.
What I wasn’t expecting was the emotional impact I would feel as a woman and mom. Each clinic was overriding with pregnant women and small children – maternity care is, of course, a core function of these rural clinics. At the large clinic that offers C-sections I witnessed four women going through stages of delivery. The first woman I came across lay in a rustic bed in the post-operative corner of the maternity ward with a thin cloth wrapped over her. She had a small bundle cradled to her breast. When I made eye contact she lifted her sheet, beckoning me over to gaze on her precious child – her first. Beautiful, perfect, healthy. She was lucky – she had been able to get to the clinic and received sufficient emergency care. She smiled at me, already a proud mom.
The second woman I met was in the opposite corner of the room in the midst of active labor – only minutes from delivery. A couple of midwives stood by as she heroically bore the pain of childbirth. A few minutes later as I walked the grounds of the clinics I watched as a third woman tried to walk to facilitate labor – aided by her husband.
The fourth woman I did not actually see – she was in the operating room have a C-section and as I passed by I heard low moans and she bore through the process. As a survivor of three C-sections I compared the rustic environment to my deluxe remodeled maternity wing at my hospital with the fancy beds, televisions, and drugs. If I was scared there, what would I feel facing the procedure here where drugs and supplies had run out two months ago?
A bit later as we were leaving the clinic the doctor ran out to our car, his face beaming. He had successfully delivered the baby – a girl – the mother’s first. His joy was infectious and reminded all of us that this was what progress looks like – moms seeking out care in facilities that have the capacity to safely steer them through the most wondrous experience known to many women – becoming a mom.
The next clinic we visited provided maternity care as well, including checkups and normal deliveries. The maternity ward was packed when we arrived. Mothers of all stages of pregnancy crowded on the beds chatting happily, excited. I smiled and congratulated them and asked how many weeks along they were. They replied and some eagerly shared the sex of their babies. They knew the sex because of a recent donation of ultrasound machines to the maternity clinics throughout the area. The women were all there waiting for their turn to see their babies.
It is often struggle to get rural women to seek out care in medical facilities and not rely on trusted traditional birth attendants in their village. Clearly in this clinic the ultrasound machine was inspiring dozens of women to come in for care – and providing them with the special joy of seeing their babies for the first time. The challenge in this clinic is that they do not perform C-sections so if a delivery becomes complicated the mother must be transported more than 10 miles on a rustic dirt road to the first clinic we visited. The women rarely have access to transport and are most often loaded onto the back of a motorcycle. Those that do deliver naturally at the site leave about an hour after delivery – by foot – with their babies in hand.
During our visit to the large regional clinic we also visited the maternal-child health ward that offers wellness checkups and vaccinations. There were dozens of young mothers there with children ranging from small babies to toddlers. As I was walking out of the building I was stopped by one of the mothers – she handed me her small baby girl – 6 weeks old. There are few things in this world I like better than holding small babies and I happy whisked the baby in to my arms. It was then that she turned to another woman and took a second baby – the twin brother – and placed him in a hanging sack to weigh. After finishing she turned back to me and we swapped babies so she could weigh her (noticeably smaller and skinnier) baby girl. The process was a three-person job. I can’t imagine the challenge of having twins in her environment – but I was touched by the fact that as a woman walking by she naturally enrolled me in the care process. Women in these communities stand together and help each other and, of course, I was expected to as well. The question becomes – how do I best contribute?