North to South

Now the Advocacy workshop is over, I am concentrating on the mid-term evaluation of our Global Midwifery Twinning Project.  This has taken me out of Kampala, past the Equator, to visit midwives up-country where our GMTP volunteer midwives have been based, learning about Ugandan midwifery, providing training in Emergency Obstetric and Newborn Care and role-modelling woman-centred care.

At the centre of things - passing the Equator on Sunday

Yesterday we visited three private midwives clinics all providing community-based midwifery services, many in remote areas currently in poverty until the rains come.  All of these small centres are providing 'gold-standard' midwifery care with continuity, privacy, cleanliness, good clinical standards and geographical accessibility.  However, they are often under-utilised for maternity services as women have to pay.  Instead, women stay at home to deliver with a Traditional Birth Attendant, or use the government health posts which are under-resourced and under-staffed.

Delivering the beds donated by one of our volunteers to a Level 4 Health Facility in rural Uganda (near Masaka)

We visited one such government district hospital; the one doctor was overwhelmed with patients and had no time to examine them or provide proper diagnosis and treatment.  As we toured the wards, an old man died in the corner died without ceremony from pneumonia.  He was peripherally shut-down and staff couldn't find a vein to start the IV antibiotics he desperately needed.  There was no oxygen and no nurse by his bedside.  In the out-patients' department a baby, no more than 4 months old, was breathing too fast with a chest infection. He should have been admitted for intensive nursing; instead he saw the doctor for 30 seconds and was sent away.  The maternity unit was quiet as the operating theatre was temporarily closed for building works.  Women are referred there for caesarean section, only to be referred onto another place.  One of our volunteers had donated some beds for the hospital and conducted some training for the midwives there.  However, maternal mortality rates in Uganda are still rising.  Political will, cultural issues and system transformation are required for sustainable change.

With Maria (UNFPA Country Midwifery Advisor for Uganda) and John (Registrar, Uganda Nurses and Midwives Council - at today's workshop

Today I attended a workshop with the Ugandan Nurses and Midwives Council, reviewing the final draft of their new midwifery handbook.  I my presentation this afternoon I urged midwives to join together in lobbying the government to introduce free midwifery care for women at any centre with skilled birth attendants and appropriate equipment.  The private midwives have so much to offer.  A voucher scheme entitling women to free services would enable many more women to benefit from this gold-standard care - and save lives.  Financial incentives such as these have contributed to a drastic reduction in the maternal mortality rates in Nepal and Cambodia (our other twin countries) in recent years.

With Elizabeth, Rose and Jemima - all senior Ugandan midwifery educators with Masters Degrees or PhDs - at the Nurses and Midwives Council workshop today

I have mentioned before that Ugandan Midwives are very spiritually minded - we had four prayers today at the workshop (I am trying to imagine an NMC workshop in the UK with prayer before each coffee break...!).  I decided to go with the flow and end my presentation using some words from the Bible, exhorting midwives in Uganda to work together, to be strong and courageous and not to give up.

'Be strong and very courageous as you lead these people.. that you may have success.  Do not be afraid or discouraged, for the LORD your God will be with you wherever you go'.
                                                                                                    (Joshua Chapter 1)

It was all a bit much for this participant at the Uganda Nurses and Midwives Council Workshop

The afternoon finished (after another prayer!) with over 40 midwives joining hands and singing:

"We are together again, in one accord.

Something good is going to happen, something good is in store".