So our daily routine is falling into a fixed pattern as we find ourselves increasingly part of the anaesthetic/hospital team. 0800 meet on the ICU with the daily review followed by theatre work. The term lunch is used loosely. Yes it is the second meal of the day, but no, that does not necessarily mean in between the hours of 12 and 1400. We have learnt to pack our bag with some bananas and water.
This week has seen our first proper encounter with obstetric theatres. Slightly intrepid as a result of some of the tales we had heard and remembering our earliest encounters in upper theatres we entered with fingers crossed and breathe held. We found a busy couple of theatres. All electives had been cancelled due to a shortage of oxygen in the hospital. Not many places have oxygen and many of those that do have misfitting cylinder heads that either don’t work at all or deliver half of the supply to the general atmosphere of the ward. Cylinders are refilled and supplied from Kampala and we were awaiting our promised delivery. In the meantime we only had one full cylinder but with plenty of emergency caesareans on the list it was decided to limit the precious supply for these true life or death cases.
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| First Obs theatre |
Working in obstetric theatres has been enlightening. The theatres although old are light and airy. The anaesthetic machines have their quirks (the Halothane vapouriser needs a bang before it kicks into life) but again, work fine. The surgical and theatre team are all very friendly. Swab, instrument and needle counts are carried out before the case and woe behold the surgeon who tries to close before the final count – all documented. All this with some of the neatest surgery we’ve seen yet. The WHO surgical safety checklist has taken a bit of a nosedive in the last few months but there is a big drive taking place to re-establish its importance this month. All a go for the group hug.
Aside from all this it’s a great opportunity to talk to patients and staff about issues surrounding health care in Uganda and general life. Most cases (>90%) are performed under spinal anaesthesia allowing us to talk in broken English but of a standard that far surpasses our limited Runyankole (a source of much amusement whenever we begin to speak).
Our latest topic of conversation has been surrounding twins. The conversation started after our first case of the morning. The surgeon happily presented the newly delivered baby to the theatre and into the arms of the waiting midwife. Just as we put the drugs into the infusion bag to help contract the uterus we heard the surprised surgeon exclaim ‘ah there are two’! “Number two?” we thought as we quickly stopped the drip – feeling foolish we re-checked the notes but there was no mention of twins there. Ah yes undiagnosed twins are very common we were told by our wiser and older anaesthetic colleague. Late emergency presentations and no routine USS mean undiagnosed twins are not an infrequent occurrence here. Once bitten twice shy. This was not to be our last case of twins for the day.
Twins have not had the best deal in Ugandan history. Their arrival has always been significant, but where some tribes perceive them as a blessing, others regard them with a wary eye. There have been reports in the history books of twins being drowned for fear of a curse on the village and to prevent drought and famine. In this region there is a strong belief that it is bad luck to not have any more children after twins. This was explained to us after we had delivered twins during an emergency caesarean for what would be the woman’s 7th and 8th children. As the obstetrician spoke he explained how he had tried to convince the lady to have a sterilisation during the operation. As he talked and the midwife laughed the realisation of this futile conversation dawned on him. He left exasperated at his wasted efforts that morning!
The events described in the blog are true although in the interest of confidentiality certain details and characteristics have been changed.
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