Report From The Front Lines In Uganda

When I travelled to Uganda in March 2012 with the partners from Saving Mothers, Giving Life, I met Boniconsilla Komugisha. Bonnie is a hard working  nurse who is committed to improving maternal health in her community within the district of Kibale, one of the target districts for SMGL. Since I returned, she's been keeping me up to date on how her work is progressing. She has written about her  joy in being able to serve more women these days but also the challenges that this work can impose. This week she shared how the latest outbreak of the Ebola virus (a deadly and highly contagious virus associated with fever, bleeding and diarrhea) has impacted her district. - Erin

July 25
The number of mothers coming to our clinic has greatly increased since the last three weeks. The reason is that we increased the number of our outreach work in the villages.  We realized that many mothers had a problem of walking long distances (10-18 miles) on foot to move from their homes to come to our clinic for antenatal examination.  So to mitigate this problem we decided to establish more outreach services in the villages whereby we can meet mothers nearer to their homes.  Of course this makes it costly on the part of the health center but it has made it easier for the mothers to come for antenatal examination in even bigger numbers.  And when the mothers come for antenatal examination we also educate them and urge them to come to the health center when time comes to deliver their babies, unlike in the past when many of them would deliver in homes assisted by traditional birth attendants and were subject to high maternal death rate.
 
As I said this innovation of extending services nearer to the people has financial implications to the health center, so we do not know for how long we can maintain the system but for now it is working as we are seeing many more mothers deliver in the facility. Of course, this is great for mothers even if it makes for some sleepless nights! On June the 18th I was on night duty with a fellow midwife at the maternity ward which had 25 mothers admitted. When we started the night shift at 8:00pm, the evening nurses told us that out of the 25 mothers, seven of them were in labor, and they were expected to deliver before the next morning. Rightly so, five of them delivered normally and the other two underwent caesarian section – when we were still on night duty. Surprisingly, as we were winding up with the last mother at 4:30am, three new mothers were brought from the villages as in emergency labor situations.  We assisted them as well and they successfully delivered their babies and were through by 7:30am.  
 
I clearly recall neither me nor my colleague had a single minute to sleep throughout the night. We were happy though to have saved life both for babies and mothers.  
 
We foresee that such is going to happen very often if the voucher programme for mothers continues plus the extended outreach to the communities.  
 
August 5
But now a new challenge strikes our community. As you may have read in the news, there has been an outbreak of ebola in western Uganda which is affecting our communities. It was first reported about two weeks ago but since then several people have died. Others have been taken to a quarantined areanear the Hospital. The disease is just in our area and at our health center we have had few suspected cases as mentioned above. We are trying to engage some protective measures for our staff but the problem is that we do not have real protective gear. They have only been supplied to the government Hospital – not to the outlying clinics like ours.

The impact of the Ebola outbreak on us as nurses and other health workers at our facility is that we are working under a lot of risk and fear for our lives because we do not have enough protective gear as we should. For example, one medical worker who had been very involved in the care and treatment of the first people who died of Ebola in recent weeks also died. The health center administration is trying its best to provide some gear but it is hard to get enough due to financial constraints as it was not something that was planned for. The task force team that was set up at the neighboring government hospital promised to give us some gear more than a week ago but we have received nothing up to now. Yet we continue to handle a lot of suspected cases including pregnant mothers.
 
We imagine that soon movement will be limited or prohibited to avoid infection. So the health center may have to look into a possibility of transporting the nurses instead to the villages to reach out to the mothers if we are to attend to them. I do not know if the health center will manage such extra expenses.

For the recent NY Times article, "Uganda- Ebola Outbreak Slows, Health Officials Say" click here.