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Case Study - Gillian Stephen

Delivering maternity care in Uganda


Dr Gillian Stephen from Saint Mary's shares her experience of working at a maternity unit in Uganda.

In February of this year, I had the opportunity to visit Virika Hospital in Fort Portal, Uganda, as part of a project organised through CMFT. This project principally concentrates on providing women who have sustained severe childbirth injuries with an opportunity to have their injuries repaired.

As the maternity unit has only one lead senior obstetrician/gynaecologist, my colleague Dr Clare Tower and I were asked to provide obstetric input on the hospital's delivery unit and teach the junior doctors and midwives.

Prior to visiting Uganda, I had never worked in an under-resourced country so was nervous and excited about my trip in equal measure. In the weeks before departure, I reflected on the extent to which my practice relied on technology and expensive medication.

Mornings began with team hand over, where cases from the previous night were discussed. Following this, Dr Tower and I would perform a ward round on the delivery unit. We were able to help staff manage a variety of clinical scenarios, including a woman in advanced labour with transverse fetal lie, septic miscarriage and on several occasions obstructed labour.

I was pleasantly surprised at the availability of medication available in the hospital. Broad spectrum antibiotics, oxytocin and anti-retroviral agents appeared readily available, which I did not expect.

There were, however, small daily challenges that were often unexpected, such as intermittent interruption to running water and power cuts whilst performing operations!

Each day we provided teaching sessions for the qualified midwives and doctors of the unit, but also to the undergraduate midwifery students. Teaching the midwifery students was a particular joy. At the beginning of the week the girls were shy at answering questions and a bit hesitant about participating in simulation training. I think their education is usually delivered in a traditional fashion. However, by the end of the week, they were much more engaged and even nudging one another out of the way to be first to show off their newly acquired skills!

Talking to the students was a real eye opener too.

Many of them had worked and saved for many years prior to starting their midwifery training and were not guaranteed to finish their course. They also gave us an insight into how the health care system in Uganda worked. Many of these students will ultimately be looking after women in labour in remote villages, with no additional medical support, minimal equipment and very limited means of transport to hospital should the need arise.

I have nothing but admiration for these young women who are willing to care for others in an environment that I would not feel confident to work in, even after being a qualified doctor for more than 10 years.

Overall, I found Uganda to be a beautiful country and the people welcoming and willing to learn. People make the best of what they have. I feel proud and privileged to have been able to participate in this project.