Case Study - Gillian Stephen
Delivering maternity care in
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
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
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.