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Giving birth in Uganda, Midwife abroad 1/2

In this post we talk to Luise who is a very special person with fantastic stories about the small new people entering in this world. Kind of like Sankte Per but the reversed version.

Name: Luise Smigay

Age: 22

Nationality: German

Occupation: Midwife, traveller, blogger (midwife abroad)

So you left Germany as the top student in your class and directly you took off for Uganda to meet the toughest of conditions for a midwife. You are here working without salary for a hospital with financial problems. From what you have experienced they also lack of knowledge and equipment. We have understood that you have made some changes in their way of working.

What are the big differences you experiences as a midwife Germany vs. Uganda?

You really have to improvise here. They have so little material. They have a very good education but no opportunity to work the way they have learned. You constantly have to compromise. For example, instead of disinfection they use honey to keep the wounds clean from getting infected.

The local midwives are also superstitious and they sometimes start praying in the middle of an acute situation instead of acting to stop a bleeding for example.

The check ups in pregnancy are very similar but some people here can not afford to come for check ups, because of the travel costs. Some people have to walk three days to deliver the baby, but they would not spend one week of walking to do the check ups. 70% of the mothers here in Uganda deliver at home, more because of poverty than by choice. Many do not have jobs, income nor food, so they will not be able to pay for going to a hospital. Many babies die here within the days after the birth. This is because of infections, caused by the dirty hospital or their life situation at home. It is not a clean environment. Some also die because the mothers don’t eat enough so there is not enough milk. The baby gets dehydrated and starved.

During the days we are here we see one case like this but the baby is still alive when she goes home on the third day. The baby looks like a wrinkled old man.

So when they do come, what happens in a check up?

A check up is done here every now and then. There is no clear regularity or system. When the patients come they get treatment. A check up is a control over the mother and the fetus's health. You basically ask some questions, feel the baby’s position from outside the belly by palpating and check the pulse of the baby.

I was lucky to to feel and listen to some baby bellies during this check up. Some were extremely difficult to here. Most were fine but I remember one case where she was many weeks in but the baby was still too small. Then you sent her home. Would you have done the same in Germany?

No, in this case she would have been sent to ultrasound. Probably to discover that the baby is undersupplied, not getting enough oxygen or nutrients from the mother. This girl may be in great danger. When the bleeding starts she may well die because the bleeding is fast and severe and she probably won’t make it to a hospital in time. Here they don’t seem to care. I am here to observe and help but I am not in the position to change their way of making decisions in this hospital. Even if they send her to Ultra sound she will not go because she can not afford it.

While Fredrik spends time in the hospital Christian is working to get supplies from the fund to help the mothers and future children in this hospital, so they can have a more clean and safe environment.

Can you tell us more about the way a baby is delivered here and why you were so chocked by the way they did it when you arrived?

They have a completely different attitude about the delivery. They have a completely different attitude towards the mother. Here the mother is the job and in Germany she is the customer who you speak to, and serve with great respect and care. This is very different, here you hardly look at the mother, you ask her questions about facts, hardly about what she feels. No african woman scream when giving birth, they breathe heavily but hardly make any other noises. When a woman here is in pain, they grunt but if they scream they may even get beaten.

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