Laboring in a Ugandan Hospital

Vanderbilt University Medical Center (my former employer), the teaching hospital for Vanderbilt University and the top-ranked hospital in Tennessee, has an annual budget of $2.9 billion and delivers 3,000 to 4,000 babies each year. Mulago National Referral Hospital, the teaching hospital for Makerere University (where I am in the process of beginning medical school) and the largest hospital in Uganda, has an annual budget of $2.7 million and delivers 30,000 to 40,000 babies each year. Last week, I was sent to Mulago’s labor ward for my first round of clinical exposure. It was my third week of my first semester in medical school, and we were expected only to make observations. My first thought: this place is like a factory, where less than ten staff members assist in the delivery of 80 to 120 babies each day. There were three rooms: one for women in active labor, one for women with complications in pregnancy, and one for cesareans. I spent most of my time in the labor and delivery room, hoping to see a birth.

I walked into an open room no bigger than twenty by thirty feet, with twenty-five beds and twenty-five laboring women on them. There were another ten women laboring on the floor, waiting for a bed. Every woman was alone. Each of them was expected to bring whatever supplies they wanted with them. Doctors and midwives waited for a woman to call out for help when she felt it was time to push, then moved around the room from one to the next, catching the baby, cutting the cord, pulling out the placenta, stitching her back up. The bassinet was simply the bed of the laboring woman next to the new mother. The bathroom was public, the bed was made up with a plastic sheet, the drugs were limited, the staff was without expression, the gender wasn’t mentioned, the mothers were relieved, but not smiling. The joy of childbirth was absent from the room. When I tried to hold a baby, the staff was afraid I was going to get sick.

Fighting back tears, I found a way to smile at the women, naked on their beds, in pain from contractions. I didn’t know what was in their minds. I didn’t know if they were lonely, or excited, or scared, or happy, or anxious, or sad. It didn’t seem to matter. It was an unemotional, impersonal environment.

I don’t think the staff had bad intentions, but I think they felt limited by their resources, and they’d forgotten that the most valuable resource of all is themselves, the human resource. I recognize that, at this point, I am only a visitor in the situation, and that such a situation is doubtlessly tolling on health care workers. But I do believe that the patients are worth more than this. I believe that our organization can help remind healthcare workers that despite the overwhelming need, there is one patient in front of them who needs their care in the moment. Largely through increased patient advocacy and bed-side care, our organization hopes to ensure better care for those in great need. At this point in my journey, I am learning what kind of healthcare worker I hope to become, through evaluating the current systems and learning about Jesus, who cared deeply for the healing and restoration of individuals, just like the women I watched laboring today.