Death in Mulago Hospital

Babies die because mothers wait too long for caesarean

By Harriet Onyalla

DAVID died. He was just a day old. This chubby baby, who weighed 5.5kg at birth, bled to death because his umbilical cord had been cut ‘badly’.

In fact, David was named after the shepherd boy in the Bible long after his little heart stopped beating. The Alur culture demanded that either way, he be named.

Every two hours, a baby dies at Mulago Hospital’s maternity ward as a result of birth-related complications. Hospital records indicate that on average, nine babies die from birth-related complications every day, nine little souls like David. This means, about 270 babies die every month.

“Some days, over 15 babies die,” a hospital source, who spoke on condition of anonymity, says.

David’s only day in this world went terribly wrong. “We spent the whole day at the hospital but nobody cared,” his father, Clinton Oketcha, narrates. “The baby was bleeding. The baby really cried. Then a nurse helped us and put him on oxygen but she said we should pray because the machine was not working properly.”

Oketcha will forever be haunted by the blank face of the doctor to whom he turned in desperation. “He just looked at me and walked away,” he says as a slight tremor creeps into his deep voice.

Mulago Hospital, Ward 5C, Sunday 9:00am: The air in the corridor of the labour ward seems to stand still. Over 20 women in labour are sitting or lying on the floor. “Musawo nyamba, nfaa!” (Doctor, help I am dying), one woman wails.

She is kneeling on all fours. She jerks forward, then crawls rapidly back. Groaning in pain, she puts her elbows on the cold, stained marble floor, rising swiftly. The white blouse she is wearing slides over her shoulder, leaving her naked.

“The baby is coming,” another woman, swaying in pain next to her, shouts. A third expecting mother sits calmly next to them, a stream of waterish blood running from under her skirts towards the middle of the corridor. The woman opposite her tries to move away from the blood running towards her. She stands up, looks around, then slowly shakes her head and sits down again as her wrapper gets soaked. There is no other place to sit. The corridor is packed to capacity.

According to Dr. Samuel Kalisoke, the in-charge of Mulago’s gynaecology and obstetrics department, about 70 mothers are admitted and 60 deliver every day, yet the place was meant to cater for only 20. Some give birth in the corridors. “We are delivering three times the number we are supposed to handle,” he says.

“Most of these mothers are referred from other hospitals when their condition is already critical. In fact, many babies are born with the skin already peeling off, meaning that they died 24 hours earlier.”

On average, one third of the mothers received at Mulago need to deliver by caesarean section. The operation theatre, which has only one bed, handles an average of 18 mothers a day.

The doctors work day and night but hardly manage to cater for the influx. A proper operation, including preparations, takes two hours. Some have to wait for a day to find a slot.

“Many times we have 21 emergency operations,” says nurse Rose Violet Nakayiza. “Babies end up being born stressed or dead because the mothers waited too long for the caesarean operation. Imagine you have 15 patients waiting for an emergency operation, all of them in a critical condition. Whom do you operate and whom do you leave out?”

Apart from lack of space and equipment, the maternity wing suffers from acute lack of staff. There are between eight and 12 staff members for the five wards at any one time, according to Dr. Kalisoke. These include nurses, midwives and doctors.

“In the labour suite, there are only three staff to cater for over 60 mothers a day, yet there should be 24,” he says.

Mulago is Uganda’s national referral hospital. It has become the only place where mothers around Kampala go to give birth. Most health centres around the city shun women who are about to give birth because they lack the operation facilities in case the delivery goes wrong.

Many private clinics only give antenatal care and refer the mother to Mulago when the labour pain starts.

“Some refer the women when it is too late”, explains nurse Nakayiza. “They don’t tell the women what the problem is or even notify us of the condition of the patient and the reason for referral. Many times, the baby is already dead in the womb. And when they come when we have a lot of work, it is difficult to give them the attention they need. So the lives of the mothers are also at risk.”

Another problem, she says, is ignorance and poverty.

“Some mothers arrive here after labouring at home for days. “Others don’t have transport and are brought in by neighbours when it is very late. Many times we are just helpless."