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A day in the Mulago post-abortion clinic

By Vision Reporter

Added 18th December 2009 03:00 AM

TIME: 9:00am. Venue: Ward 5A, post abortion care, Mulago Hospital. I had been waiting for this day when I would sneak into this ward posing as a patient with post-abortion complications. No cameras, no pens, no notebooks.

TIME: 9:00am. Venue: Ward 5A, post abortion care, Mulago Hospital. I had been waiting for this day when I would sneak into this ward posing as a patient with post-abortion complications. No cameras, no pens, no notebooks.

By Irene Nabusoba
TIME: 9:00am. Venue: Ward 5A, post abortion care, Mulago Hospital. I had been waiting for this day when I would sneak into this ward posing as a patient with post-abortion complications. No cameras, no pens, no notebooks.

Donning a pair of faded jeans, a black T-shirt, and slippers with a lesu (kanga) hanging loosely over my shoulders, I studied the environment quickly under a heavy breath to conceal my tension.

Several women writhed in pain on the floor in the corridor leading to the ward, as others sat miserably. Four men, including a reverend and a young man with relaxed hair, also stood there. I later learnt they were caretakers of some of the patients. They stayed out because there was no space in the ward that has 16 patients admitted, instead of the 10 people.

Realising that my hair was neat unlike other patients, I hastily ran my fingers through it to make it unkempt. The gateman referred me to the registration desk to get a form before he could let me in.

Forty minutes later, I joined a long queue of about 27 patients. Here, everyone seems to be an emergency case as all the women are wincing in pain. With only two benches facing each other, I was lucky to find space when one patient went to the washrooms. Upon her return, she tried to evict me but the others squeezed and created the space required.

Then a lady walked in, visibly in a lot of pain. Grinding her teeth, holding her abdomen, with an unfocused gait, the lady of about 25 years took each step with difficulty until she sat down. But she had to wait. No one is allowed in because the nurses are finalising with the admitted patients. Time check 10:30. Silence reigned as every patient anxiously waited for the medical workers.

“She is in so much pain, can’t they let her in?” I broke the silence. “Aren’t we also in pain? I have been here since 7:00am,” my neighbour retorted before asking me what I was suffering from.

“I had a complication after abortion,” I replied, attracting stares from others. For a moment I wondered whether all of us were there for the same reason. I later learnt that rape victims and women with gynaecological problems related to pregnancy, including miscarriage and deliberate abortion are also handled at the ward.

At about 11:00am, the midwife called out my pseudo-name under which I registered. I entered the room for basic examinations. On the other side of the room, all 16 beds were occupied by patients.
In the far corner of the ward was a mother being ‘evacuated’ as the nurse put it. It means using a vacuum machine to suck out a dead foetus after an incomplete abortion. A few beds away, a woman was complaining of hunger and also wanted to pee. She looked yellow.

“She is anaemic,” the nurse was kind to answer when I showed concern over her colour. “She is three months pregnant and suffering from malaria. Malaria causes anaemia and can lead to a miscarriage,” she said casually. She was writing a ‘situation report’, according to what was marked on the back.

Another nurse was counselling a 13-year-old P.7 girl that had been defiled by a boda-boda cyclist. That meant that I had to wait a little longer. In all, there were five midwives - two counselling patients, one writing an administrative report, another one handling a sick mother, while the other one was attending to patients. Too few hands, for too many patients, I thought.

As I scanned the room, my eyes fell on a file of sexual cases, and I was shocked at how big it was. There were cases of sodomy, rape, defilement, domestic violence.

At this point the anaemic mother asked to go for a short call, but there was no one to help her. They called in the husband, who was waiting in the corridor.
“What is your case,” the midwife startled me. “Abortion,” I whispered. “What about abortion, we do not provide abortion services. We only care for people who come with complications,” she said.

Fearing to be examined, I told her that I had done the procedure a month back, but had some fears of infertility if I took family planning and needed counselling. “That counselling can be done anywhere where they offer family planning services. We handle more complex cases,” she said before turning back to her defilement case.

Another midwife asked me to hurry up and join a group counselling session in a wooden office. My colleague of about 22 years had just had a foetus evacuated after an incomplete abortion and was being counselled on family planning. Apparently she had stopped using contraceptives and ended up pregnant. She decided to abort, but she bled badly and the dead foetus failed to come out.

“The last time I took Injectaplan I bled a lot. That is why I left it. But again I cannot handle the pills. I will just go back to the injections,” she said. “I have to take it today,” she emphasised.
I asked the midwife if there was any other method apart from injectaplan or pills. But she referred me to the family planning clinic in New Mulago. “Because of limited space and staff, we can only provide pills and Injectaplan,” she explained.

I told her I would opt for the coil (IUD), requesting to stay and listen to the next counselling session. My friend got her injection and last minute advice on foods that can increase her blood supply to replace what she lost. I learnt that she sells cooked food in Owino market and was rushing back to work.

I challenged the midwife on why they were sending me to another clinic instead of giving me the family planning services I needed. But she was firm in her refusal: “There is nothing we can do. We have no space and staff to have a family planning service here.”

Time check, 12:05pm. A midwife walked in with another patient – the one that looked very badly off. Apparently she had registered with a pseudo-name and when that name was called, she could not remember it was hers. She finally gave her real name. Asked why she had lied, she smiled guiltily, but remained silent. She and I were ushered into another counselling session.

At first she did not want to talk about her condition. I have told you I’m sick, she said when asked to explain her sickness. “I feel terrible pain. I’m shivering, also bleeding and it really smells,” she explained.

When the midwife asked what caused it, she first feigned ignorance. “All I know is that I was about three months pregnant. It just started,” she said as she looked around suspiciously. Outside, her husband was waiting.

The midwives reassured her that they would treat the information received as confidential and would not tell anyone, not even her husband. “Everyone in this room is here for a similar reason. No one is going to reprimand you. Neither are we going to tell your husband. But for me to help you, you have to tell me the truth,” a midwife said.

With this reassurance, she opened up. She is a mother of two and a housewife. She wanted to space her births, but did not use family planning because her husband does not approve it. At one time he learnt that she was using pills and beat her until she stopped swallowing them.

But she did not want another child because she wanted to set up an income generating project. She did not want pregnancy and childbirth to bog her down. Neither was she prepared for the expenses that come with more children. “I feel wasted sitting at home doing nothing but child bearing. We even struggle to support the two we have,” she said.

When she realised she had conceived, she took six tablets of Septrin mixed with very strong tea. She took it at bedtime and woke up bleeding. “A few parts came out, but I remained in pain. I hoped it would go away but it didn’t,” she said.
Two weeks later, the pain became unbearable and her husband took her to a clinic before they were referred to Mulago.
Given the family planning options, she opted for Injectaplan. She pleaded with the midwives to lie to her husband it was a miscarriage.
“He wants more children. He will kill me if he finds out the truth,” she said as the midwife led her out.

The midwife turned to me and asked if I had made up my mind. She said I looked undecided, “Anyway, I don’t mind you keeping me company,” before she went out to bring another patient. Time check, 1:00pm.

The new patient was a mother of three and a second wife to a man who is always away on safari. She chose pills, but unfortunately got pregnant, while taking them. Reason, she would take pills only when the man was about to return. But, according to medical literature, pills may not work when taken irregularly. Indeed she became pregnant. Consequently she took a mixture of strong tea and chloroquin. Blood gates opened and she collapsed. “I was rushed to a clinic nearby after I fainted,” she said.
Asked why she aborted, she said: “I have suffered enough with children. No, not now. We women in causal relationships have so many problems.”

Another woman, aged 28, had done her ninth abortion. “You are still here? I thought you are gone,” she joked, still wondering how I had declared audibly in the queue that I had done an abortion. We compared notes. “Where did you do yours?” she asked me as the midwife stepped out. “In some clinic in Wandegeya,” I replied.
She continued; “There are many clinics that do abortions in Wandegeya because of campus girls, but some are not good enough. I have my guy in Nakulabye, who does it well. I just don’t know what happened this time,” she said.

My new acquaintance, a sales girl at a cell phone shop in town, said she cannot take contraceptives because of their side effects on her. “This one (abortion) almost killed me. Next time, I will just give birth. I’m now able to take care of my child even if I do not find a man to marry me,” she said.

The midwife explained that she had lost so much blood and might need transfusion. The birth canal was so septic that she would need an antibiotic infusion immediately. But she did not want to be admitted, which made the nurse angry. Later she accepted.

It was 2:50pm when they led her to her bed. The midwives who were five in the morning had reduced to three.

Then came a 19-year-old teenager who had been raped and impregnated by her uncle. She later carried out an abortion, but got complications. The midwives were angry that the family did not immediately bring her for emergency contraception.

“We would have given her emergency contraception and HIV post exposure prophylaxis. Now we can only treat the abortion complications,” said a midwife.

Then there was a Senior Four girl who was supported by her mother because she was too weak to stand. She had used a local herb called nanda, which she pushed into her vagina to get rid of her pregnancy. Earlier she had gone to Mulago asking for an abortion, but the midwives instead counselled her and sent her back home. However, she was so determined to abort. She looked for an alternative, and it was a deadly one. Nurses told her the herb ruptured the uterus and she might never get pregnant again. Indeed the stench coming from her indicated that something might be terribly wrong.

I had stayed long enough to raise eyebrows and did not want to stay longer. But as I made my exit a mother of nine, who discovered that she was HIV-positive and decided to terminate the pregnancy, was wheeled in by her older daughter.

She did it in a clinic in Bwaise, a Kampala surburb, at a cost of sh35,000 but it went wrong. When she went back with complications they denied knowing her.
These were just a few hours of one day, but I came out shaken. But stories like these happen every day, week, month and year.

According to health ministry estimates, about 297,000 abortions are procured in Uganda annually, with only 85,000 being treated in medical facilities for complications. Another 65,000 experience complications but receive no treatment.

A day in the Mulago post-abortion clinic

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