Birthed against all odds

Three doctors were on a routine rotary dental and medical outreach at Kalangala Health Centre IV when a 21-year-old expectant mother was brought to their attention.

Faced with an ill-equipped health centre without a functional theatre and surgeon, the young doctors had to make a split second decision to save the mother and her baby. One of the doctors, Juliet Nabweteme Mugerwa shared the experience with ELIZABETH NAMAZZI.

In Kalangala district, some patients die because they cannot get to hospital fast enough. Sometimes the patient has the money, but not the means of transport, usually a boat, to take them across the lake to the nearest hospital or health centre.

The situation is so bad that burial arrangements kick off if a patient’s condition worsens during the night. Often, however, issues like lack of medicine and absence of medical personnel come up, a situation that Aida Nakuya, a 21-year-old first time mother, encountered when she reported to Kalangala Health Centre IV on December 7, 2013.

She had reported to the hospital in time to deliver her baby, but something went wrong and the baby failed to come out. Under normal circumstances, Nakuya would have been operated on immediately to save her life and that of her baby.

Unfortunately, Nakuya’s was no normal circumstance. Although she was at a health centre, there was no surgeon on duty.

Her next option was to hire a motorcycle and a boat. If she had no money, she had to wait for the ferry before hiring another motorcycle to the next hospital, which is 60km away. Her transport, medical expenses, food and upkeep would have cost her about sh500,000, money she did not have. There was no doubt that Nakuya’s life, and that of her baby, was in danger.

Desperate interventions

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Destroyed hospital furniture. This is a reflection of most health centres.

It was by pure luck that three young rotarians, Dr Brenda Anena, a post-graduate surgery student, Dr Julie Nabweteme Mugerwa, a public health physician and Dr Mark Makubuya, a general practitioner, arrived for a quarterly medical and dental outreach at Kalangala Health Centre IV the following morning.

They had travelled with a team of rotarians from the Rotary Club of Kampala to Ssese Islands for a routine outreach.
Nakuya was noticed by one rotarian, Dan Lubinga, at about 10:00am. As one of the doctors who attended to her recalls:

“Nakuya had been in labour since 9:00pm, the night before. Lubinga alerted one of the doctors who was attending to other patients and upon reviewing her, it was noted that her labour had stopped progressing normally and she had lost contractions.

“However, her cervix was already dilated (open) and in active labour. We advised the midwife who was attending to her to put her on drip to re-initiate contractions, Nakuya was still comfortably asleep without any progress one hour later. We took a desperate measure to insert another drug in the cervix in an attempt to further stimulate the labour process.

Unfortunately, this was also futile. The best option to save the mother and the baby was a delivery by emergency Caesarean section,” Nabweteme recalls.
 

No surgeon
 

Before the operation was carried out, the three doctors examined the baby and found that it was okay. However, when the doctors told the midwife about the urgent need for surgery, she informed them that the surgeon was away. None of the doctors was a surgeon, so the seniour nursing sister at Kalangala Health Centre IV, Ruth Nalwoga, advised that Nakuya be referred to another health facility.
 

The dilemma, though, was that Nakuya was attended to by her two younger sisters who did not have any money on them. Her partner, a Kampala-based student. The three doctors had some serious decisions to make.

Between life and death

As the rotarians were still brainstorming on how best to help Nakuya, the doctors realised that referral was not an option. “The ferry to Entebbe had left at 8:00am and the one to Masaka had no fixed schedule. There was no guarantee that Nakuya would make it to Masaka, notwithstanding the obvious financial constraints,” Nabweteme says.

Given the urgency of the situation, the doctors decided to perform an emergency Caesarian operation. It was the only way of saving her life and that of her baby.

“In our profession, we always know that a time will come when we have to make vital decisions to save a life,” Dr Anena says.

Theatre closed

Often, we read stories about Uganda’s ill equipped-health centres, absentee doctors and non-functional theatres. The three doctors witnessed all three at Kalangala Health Centre IV as they prepared for the operation. “We learnt that the theatre was closed off for lack of blood, sutures and anaesthetic drugs.

The words ‘we need to refer the mother now’ could be heard now with greater firmness, this time from the health centre official in charge, but our hands were tied. It was deeply disappointing to learn that the system had failed these two innocent lives.

By this time, there was a heavy downpour at the health centre. It was 2:15pm and there was no obstetrician, no functional theatre and no ambulance!” Nabweteme narrates.

“We had to take a huge risk and make the most of the resources available in this proclaimed non-functional theatre. After serious negotiations with the health centre in-charge, we managed to get some sutures and anaesthetic drugs, but not blood, yet it is very vital that blood is booked before every operation, more so a Caesarean delivery, because loss of blood is always anticipated.

“Fortunately, we established that Nakuya had a good haemoglobin level, so she was immediately prepared for theatre,” Nabweteme explains.

Safe delivery

At about 3:40pm, the trio successfully delivered a healthy baby boy. He weighed 3.8kg and did not need resuscitation. “It was both an emotional and exciting moment for everybody as the rotarians, who included Rotary’s District 9211 District Governor, Rotarian Emmanuel Katongole and the president of the Rotary Club of Ssese Islands, Ruth Kavuma, welcomed a miracle baby that had been birthed against all odds.

“The mother and baby were reviewed the following day and were in good health. The mother recovered very well,” Nabweteme adds. When her son was handed to her, Nakuya testified that her experience was a miracle from above.

“I am very grateful to the rotary doctors who saved my life and that of my baby. This baby is a gift from God and the doctors are the angels who have delivered the gift to me,” she said  tearfully. She named him Dan Birungi Rotary, (after rotarian Dan who had identified her).

For Nabweteme, performing the lifesaving operation made her day. “It always feels good serving others because that is what we are expected to do as Rotarians,” she says.

“We were in the right place at the right time. Making that split second decision to carry out the C-section  as a true manifestation of the four way test that rotarians stand for,” she adds.

Nalwoga noted after Nakuya’s operation: “I do not want to imagine what would have happened had these three doctors not been here at this opportune time. We had the operating theatre, but no doctor and as nurses, our hands were tied.”