When a messy referral system forced a young woman never to conceive again
When Betty of Mayuge District in Eastern Uganda started feeling labour pains, she immediately went to a nearby drug shop which was operated by an enrolled midwife. This was her first pregnancy, it had also caused her to drop out of school.
She was admitted at the drug shop and stayed until the next day. In the morning, the midwife discovered that labour was not progressing as expected and therefore advised her to go to a hospital. She was however not given a referral note to take to hospital, and besides, drug shops aren’t permitted to deliver mothers.
It took Betty about 6 hours to make it to the hospital by public means of transportation. By the time Betty arrived, she had already spent several exhausting hours of labour. The process had gone on too long and gotten too complicated. It was dangerous for the mother and the unborn baby and needed an emergency caesarean section.
The caesarean section was done, but as anticipated given all the distress she went through, the outcome was a fully grown boy weighing 2.8kg delivered dead.
Betty was later discharged from the hospital after 2 days of admission and 6days later, she checked into another hospital (St. Francis Hospital, Buluba). She had pus coming out of the incision site where the caesarean section was done. She was diagnosed with Puerperal sepsis (a severe infection often with pus discharge vaginally and/or incision site). At Buluba another operation was conducted to get rid of the sepsis and for over three weeks, Betty had to stay at this private not for profit facility, which obviously came with some costs.
Today, she is steadily on her way to recovery but the horrors surrounding her delivery still linger in her mind. Traumatized and scared she has made the decision to never give birth again.
Betty’s story raises a number of concerns first about the health seeking behaviours of our mothers and the referral system.
In many of our villages, mothers continue to seek obstetric care in drug shops and other unauthorized clinics. Here lots of money are extorted from them yet very little help is given. It is also the poorest mothers who tend to seek care from such places. We can’t achieve health care for all with such practices still happening.
Secondly, the ambulance system in Uganda is a sham, it is unbearable to know that a mother in labour spends 6 hours on the road trying to reach a place of care. We have so many ambulances parked in hospital compounds yet mothers continue to risk their lives travelling on motorcycles to reach hospitals when in labour.
This is a call to all leaders in health care to ensure that ambulances in hospitals serve their purpose rather than keeping them parked. Secondly, district authorities need to step up surveillance and stop illegal practitioners because they are a set back to our health system.