ProDUCing

I reeeeeeally wish I could record some of the conversations I have here in Gulu... Or even just some of the conversations I overhear. Today we had a pretty slow day in theatre because the medical students are doing exams this week. So I just sat around chatting for a bit with some of the nurses and anaesthetists in between cases. We were discussing the wedding of one of the surgeons (third marriage) to a much younger woman. Apparently she's a very clever woman because he has the money in the bank ('IN THE BANK' was the phrase of the day really), will treat her well and she won't have to work anymore as a midwife, which is a major bonus.

Hard at work...

 When I was asked about my marital status I said I'd been divorced three times (and that's why I actually came to Uganda) the sarcasm was lost on one poor intern who wondered how my father had so many cows.

It is a completely different world here. Family is the epicentre of everything. I honestly have never heard so much discussion about children, pregnancy, menstruation and uteruses in my life. Tuesdays and Thursdays are gynaecology surgery days, and the day passes so quickly with lists full of women eager to discuss their gynaecological and obstetric problems and concerns, and everyone from the surgeon to the cleaner to the medical student contributes to the conversation. All sorts of tips and tricks to 'produce' from various plants and herbs to special rosaries. I found the use of the word 'produce' particularly strange in the beginning but now I've started using it myself (pronounced in the right way as well: proDUCE),  but then I got carried away and nobody understood my joke of calling the newborn babies proDUCTs  so I gave up on it.

I seem to have had loads of conversations with the women here about babies and pregnancy, and they know I'm starting a six year training programme in July, so one friend pulled me aside the other day to tell me that she'd worked it out and if I start proDUCing as soon as possible after I finish I could have at least four children easily before I hit the menopause. Phew. A few weeks ago I told one of the young surgeons I had to leave early because I had a headache - his first question was when was my last menstrual period and before I even answered he said it was probably just PMS. Everyone else in the operating theatre agreed and advised me to 'take some tea'.

A woman's ability to produce children is of major importance here. In a society where polygamy is accepted and very common, if a woman doesn't have children she doesn't command the same attention or power as other women or wives. Most women I've met would like to have four or more children, and this is naturally supported by the strong religious presence in society. One of the obstetricians asked me what I knew about causes of infertility and I said 25% of the time it is a female problem, 25% male and 50% a combination of the two. He laughed, and said I was right, here but in Uganda it is the woman's fault 100% of the time. It really is a man's world.

I could only tell him about the one time I knew for definite it was the doctor's fault a woman couldn't conceive. A few weeks ago we were doing a diagnostic laparoscopy (keyhole surgery) investigating infertility, where a 35 year old woman stopped menstruating two years ago after her last pregnancy. The patient arrived down for surgery and we gave her the general anaesthetic as usual and we had some trouble with her blood pressure at first, but once she was settled the surgeon began to set up and I started having a mosey through her medical notes (which were basically like a few post-its stapled together). On the very first page it documents her medical history - noting that she had 3 children and her last pregnancy 2 years ago ended with an intrauterine foetal death (stillbirth), which was complicated afterward by bleeding so she had a hysterectomy. I told the obstetrician he could put away his fancy keyhole cameras because I had the diagnosis.  He examined her and confirmed it. Obviously having no womb anymore was the cause for the infertility and lack of periods, and this part of the history had just been overlooked at the clinic visits.

Even worse than the unnecessary tests and the unnecessary anaesthetic and the expense of investigations and clinic visits, this woman had had her womb removed in another district hospital and nobody had even told her. So when she woke up from the anaesthetic that day, expecting an answer and a solution to her problems conceiving, she was met instead with the devastating news she'd never conceive again. It must have been absolutely heartbreaking, especially in a society which places so much importance on reproduction, where women are revered for their capacity to deliver and rear babies, and the womb itself in many ways symbolises the very essence of their womanhood and proud motherhood.

In addition to their role of prolific baby producing, the women I have met in Uganda are also incredible natural midwives. One of my very first experiences, almost three months ago now, was a woman arriving for an emergency Caesarean section, collapsing on the tiled floor of the operating theatre and pushing the baby out on the floor. I just stood back gaping uselessly as the anaesthetist delivered the baby while still maintaining a chat with the nurses. When I suggested moving her to a trolley I was told she needed to rest, and twenty minutes later I almost tripped over her, still lying on the tiled floor, having a wee snooze! A friend in Gulu Regional hospital told me she was left alone at one stage on the labour ward, a woman started delivering a baby and the cleaner swooped in, cast aside her mop, took the only pair of gloves on the ward and expertly delivered the baby without breaking a sweat. She presumably nonchalantly went back to the mopping after that, no big deal eh?

Sudoku