Final Clinical Log–Mulango Hospital

Yesterday I completed my last clinical day in nursing school–what an exciting and surreal feeling! I am so grateful for the opportunity to finish my BS here in Uganda. The past five weeks have been truly wonderful.

I spent the last two weeks in Ward 14 working with women experiencing uncomplicated, normal labor and childbirth. Ward 14 was very different than acute pediatrics. I can’t say one was better than the other, I can only say that I learned a lot from both experiences.

I truly enjoyed working with the midwives and with the student nurses on Ward 14. Although the system and practices on the ward are far from perfect, most of the midwives are extremely skilled practitioners and are also excellent teachers. The midwives and staff are also incredibly kind and welcoming, as most Ugandans are! During the first week on the ward I mostly observed. My colleague Kay had spent the past four weeks on the ward, so I followed her and she taught me the skills she had learned. It was fantastic to see one of my colleagues in action! She is going to make a truly wonderful midwife someday and I was grateful for the opportunity to learn from her and to learn with her.

A group of student nurses on the ward during our time there. The students were nice to work with, however, the manner in which they worked made me uncomfortable at times. Most of the students were doing general nursing and were not interested in midwifery. However, the students needed to get a few cases that were required for their program so they had to be there and perform certain skills. Many times I would find myself with a mom and a few students and the students would do things without any supervision or advice from a midwife. It made me very uncomfortable because the way in which they were working was not safe for the patient or for them. When it was appropriate I called for a midwife to help so that the students did not put the mother, baby or themselves at risk. Other than that, the students were very nice to work with and we were able to learn from each other.

One day this week, the head of the midwifery program for one of the nursing schools came to the ward to check on her students and to do some teaching. The instructor turned out to be somewhat of a midwifery guru. Not only that, but her approach to caring for a patient was completely different than that of most of the midwives on the ward. She reinforced performing the various assessments, building rapport with the patient, explaining the birth process to the patient, and using therapeutic touch. At the same time she explained midwifery skills and procedures to another student and me. After that she started talking about the Millennium Development Goals. It was amazing! It was very interesting and surprising to see someone using the nursing process that we learn at Hopkins since I had not seen that approach during the previous weeks at Mulago. I was shocked, but also inspired to encounter such a wonderful teacher and nurse midwife.

On my final day on the ward I had the opportunity to admit one patient and follow her throughout the day. I did the initial assessment, admission, two vaginal exams, charting, delivery of the baby and placenta (with assistance), postpartum care, and newborn care. It was a great experience to be able to focus on the entire continuum of care for one patient. I loved the opportunity to connect with and care for the patient, and it also made me realize how much I had learned. I could not have asked for a better ending to my clinical experience. I will always remember that mom and her baby.

Overall, I loved Ward 14. It was exciting and inspiring to see so many natural childbirths. It is mind boggling to think of the discrepancies between our labor/delivery system and the one here in Uganda. I have definitely gained a perspective here that I never could have gained anywhere else.

The past five weeks has evoked in me many emotions: excitement, frustration, fear, joy, inspiration, and despair, just to name a few. In the end, I am beyond grateful to have had this experience. Not only did I learn about nursing, but I learned about humanity. Mulago is a hospital with an extreme lack of resources, extensive systemic problems, dilapidated facilities, and (at times) mediocre patient care. However, behind all of those impediments are the Ugandan practitioners and patients who will smile or say something kind even in the most difficult moments. I have traveled to many countries, but I have never, ever encountered people like Ugandans. I will always carry with me the memory of the Ugandans, their warmth and kindness, their smiles and friendships when I leave here.  And, where ever I meet a Ugandan in the future, I will tell them how much my summer in Uganda meant to me, and that the people of Uganda touched me in a way which I will never forget.

–Rachel Jackson, BS ’13