Walking through the maternity ward at Mulago hospital provides a stark reminder of just how far this country has come and how far it has to go. When I was here last, it was one of the world’s busiest birthing centres with 30,000 babies born every year. Today, I’m told that number is over 35,000.
That is 100 births every day.
To put that in perspective, staff at St. Joseph’s in Hamilton deliver 3,600 babies per year and at one of the largest in the country, BC Women’s Hospital, they deliver approximately 7,000 per year.
Mulago is a big place but it’s not that big. Consequently, competition for beds after delivery is scarce and the majority of mothers and babies spend their first night together on the floor. Thin mattresses are laid down, covered in a plastic tarp and then with a blanket brought in from home. Mom and baby swaddle together and grandmothers bring in food and water.
This tableau is simultaneously heartbreaking and deeply moving.
Like new mothers everywhere, they are visibly exhausted. It is also clear that for the most part, they are happy. They are alive and so is their baby. In a country with a maternal mortality rate this is forty times higher than in Canada, living through childbirth is not taken for granted.
Luckily for these women, Sarah Nakubulwa is looking out for them.
Sarah came to Canada ten years ago as medical resident sponsored by the St. Joseph’s International Outreach Program and McMaster University. In that time, she learned new skills, developed a sense of what is possible and went home determined to make a difference.
Now a senior physician and PhD candidate, she remembers coming back from Canada and attending the daily patient meetings.
“At least three times a week, we would deliver a baby, admit the mother to the recovery ward and show up the next morning and she would be dead,” she says.
“I knew these deaths were all virtually preventable and I knew from my training in Canada that we just needed to take a fresh approach, establish some new protocols, and that we could solve this problem. I didn’t want another mother to die unnecessarily.”
She and her colleagues developed and implemented a so-called High Dependency Unit and worked collaboratively to identify the women most at risk, remove them from the general ward and monitor them every thirty minutes in the 24 hours after delivery.
In the first three months following implementation, not a single mother died in childbirth at Mulago hospital. Not one.
Five years later, mothers still die here but the number is down to 1 every other week and sometimes, only one per month. Still one too many, but so much better than three a week.
Since Sarah started this program, at least 650 children didn’t go home from Mulago motherless.
I ask her what success will look like ten years from now, not sure what to expect. Her response shows her humility and humanity:
“I really hope every mother here will have a bed.”