By Babu Karavadra
In this blog, Babu, an East of England Global Health Fellow, discusses his experiences with the Kampala-Cambridge Maternal and Neonatal Partnerships and supporting a textbook titled: ‘Principles of Obstetrics in Africa’ written by an African team.
Babu Karavadra is an ST5 in Obstetrics and Gynaecology in the East of England. He has recently completed and graduated with a PhD in endometriosis from the University of East Anglia. Babu has an interest in research and global maternal health.
As part of my Global Health Fellowship, I have joined the Kampala Cambridge Health Partnership to further develop the existing Maternal and Neonatal Health Partnership. In February I joined the team for a week in Kampala. This partnership is between clinical and academic departments of Makerere University, Cambridge University and the major maternity hospitals in Kampala (Mulago Specialised Women and Neonatal Hospital and Kawempe Hospital) and the Rosie Hospital, Cambridge. The objective of this trip was to further the textbook ‘Principles of Obstetrics in Africa’ authored by the team in Kampala and due to be published by Cambridge University Press. The aim of this project is to complete a textbook that provides information that is appropriate for the context in which it is being used (Africa) and written by authors who work in Africa; a first of its known kind. In this way it is hoped that the information in it will more truly represent the issues and problems experienced by pregnant women in sub-Saharan Africa. My last visit to Africa (Tanzania) was as a medical student on my elective. I was extremely excited at the prospect of meeting new people and learn more about the Ugandan healthcare system. The visit was focused on meeting the authors, confirming that all the book chapters had sufficient accurate information in them, preparing a list of illustrations and to start editing the chapters to prepare for publication.
As we left Entebbe International airport in our taxi journey to the hotel, the sun was just slowly starting to rise. The streets were hustling and bustling already with people either commuting or opening their businesses. In my very sleep deprived and jet lagged state, it felt quite surreal that I was in Africa. After a few hours of sleep, we decided to explore one of the local mosques, the Uganda National Mosque. It is situated in the Old Kampala area and is the largest known mosque in East Africa. We had an official tour of the mosque and then climbed 304 steps to the top of the minaret! I genuinely don’t know how I managed this considering I had three hours sleep post flight- I felt as if I had done a 12-hour night shift on the labour ward! Nevertheless, the views of Kampala were breath-taking, and it was a moment of reflection.
A view of Kampala from the top of the minaret- breath-taking
The UK team were Dr Charlotte Patient, Dr Jane MacDougall and Professor Ashley Moffett. For the following five days, we visited Mulago Specialised Women and Neonatal Hospital and Makerere University. We met three senior Consultants in Obstetrics and Gynaecology (Dr Musa Sekikubo, Professor Annette Nakimuli and Professor Josaphat Byamushiga) from the existing partnership links. All three individuals are involved in leading the book writing project from Uganda. We also met and collaborated with several of the authors involved in the project and clarified their respective chapters. This was an excellent opportunity to engage with the wider team and gain more insight into the Ugandan medical system. The biggest learning point for me from this was not to assume anything; this was important for cultural sensitivity, but also to ensure the content of the book is purely focussed on practicing medicine in Africa and not in the United Kingdom.
Round table discussion about the book chapters with the local team
Mulago Specialised Women’s and Neonatal Hospital.
During my time at Mulago Women’s hospital, I was also able to meet a PhD student who is focussing on maternity and neonatal outcomes in Uganda through a mixed methods approach. My own PhD adopted a qualitative approach, and I was therefore able to support her through this. We discussed ways in which she could further analyse her data and apply the findings to the context of maternity care in Uganda. We also spoke about how she could further publish her work in recognised research journals.
We had the opportunity to visit Kawempe National Referral Hospital and meet the new Director and observe the morning ward round. We also visited the labour ward for observation. This was certainly an eye-opening experience. The hospital has a delivery rate of approximately 32,000 babies per year, compared to just under 6,000 deliveries per year for the Rosie Maternity Hospital, Cambridge. This is an incredibly busy hospital and undoubtedly, with significant challenges due to constraints in resources. I learned that a major cause of maternal mortality was postpartum haemorrhage, and this problem was further exacerbated by the lack of availability in blood products. The ward round was also a very interesting experience. I gained insight into how busy the maternity hospital was as well as some of the challenges healthcare professionals are faced with. It is not unusual for patients to present with heavy vaginal bleeding or signs of sepsis following unsafe termination of pregnancy procedures carried out by non-medical qualified individuals. I could not help but compare our National Health System and how lucky we are indeed.
I hope to discuss my experience in Uganda with the wider obstetrics and gynaecology team at my current workplace at Peterborough City Hospital. It has been a real eye-opening experience. At my current trust, I work with several colleagues who are international medical graduates within the specialty, and it has made me appreciate the value of their personal and clinical experiences they may have encountered in their own countries to the wider working team in the UK.
We had very few challenges on this trip and despite a doctors strike the Uganda, the local team managed to be present for the whole week. I would encourage every healthcare professional to spend some time in a global health opportunity, in any capacity, at some point during their career. This trip has taught me the importance of developing and maintaining collaborations with others- we cannot work in isolation to improve women’s healthcare. A truly collaborative approach, where both parties listen to each other with the aim of understanding what is being said, rather than responding to what is being said, is so incredibly important. I hope to further use my fellowship time to engage with the Uganda team to further develop on the book project, as well as engage other colleagues in wider global health related projects. My East of England regional global health fellowship project is focussed on developing support resources for international medical graduates joining the obstetrics and gynaecology department.
Finally, I want to share a photograph. I was excited to try Tilapia fish once again. When my dish arrived, I was totally taken back by the size and of course the anatomy!
If you would like more information on the Global Health Fellowship Scheme or to contact Babu please email firstname.lastname@example.org.
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