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Case study: red stickers, white boards and emergency boxes (Mbarara Regional Referral Hospital, Uganda)

This is one of the stories from the RCOG’s trip to Uganda to witness the work that RCOG volunteers are doing to improve women’s health in the region.

Judith, midwife, Mbarara Hospital, UgandaEvery day 30 babies are born at Mbarara Regional Referral Hospital, ten of them via emergency caesarean. The majority of women who give birth here have travelled many miles to reach the hospital; they have often been referred to the hospital from rural health facilities that are unable to cope with complicated labours.

The maternity unit is overwhelmingly busy. Hundreds of women accommodate every available area in the four wards. When bed space runs out, women who are on their second night in hospital are transferred to mattresses on the floor so that new admissions can take their beds. The department has just 20 midwives to cover the evening, morning and night shifts. Some days there are just two midwives on duty in a postnatal ward that accommodates 70 women and their babies.

White board, Mbarara Hospital, UgandaYet, despite these workloads and the challenges the midwives are facing, the ward is organised and the midwives are focused in their work. Judith Kyarisiima, the midwife in charge at Mbarara Regional Hospital, describes the support she and her team had from RCOG volunteer Doctor Kim MacLeod to develop their working practices and their skills.

‘Doctor Kim made us think about how we identify and manage high risk mothers. We have morning meetings to discuss the previous day and look at the one ahead. Kim suggested we start using red stickers to mark patient files and she put up a white board so that we could quickly track the situation on the wards. These systems are helping us to monitor high risk mothers who are critically ill.’

Many of the team have also received emergency obstetric care training. As well as being trained in recognising and managing obstetric emergencies, the midwives were also given advice on simple steps to take to be better prepared for emergencies:

Hospital, Mbarara‘Before, we were not well-prepared for emergencies. Let’s say we had a mother with eclampsia, first we had to run around looking for the cannula, the magnesium sulphate, and the other things we needed. But now we have created emergency boxes where we arrange all the things required for the management of eclampsia so now we can just quickly pick a box, go to the mother and start managing.’


Judith is proud when she adds: ‘The most important thing we’ve changed is we have reduced maternal mortality. In 2011, the year before Kim came, the maternal mortality was 57. Last year it was 27. I really, really appreciate Kim’s efforts and what she introduced within the ward and department.’

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