My 24 Hours as a Midwife

My first pregnancy resulted in a complication and I needed extra medical help. I realise how lucky I am. If I lived in Uganda I would be dead. It should be a basic human right to have a baby in a safe environment with adequate medical support.
Comic Relief

I must have been about seven years old the last time I played Doctors and Nurses. I covered my poor brother Blair in bandages made from toilet roll and forced him to spend a whole afternoon on the couch. It's fitting that this memory should creep up on me as I slip into a pristine pink uniform and start my first ever shift as a midwife.

This most definitely is not what I had in mind when Lenny Henry dispatched me on a special mission to Uganda. I knew all about Operation Health and the bid to get a vital health care facility in Iyolwa completely refurbished. I had foolishly assumed I'd be doing a bit of painting, advising on soft furnishings or positioning the odd scatter cushion. Why else would someone of my limited DIY capabilities be sent to a building site?

All becomes clear the second I meet Dorothy.

Dorothy is tall, slim, strikingly beautiful and wearing exactly the same pink uniform as me. At just 26 years old she, along with one other midwife, have been running the maternity clinic at Iyolwa, they deliver more than 40 babies a month, without any running water, and often in the pitch black. The remote rural health facility has no power whatsoever, so as soon as it gets dark all medical treatments are conducted with the help of a paraffin lamp or mobile phone light. This, I am soon to discover is one of the biggest hurdles Dorothy has to overcome every single night.

I could listen to her life story for hours but it's 8am and already there is a patient in labour waiting to be examined. I step aside to let Dorothy do what she does best when I realise that she has done the same and stepped aside to leave me in the firing line. "Take this," she says thrusting a silver metal cone in my shaking hand, "Listen to the baby."

The Fudus (or elephant trumpet) may be simple in design but as soon as Dorothy's expert hands guide it into place for me, I can hear a distinctive, strong heartbeat coming from the pregnant lady's tummy. I don't know who is more surprised by what is happening, me or Mum-to-be Esther who now has two very white hands cradling her belly. Thankfully we both laugh and I feel an immediate sense of privilege being able to share this intimate and private moment with her.

I ask if this is Esther's first child and she replies by holding up nine fingers. "NINTH," I exclaim failing to hide my shock. Five are still alive Dorothy explains but three have died from malaria. As a mother of three myself I cannot comprehend the pain of burying your own children.

Malaria is the third biggest killer of children in Uganda and frustratingly it is completely preventable.

Whilst Esther remains silently contracting in the background, Dorothy asks me to help weigh and monitor the ten other mothers waiting under the tree outside for their pre-natal appointments.

The Muzungu (foreigner) dressed like an extra from 'Carry on Uganda' raises a few eyebrows and the odd chuckle as I help women onto the scales.

Alarmingly I weigh more than the first three patients we see. "Malnutrition is also a big problem," explains Dorothy. "You need to eat more," she instructs a seven month pregnant woman. I get the distinct feeling this is said hundreds of times a month but unfortunately can rarely be adhered to.

It's late afternoon and Dorothy's 12-month-old daughter has been running around the clinic with us all day. The suggestion of a break and some tea comes as a welcome relief so we gather up Noelina and carry her to the back of the old clinic where they both live in a simple concrete house with a corrugated iron roof. It's small and functional but instantly I feel at home. I agree to spend the night to fully appreciate the challenges of life in rural Uganda and as Dorothy breastfeeds Noelina on the porch she explains why her job is so important.

"When I first came to Iyolwa all of the staff had fled," she says." The clinic was on the verge of being closed down. I had to visit the village councillors and tell them that I was prepared to stay, that it was essential for pregnant women to still come and get care. There were bats in the roof and the ceiling was hanging dangerously low. Rats and termites had infested the building and there was no running water or electricity. I still knew I had to do my job though no matter how bad it got. One of my more challenging days was having to deliver a baby while I was in labour myself. There was no one else to help so I came home and delivered Noelina right here in the dark." Dorothy points to the bare concrete floor in her sitting room where she self-delivered her own baby. I too have experienced a home-birth but I get the distinct feeling our experiences were worlds apart.

By 7pm it's starting to get dark and Dorothy wants to go back to check on Esther. Alongside her professional and no-nonsense approach to work, there is a softness and genuine affection for what she does and the women she cares for. I expect to hear screaming and wailing as we approach the clinic but the delivery room is not only in darkness, it's completely silent. I'm gutted that we must have missed the birth but Dorothy smiles knowingly and navigates the room to find Esther and her sister on the floor in the corner.

"Women in labour do not really make any noise," says Dorothy. "I tell them to keep their strength for the baby instead." The only indication I can see that Esther is in pain is when she curls her toes. I remember my own contractions and explain that I mooed like a cow. By the look on Esther's face I sense that this story possibly gets lost in translation and I am just making random cow noises!

Suddenly everything happens at speed. Dorothy predicts exactly the right moment to get mum into position and within a few minutes I find myself catching a baby - quite literally! No epidural, no pain relief, no screaming, just a few soothing words from the amazing Dorothy and I have a little baby boy in my arms. I wipe his face and body as Dorothy showed me how and wrap him up. As he opens his eyes and looks at me it's love at first sight. It's only then I realise I'm the only person in the room crying. The whole day has been a bit overwhelming and it hits me all at once.

My first pregnancy resulted in a complication and I needed extra medical help. I realise how lucky I am. If I lived in Uganda I would be dead. It should be a basic human right to have a baby in a safe environment with adequate medical support.

I find myself asking about complications before I have time to prepare myself for the answer. "They need to be transferred to the hospital," replies Dorothy matter-of-factly. "Often women don't have money for the transport though (£2) so sometimes they just go home to die."

Esther is obviously one of the lucky ones. As I reluctantly hand over her beautiful baby, Dorothy is already stripping the bed and tidying up. There are no cleaners or assistants to step in and deal with the mess, Dorothy does everything. "I can't leave it till the morning in case we get another delivery tonight," she explains. "I want to be ready."

Heading back home with the help of light from our mobile phones I think about all the other midwives like Dorothy, getting into bed tonight and wondering how many hours, or just minutes sleep they will get before being woken up for the next emergency.

Dorothy has been on her feet for 18 hours and I have not heard her complain once. She is inspiring, motivating and a natural hero. The least self-important person I have ever been lucky enough to spend time with. Before going to bed she tells me I'm a hard, strong woman and coming from her that's the biggest compliment I think I've ever had.

Tune in to BBC One at 9pm tonight for Comic Relief: Operation Health - a one-hour documentary with all the ups and downs from Iyolwa clinic.

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