Diane Lockhart is a Midwife Trainer in Uganda

Life in Uganda is amazing but not without its challenges, some of which are extremely difficult.  The traffic and the roads are atrocious, the dirt is horrendous, the poverty is heartbreaking but do you know what, I as one person cannot change it all.  I can only do my little bit and after a while you learn to live with it and make the best of it you can. We have also had to deal with a number of issues which has resulted in a couple of house moves along the way, there have been tears and phone calls to the Kampala office, and brick walls to overcome but nothing that has ever made me regret my decision to come here or that with help form others coul not be sorted.  My role here was initially as a midwife tutor in the International Hospital in Kampala.  Work in Ugandan culture, will always throw very frustrating problems in your path, whether it be attitudes, work ethics (which is incredibly different from where I come from) and the speed at which things move is often painfully slow and requires determination and sheer perseverance, with a bit of ego massage for a few personalities along the way, but eventually there is a realisation that actually it does eventually sink in and things start to happen.

In terms of the unexpected, it would be remiss and very disrespectful if I did not acknowledge the fact that we experienced life in Kampala during and just after the twin bombs in which Somalia's Al-Qaeda-inspired Shabaab rebels claimed responsibility for 2 bombs that ripped through the rugby club and Etiopian Restaurantas killing over 70 people as they watched the World Cup final.  On 11th July, despite my deep dislike for football, I agreed to go to one of the local venues to partake in the 'atmosphere' that I was promised!.  Thankfully we drew the long straw and chose a venue about 1km from the rugby club which claimed a large majority of the lives although a rumble in the distance did alert us to question the unidentified rumble.  All the hospitals went into action and as IHK took many of the casualties, I offered my somewhat rusty nursing skills at 1am (having found a very last minute baby sitter!) and ended up ICU!!  I was amazed at how the staff in the hospital dealt with such carnage and horrendous injuries with a calm professionalism and it was a real privelege to be part of the nursing team that night and for the weeks that followed.  I learnt alot from them and hopefully I was able to give something back.  But the aftermath continued until fairly recently for me as I had got involved in the longer term care of one young 29 year old man, Francis Ssemwogere, who sustained severe injuries that night at the rugby club venue, and his family  Due to his extensive injuries, he remained in ICU for over 4 months on a ventilator.  An exiciting day happened when he was finally moved out of ICU for the first time onto Hope Ward (the International Medical Foundation, charity hand of IMG.  However, just a few weeks later after his 9th cardiac arrest, very sadly at the end of November, he gave up his fight and died peacefully leaving a young wife Grace and 3 year old daughter Sasha.  Whilst this does not come as part of the VSO package of expections, it has been this very experience which has taught me the biggest lesson during my time here and no doubt will remain for ever in my memories of Uganda.  Having been brought up in Belfast through the 70's and 80's I am no stranger to seeing the impact of terrorism on communities, but when placed in a country which already struggles with indescribable poverty, the effects are significantly multiplied and these pepole would put us in the Western world to shame with their strength in trying to overcome this.  And as for Francis, I thank him for his fun, his wonderful spirit and his incredible inspiration during his last journey and I pray he rests now, and that his wife Grace finds that strength and support to move on in what will be a difficult life for her.

One of the biggest challenges I believe for any volunteer and certainly for me is knowing your limitations when you arrive. We all arrive with expectation of what has to be done during our time....we plan to change a whole population or organisation or culture but over time you suddenly come to the realisation that you will achieve a tiny 'nibble' off the edge of what has to be done, but that that tiny nibble makes a huge impact.  And after a year my role as Midwife Tutor has mushroomed into a huge and exciting collection of jobs from teaching midwives and nurses, Drs, developing protocols to ensure good risk management and I am currently working with the IMF (charity foundation of IHK) in developing the midwifery services in Lira, a more rural district about 5 hours North of Kampala, in view of them building a new theatre. It is no secret that Sub- Saharan Africa still has an unacceptably high maternal and infant mortality rate, which scratching beneath the surface, clearly starts in the community.....so logic suggests thats where we need to be, starting at the source of the problem.  Another project I am working on is trying to increase an awareness of the importance of effective bereavement care for mothers who suffer loss in child birth.  One down side of such a high death rate in newborns, is that there comes with it a somewhat complacent attitude to death and the reassurance ' sure you can have another one'.  This is a common thread throughout mothers and staff but when I spoke to some of the mothers at a more in depth level I started to realise that actually they were no different in their pain to mothers who I cared for at home, and they struggle with the lack of acknowledgement of their loss.  Helping the midwives to see this point of view and designing a few tools for them to help a mother start the grieving process may go some way to making this tragic loss a more positive experience