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Report Lira regional referral hospital & Lira university general maternity

Report from two week visit to Lira regional referral hospital and Lira university
October 2016

Logistics
This was my first visit to Uganda and I was pleasantly surprised by the lack of tension in the streets and generally felt that this is a safer place to be than in South Sudan. Very few guns were on show which was again reassuring.
From a logistical aspect that safety was helped by our driver Arnold who was available to meet not only our transport needs but various practical issues around phones, banking, printing and supplies etc. and general practical advice.

Lira Referral hospital

Although we didn’t receive the very enthusiastic welcome we have grown accustomed to experience in Wau, those I met were pleased to see us. I visited nearly every ward and department and everyone was pleased to chat about their work. The hospital looks well-manicured on the outside but inside it’s a very different tale with crumbling walls, old paint and in need of a good clean. Mostly there seems to be running water but some drains are blocked and inside maintenance is poor. Lots of kit just don’t work and is not sent for repair. Basic supplies such as disposable gloves are lacking and stores say they can’t get them from the supplier, so cleaners use expensive sterile gloves for cleaning and students insist they wear them even to push a clean trolley! All the kit we took was very gratefully received and my biggest asset was the nurses’ watches, used for persuasion and trading purposes and making new allies!!
Another popular item were the knitted baby hats, gratefully received by maternity staff and new mothers.

Labour ward

I spent most of my time on the very busy and overcrowded labour ward assisting the excellent VSO midwife. We struck up a good rapport and were able to bring about several positive changes during my two weeks there. A major issue is privacy for mothers, having examinations and during delivery. The first stage room had no curtains and I was able to have some bright pink ones made in the market which we hung up using old giving set tubing. The mattresses in the post-natal ward were in a disgusting state and were decaying, dirty foam with very torn or no covers. Forty eight hours after discussing this and the resulting neonatal infection risk with the hospital director and senior principal chief nursing officer, the mattresses were miraculously replaced with some in better condition!
I reorganised the neonatal resuscitation area and the trolleys in the labour ward and we set up an emergency PPH box.
All the small items of kit I took such as sphygmomanometers, thermometers, pen torches, pens, notebooks etc were much appreciated.
As well as being overcrowded with patients (nearly eight thousand babies are delivered per annum in a very small labour ward with four cramped delivery tables in a bad state of repair), there are crowds of student nurses from the various nursing colleges. Their experience and ability varies hugely but there was always plenty of opportunity for informal teaching which I enjoyed and was much appreciated by the students, though their grasp of dignity and privacy for the patients, along with infection control has a very long way to go. They are rarely set a good example by local staff. Apart from Lira university tutors there did not appear to be any tutors from the many other colleges supporting their students.
There were no proper delivery packs and poor preparation for delivery which the VSO midwife was trying to address. We were able to provide a small amount of funds to buy enough material to have 30 cloths to wrap up instrument trays and 30 baby wraps, all reusable.
The labour ward has a good autoclave and is well used. There appear to be sufficient instruments but other kit is sadly lacking. Lighting is poor and there is no dedicated working light for suturing and mobile phones or the pen torches I took were often used as a light source.

Ante natal clinic

A very well run area, with lots of education for parents and students. Also enthusiastic singing and prayers to start the day!

HIV services

Services supporting HIV patients and disease prevention appeared very good. There is an excellent adolescent disease prevention clinic, a good counselling service and plenty of HIV drugs. The whole service appears very well organised and efficiently run with friendly enthusiastic staff.

Lira University

My impression was a bright and fairly well stocked building though communication re timetables needs some improvement. Most students showed enthusiasm and enjoyed our lectures.
It was a delight to meet with Professor Jasper the vice chancellor and we had a very productive time with him.

Hilary Fenton-Harris RN
PAL co-ordinator



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