Lira report Emily Seddon 2022

Lira, Uganda October 2022
Poole Africa Link
Emily Seddon, Perinatal Mental Health Specialist Midwife

Being a midwife is a gift and I have always known that I wanted to go to Africa to share my knowledge and practice outside of the United Kingdom. I started working at University Hospital Dorset in February 2022 and became aware of the Poole-Africa Link charity. I wanted to know more about the charity and was aware of the potential opportunity to fulfil a dream. When I found out that I was coming to Uganda in October, I was elated to be able to have this opportunity.

I didn’t know much are Lira before I arrived as did not want to have any preconceived ideas or expectations. During my trip I have been fortunate to visit the local government run Lira Referral Hospital, the Lira University Hospital and a Level 4 hospital in Abukey. Each hospital offering a different level of care to their local communities.

Lira Referral Hospital

Midwife Rosie and I became familiar with the midwives and students at the Lira Referral Hospital and spent most of our teaching time there. We taught a varied number of student midwives obstetric emergencies including shoulder dystocia, breech, postpartum haemorrhage, pre-eclampsia, sepsis and maternal mental health. Rosie and I taught together based on the wishes of the students and took into consideration morbidity and mortality in Uganda. We used discussion, story telling and hand on experiences as the basis for our teaching sessions.

We were welcomed into the newly built unit at the Lira Referral Hospital and felt part of the team. We were able to observe practice from antenatal admission to postnatal care on the ward. The referral unit has approximately 6000 births a year, is a very busy unit and often staffed by one midwife sister and supported by students. We were shown around the birthing unit and my preconceptions of birthing in this hospital were proved wrong. Each birthing woman had their own room, separated by a wall. The back of the birthing room was open, presumably so the sister in charge can observe many women at one time, without the barrier of walls and doors. This open approach to the birthing room, meant that a woman may have many people watching her birth, she would be laid on her back, on a plastic sheet and mostly naked. This meant that our teaching always included a discussion about privacy, dignity and consent. We also noted that teaching and demonstrating birthing positions, including upright, all fours or squatting positions would be beneficial.

I was so impressed with the student midwife’s knowledge, eagerness to learn, compassion and reflective thinking. It quickly became apparent that we were going learn together and we were able to have a deeper understanding of the maternity care provided in Uganda. We had positive feedback and the day we did not go to the hospital due to other commitments; the students and sister told us how we were missed.

We listened about the students telling us about the number of women who are HIV+, women dying from postpartum haemorrhages and the lack of resources that are available. I took for granted that when I open a cupboard in Poole Hospital, there are supplies, medicine and staff that can provide the care required. With this knowledge and understanding we adjusted our lectures and teaching so that it was applicable to Uganda and I was very aware that I didn’t want it to appear that the UK was somewhat superior.

Maternal Mental Health

As a midwife with a specialism in maternal mental health I was eager to discuss mental health concerns with the students and it was not a surprise that mental health is not on the current curriculum for midwifery students. I read reports of stigma, women losing their families, homelessness and a lack of awareness of mental health. I shared my presentation and gave my contact details, if the students wished to contact me. They shared their personal stories of family members and their own mental health. Following my lecture, a student midwife contacted me to say that she recognised that her aunt had struggled with mental illness, but it was spoken about, and no support was provided. The students thanked me for discussing a topic that is important, but not taught. They said that they would feel confident to talk about mental health now and wanted to learn more about how they could support women and their families in the future. This feedback made me realise that I am a midwife with a specialism, I am perfectly placed to try and find a way of creating a relationship with Lira referral hospital, Lira university and look at ways of putting maternal mental health on the agenda and curriculum.

I was fortunate to meet the lead psychiatrist officer at the referral hospital and we talked about current mental health screening, referrals and support offered. We talked about maternal mental health and our common interest and passion for improving perinatal mental health. He told me about the correlation between mental illness and domestic violence, women parenting on their own, rape, unwanted pregnancies, women and their children that are HIV+ and mothers whose children have cerebral palsy. If and when screening questions are asked they use PHQ-9 and ask the two first questions:

Over the last 2 weeks how often have you been bothered by the following problems:

• Little interest or pleasure in doing things?
• Feeling down, depressed or hopeless?

Screening for PTSD is also offered for women that disclose a history of rape, violence or trauma.

If women are struggling with their mental wellbeing, then this may be recognised from the HIV or cerebral palsy clinic, from a social worker in the hospital or a woman presenting herself at the mental health unit. Women may come to the clinic to discuss how they are feeling, but do not want to tell more than one person their story, so engagement following the initial meeting can be poor.

The future

Following this positive meeting, the chief psychiatrist and I have agreed to work together to discuss how to improve the knowledge and awareness of maternal mental health for the local community of Lira. I aim to form relationships with the nursing and midwifery council of Uganda, the white ribbon alliance and charities based in Uganda to assist awareness and integration on perinatal mental health on the curriculum for student midwives in Uganda.

Coming to Uganda has been a life-changing experience and I am very fortunate to meet so many wonderful, dedicated and caring people. This trip will be the start of a relationship with Lira referral hospital, Lira University Hospital, Dorset Health Care and University Hospital Dorset.