Written by Dr. Gregory Bartha
One afternoon a young woman was brought to the clinic in very serious condition. She was poorly responsive, and her blood pressure could not be obtained. She had severe abdominal and back pain and was bleeding from the vagina. She was 4 to 5 months pregnant. The working diagnosis was miscarriage and low blood pressure from blood loss or infection. We administered IV fluids, and her mental status and blood pressure improved. We transported her to the Mbale Regional Hospital obstetric ward.
She could not lie down because of severe pain. I had to physically prop her up until the obstetric officer evaluated her and gave her medicine to help her evacuate “the products of conception”. The injection did not help and later had to be repeated. She eventually had to have surgery and recovered well. Miscarriages are common in Uganda probably because of poor nutrition and the young age of many mothers.
More attention needs to be given to maternal health and family planning. The government has done a fairly good job of encouraging delivery in a health facility rather than at home, but more emphasis should be made on family planning and delaying age at first pregnancy. Most Ugandan women end up delivering 6 to 8 children. The population of Uganda is estimated to be 44 million, and it is smaller than the state of Texas. In 50 years the population is projected to be 80 million, a number which would pose many problems. Women are more receptive to family planning than men. Men consider having many children to be a sign of manhood. So the culture must change to avoid famine, epidemics, and increasing poverty. Smaller family size is now being accepted by educated young adults living in the cities, but the village mentality is not changing.