We have now spent two weeks in Masaka Regional Referral Hospital. Some shifts have been light, but many have been tough – for a myriad of reasons.

• The air in the delivery room is hot, and made hotter by the heavy plastic full-body aprons we wear to conduct births. My hands are constantly wet from sweat from the double gloves I have to wear to keep protected due to high rates of HIV. My “birth goggles” are constantly fogged up and I can’t even count how many times *a minute* I wipe the sweat off my face on the sleeve of my shoulder.

• The smells are strong: body odour is thick, birth smells are amplified in the heat, and somehow the placenta container lost its lid this week! One woman yesterday had chorioamnionitis and I have never, ever smelled anything so foul. The room smelled for the rest of the day and we all felt like we could taste it. Ugh.

• The floor is… not clean. Squeegeeing all the fluids across the cement delivery room multiple times each day is the least fun part of… everything. [Lesley disagrees – she thinks the spraying fluids is worse! She’s had multiple pphs or bursts of amniotic fluid *across the room* most days!!!]

• I am constantly, constantly learning. Every moment on the ward is a moment to take something in and when we return home each night I am wiped out.

• The systems in the hospital can be frustrating. I won’t go into the specifics of these, but everyday I’m baffled by some aspect of organization. But…. I am in a different culture, and each and everyday I have to remember that.

• I am in a different culture, and the rules are different here.

In the midst of the challenge there are spurts of joy.

• Cathy is hilarious, and always up for fun. After our first day in the hospital I asked if we could buy hand towels so we could dry our hands after washing them (rather than wiping them on our filthy scrubs). Cathy bought brightly coloured towels and promptly named them our “victory towels”, which we wave when good things happen on the ward!

• Bababz the cleaner shoulder-checks me in the mornings to greet me, and gives me the fist-to-fist greeting throughout the day. Hilarious.

• Alice the midwife makes me smile the moment she walks into a room. She is always ready for cheer and is so, so helpful.

• The colours of the birds are incredible – yellow, purple, blue, red. We walk ~15 minutes to hospital everyday and it’s delightful to see incredible flora and fauna all about – especially the ugly storks outside the maternity ward.

• Neonatal resuscitation works!

• The people LOVE it when I use my Lugandan phrases. “Wasuzoteea!” “Kah-ley!” “O-lee-o-tee-ah!” “Whey-bah-ley!” I *love* their smiley reactions!!

• The women amaze me each and every day. What they face in daily life – and in birthing their babies – requires resilience, courage, and strength. They teach me what is possible, even though I don’t think they should have to face what they face.

Tonight I am tired, and to be honest, I don’t feel like going in to the hospital tomorrow. Witnessing first hand maternal-infant health in Uganda has been eye-opening, challenging, and an incredible opportunity to solidify my knowledge and skill. But it’s hard work. Standing on the threshold of the delivery room you just don’t know what awaits you inside.

• Will you be confronted with a woman who received bad care at one of the local private clinics? Or a woman who took “the native” – local plants to speed up labour, unknowingly at her baby’s expense? Or will she have paid someone to give her a shot of oxytocin or a few pills of misoprostol to do the same?

• Will you find a woman who has been laboring for days, but because her lack of nutrition as a child her pelvis did not grow wide enough to allow passage of a baby?

• Will there be a woman whose water broke 4 days earlier and she is now overcome with infection?

• Will a baby die today? Will a mother?

I have learned to look closely at the codes for my clients to know if they are HIV+ or not; many are positive. Today a 17 year old HIV+ mom gently asked us to make sure her baby would get treatment, and another 20 year old asked us not to let her attendant know her positive status.

When you are not used to them, these realities take a toll. I have only been here for two weeks. Two weeks. The midwives here face these stories – these women – day after day after day. And they are tired too. They are paid for 8 hour shifts, but are required to stay for 12 hours.

This weekend is our retreat weekend with the Mbale team. We’ll meet up in Jinja and have some fun together – and I am ready for a break! We will also have a clinical “case study” academic exercise and go through our midterm evaluations. Next week we’ll be in Kampala at Mulago National Referral Hospital facilitating teaching workshops and participating on various antenatal and delivery wards. I look forward to a change of pace. After that we’re back to our respective sites in Masaka and Mbale for until we head home early July.

Time is passing so quickly and so slowly at the same time. It’s sometimes overwhelming and sometimes super gratifying. But for right now, I’m so happy to be going to bed.