Corrie Verduyn, recently returned CMS mission partner, reflects on seven years at Kiwoko hospital, Uganda
I spent seven years working at Kiwoko, based in a Christian community. Invariably, when you leave such a place it generates various reflections over the things that have been done over the years. Some people have asked what I achieved (a very Western question indeed!) while others asked “have I done what I came to do?”
It is not easy to answer such questions. A hospital is a community, so to apportion any kind of progress to one particular person is difficult. You work in a team and it becomes a process which involves many people. In the setting where I worked you cannot say this person has achieved, whether it’s me or somebody else, because we have achieved together.
What I do know is that the maternity and gynaecology units are now very different from seven years ago. That is not only attributable to me but something that the whole of Kiwoko Hospital can take pride in. The hospital has grown considerably – both in terms of patient numbers, but also in quality of medical care.
“The reason people want to come to work at Kiwoko is because of its reputation…”
Recruiting more staff was part of that – which could be difficult outside of the capital, Kampala. But the reason that people want to come to work at Kiwoko is because of its reputation. They hear about accountability of finances, of procedures, of things being in place and that corruption is not there and that people are willing to work hard and achieve things around for the community rather than for their own personal gain.
The biggest changes have been in personnel; in 2012 there were only two or three midwives on duty at any given time but now it is six or seven. That makes it possible to deliver a much better quality of care and it’s now unusual for basic routine work not to be done, whereas seven years ago it was commonplace. All staff are now midwife-trained – not just nurses – and Kiwoko Hospital now has its own midwifery training school.
Maternal health is my area of specialism and the area I have been leading at Kiwoko, so that is where I have played more of a part in changes. When I came we had a mixture of midwives and nurses. The nurses knew how to deliver babies but they hadn’t really been trained in complications. And even the midwives were not so confident in applying their teaching because there was still quite a hierarchal structure that the doctor says and the midwife just obeys. And I think one of the achievements I hope I’ve made is to get away from that culture and empower the midwifes to manage most of the cases because we only have one doctor. The doctor cannot be everywhere and sometimes if a complication happens on the ward midwives will have to manage it.
Over the years I have organised regular staff training workshops for midwives, which has improved both their skills and confidence in using these skills. Midwives are at the frontline of medical care and the first to deal with most emergencies and I am proud to say that they are now very good at this at Kiwoko. Over time, it’s also contributed to the fact that fewer midwives are looking for jobs elsewhere, and it’s easier to reach a higher skill level if there is not such a big staff turnover.
“Maternal health is a big issue in Uganda, with 300+ mothers dying per 100,000 births”
Maternal health is a big issue in Uganda, with 300+ mothers dying per 100,000 births. In the UK it’s about 10 per 100,000. So that is thirty times more and that those figures are probably on the optimistic side because a lot of the deaths in villages are not recorded. In terms of making a difference, at Kiwoko we had just 8 deaths in 3,000 births last year. Basically, when you reach Kiwoko hospital – because we have the staff, medicines and knowledge to treat those people – your chances of survival improve drastically. And if you look at the eight last year who did die when here, most of them died in the first hour of arriving – and the delays in coming for whatever reason meant they were already on death’s door when they arrived.
There are many issues feeding into the problems of poverty and poor maternal health. And my role was only a small part of tackling that. But still in many situations and many settings in Uganda, even that part that I played is not present. So, although my role was just only one little thing in the whole big picture of things and nobody can single-handedly erase poverty, I have seen that things have improved. But it takes a long time. In Uganda I’ve seen over the last seven years economically things have improved. Poverty, what I have seen, has become a bit less and also knowledge has increased. People are becoming, even deep in the villages, more aware that maybe mothers don’t have to die when they have a baby. For so many centuries, you ask any Ugandan and they all know somebody who has died having a baby. So they see it as, “Well that’s how it is.” And to come to a mindset and say well maybe it doesn’t need to be like that – that’s a long process which will take many more years.
“Kiwoko was a special place because of the way that the Christian faith is incorporated… at every level.”
For me, Kiwoko was a special place because of the way that the Christian faith is incorporated in each and every thing, at every level. If the tea lady brings the tea in a meeting room, she will be the one that goes on her knees to pray for the tea. And on the wards before operation we pray for patients. There’s prayer teams going out on the wards to pray for people there. If there is a board meeting or a management meeting they start with time of prayer. It is part of the whole fabric of life.