Antenatal Care Group Reflection

Reflection:

                This Wednesday we had our first group led reflection session, with the antenatal group as the facilitators (Abby, Belinda, and Mary).  We first pulled from our homestay experiences, topics which varied from any struggles that were faced that first night and how incorporated we felt by our hosts, to the efforts put forward by our families. 

We transitioned to a discussion about the ethics of working with patients, and the confidentiality that each person has the right to maintain.  The topic of HIV disclosure was one which had varying opinions.  When is the right time to tell a partner or child?  If a couple is discordant, where the wife is HIV positive but the husband is HIV negative, how would one go about sharing this information?  How is a researcher able to move forward with a participant, knowing that he/she may not disclose an HIV positive status with a partner?    

The ethical discussion was left with the thought of how people felt touring the hospital at Kalisizo.  The interesting thing about this experience was that although the students were there to investigate our topics and see different wards, patients’ were laying before us, experiencing real life pain and discomfort.  When we thought about the tour from the patient’s perspective, it made us feel a bit uncomfortable, as if we were invading the patient’s privacy.  During one of today’s interactions, a student was even invited to witness the birth of a child.  This experience brought up uncomfortable ethical issues, but allowed us to gain perspective on healthcare in Uganda.

                Today the three of us met with healthcare professionals at Kalisizo Hospital, a private clinic, and Rakai Health Sciences Project. All three shared with us the different aspects of antenatal care in Uganda, challenges for women in obtaining antenatal care, and frustrations that healthcare providers face. One of the biggest challenges brought up was the lack of available transportation for women to get to healthcare facilities. Women who cannot afford the time or money to get to a hospital or clinic often do not receive any antenatal care and deliver at their homes, with a traditional birth attendant.

              Transportation challenges exist even for those able to reach the hospital or clinic. Women with complicated pregnancies are often referred to regional hospitals for ultrasounds and other care unavailable at the smaller health centers. (In Uganda, the health centers are national, regional, and local hospitals, and health centers are rated on a scale of two to four, a four being the highest standard of care. Kalisizo Hospital is a level 4 health center.) The procedures the women are referred for may also be too expensive or the woman may be unable to be away from home long enough to receive them. 

Billboard promoting access to health care

           Even at the level 4 health center, there was an obvious lack of resources and funding to care for the large number of women wishing to receive care. One service Kalisizo did provide, was the access to what is called “Mother Kit”.  This included 3 pairs of gloves, soap, cord ligature, polythene bags, a razor blade and an infant immunization card.  Mosquito Nets are also provided, which are all given gratis. We also found that HIV testing for pregnant women is compulsory nationwide before receiving care.  HIV positive women are given appropriate counseling and care to prevent the passing of HIV to the fetus.

          Male involvement is also an issue in receiving proper antenatal care. Oftentimes men are entirely uninvolved in the pregnancy, delivery, and postnatal care. A midwife at Kalisizo Hospital cited the need for more education, especially for men and in rural areas, to teach people the importance of proper antenatal, delivery, and postnatal care.

Antenatal facilities at Kalisizo Hospital

          For our group, there were many surprises during our day in the field. First, we were interested to learn that HIV testing is mandated nationwide at health centers in Uganda for all pregnant women. Our initial reactions were all positive, because an HIV-positive mother would be directed to appropriate care, but with more reflection we realized the test could be a deterrent for some women. All three health professionals we spoke with brought up problems including women who don’t want to be tested or receive the results of the test, or women who might not return to the health center after being tested. We were also surprised by the general lack of resources, both in terms of the women’s challenges with transportation and finances and the health facilities’ lack of appropriate physical supplies (e.g. curtains between beds, ultrasounds) and their process of referral for more complex care that made it even harder for the women to receive the care they need. Finally, we were very interested in the role men play in antenatal care here. As in the United States, men in Uganda are less likely to visit health centers than women. It was still surprising to hear accounts of men who refused to provide their wives with transportation to a health center, even for delivery, or men who were generally completely uninvolved in their wives’ health during pregnancy. We’re looking forward to learning more about these topics as we continue to explore antenatal health in Uganda.