It's Monday morning, March 12. A pregnant Jovia Kyamulabi, 24, and her mother, Nalongo Mukiibi, in her late 50s, check into Old Mulago hospital's labour ward 14, following contractions that started at the weekend.
Even though she is unemployed and her boyfriend is a low-income earner, Kyamulabi is the picture of excitement. This is their first child. The couple had settled for Mulago's free but expert services, having researched about private hospital options - including Mulago's private wing - and found them too expensive. Old Mulago's obstetrics unit, which is cleaner and less congested than New Mulago a few metres away, is, however, reserved for mothers without any potential complications, according to the hospital's spokesman, Dan Kimosho.
Mothers likely to need theatre due to their height, the foetal weight or a history of hypertension and caesarean births, are referred to New Mulago, which is better equipped for crises. Kyamulabi, whose progress I had been tracking for this report, asked her mother to inform me that they were waiting for an ambulance to take her to New Mulago's obstetrics unit. Her baby had been found to be too big and she had a suspected borderline pelvis (her pelvis was too narrow), unlikely to facilitate a vaginal birth.
At Mulago, I was surprised to find that the old labour suite opposite ward 5B had been turned into a gynaecology oncology ward for women with cancer, and the labour suite and theatre were now in ward 5C on the same floor. So, unlike in the past, where labouring mothers collided with visitors, the women were now tucked away for privacy, albeit under tough conditions. The congestion in ward 5C was appalling. It was a moths' breeding season and, on the ceiling and walls, hundreds of moths and butterflies looked more at home than the labouring mothers.
Kimosho, however, says the hygiene conditions have greatly improved.
"At least we endeavour to clean and there is no foul smell anymore like it used to be," he said.
I left for work and returned to Mulago at 8pm that Monday. Nalongo was seated on the terrazzo floor on the lay-off balcony, outside between wards 5C and 5B, with about 50 other anxious attendants of women that were here to give birth. Nalongo told me her daughter was yet to go into theatre; the medical staff had decided to let her try a vaginal birth and had put her on intravenous medication to accelerate the contractions. Kimosho later explained that it is the hospital's policy to encourage normal delivery.
"Some women opt for theatre because they don't want pain. Taking one to theatre is a last resort," he said.
As I left later, Nalongo and her son-in-law, Kyamulabi's live-in boyfriend, were retiring for the night on the open balcony.
"Mulago has no luxury for in-law politics! Muko (my son-in-law) and I tried to squeeze into this congested space with as much respect as possible, but at one point in the night, I discovered I had rolled over and my hand was on his head; thank God he didn't notice, because he was snoring!" a bewildered Nalongo recounted later in Luganda, in reference to the Ganda culture that bars a man and his mother-in-law from coming into close proximity with each other.
I had suggested that Nalongo pays for a private room on that floor for some comfort. Although services are free on this floor, there is a charge for the private side rooms; Shs 10,000 per bed, per night. I marched up to a red-belt nursing officer and inquired about a room.
"They're all full, but tomorrow we will discharge some patients and you can pay then," she pleasantly said. I left Nalongo some money for a side room and wished her a good night.
But on Tuesday morning, Nalongo returned my money, saying the nurse on duty had told her all the rooms had been booked upfront by 'big' people hoping to come in. Kimosho is aware that there are still many bribery and unethical practices in the general wards, but it is mainly facilitated by the hospital's clients.
"When attendants don't co-operate, it's hard to net the culprits," he said.
Meanwhile, in 5C, Kyamulabi's labour failed to progress; the baby had not descended a single centimetre, despite the medication. She had been taken off the drip and had rejoined the queue for theatre.
More women in labour were arriving, some cases so critical, they were rushed straight into theatre as Kyamulabi and her colleagues waited impatiently and in agony.
"One nurse told me the midwives were wondering why I was still fully clothed. Other women had stripped down to their petticoats or less, and were groaning in pain. One kept falling off the bed, which, by the way, cost her her baby. According to the nurse, the consensus was that my condition wasn't that bad yet," Kyamulabi said.
At 7pm, a nurse told her to find Shs 250,000 and she would help her jump the theatre queue. It sounded like a bribe all right, but the choice between integrity and life is a tough one. Kyamulabi's mother and boyfriend quickly mobilised family members to raise Shs 100,000, which they handed to the nurse. She reported back that Kyamulabi had moved several places forward and was now third in line for theatre. In the wee hours of Wednesday, an ecstatic Nalongo called me with news that she had just welcomed her grandson to the world.
According to Kimosho, sometimes this ward delivers up to 150 babies a day and between 30,000 and 40,000 a year. I went to Mulago at close to 2pm, bearing gifts for the newborn. Kyamulabi was now in ward 5B, which is reserved for only new mothers - in the hospital's bid to decongest it. Not that it is helping!
"It wasn't easy," Kyamulabi told me, recalling her ordeal. "At the theatre door, Professor Lule told me he was too tired and asked that he starts with me in the morning. I threatened to raise an alarm and throw a fit if they dared wheel me back to the ward. That is how I was finally let in."
Dr J.C. Lule is an associate professor in the Mulago hospital's department of obstetrics and gynaecology. Indeed, Nalongo had earlier told me about how doctors on duty the previous night had kept running up and down as they attended to one mother after another, never taking a moment to sit down.
In ward 5B, there was hardly any standing space for visitors between the beds. For a mother that had just had a C-section, Kyamulabi was lying on her side on the narrow bed to make room for baby Joshua, since this section of the hospital has no cribs. The section also has no bedside lockers for one to keep their supplies, and no tables. Packs of Lucozade an earlier visitor had left were resting by Kyamulabi's pillow.
I looked around for where to place the pack of diapers and toiletries I had just brought and reluctantly placed them next to the Lucozade, above baby Joshua's head. I was glad I hadn't carried flowers as I had intended, as they would have been such an inconvenience. On my way into the ward, I had noticed a small room right next to the nurses' office. About 20 women are either sitting or lying on the floor. One of them told me they were the mothers whose babies were in the special care unit a few feet away. This room, in Mulago's heyday, according to Nalongo who has a set of twins, used to be where mothers to multiples were monitored from.
Nalongo and Kyamulabi were gripped with a new fear; the scramble for beds in this ward. Since her arrival, Kyamulabi had seen two C-section mothers being asked to vacate their beds for positions on the floor, to allow others fresh from theatre to recuperate on the beds.
Kimosho says the story about congestion is an old one for which the hospital is trying to find a permanent solution.
"We're waiting for Parliament's approval for us to get a loan from the Islamic Development Bank to build a fully fledged women's hospital," he said, adding that under another African Development Bank grant, the proposed regional referral hospitals at Kiruddu and Makindye in Kampala should further decongest Mulago as it transfers some of its services there.
To the staff's credit, Kimosho says, despite the overwhelming number of patients, they don't lose mothers and babies that often.
But when I returned to ward 5B on Thursday, it was abuzz with the story of a woman sleeping next to Kyamulabi, who had come from theatre without her baby. She had initially been told the baby was in the special care unit. A nurse doing her rounds found her on the bed and rudely asked whether she was one of those notorious baby thieves - why else was she in the ward without a baby?
Babies mysteriously go missing from this ward, despite the hospital not allowing anyone to leave with a newborn without proper discharge forms. The woman replied that she had been told her baby was in the special care unit, to which the nurse reportedly quipped as she moved on: "Which baby? Check the mortuary!"
The woman's husband had to come in and after a hot exchange during which one nurse had reportedly said the woman had not delivered in the hospital in the first place, the corpse of a baby was eventually produced. This section has one 'working' toilet - a filthy one, as the new mothers try to flush down their sanitary materials and often block it.
Shortly after 2pm, as I was trying to digest the market-like environment, two uniformed security personnel, Dan Mulekezi and Patrick Nsiiro, walked through the ward, announcing that visiting hours were over. Attendants and visitors were shooed out of the ward and told they could only return at 6:30pm (in the private wing upstairs though, attendants stay with their patients throughout).
I left as Nalongo settled down on a mat in front of the dysfunctional elevators outside ward 5B, a food vendor serving her lunch. Other attendants walked out with their laundry and headed for the hospital lawns at the back where they hung their clothes and sat watching them dry, because unattended laundry gets stolen. When I returned on Friday at midday, the door to the ward was closed; the visiting hour is between 1pm and 2pm.
At the door, a crowd was growing. A young woman in her early 20s sat at the stairs with her basin full of folded laundry. I heard someone call her Teo. Nsiiro walked out of the ward and asked the women to clear the staircase for traffic. An angry Teo vacated the staircase to stand next to me, cursing: "Mulago! After what I have seen here, I would rather have my baby in the village."
She recounted how her sister had almost died on Wednesday, after the midwives refused to attend to her, despite her baby having crowned.
"One of them kept telling me: 'Genda e Kasawo (go to Kasawo)' and I had no clue what she meant until someone explained that she was asking for a bribe," Teo said. Kasawo is a Luganda word for purse or small bag, although it is also the name of a town in Nakifuma in Mukono district.
Teo said she offered Shs 30,000 and soon after, her sister was helped to deliver.
"That's why we're still here two days after a normal delivery. She almost died! Don't let anyone dupe you; nothing there is for free in Mulago," she said.
Our conversation was cut short as Nsiiro ushered us into the wards.
"If we have offended you in anyway, please forgive us, for we're human too. Go on and see your patients, and please mind the pickpockets," he announced in Luganda as a sea of people pushed past him.
Kyamulabi was not on her former bed. I searched the other beds and the floor, covered with women sitting or lying on mats and eventually found her in another part of the ward, carrying her baby in one arm and the urine sachet connected to a catheter in the other - since she was not yet able to use the toilet.
"My mother has gone home to prepare porridge for me, and you can't leave your baby unattended; you'll not find him," she explained the 'expert juggling.' She needed to walk around to quicken the healing process, but had no one to leave the baby with.
I noticed the drugs for the first time: three packs of Metronidazole intravenous infusion (she said she received six after the operation and a nurse has been administering them twice a day), four packs of Ceftriaxone injectables, paracetamol, a roll of gauze, a roll of cotton wool and two diapers.
"They gave us all that for free. Isn't that great? But you have to watch your medicines. I have been warned that people, including some staff members, steal them and they end up in drug shops," said Kyamulabi, adding that if one lost their supplies, they would have to buy another lot from the hospital's pharmacy - and the drugs are not cheap.
Kyamulabi and baby Joshua were finally discharged on March 17 and left the ward as more mothers and newborn babies arrived to have their own share of this unique and trying experience.