The Triplets

I am a neonatologist and for the majority of my clinical time I care for babies and their families at a large University-based referral neonatal intensive care unit (NICU) in the United States. In 2003, I first visited this rural Ugandan hospital shortly after the opening of a special care baby nursery there, and have been involved with development of that program ever since.

Uganda is a beautiful, land-locked country in East Africa with a sordid political history. It is a developing country that is poor, mostly rural with a high fertility rate and a life expectancy of 42 years. The government spends $5 per capita per year on healthcare. The district with the hospital has a population of 500,000, the majority of which is rural. Access to health services is poor, even by Ugandan standards, and child mortality is in the higher band in the country.

Most people in the region live in extended family clans. A common home is made of earth, with a grass roof, and a jerry can out front for collecting water from the well. It is an exquisitely lush landscape with fecund soil. At the hospital, there is limited electricity, lab support, medications, blood supplies, and health care workers. For the 200 bed hospital (that accommodates upwards of 400 inpatients when necessary, no one is turned away) there are four to seven Ugandan doctors, who do everything from C-sections, to colostomies, to HIV care to resuscitate babies in the NICU. For a ward of 20-80 patients there are one to two nurses, and maybe a nursing aide. Families do the majority of the care in the hospital, even in the NICU. Mum's express breast milk, perform tube feeds, wash the linens, notify staff when an IV infiltrates, and keep babies warm.

Day One

Another beautiful morning, with fresh instant coffee in hand, birds chirping and kids playing outside. It is good to be back. Over the last eight years, I've made some close friends here and its good to be among them again. Every time I visit and return home, I leave a piece of me here, and bring back something new with me. This morning that feeling is overwhelming me, an incredible inspiration swells. I am not tired and I want to be busy. It is no wonder that this is where I was inspired to pursue caring for babies as my career. Over these years, it has been amazing to see the staff care for the community's babies and mums here. As an outsider, an opinioned one at that, I feel burdened at the thought of these babies dying somewhat needlessly. Is it really no-one's fault? How should one act in the face of scarcity, knowing there is a better standard to be had if only circumstances were different?

I walked into the NICU to find triplets had arrived! Born at about 33 weeks they were two months early. Since they weighed around 1.5kg (about 3 lbs) each, they were at very high risk of dying —however, it was absolutely incredible to see the way they were tucked in by the skilled team. Within an hour of delivery—they were in incubators with IVs, having their hypoglycemia corrected, and two out of three were on oxygen (all of them had their O2 saturations checked). The three babies were tucked in so calmly, with the finest skill and expertise neonatal care anywhere has to offer. In stark contrast to the first admissions I witnessed years ago, the nurses now knew exactly what to do and how to do it. As a result, they had saved many lives and restored hope among the mums of the region that there was somewhere to go to get help. This success resulted in a healthy swagger among the staff because they could intervene successfully.

These were spontaneous triplets to this young mum, who already had three other children. She looked tired when she walked into the NICU one hour (yes one hour) after delivering the trio, but if I hadn't known prior, there was no way to know...