Delivering Hope: Training for Safer Births in Rural Uganda

CWM
Jul 16, 2025
3 min read

UGANDA

By Jeff James

Anxious energy filled the delivery room at Iceme Health Center as a group of nurses, midwives, and two volunteer doctors surrounded the delivery table. A mother, visibly in pain and struggling through labor, lay at the center of the group. The urgency in their movements and voices suggested a complicated delivery.

Safe Passages program, a program designed to teach emergency obstetric procedures in rural settings where maternal mortality is the highest.

I stood behind a Hawaiian themed curtain, watching the clinicians' silhouettes. Some observed quietly, while others moved swiftly, assisting the on-duty nurse. As this shadow play unfolded, I prayed silently for a safe delivery and a healthy baby.

Moments later, the curtain parted, revealing a bluish-gray newborn carried to a neonatal resuscitation table near the mother’s head. Dr. Elisa Lupi acted swiftly, rubbing the baby vigorously with a towel and manually suctioning the airway to help it breathe. In the tense silence between birth and the first cry, time seemed to stretch endlessly. Fearing the worst, I bowed my head and prayed for life to fill the child’s lungs. Suddenly, a nurse reached past Dr. Lupi, grabbed the baby by one ankle, hoisted it into the air, and delivered a sharp spank to its bottom.

“No!” Dr. Lupi exclaimed, her face registering shock. This outdated technique, once common but now discouraged in modern obstetric care due to its potential to harm fragile newborns, startled everyone. Yet, miraculously, the baby took its first breath and let out a cry. The room erupted in smiles, including Dr. Lupi, as the glorious sound echoed. Amid the relief, this became one of many teachable moments.

In May, I traveled to Uganda with two exceptional doctors: Dr. Lisa Gilbert, a family physician from Wichita, Kansas, and Dr. Elisa Lupi, an obstetric gynecologist from Verona, Italy, now based in Kenya. Our small SUV, packed with vital supplies—an ultrasound machine, infant resuscitators, balloon tamponades for postpartum hemorrhage, training manikins, and blood pressure devices for assessing hemorrhaging mothers—carried us 400 kilometers from Entebbe to Lira, Uganda. Our mission was to train nurses and midwives in the Diocese of Lira’s Catholic health system in our Safe Passages program, a program designed to teach emergency obstetric procedures in rural settings where maternal mortality is the highest.

Uganda’s maternal mortality rate is unacceptably high, primarily from hemorrhage, infections, and hypertensive disorders during childbirth or the postnatal period. Neonatal mortality stands at 22 per 1,000 live births, compared to 3.4 in the United States. This is driven by birth asphyxia, prematurity complications, and sepsis. These figures highlight the urgent need for better training and equipment in rural health facilities.

Over a span of two weeks, Dr. Gilbert and Dr. Lupi trained approximately 25 grateful clinicians at Iceme and Minakulu Health Centers. A key focus was teaching ultrasound use to identify complications before delivery. Many rural facilities, including Iceme and Minakulu, lack blood transfusion capabilities or surgical options for cesarean sections. When complications arise, the 1.5-hour journey to a referral hospital—assuming an ambulance is available—can be life-threatening. Postpartum hemorrhage (PPH), the leading cause of maternal deaths, can kill within minutes to an hour without intervention. Prenatal ultrasound assessments allow mothers to plan deliveries near hospitals. Additionally, training clinicians to assess shock and use balloon tamponades or non-pneumatic anti-shock garments buys critical time to transport hemorrhaging mothers to advanced care.

While it’s too early to measure reductions in maternal and neonatal mortality, the training has equipped these clinicians to handle emergencies more effectively. Our commitment continues through an online group connecting all facilities, enabling ongoing consultations with Dr. Gilbert and Dr. Lupi, who are actively engaged with the clinicians. This sustained support promises to strengthen maternal and neonatal care in Lira, fostering hope for safer deliveries and healthier futures. One midwife from the group offered these encouraging words: “Let’s cascade the knowledge we have acquired to those who might not have attended this training, and let’s all keep this fire of saving mothers and babies burning.”

Thank you for your support. It is because of you and the passion and commitment of Dr. Gilbert and Dr. Lupi that this Safe Passages training could take place and is making a difference