“Ask her to get up on the examining table so I can examine her abdomen,” I said to Joey, my translator. He mumbled something to the woman I had just interviewed and she got up and walked across to the table. He seemed to be able to speak any african language with hardly any movement of his lips.

The woman complained of tiredness, intermittent dizziness, abdominal discomfort and low back pain. These were frequent complaints of the women I met in the Nakivale clinic. Through Joey I had questioned her at length to fully understand her problem. My examination was just to confirm my suspicions.

To see her abdomen I had to undo the bulky african fabric that forms the loose long dresses that many of the women wear. I began to gently palpate the four quadrants of her abdomen in the stylized manner of a medical examination. In the lower abdomen I felt a hard mass. This was unexpected. It was mobile under my fingers and it didn’t cause any pain if I gently squeezed it. At that moment she turned and spoke to Joey.

He laughed. “She just told me she’s four months pregnant.”

This was not the first time in the past three weeks a woman had failed to mention she was pregnant. It had happened often however this was the first time I thought I had discovered a tumor when it was simply a gravid uterus.

It seems that pregnancy is natural state of being for women in Uganda. During their child bearing years they are more often pregnant than not. Families of 6 or 8 children are not uncommon. The fertility rate in Uganda was 6.5 in 2007, down from 7.1 in 1990. The annual population growth rate is 3.1%, one of the highest in the world. By way of comparison the fertility rate in Canada is 1.5 and our population growth rate is 1%.

One factor that may encourage childbirth in Nakivale is the policy of giving the same food ration to a child as to an adult. This means that an extra baby in the family will give them an extra bag of maize and a jug of cooking oil every month.

We have two midwives in our clinic and they are very busy. They run a prenatal clinic twice a week and deliver up to three babies a day in our little delivery room. Some mothers still prefer to have their baby at home, especially if they live a long way from the clinic. A mother could live up to 10 kilometers from the clinic - that’s a long way to walk when in labour.

I’ve only had two women request contraception during my time at the clinic. Both of these women were well educated. Most of the women we treat come from small villages and have had minimal education. The occupation listed on their medical chart is often ‘peasant’. It is possible that they are not aware that we can give them the ‘pill’ or an injection of depoprovera.