Global Health Educators spent two weeks in Uganda with a great team of people including 4 students from the Physician Assistants Program at Jefferson College of Health Sciences, Brian Bixler, Brittany Krantz, Shayla Fawcett, and Joshua Brima along with their director, Wilton Kennedy, DHSc., PA-C. Other travelers included Stephen Hill MD, Susan Hill RN, CRNA, Mark and Judy Gustafson MD, MPH. A HUGE thanks goes out to Maegan Hubbard Gahima and her husband, Dr. Emmanuel Gahima who are currently living in Uganda. They were instrumental in helping to organize supplies, transportation, and logistics prior to our arrival in Uganda.
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| Brian Bixler and two young students at St. Angela's School |
Summary of Projects
Albinism
More than 30 children and adults with albinism live in the Magale area. A great deal of misunderstanding has resulted in tragedy and early death for many of these people with albinism.
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| Joshua Brima gives out hats and sunglasses |
The Vision Pilot Project
St. Angela’s School has an enrollment of 750 children, none of whom wear glasses. The vision pilot project was designed to instruct teachers how to identify children with vision impairment and correct their vision with immediately adjustable lenses purchased at a reduced cost from the Adlens company.
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| Annette, a teacher at St. Angela's |
Brian Bixler led the program in which four teachers at St. Angela's School volunteered to be “champions” of the vision program and were instructed on how to perform a basic vision exam and to assess for refractory error. Out of an initial thirty students screened, five children were successfully fitted with glasses achieving near 20/20 vision. More importantly, these teachers will continue to do vision assessments, fit glasses and plan to update us on their progress in the coming months. Since people with albinism have visual problems that may not be correctable with glasses, we will be looking at other options including magnifying lenses.
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| Newly trained teachers make vision adjustments with Adlens Glasses |
Maternal Health - Antenatal Clinic and Labor/Delivery Ward at Magale HC4.
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| A new mother and her newborn |
Postpartum bleeding and eclampsia are leading causes of death for pregnant women in Uganda. For this reason GHE conducts maternal health training programs to the staff at Magale HC4. Eight midwives attended the educational program led by Dr. Mark Gustafson and Shayla Fawcett. The program included scenario based discussions and reviews of treatment options for postpartum hemorrhage and eclampsia. This interactive approach helped the GHE team better understand the local approach to these dangerous medical emergencies. Management algorithm charts and permanent blood pressure monitors were mounted in the labor and delivery area.
Newborn Health - Resuscitation and Infant Warming Programs
Newborns, especially low birthweight infants, are unable to regulate their body temperature and are at great risk of hypothermia, one of the leading causes of infant mortality in developing countries. This is especially true during the cooler, rainy season in Eastern Uganda. The Newborn Warming Pilot Project was aimed at increasing awareness as well as encouraging temperature monitoring of the newborn.
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| Shayla and Brittany with Newborn |
Warming Program:
Brittany Krantz and Shayla Fawcett provided education for clinical staff and traditional birth attendants on the importance of temperature regulation. A “Thermospot” crystalline thermometer that changes color according to temperature was used on each newborn delivered at the clinic. Charts were mounted on the walls next to patient’s beds showing how to “read” the infant’s temperature based on color changes. Finally, each mother was given a hat and blanket as a reminder of the importance of keeping their babies warm. A special thanks to all the women at home in the US who supplied all the hats and blankets.
Newborn Resuscitation:
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| Susan Hill teaching Newborn Resuscitation |
Due to the delay in seeking medical care for labor and delivery, many babies that are born at the health center require aggressive resuscitation including bag/mask ventilation. Susan Hill CRNA, RN presented newborn resuscitation instruction to midwives and medical staff at Magale HC4 as well as to midwives from surrounding health centers attending the training programs.
TBRA (Traditional Birth Referral Agent) program
The maternal and infant mortality rate is 10 times greater than in the US. Of note, more than 50% of mothers still deliver outside the Ugandan Health Centers with the assistance of men and women with little or no medical training who are referred to as “Traditional Birth Attendants.”
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| TBRA Leader, Patrick Kimuku, presents the uniforms/t-shirts |
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| Susan Hill is being escorted into to Bunambale HC3 |
The emphasis for this October trip was on the leadership of their new organization. Educational materials were developed by Global Health Educators with specific topics identified as most critical by the TBRA leadership. These topics will be presented to TBRAs at the 13 surrounding health centers in the Manafwa District by the leaders of the TBRA program.
Our last day in Eastern Uganda was spent traveling to 6 of the more distant health centers to meet the medical staff and their associated TBRAs. The green TBRA t-shirts and certificates were presented to the most active TBRA members.
Surgery/Anesthesia
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| Dr. Hill, Brian Bixler, and Dr. Maria |
Twenty-six surgical cases were done in the surgical suite including emergency cesarean sections, hernia repairs, and hysterectomies. Steve Hill, MD and Mark Gustafson MD, provided surgical mentoring with the assistance of the Physician Assistant students of Jefferson College of Health Sciences who also traveled from Roanoke. Susan Hill, RN, CRNA, provided anesthesia care and mentoring for the anesthesia staff. Donations from Global Links provided suture supplies and Al Strickler provided the electrocautery equipment from ERBE. Maegan
Hubbard Gahima and Dr. Emma Gahima arranged the delivery of a new operating table and fresh oxygen tanks!
Ultrasound Program
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| Dr. Gustafson evaluates an abdominal mass |
Sonosite Soundcaring program provided an ultrasound for the trip that proved to be very beneficial in helping to rapidly diagnosis medical and surgical conditions. The ultrasound was used on several patients in the clinic. The most notable cases included the diagnosis of large uterine fibroids (leading to an abdominal hysterectomy), an abdominal seroma, and the evaluation of pelvic pain. A crowdsharing program, GoFundMe, is currently underway to purchase an ultrasound machine for Magale, HC4. Thanks to Marguerite Underwood of Carilion Clinic for helping this program become a reality.
Orphan Students at St. Angela’s School
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| Orphan Students at St. Angela's |
Sister Claudia Chebet is the Head Mistress of St. Angela’s School that educates 750 students in the Magale area. The school teaches day students, handicapped children, and boarding students, 70 of which are orphans. Tuition/board for each child costs the convent $23 per month. The school does not receive nearly enough in subsidies and donations to educate, feed, and clothe the orphans living at the school. A program is being developed, in conjunction with Christine Mighion of GHE, to help with these challenges. Sister Claudia has created a brief biography, with pictures, of each of the 70 orphans living at St. Angela’s.
St. Angela’s Convent Receives a Refrigerator
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| Sister Claudia and Sister Helen with their refrigerator |
A big thanks to Dr. Dallas Crickenburger who, after learning of the lack of refrigeration at the convent in Magale, had a refrigerator delivered to the convent prior to our visit, with the assistance of Professor Wilton Kennedy, Maegan and Emma Gahima.
Pen Pals from Roanoke to Uganda
Marcy Wells’ second grade class in Roanoke, Preston Park Elementary, sent gifts and letters to the Ugandan Students at St. Angela’s School (Left).
Wilton Kennedy frightens/delights the children with puppet gifts sent from the US (photo right).
A New Birth Attendant Educational Program Begins in Sipi Falls, Uganda
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| The Sipi Falls Convent |
Mark, Judy, Brittany, and Shayla traveled to Sipi Falls where 26 Traditional Birth Attendants gathered at the Sipi Falls Health Center 2. A focus group was conducted and films on the birthing process, clean delivery practices, and newborn care were viewed and discussed. A demonstration on management of the newborn and newborn airway management was conducted with a very active question and answer session. At the end of the program, the Traditional Birth Attendants chose leaders who would mobilize the birth attendants to conduct regular meetings and discuss safe birth and referral practices. Our appreciation to the Sipi Falls Convent and Parish for providing lodging and dinner for the entire group.
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| Sister Claudia (left) helped to organize the first gathering of Traditional Birth Attendants at Sipi Falls HC 2. Dr. Mark Gustafson leads the focus group and subsequent trainings. |
Thanks to all the people both here in the U.S. and Uganda for making this such a successful trip. Special thanks to the Ugandan nuns who have an organized network throughout Uganda with their associated health centers. This allows for visitor safe lodging, good food, and health facilities that ensure the security of medical supplies.
We are looking forward to the next trip planned for the Spring of 2016.
More information to be added to the Global Health Educators Website:
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