Newsletter for October 2016 trip to Uganda

October 2016 

Ugandan Trip Report - Global Health Educators

Travelers to Uganda in October 2016:  Steve Hill MD, Susan Hill RN, Wilton  Kennedy DHSc., PA-C, Mark Gustafson MD, MPH, Judy Gustafson MD, MPH.   Physician Assistant students from Jefferson College of Health Sciences:  Laura Cunningham, Ashylnn Baird, Kristen Peansky, and Alyssa Shroeder.

Programs Addressed

1.  Traditional Birth Referral Agent Program

2.  Surgical and Anesthesia Mentoring Progam

3.  Albinism Program

3.  Maternal/Newborn Health Teaching Programs - Ultrasound, Management of Maternal Emergencies, Breast Feeding, Newborn Resuscitation, Repair of birth lacerations and suture training

4.  Convent School Volleyball and Vision Programs

Traditional Birth Referral Agent Program (TBRA)

  Reducing Maternal/Infant Mortality Through Community Involvement

The Challenge:  Maternal and infant mortality rate is 10 times greater in Uganda than in the US.  More than 50% of mothers still deliver outside the Ugandan Health Centers by men and women  called “Traditional Birth Attendants (TBAs).”  Some caring for Ugandan mothers may have little or no medical training.

A Promising Solution:  The TBRA program was initiated in October 2014 following focus group meetings with the medical staff at Magale Health Center and Traditional Birth Attendants (TBAs) within the community.  Since 2014, the TBRA program has become a grassroots movement spreading to 14 health centers and villages throughout the Manafwa District in Eastern Uganda.  A core of 15 Ugandans comprised of physicians, midwives, and community members lead the educational programs, encourage membership, and collect data on maternal referrals to antenatal clinics and health centers for delivery.  To celebrate their success, we were invited to their gala event on October 19th that included 500 TBRAs, Midwives, and political leaders.  In addition, 5 representatives from the Kitgum area in Northern Uganda attended the TBRA and midwife training programs to learn how a similar program could be initiated in their area.

A Better Understanding of the Challenges in Caring for Mothers/Newborns in Uganda

A trek to the highest village, Bukomi Village (shown in terrain map above), showed representatives of GHE the access challenges facing local TBRAs and their mothers to obtain needed medical care.  “Dramas” were performed along the 2 hour hike to the top and an afternoon rainstorm extended the return trip back down an additional 3 hours.  The experience underscored the need for further education of the entire community and desperately needed rain gear including rubber boots for TBRAs to help transport mothers walk to the clinics during the rainy season.

A "dramatization" of trying to bring mothers down the mountains from the high villages.

Clinic and Village Visits

Other site visits included meeting with TBRAs, Village Leaders, and interviews with mothers at Bubuto HC3 and at Bumwoni village with a high maternal/infant mortality - noted the importance of including village leaders and fathers in maternal health education programs.  The albinism program was discussed at each of these visits as well.

Lessons Learned

There has been a dramatic improvement in the relationship between TBRA members and health workers at the 14 health centers in the Manafwa District as reported by individual interviews of the TBRA leadership.  It is now common to see mothers being brought to the health centers by TBRA members wearing their green t-shirt uniforms. 

Several obstacles that keep mothers from the recommended 4 antenatal visits and delivering at a health centers include: lack of financial support by their husbands to obtain transportation, lack of education, fear of abuse by health workers, fear of testing positive for HIV or other diseases with resultant stigma, and family obligations at home.

“The Way Forward” for the TBRA Program

Educational Support

The most requested topics obtained through leadership interviews include:  Nutrition, HIV testing/couseling, financial preparation for birth, importance of antenatal visits, family planning, danger signs during pregnancy, malaria prevention, breast feeding, newborn childcare,  dangers of herbal medicine, and importance of delivery by qualified medical personnel.  The Ugandan TBRA leadership requested help in the development of these educational programs to be presented in a “Flip Chart” format since electricity is a problem at all health centers.  

Financial Support

Operating expenses for the TBRA program have been helped through the donation of green T-shirts and subsequent selling the TBRA uniform (green T-shirts) to the TBRA membership.  During this visit, a financial donation (from GHE and supporters from the US) was made in order to purchase more uniforms as well as rubber mud boots. 

Data Collection

Monthly data has been collected since January 2016 showing a general positive trend in more antenatal visits and referrals of mothers to the health centers for delivery.   

Surgery and Anesthesia

Steve Hill, MD in Magale OR with Laura Cunningham, Mary Nakye, and Susan Hill, CRNA

Susan Hill, CRNA, names the baby “Grace.”

Over 45 surgical cases were done at Magale Health Center Level 4 despite challenges with limited medical supplies, anesthetics, and oxygen.  The majority of surgical cases were able to be performed under local or spinal anesthesia including a c-section where there had been a question if the infant was still viable prior to surgery.  The mother was so grateful, she requested Susan Hill to name her baby girl. 

Albinism Program

The Challenge:  Albinism is still considered a “curse” with resultant ostracism and illness.  The Traditional Birth Referral Agent leadership has taken over the training and delivery of supplies for the albinism project.  

During the visits to outlying clinics, Ugandans with albinism were encouraged to attend meetings and the communities received education regarding genetic transmission and sun protection for people with albinism.   The TBRA program will continue with trainings and outreach to other organizations in Uganda working with Albinism.

Maternal/Newborn Health Teaching Programs

Ultrasound, Management of Maternal Emergencies, Breast Feeding, Newborn Resuscitation, and Hands-on Suture Training

Each PA student helped develop and present topics on the use of the ultrasound, maternal emergencies, and breast feeding.  Subsequent to the trainings, the ultrasound was used to help in the diagnosis and treatment of more than 15 patients.

Susan Hill, RN teaching newborn resuscitation

Mark Gustafson MD, MPH teaching Ultrasound with Dr. Lukia of Magale HC4

Convent School Soccer Ball and Vision Programs

The Physician Assistant Program of Jefferson College of Health Sciences was successful in a soccer ball drive that resulted in twenty soccer balls being donated to the students at St. Angela’s Convent primary and secondary schools.  

Wilton and students present soccer balls to St. Angela’s primary and seconday schools.

Vision Program

The program began in October 2015 with the first group of PA students from Jefferson College. 

The Vision Committee, consisting of teachers at St. Angela’s primary school, continues to test vision.  Of note was the significant improvement in vision for students with albinism using readers of 3.0 and greater.  Donations for this program continue to be appreciated!

A Final Word of Thanks

Thank you to all our families and supporters in the US for encouraging us to continue to return to Eastern Magale and be witnesses to the continual progress being made by these committed Ugandans. A sincere thanks also to St. Angela’s Convent for providing our travelers with a convenient, safe, and loving place to stay.

From Left to right:  Susan, Steve, Sister Immaculate and Judy

From Left to right:  Laura, Kristen, Ashlynn, Aly, and Sister Symphrose

Ugandan Leadership takes on the Albinism Project

The Leadership of the Traditional Birth Attendant Organization:

Taking on the Albinism Project 

Addressing Albinism in Uganda - The new organization - Bubulo East Traditional Birth Referral Agents have begun efforts to educate villages surrounding 14 health centers in Eastern Uganda. This is the thing....this new grassroots movement has sprung up in the area in Eastern Uganda in which we work. There are 12 Ugandan Volunteers- leader and 390 members. They teach maternal health and when to refer mothers to clinics. But also, they are using GHE teaching materials to help all the communities around 14 health centers to learn about albinism, that it is not a curse, and how to help protect those with albinism.

Without sun protection, children with albinism are prone to severe sun damage to the skin and early skin cancers.

Patrick uses GHE teaching materials to teach a mother with an albino child about Albinism

Dr. Lukia holding a child with albinism at clinic visit in March 2016

Gerald with Albinism Community - program continues

Check out the latest article in the Roanoke Times Newspaper:

Roanoke Times - June 2016

Tribute to the Men Who Care About the Women of Uganda

Global Health Educators is a 501c3 non profit working in Uganda to promote women and infant health.  Starting in 2014, new grassroots movement has taken hold in Uganda.  Naming themselves "Traditional Birth Referral Agents," these Ugandans are helping to bridge the gap between home birth attendants and health centers in the Manafwa district of Eastern Uganda. Their aim is to ensure that all women can get safe healthcare during pregnancy and delivery.  

To my pleasant surprise, many of the people working hard to help the women of Uganda are men from both Uganda and the USA.  This video is devoted to the men who take the time to care...

Who are some of these Uganda men?

On March 4th, 2016, Charles agreed to be interviewed about the TBRA program and the reasons for his involvement.  He is one of several Ugandan volunteers who are trying to make a difference in Uganda.

The Green T-shirts for the Bubulo East Traditional Birth Referral Agents - BETBRA

To help their program continue to develop, Global Health Educators provides training materials and the green T-shirts that are so important to identify members and supporters of the association.  These "uniforms" provide an identity, status in the community, and recognition from health center staff when mothers are taken to the health centers.  This becomes especially important at night when the gates to the health centers are locked to the public.

                 

 Global Health Educators 

 Program Report from Uganda Trip - Spring 2016

The Nile River, Murchison Falls, Uganda

Travelers:  Mark Gustafson MD, MPH, Judy Gustafson MD, MPH, James Drougas MD, Raven Sullivan, and Brooke Parker

Vision:

Improve women and newborn health in the developing world. 

Mission:

Improve the health of communities through educational teaching programs and sustainable interventions.   

Goals:

• Improve maternal and newborn health.

• Strengthen medical care at the level of the health center.

• Improve community health through educational and sustainable interventions.

Below is just a brief report on what we tried to accomplish during our most recent visit.  Our intent for this trip was to evaluate programs that have been initiated on previous trips and present just a couple new topics that were specifically requested by the Ugandan medical staff and community leaders during our last visit in October 2015.  

Magale Health Center Level 4 - Health System Strengthening 

Dr. Drougas (right) working with Dr. Lukia in Magale, Uganda

Surgical and Anesthesia Mentoring: Dr. Sr. Maria Goretti was transferred to Tororo to act as administrator to multiple health centers with Dr. Lukia now acting as the new physician for  Magale HC4. Dr. Lukia  assisted Dr. James Drougas and Dr. Mark Gustafson in multiple surgical cases that were chosen to help improve her surgical skills including Ob/Gyn and general surgical cases.

Skills Training Workshop for Medical Staff: 

A hands-on workshop was conducted with new training topics including suturing, airway management, spinal anesthesia, and IV placement.  Clinical health officers, midwives, and medical staff from several health centers attended these training programs.  

Ursula, midwife, teaching patients
and family about temperature monitoring

Newborn Warming:  The program was initiated by the PA Students from Jefferson College of Health Sciences in October 2015.  Upon return the midwives were continuing to monitor newborns for hypothermia although they had run out of thermospots (stick-on crystalline thermometers).  The midwives will continue with the thermospots donated from VT and temperature monitoring charts posted on the walls near each patient bed.  

Virginia Tech Engineering Students’ “Baby Pod” Evaluation:

The engineering students at VT in Blacksburg, VA requested an evaluation of their  “Baby Pod,” a simple device designed to prevent heat loss that could be made with local resources.  A prototype was taken along with staff surveys to determine acceptance and feasibility in a low resource setting.   Of the 10 midwives who attended the trainings, all provided comments and positive feedback and hope to incorporate this type of device for their newborns at risk for hypothermia.   

Continuing Medical Education:  New topics were introduced including management of wounds, hand hygiene, and an exclusive breastfeeding program for a minimum of 6 months.  Although mothers breastfeed their infants, there are many superstitions and misunderstandings leading to supplementation with contaminated water resulting in early newborn diseases and death.  Time was spent trying to understand the cultural challenges facing mothers and the ability to implement an exclusive breast feeding program as recommended by the WHO and the Ugandan Government. 

Ultrasound Training:  Demonstrations and teaching programs were presented to the staff.  An ultrasound machine was then presented to Magale Health Center to assist with diagnostic imaging.  Sister Aligonda is the new acting head of the medical staff and will continue these training programs as well as assure the safety of the Sonosite ultrasound machine.  Appreciation goes to all who donated toward the purchase/renovation of two ultrasound machines through the Sonosite Soundcaring program.

Antenatal Clinic:   Prior to delivery, four antenatal visits are recommended by the Ugandan government.  To encourage mothers to attend these clinics, “Mama Kits” were given to mothers who were near delivery and had attended all 4 antenatal visits at St. Angela’s HC4 in Magale, and Gamatui HC2 in Sipi Falls.  Pictoral teaching materials developed by GHE were given to the clinic staff and the “Mama Kits” were donated by mercyformamas.com.  GHE is hoping to work in collaboration with “Mercy for Mamas” to improve maternal  and infant care. 

      

 Community Health Programs - Manafwa District 

 Bubulo East Traditional Birth Referral Agents, BETBRA

Traditional Birth Attendants assist more than 50% deliveries in rural Uganda.  To help improve maternal and infant health, GHE has been working with community health leaders and midwives to form a new organization, Bubulo East Traditional Birth Referral Agents.   

BETBRA leadership shown in the photo in front of their new sign

One of several health Centers
 visited by GHE

The referral program was initiated by leaders in October 2014 and now the organization has 390 active members in less than 2 years.  Their goal is to improve education among their members and encourage referrals to the 13 health centers in the Manafwa District as well as becoming recognized by the Ugandan Government as a community based organization.  Of note is that all leaders and members of the organization are unpaid volunteers.  The t-shirts are purchased in Uganda through GHE donations. The leaders then sell these t-shirts to members at a very nominal price that then goes toward expenses of running their programs including communications, office supplies, and collection of data from the health centers.  

In March 2016, the GHE travelers were welcomed into 6 of the 13 smaller Health Centers that refer into Magale HC4.  BETBRA teaching Materials were left with clinic staff and official T-shirts were presented to active members of the newly formed organization.  The T-shirts provide recognition to the people who are committed to improving maternal and newborn health.  

Video below:  A typical warm welcome from one of the 6 health Centers visited on March 5, 2016

Patrick demonstrates the use of a
 handheld magnifier

The leadership of the TBRAs also organized the “Albinism Awareness Program,” that had been initiated in October 2015 with the help of Jefferson College of Health Sciences in Roanoke.  The program included in 4 health centers with multiple Ugandans with Albinism attending the program.  Delivery of hats, sunglasses, handheld magnifiers, and Albinism handouts were left at the health centers for continued education of the health center staffs and communities. 

Albinism education draws many members at their community Health Center

St. Angela’s Schools

The Older Nuns get fitted for reading glasses at St. Angela's convent in Magale, Uganda

(Above) The reading chart used to help
determine strength for glasses

Vision Project:  This project was also initiated in October 2015 with the PA students from Jefferson College.  The teachers at the school created the “Vision Impairment Committee,” composed of 5 teachers at the primary school.  This most recent trip included a review for the teachers about vision testing for both near and far vision difficulties.  The committee received certificates for being part of the committee along with more glasses for reading and distance vision.  Shortly after the visit with the vision committee, the teachers from the primary school tested teachers in the secondary school and fitted 8 with reading glasses.  More reading  glasses were fitted for the older nuns at the convents and left behind for the program to continue.  Sincere thanks to all of our friends and family who donated glasses for this program.    

(Above)  Sister Claudia uses the chart to determine correct lenses for her older brother, Joseph, and his wife, Olive

Orphan Program At St. Angela's School:  

With the generous donations received during Christmas in December 2015, the headmistress of the school, Sister Claudia, purchased large quantities of rice and beans along with fabric to make uniforms for the many children living at St. Angela’s School.  Sincere thanks to everyone who helped with this program. 

Of note:  Roughly 160 children living at the convent school have little clothing.  The donations for the school uniform project also benefitted the community.  The fabric was purchased in large bulk and local tailors helped with the making of over 100 school uniforms.

 

Pen Pal Programs:  

One class at St. Angela’s school was delighted to receive pen pal letters and copies of Charlotte’s Web sent by Marcy Wells’ second grade class from Preston Park Elementary school in Roanoke VA. We are returning with letters written by the Ugandan School Children.  Hope they enjoy! 

We are also bringing back letters from 20 High School students in Magale requesting penpals from Roanoke, VA.

Sipi Falls, Uganda

After spending a week in Magale, Uganda, the group traveled to Sipi Falls to present a training program for midwives and birth attendants at the Gamatui Health Center 2.  Billy Wauyo, the representative from “Mercy for Mamas,” traveled from Kampala to present Mama Kits to mothers who attended the trainings and to meet with the GHE travelers to start a collaboration for training programs for mothers, birth attendants, and clinic staff in Uganda.   

  

Billy Wauyo, representative from Mercy for Mamas, presents "Mama Kits" to mothers participating in the GHE training program in Sipi Falls, Uganda

Dr. Mark Gustafson presents the GHE teaching program to the participants at Gamatui HC2 in Sipi Falls, Uganda.

The Sipi Falls Convent hosted the team for 2 nights.  In addition, one evening was spent with Sister Claudia’s brother, Joseph, a coffee farmer in Sipi Falls.  Several members of his family traveled to Sipi to share in the authentic Ugandan meal and evening with the representatives from GHE.

Sister Immaculate, the "dancing nun," also head mother of St. Angela's Convent in Magale, Uganda

The generosity and hospitality of the Ugandan people is truly remarkable.  This was my 8th trip to Uganda and it felt like coming home.  Again we were fortunate to be hosted by the nuns in convents near 2 health centers.  This association with the convents has provided us with safe food and lodging, a convenient place to stay in close proximity to the health centers, the benefit of learning the culture first hand, and most importantly making us feel appreciated and loved. The nuns living and working at the convents, schools, and associated health clinics devote their lives to caring for their community and visitors regardless of religious beliefs or affiliations.   Their ability to laugh, sing, and dance despite their challenging conditions is always an inspiration.

Sincerest gratitude to all those who make GHE possible,

Love to all who make this possible,

Judy

Judy Gustafson MD, MPH

Program Director

Global Health Educators

Letter from Sister Claudia Chebet - Uganda January 11, 2016

Dear Dr. Judy, I hope everyone is doing well. We too are fine. Thank you very much for loving me and I really do not know how I can pay you for that but all my prayers are for all of you. I have today bought material in process to make. Am sure they will be ready by the time you come. Attached are the receipt and photos of my accident. The receipt for the bought food and photos will be sent later. I just forgot them at home when I came to town. I am very appreciative to you all for your love, care and concern for us especially the children under my care.May God reward you abundantly.

All the best and my regards to all those who made donations.

Sr. Claudia

Everyone,

I wanted to share this letter with you from Sister Claudia after sending her the money that was raised at Christmas. In addition to the money for food, I sent money specifically designated for 150 school uniforms.   What the money did was affect multiple aspects of the community including:  

1. Paying the cloth makers and farmers (who grew the rice and beans)

2. Paying the seamstresses who will make the school uniforms

3. School uniforms for the children who have little or no clothing when they come to school

4.  Which in turn improves self esteem for the children - no children are singled out due to their lack of school clothes - also better nutrition with more food allowance

5. and finally allowing improved learning for the children and better economy for the local community.

I strongly believed that aid can be given carefully to ensure that more than just a few people can prosper (and others will not be hurt in the process) - rather than sending clothing and food directly.  Luckily, there are people like the Nuns in Uganda who can provide a conduit for donations to ensure that the money goes to help the people for which it is intended.

The photo of the overturned minibus is when she was traveling to town about a month ago.  There were about 12 people on the bus, including Sister Claudia. Luckily no one died but it sounds like she had several fractured ribs.  Unfortunately, Internet access and shopping is about 2 hours away on a public bus that is generally overcrowded.  She takes this trip two or three times a month.  (Incidentally, we gave Sister Claudia a digital camera one year ago and she now documents everything!)

Thank you again for being so supportive of this program.

Sincerely,

Judy