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.
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| 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
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Steve Hill, MD in Magale OR with Laura Cunningham, Mary Nakye, and Susan Hill, CRNA
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Susan Hill, CRNA, names the baby “Grace.”
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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.
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Susan Hill, RN teaching newborn resuscitation
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Mark Gustafson MD, MPH teaching Ultrasound with Dr. Lukia of Magale HC4
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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.
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| 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.
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From Left to right: Susan, Steve, Sister Immaculate and Judy
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From Left to right: Laura, Kristen, Ashlynn, Aly, and Sister Symphrose
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