Newsletter Global Health Educators Uganda May Trip 2017

Travelers and Educators 

Physician Assistant Students (left) from Jefferson College of Health Sciences:  Andrea Hawkins, Annie Poetker, Chadwick Kanney, and Elyse Pope

GHE Board Members Traveling:  Stephen Hill, MD, Susan Hill, CRNA, Mark Gustafson MD, MPH, and Judy Gustafson MD, MPH

Educational Programs at Magale Health Center IV

NewbornsPrograms to address techniques to improve survival under challenging conditions included newborn resuscitation, exclusive breast feeding, and warming strategies using blankets, hats, and skin to skin contact.

Susan Hill CRNA directing newborn teaching program along with PA students Andrea and Chadwick

Surgery

Multiple surgeries were accomplished in collaboration with the Ugandan medical staff.  A suture training workshop and trainings on surgical and C-section techniques were conducted with the medical staff at Magale HCIV.

Steve Hill MD,  Mark Gustafson MD, and Susan Hill CRNA assist in a c-section delivery with the Ugandan Medical Staff.

Annie and Elyse work with Uganda Medical Staff with Suture Training

Anesthesia

Oxygen and anesthetic supplies are limited for mothers who require C-sections in the rural health centers in Uganda, To help improve maternal and newborn health, a spinal anesthetic program was begun in January 2013.  With each return visit, more spinal supplies are delivered along with anesthetic mentoring for the medical staff at Magale HCIV. 

C-section under spinal anesthesia.  Ugandan medical staff:  Dr. Lukia, Dr. Patrick, and Emmanuel 

Maternal Health Programs

Topics discussed with the medical staff at Magale HCIV included basic ultrasound techniques and hands-on training, postpartum hemorrhage management,  urinary incontinence diagnosis and management, and management of cesarean section complications. 

To improve mother’s attendance to Magale Health Center antenatal clinics, Mercy for Mamas, a NGO based in the US, donated 100 “mama kits.” These kits contain the supplies necessary for mothers to have a safe and clean delivery of their newborns and is especially helpful for those mothers who do not have the finances to purchase their supplies. 

Community Health Programs

 for the Manafwa District Eastern Uganda

Albinism

Albinism, and it’s associated complications of skin cancer, sensitivity to light, and social stigma, has been a problem for large numbers of Ugandans living with this genetiic disorder.  Since 2014, GHE travelers continue to provide education materials along with donated hats and sunglasses to be distributed to the Albinism communities by the Ugandan leadership of the TBRA program. 

Vision

Since very few individuals in this rural area wear glasses, vision testing clinics were held to identify people over the age of 50 who would benefit from reading glasses.  Teachers, community health leaders, convent nuns, and medical staff were especially targeted for this program.  

Annie and Chadwick testing for the correct reading prescription

A leader/teacher of the local birth attendants

Alice, a midwife at Magale HC4

Thanks to the generous donations of reading glasses, many people were delighted to be able to read again without difficultly.

St. Angela’s Convent, School, and Orphanage

The Nuns at the nearby convent again provided lodging and food for the travelers.  Their generosity has allowed us to spend more time at this remote clinic without having to travel long distances to reach a tourist hotel. The children at the school presented song, dance, as well as gifts for all of the travelers.  GHE and Jefferson College PA program presented a financial donation to help with the orphanage along with soccer balls for the children.

Bubulo East Traditional Birth Referral Agent Program (BETBRA)
Meetings and Site Visits with the Executive Committee of BETBRA

Map showing the terrain and location of the 13 health clinics associated with BUTBRA and GHE

The BETBRA program is now officially recognized by the Ugandan Government as a Community Based Organization!  Their numbers now include nearly 400 members and cover 13 health centers in the Manafwa District.  Their goals are to educate mothers and communities about maternal and newborn health along with the need to receive antenatal care and deliver at the health centers by trained medical staff.

Financial Review of Program

Of note is the leadership of the Traditional Birth Referral Agent Program (TBRA) work as volunteers.  The financial donations made to run the program are carefully managed to augment local funding for targeted items necessary for the programs success including communications, supplies/fuel for traiinings, and rain gear to help local TBRAs to transport mothers to the clinics.

Review of Program Data

Eighteen months of data was collected by Gerald Mukhwana, the secretary of BETBRA.   This data was presented in graph format (2 shown below) to identify trends in patient clinic referrals and deliveries, and discuss recommendations for improvements for all the clinics involved. 

Train the Trainer Flipcharts, Site Visits, and Newborn Resuscitation

A newly developed maternal and newborn health training flipchart was developed through input by the TBRA leadership during the previous visit to Uganda in October 2017.   Presentation of this newly developed 24 page training program was presented to the leadership and used during the site visits in May 2017.

The site visits included 6 of the 13 surrounding Health Units and one remote village with challenging access to a health center.  These site visits reinforced the understanding of the challenges faced by these remote communities in accessing health centers.  Flooding causing a washout of the road and the use of alternate methods for crossing and a long walk back to the convent/clinic facilities.

Patrick, program director for the TBRA program, standing 
in front of the washed out road caused by extensive rains and flooding.  

At each site a program was conduced for training of TBRAs and midwives with the newly developed training guide for maternal and newborn health.  Newborn resuscitation programs were conducted with health center nurses and midwives.  In addition, permanently mountable BP Monitors/Cuffs and newborn manikins were presented to the 6 health clinics.  Seven more BP monitors were left for the leadership to deliver to the remaining health units.

Future Plans 

1.  Ugandan BETBRA Trainers are planning to continue with the trainings all 13 Manafwa Clinics using the flipcharts developed in conjunction with USA based GHE.
2.  Development of Ugandan leadership groups in the communities served by each of the 13 health clinics to .  These groups, in collaboration with BETBRA, will focus on major challenges faces by these communities in accessing health care including communication, patient transportation.   BETBRA leadership will facilitate  with local leadership the prospect of the pooling of community resources to address major concerns including the purchase phones for communications, and stretchers for patient transport.
3.  Continued performance assessments of TBRAs at all of the 13 association health clinics with quarterly data collections for each of the 13 health units.
4.  Continued accountability of donated funds with management of funds carefully monitored  by at least 3 members.
5.  Continue to encourage referral to health centers rather than deliver at home
6.  Encourage income generating activities among groups of TBRAs

Ronald
Follow-up Success Story

We met Ronald as a 12 year-old orphan with osteomyelelitis, a chronic infection of an exposed bone fracture of his left leg.  In March 2015 Dr. Drougas performed the necessary amputation of his left leg above the knee.  Since the amputation Ronald has grown out of one prosthesis and is having a new device constructed in May 2017. He is enrolled at the St. Angela’s Convent Boarding School where he is able to enjoy being a student for the first time.  His clothing and school fees are made  possible through generous donations from friends in the U.S.

Ronald age 12 

Surgery/amputation March 2015

Ronald age 14 in May 2107.  Donated clothing, student at St. Angela's boarding school.