The team has arrived home safely

I thought I would post a final entry to cap off the February/March 2012 trip, to let everyone know that the team arrived home safely on Wednesday afternoon (March 7th).  Dr. Francis Tabu joined us on the long journey from Kampala to Toronto, to begin his 4 month residency placement in Obstetrics & Gynecology, beginning in Brantford.  The team was also very glad to reunite with Stoyan Gueorguiev at Heathrow airport on Wednesday morning, as he was en route back to Canada from Bulgaria.  It was great to have the team back together just as we started, for the last leg of our journey.

And so ends a full and productive 11 days that went by in a flash.  It was wonderful to reconnect in person with our Ugandan colleagues in Kampala, Mbarara and Gulu and a true privilege to walk beside them as we continue our collaborative work together. We are so grateful for the kindness, warmth and hospitality of our colleagues and friends during our time in Uganda.  We have much to look forward to in the coming months as we prepare for the Side-by-Side Uganda conference in October in Hamilton.  Many of our Ugandan colleagues plan to join us for this conference and along with them, we look forward to this event with eager anticipation.

http://www.internationaloutreach.ca/Uganda-Conference.htm

We look forward to sharing all of our work and photos with you in the coming weeks.  Thanks for following along with us over the past 2 weeks.

It is a privilege for us to be part of this team.

 

NeoNatalie

 

At Mbarara Regional Referral Hospital, Dr. Ttendo our coordinator had very kindly arranged for me to have access to the former ICU, which is currently vacant, so I could use the space for Nursing teaching activities.  This small room just off the Postnatal Ward (that until recently held two critical care beds) is empty and apparently there are plans to convert it into a permanent teaching space.  Given the extreme congestion and overcrowding in the obstetrical area, we have encouraged the team to consider utilizing the space to help decompress the cramped wards, perhaps for high risk or unstable mothers.  One of the major barriers to this is lack of staff to support the space.  So for now the room sits empty and locked, and I was very grateful to have the key and be able to use the space so as to avoid obstructing the nurses’ workflow directly on the wards.

So today I had the pleasure of facilitating some Nursing and Midwifery education, thanks to a “baby” named NeoNatalie. 

Sister Agirie and I had been working on plans to provide some education sessions for the staff on maternal/newborn Nursing documentation, team communication and basic neonatal resuscitation skills.  These are just three of the many areas requiring extensive ongoing support and education for the obstetrical staff on the wards and in the Operating Theatres.  I had prepared short presentations using Sister Agirie’s roll of SmartSheets self-adhesive vinyl posters (thanks to Marnie Buchanan for providing these on the last IOP trip – they are being well used by Sister Agirie for Nursing education and it was great to have the roll available this week), however it has been challenging to gather a large group of nurses together at one time as this means pulling them away from patient care when they are already so stretched and busy.

The hospital recently received two NeoNatalie simulation kits through an initiative of the Ugandan Ministry of Health called “Helping Babies Breathe”, however the dolls had never been used for staff education on the wards.  Conversations that I had been having with staff, as well as my own observations at deliveries, confirmed that there was an ongoing need for some education and consistency in the way that the nurses and midwives were caring for babies immediately after birth.  So Sister Agirie and I cracked open one of the kits and assembled NeoNatalie together.  The doll is made of plastic with a formed head and flat body that you fill up with 2 liters of water, and NeoNatalie then takes the shape and weight of a real baby.  She comes with all of the basic equipment required to provide drying and warmth, suction, bag/mask ventilation and the instructor can even control crying/breathing, chest movement and pulsation of the umbilical cord with a small handheld bulb.

The morning started quietly, with 2 midwives who quite reluctantly joined Sister and I in the “teaching room” where we had NeoNatalie set up on a table.  About 30 minutes later, word had spread and there was a steady stream of nurses, midwives and students who wanted to get a glimpse of NeoNatalie and have the chance for some hands-on experience.  We reviewed the basic principles of neonatal resuscitation together and each participant was able to practice her bag/mask skills on the doll.  The nurses and midwives asked excellent questions and I was impressed by the teamwork that started happening as they talked through each scenario together.  Sister Agirie is an excellent teacher and I encouraged her to try and provide these sessions for the staff on a regular basis.  By the end of the morning we had inserviced 14 nurse midwives and 6 student nurses and we plan to run another session on Monday.    

Given the extremely challenging environment, it was so encouraging to see such engagement and enthusiasm among the staff this morning.  It’s overwhelming to think of the magnitude of the issues and challenges these nurses face on a daily basis as they do their best to care for patients and families.  Then I wonder, if it’s overwhelming for me to think about, what must it be like to live this experience day in and day out?  Despite this, the nurses still have hope, they still smile, they still take pride in the work that they do, and when given the opportunity, they will tell you all about it. 

We just have to keep asking. 

The Mothers of Our Nation

Note: as predicted, internet access has been patchy here.

Wherever you go, there you are. So here we are in Mbarara, Uganda, a bustling town that seems never to sleep. We arrived here on Monday evening after a nearly 5 hour drive from Kampala. We were glad to see that the road conditions have improved greatly from last year, with far fewer unpaved sections which can be precarious to navigate. Simon, our driver did an excellent job of negotiating the terrain and often erratic flow of traffic. Close to our destination at about 8pm in darkness, we did encounter a huge overturned transport truck on the right side of the two lane road. The smell of diesel hung in the air as our vehicle carefully sidestepped large pools of the spilled fuel all over the road. At first glance one would assume that this accident had happened mere moments ago.  Not the case. Simon recalled passing this very scene almost a full day before. The cleanup would happen eventually, but as with many things here, the process would be a slow one. There is a constant stream of traffic on the busy main road; everything from cars to boda bodas (motorcycles carrying 1 to several people each – nobody wearing helmets) to bicycles to large open trucks carrying bananas to Kampala.

On the journey to Mbarara, one of our IOP team members, Stoyan Gueroguiev, unfortunately received the very sad news that his mother had passed away.  Our sincere condolences are with Stoyan and his family during this very difficult and sad time.  Stoyan left Mbarara to travel to Bulgaria on Tuesday morning and we wish him safe travels.  Our thoughts are with Stoyan as we continue our work here in Mbarara, and we know that he was very much looking forward to working with his Biomedical colleague during our time here.

So the team is here and busy working with colleagues in our respective clinical areas at Mbarara Regional Referral Hospital.  Dr. Hutchison, Mary Griffiths and myself (Kim Ross) describe some of our experiences so far:

Mary Griffiths (RN – Mental Health) was very happy to see that the Psychiatry Unit has moved into one of the new buildings.  Now the Occupational Therapy and Social Work staff have an office in the Psychiatry department, which provides patients with better access these services.  Conditions have greatly improved in the Male and Female dormitories, as well as facilities for family members to stay with their loved ones.  There are areas for cooking, bathing and doing laundry which is extremely important as patients rely solely on their families to provide their meals and supports (these are not provided by the hospital).  Mary has conducted two staff workshops on Nursing Assignments and Hearing Voices (an experiential workshop to help participants understand how hearing distressing voices can affect patients’ lives).

Dr. Bob Hutchison (Obstetrics & Gynecology) has joined the Obstetrical staff at Mbarara Regional Referral Hospital (MRRH) in providing an operative obstetrical course for the interns, over a three day period (Wednesday to Friday this week).  This course, developed by the Canadian Network for International Surgery (CNIS) provides a framework for early surgical training, particularly important for interns who will go into rural areas right after graduation.  The obstetrical unit, which services the city of Mbarara and the far-reaching rural community, has seen its obstetrical population increase by approx. 2000 over the past few years, now delivering approx. 9000 per year. Concurrently, through a number of initiatives, the team has seen a significant improvement in Maternal Mortality.  These interventions have included more rigorous tracking and analysis of maternal deaths with support from St. Joseph’s Health System, the introduction of a fund for emergency drugs and supplies for critically ill women who have limited financial means, and an initiative to improve obstetrical perioperative care with the introduction of the Surgical Checklist, improved monitoring during the postoperative period and an improved (though still challenged) Intensive Care Unit. 

Dr. Francis Tabu, a final year obstetrical resident from Mbarara, will be coming to Canada for 4 months of training, starting in Brantford in early March.  We look forward to working with him.

Kim Ross (RN - Maternal/Neonatal) is working with Sister Agirie, the Area Manager for the Operating Theatres, which includes the ”Gyne Theatre” where all of the Caesarean sections are performed.  Sister Agirie is a midwife by training and is very passionate about maternal newborn health, and continuing education for the nurses and midwives.  Kim has also been meeting with the nurses and midwives in the Antenatal, Labour and Postnatal Wards to reconnect from our previous Nursing visits and discuss the current nursing/midwifery challenges in the clinical areas.  Sadly but as expected, many of the same challenges exist related to extreme understaffing (4 nurse/midwives on day shift and 2 on nights for approx. 30 antenatal/labouring women, the 3 bed Labour Ward where deliveries take place, and 30 postpartum women).  Lack of equipment and instruments continues to be a challenge, and as recently as today there was no oxygen available in the Labour Ward for neonatal resuscitation.  The nurses had developed a contigency plan for moving babies to the new ICU when oxygen is needed for resuscitation, however this involved walking outside along several paths to the connecting building where ICU is located.  Today plans were discussed among the nurses and physicians to move an oxygen tank with the necessary accessories, as well as a portable suction machine into the obstetrical area.  Sister Hope, the Charge Nurse, advocated for these changes and has also taken ownership of the emergency drug/supply cupboard, where she carefully tracks inventory to ensure that adequate supply is on hand.

Side note about our supplies and equipment: I forgot to mention that unfortunately most of our boxes (7 of 10) of medical equipment and supplies were impounded by Ugandan customs at the airport upon our arrival.  We anticipate that Dr. Ttendo our coordinator will be able to retrieve most of these items early next week.  A significant inconvenience but unfortunately these are the realities with which we are faced.

Upon our arrival at MRRH we were pleased to see that the first phase of construction of the new hospital has been virtually completed, although still without electricity.  Those of you who have been in Mbarara on previous visits will recall that the building was in various stages of construction for quite some time.  Obstetrics, though anticipating being an early occupant of the new hospital, will unfortunately have to continue in their present challenging environment indefinitely.  The team needs our continued support and encouragement to advocate for this very necessary move, to improve conditions for women, babies, families and staff.

So this is a somewhat lengthy account of our observations and experiences thus far in Mbarara.  We hope this gives you a glimpse into the environment and the work that is happening here.  It’s difficult to fully describe through words alone, and we hope to post several photos for you tomorrow.

Mary, Bob and Kim are currently enjoying samosas and pizza under the stars at the Acacia Hotel, where we are staying.  We are enjoying the opportunity to unwind and chat about the day. 

Regards to our colleagues, families and friends back home, we thank you for you ongoing support while we are here in Uganda with the IOP.  Signing off for now. 

Kim on behalf of Bob Hutchison and Mary Griffiths

We have arrived

Hello everyone, this is our first official blog post of the February 2012 Uganda IOP trip.  I’m pleased to report that after a long journey the team has arrived safely in Uganda, more specifically in Kampala at Makerere University Guest House.  Our team consists of Stoyan Gueorguiev (Biomedical Engineer), Mary Griffiths (RN – Mental Health), Dr. Bob Hutchison (Obstetrics & Gynecology) Dr. Peter Kagoma (Hematology and our Uganda IOP Coordinator and Team Leader) and myself, Kim Ross (RN – Maternal/Neonatal).  We were also joined on our travels by Dr. Phil Dass, an Anesthesia resident at McMaster University who is completing a 3 week elective placement here in Uganda, through SJHH IOP.

We arrived late on Sunday night (we are 8 hours ahead here), weary after two long flights punctuated by a 4 hour stopover at London Heathrow before completing the second and last leg of our journey to Entebbe International Airport, just outside Kampala.  The temperature here tonight is about 22 degrees with a lovely refreshing breeze. 

It was great to see some familiar faces when we landed, as we were warmly greeted by our colleagues Dr. Stephen Ttendo, Dr. Musa Waiswa and our wonderful logistics coordinator Joseph Musisi.  We made our way outside, loaded up the vehicles with luggage and people, and headed for the Guest House where we had a bite to eat and held a mini team meeting before retiring for the evening. 

We are excited about what lies ahead as we divide ourselves between Kampala, Mbarara and Gulu and we have worked with our Ugandan colleagues to plan many collaborative activities for the next 9 days.

Our goal is to post daily on this blog, barring any issues with internet access but so far so good.  Thanks for following along with us on our journey.  It is a privilege to be here and we look forward to sharing our stories, work, and hopefully some photos over the coming days.  Thanks to our families, friends and colleagues back home for your support.

Signing off for now.

Kim Ross

Preparing for departure to Uganda

Hi everyone, Kim Ross here with a “test post” to the blog to ensure all is working well.  Five team members are busy preparing for our upcoming trip that begins February 25th 2012.  We will be blogging about our experiences as we continue working on initiatives with our Ugandan colleagues.  Looking forward to seeing our dear colleagues and friends in just over a week.  Signing off for now, more to come.

Conflicted

What’s it like to travel seven hours through one of the poorest countries on earth?

It’s exhausting. Physically and emotionally.

Physically in my case yesterday because the road we traveled has to be one of the worst anywhere on the planet. Of the 7-hour trip, the last three are spent on what I can only describe as a bumpy garden path wide enough for two cars (barely) over terrain that has never been graded. There’s no worn-down flat part because this ‘road’ is made out of rocks (small boulders actually) and three times, we had to cross a river without a bridge. When the rains come, the road is impassable. And this is the only access from Port-au-Prince to La Pointe where we are staying. To dull the monotony of the return trip, I’ve convinced my host to let me drive home.

But the real drain is on your emotions. I found myself tired last night. Tired of seeing people live in miserable conditions. Tired of seeing little babies struggling for life due to malnutrition; one of whom surely died through the night. Tired of hearing doctors telling me stories that would make you cry. Tired that the world, despite uncountable efforts, seems so damn incapable of ridding us of this scourge. Of poverty.

And then the guilt sets in. I get to go home. I will eat tonight. I will sleep safely. And then…how dare I let myself get tired from just seeing their poverty. They’re the ones who have to live it.

The guilt is crushing. And it’s a useless emotion because in the end, it’s selfish.

The balance comes from, all of all things, the wisdom of the tacky serenity prayer you see on bumper stickers: know what you can change and what you cannot. Our work cannot rid this land of poverty, nor can it solve the crisis that is public-health here. We can however, help a little hospital work a little better. Patients there will get care that is a bit more timely, a bit more effective, and a bit more clean today than they would have a year ago. There’s a little baby boy that (hopefully) had his first birthday last week because two of our volunteers saved his life minutes after he was born last October.

I held that baby last year. I wish I could see him today. Maybe he’d give me the hope I crave.

Looking for it, instead of at it…

Six weeks ago we shipped a container full of medical supplies, birthing beds, and 300 feet of plastic pipe to hook up the water system at the hospital. Worst-case, it takes 4 weeks to get a container to Port-au-Prince. We left ourselves a lot of wiggle room. Or so we thought.

Alas, nothing in Haiti is predictable. With the change in government last week, we got caught in transition (and translation) and as of this morning our container had not cleared customs. Only a senior government official can do this and despite our best efforts, we couldn’t find this elusive character.

We hoped to get here and start the week by looking at our supplies. Instead, we’ve spent the last two days looking for them. We’re only here for five days and I was worried we wouldn’t meet our goals so we made a decision to stop waiting on others. We had bought supplies locally many times so we figured we could do so again, even if 300 feet of piping was a tall order. We had already expanded the scope of our water project the day before, so we were going to need to buy more anyway. Why stand around waiting for some official to grant us our goods. Action beats waiting any day.

As I mentioned in the post this morning, our goal is to provide clean water to the maternity ward by the end of the week. The only way that can happen is if we start today. And so we went to work. You can see below that the reference to the “Haiti Home Depot” is based on fact, although I suspect this is not a licensed franchise.

The Haitians are nothing if not enterprising.