I have been in Uganda for over two weeks now which means less than two weeks left! Unfortunately there is not much to update you all on the project but I'll share other things that I have been doing in my free time.
First, the follow-ups have started. Sister Rose Baluka is in charge of this as she knows the language and the mothers know her so it makes for better communication and data. From first glance at the data it looks like there is success all around. Of course, because I have such a small sample size, I am not expecting a large amount of infant death. Out of the 50 mothers I plan to have enrolled, there should not be more than 5 infant deaths. The mothers we cannot contact via phone will be reached by us traveling to their home. This will be starting this week. So far there is a total of 38 mothers enrolled in the program that have received the health care education and 16 controls enrolled who did not receive the education for one reason or another. We shall just continue with what we are doing until the project completes.
In my free time, I have been reaching out to other organizations I am involved with or know of in Uganda. On Sunday I traveled to the capital city, Kampala, to a Village Health Project colleague. The Village Health Project is a student org and nonprofit at my University that also works in Uganda. I helped Paul, the contact, with the construction of water tank manuals that our organization uses in the villages. Today I just returned from Bulamagi village where I traveled with the Uganda Village Project, another nonprofit, to help them in the building of proper sanitation and hygiene facilities at the villagers home. It is interesting to see the differences between those who live in town and the villagers. From today's visit-I much prefer the villagers! They seem to really appreciate the help offered and respect us more.
It's getting dark here (at 6 pm) so I must end to travel home. Til next time!
Monday, August 22, 2011
Monday, August 15, 2011
Slow but Steady
It's been quite a while since an update so this may be long! I have spent everyday at the hospital so far (meaning Saturday and Sunday as well) and think we finally have a system down. After the first day with Sister Agnes, a different midwife that I have never met before was discharging-which means she should have also been in charge of the education program. I tried to explain to her what she needed to do, but she had a very difficult time understanding me and basically ignored the project. But all is not bad! I decided to use this group of mothers as controls-meaning I will still track them one week later and compare the results between the two groups of mothers: those who received the proper education and those who didn't. And theoretically those who didn't receive the care should have a higher infant mortality rate. This may be hard to prove because the numbers of mothers are so small but it does make the project a lot more reliable (though I do feel a little unethical depriving mothers of proper information). The same midwife was there the next day as well, so I just collected the same information and will do so in the future.
After getting nervous that Sister Agnes may not return to administer the education (she is incredibly busy and in charge of a lot of areas), I expressed this concern to Michael. We quickly set up a meeting with the two in charge, Sister Rose and Sister Agnes and decided to create a private contract to ensure the education is given. Sister Agnes is now responsible for ensuring the education is given everyday and she will be compensated for this extra effort. The past two days she has followed through on her word and beautifully executed the education, interview, and follow up information that needs to be given to the mothers. This Thursday I will be starting the follow-ups of the first mothers that went through the programs and will be accompanied by Sister Baluka for translation purposes.
As for the "runaway mother" issue--I've decided to do some interviewing of the mothers who do not run away to find out why they stay. And I will also be asking others in the community, if we can track them down, why they didn't stay. Some answers I've been given so far all lead the mothers simply not knowing that they should stay for the extra care. I'll probably address this by contacting the antenatal clinic and delivery suite to have them make sure the mothers are aware of the entire process. I may also make some signs...
That's about it for the project updates! I go through about 8 hats a day and am worried I'll be running out within the next two weeks but I may be able to purchase some here. And I finally got a new bed! But instead of bed bugs, for the past two nights I have found a lovely mouse turd laying next to my pillow. I can't win.
After getting nervous that Sister Agnes may not return to administer the education (she is incredibly busy and in charge of a lot of areas), I expressed this concern to Michael. We quickly set up a meeting with the two in charge, Sister Rose and Sister Agnes and decided to create a private contract to ensure the education is given. Sister Agnes is now responsible for ensuring the education is given everyday and she will be compensated for this extra effort. The past two days she has followed through on her word and beautifully executed the education, interview, and follow up information that needs to be given to the mothers. This Thursday I will be starting the follow-ups of the first mothers that went through the programs and will be accompanied by Sister Baluka for translation purposes.
As for the "runaway mother" issue--I've decided to do some interviewing of the mothers who do not run away to find out why they stay. And I will also be asking others in the community, if we can track them down, why they didn't stay. Some answers I've been given so far all lead the mothers simply not knowing that they should stay for the extra care. I'll probably address this by contacting the antenatal clinic and delivery suite to have them make sure the mothers are aware of the entire process. I may also make some signs...
That's about it for the project updates! I go through about 8 hats a day and am worried I'll be running out within the next two weeks but I may be able to purchase some here. And I finally got a new bed! But instead of bed bugs, for the past two nights I have found a lovely mouse turd laying next to my pillow. I can't win.
Thursday, August 11, 2011
Commence IM Program!
This morning I headed out to the hospital at 8 am to prep the staff on the infant mortality education protocol. It was slightly intimidating to be telling these much older, experienced midwives on how and what they should teach but I hope their blank stares were only because it was so early in the morning. Today a midwife named Sister Agnes ran the education and I am so glad she did. She did such a fantastic, thorough job. So fantastic that it made me question if she hadn't done this before. I asked the student nurse who was assisting how this education differs from what they say everyday at discharge time. Her disappointing response? "In no way. We say this everyday." Ahhh, what? Apparently since the creation of the project, the ward received books and information about proper postnatal care. I obviously went home at lunchtime very frustrated.
After lunch I decided to speak to Sister Agnes directly and ask how the project could now be improved. She informed me that the resources I have provided her actually will ensure that all of the education is given. Currently some days the midwives will only discuss breastfeeding or even none at all if they are too busy. At least while I am there, they will cover all the needed information. I also learned of a very disturbing occurrence. Over half of the mothers who give birth simply "run off" and do not stay to receive monitoring, care, vitamins, or discharge information (including how to receive their 6 week infant vaccinations). I am currently brainstorming and working with the staff on how to address this.
For the knitters in the crowd: There were 6 mothers in the program this morning and they simply loved getting to pick out a hat. Though a lot of their babies cried when they put it on, I hope they try it again. And in the afternoon I learned of a mother who gave birth to triplets yesterday (she must stay one week in the ward-which means she won't enter the program) but I gave her three small hats anyway and have some great photos to share!
After lunch I decided to speak to Sister Agnes directly and ask how the project could now be improved. She informed me that the resources I have provided her actually will ensure that all of the education is given. Currently some days the midwives will only discuss breastfeeding or even none at all if they are too busy. At least while I am there, they will cover all the needed information. I also learned of a very disturbing occurrence. Over half of the mothers who give birth simply "run off" and do not stay to receive monitoring, care, vitamins, or discharge information (including how to receive their 6 week infant vaccinations). I am currently brainstorming and working with the staff on how to address this.
For the knitters in the crowd: There were 6 mothers in the program this morning and they simply loved getting to pick out a hat. Though a lot of their babies cried when they put it on, I hope they try it again. And in the afternoon I learned of a mother who gave birth to triplets yesterday (she must stay one week in the ward-which means she won't enter the program) but I gave her three small hats anyway and have some great photos to share!
Wednesday, August 10, 2011
No Cockroaches=Bed Bugs and Mice
I have exchanged not having cockroaches for bed bugs and 2 mice. It seems I cannot escape beds infested with bed bugs! It is the 4th time that I have acquired bites from these hard to kill insects. But my host family has tried to rid them so we will see if they return.
The project has been running smoothly, that is to say for being a foreigner in Uganda. Yesterday I went to the Hospital and visited the maternity ward and met with midwives and nurses in the antenatal, labor suite, and postnatal clinics. Everyone was very inviting which is a huge difference from last time I was here, especially the young nursing students who are my age. I observed some deliveries and was told that I shall deliver the next one! I politely declined but they insisted the only way to learn is by hands on practice. We will see if I can escape this request. I observed how exactly the mothers are shuffled through the wards and unfortunately witnessed how small the wards are and how poor of condition things are in. For instance, the delivery beds are metal and somehow managed to get two large holes in it where the women's feet would sit. There are only 3 beds available for mothers who are about to deliver, and 2 working beds for mothers in labor. The rest must sit on the floor. Birth is quite uneventful when compared to the images the US depicts. Mothers are discouraged from making any noise and there are no machines on or fast paced action for that matter. It is simply daily life to give birth and go home, back to work.
This morning I have met with a women named Sister Rose Bulaka who wholeheartedly supports the project and we have discussed in detail how it will be implemented in the hospital. (She adored the baby hats as well! A pregnant mother nearby our meeting even asked if she could have one when she delivered at the hospital.) The project shall begin tomorrow morning at 8:30 am as mothers are only discharged between 8:30 and 10:30. Eventually my afternoons will consist of following up with mothers. The only thing that remains is finishing of document printing (it is more expensive than I expected-50 cents a page!) and meeting of more doctors and midwives at the hospital. I will update after the project begins!
The project has been running smoothly, that is to say for being a foreigner in Uganda. Yesterday I went to the Hospital and visited the maternity ward and met with midwives and nurses in the antenatal, labor suite, and postnatal clinics. Everyone was very inviting which is a huge difference from last time I was here, especially the young nursing students who are my age. I observed some deliveries and was told that I shall deliver the next one! I politely declined but they insisted the only way to learn is by hands on practice. We will see if I can escape this request. I observed how exactly the mothers are shuffled through the wards and unfortunately witnessed how small the wards are and how poor of condition things are in. For instance, the delivery beds are metal and somehow managed to get two large holes in it where the women's feet would sit. There are only 3 beds available for mothers who are about to deliver, and 2 working beds for mothers in labor. The rest must sit on the floor. Birth is quite uneventful when compared to the images the US depicts. Mothers are discouraged from making any noise and there are no machines on or fast paced action for that matter. It is simply daily life to give birth and go home, back to work.
This morning I have met with a women named Sister Rose Bulaka who wholeheartedly supports the project and we have discussed in detail how it will be implemented in the hospital. (She adored the baby hats as well! A pregnant mother nearby our meeting even asked if she could have one when she delivered at the hospital.) The project shall begin tomorrow morning at 8:30 am as mothers are only discharged between 8:30 and 10:30. Eventually my afternoons will consist of following up with mothers. The only thing that remains is finishing of document printing (it is more expensive than I expected-50 cents a page!) and meeting of more doctors and midwives at the hospital. I will update after the project begins!
Monday, August 8, 2011
Arrived Safe and Sound
After 16 hours of flight, 8 hours of layover, and a 4 hour matatu (cramped taxi bus) ride, I have arrived at Iganga, Uganda. Not much has changed, except there being more trash on the streets. And the sun hasn't shown itself since I arrived which is also not normal. The children still yell "Muzungu bye!" Which means bye white person. Michael's family has been incredibly welcoming to me and I did get to meet his new baby boy Kevin. Good news-my room this time has been cockroach free (so far)!
The plan of action for the next three days is as follows. Today, I will acquire all the materials I need for the project, which includes printing consent forms, questionnaires, and drawing the educational materials. Tomorrow, I will go to the hospital to observe their postnatal care and determine how they currently track infant mortality. And then on Wednesday, I will be meeting with the heads of the hospital to create a team who will be in charge of the project. Because I cannot speak the local language, Lusoga, I unfortunately will not be administering the education. After the meeting, the project will officially begin. Wish me luck!
The plan of action for the next three days is as follows. Today, I will acquire all the materials I need for the project, which includes printing consent forms, questionnaires, and drawing the educational materials. Tomorrow, I will go to the hospital to observe their postnatal care and determine how they currently track infant mortality. And then on Wednesday, I will be meeting with the heads of the hospital to create a team who will be in charge of the project. Because I cannot speak the local language, Lusoga, I unfortunately will not be administering the education. After the meeting, the project will officially begin. Wish me luck!
Thursday, August 4, 2011
Countdown: 2 days until departure
In two days I'll be setting out on a month visit to Iganga, Uganda. I'm going back to this beautiful town because of an opportunity of a lifetime. I recieved a Wisconsin Idea Undergraduate Fellowship Grant to fund a infant mortality research project I designed. The goal of the project is to lower infant mortality rates at Iganga District Hospital and will do so by implementing a postnatal education program provided to mothers before they are discharged from the hospital (from giving birth). This project is aiming specifically to the deaths that occur during the first week of life.
Not to bore you too much, but here are the logistics of the project: It will be completed in three phases. First I will be observing what sort of infant mortality tracking the hospital has in place in addition to learning the postnatal care provided now. After this, a member of the hospital staff (most likely a midwife) and myself will sit down with each mother who has given birth within the last 24 hours and administer an assessment questionaire to determine the mother's current knowledge. This will guide us to areas of needed education and allow for an assessment of our own teaching skills to see if the mothers retained information. Then the education will be given which will consist of proper breastfeeding techniques, kangaroo care (warming of the infant), danger signs to look for in the infant, etc. The same assessment questionaire will be administered after to determine if learning occured. And finally a baby hat made by wonderful women in the States (shout out to my mom, grandma, Sue, Carol Curtis, and her fellow employees!) to help keep the infants warm. And finally to track if the project is actually making a difference, contact with the mothers will be made one week after the educational intervention to determine the health status of their baby.
All of this is expected to happen within one month (a push I know!, especially with the laid back culture of Uganda.). I will be staying with Michael Kaidhiwa and his family, who was my past internship coordinator when I participated in a medical internship at Iganga Hospital in 2009 and had helped immensely with the project proposal. I will also be working with Dr. Peter Waiswa, a fantastic person for mentoring me on this project who has also completed much infant mortality research in Uganda.
That's about it for now! I will update this blog when I have access to internet. Thanks for following!
Not to bore you too much, but here are the logistics of the project: It will be completed in three phases. First I will be observing what sort of infant mortality tracking the hospital has in place in addition to learning the postnatal care provided now. After this, a member of the hospital staff (most likely a midwife) and myself will sit down with each mother who has given birth within the last 24 hours and administer an assessment questionaire to determine the mother's current knowledge. This will guide us to areas of needed education and allow for an assessment of our own teaching skills to see if the mothers retained information. Then the education will be given which will consist of proper breastfeeding techniques, kangaroo care (warming of the infant), danger signs to look for in the infant, etc. The same assessment questionaire will be administered after to determine if learning occured. And finally a baby hat made by wonderful women in the States (shout out to my mom, grandma, Sue, Carol Curtis, and her fellow employees!) to help keep the infants warm. And finally to track if the project is actually making a difference, contact with the mothers will be made one week after the educational intervention to determine the health status of their baby.
All of this is expected to happen within one month (a push I know!, especially with the laid back culture of Uganda.). I will be staying with Michael Kaidhiwa and his family, who was my past internship coordinator when I participated in a medical internship at Iganga Hospital in 2009 and had helped immensely with the project proposal. I will also be working with Dr. Peter Waiswa, a fantastic person for mentoring me on this project who has also completed much infant mortality research in Uganda.
That's about it for now! I will update this blog when I have access to internet. Thanks for following!
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