Arrived Home Safe and Sound

I have arrived back to my University in Madison, Wisconsin after a safe flight home.  Reflecting back on the trip, it is safe to say it was a challenging one but definitely productive.  I will continue to receive follow-up information from my midwife contact at the hospital of mothers and their infants as it becomes available.  And so far, there still has been no infant deaths!  This in itself is a huge success. 

The biggest benefit I see from this project is truly learning where a great need lies in the Iganga area regarding infant mortality rates.  As I mentioned before, it is within the village away from the hospital.  There are many different levels of health centers surrounding the district serving many mothers where the resources and education are severely limited.  This is my new focus as I feel confident the staff at the hospital has learned how to give the appropriate discharge health education. There is still an issue at the hospital of a large number of "runaway" mothers who fail to stay at the hospital until discharge--but I am also working on this issue.  I have met many contacts and organizations working diligently in the area addressing similar health focuses as me and I am so glad to learn of the efforts and the potential connections of the future.

Thank you for following my first blog! I have posted photos of the trip on facebook.  And if you have any questions regarding the project or are looking for connections in the area, don't hesitate to ask.  Until next time...

Inspiration

Some inspiration for the project!  At the hospital, I recognized a mother who participated in the project a few days prior.  She had her baby with her and was speaking to a student nurse.  I went to say hi to the mother and noticed she had the baby hat on her infant still (yippie!) and found out she had returned to get help because her baby was bleeding from her nose.  Bleeding from the nose is one of the dangers signs we stress to the mothers in the health education, and if that should happen they should immediately seek help. It is unfortunate that her infant was ill, but so great to witness a mother listening to the health education and acting upon it!  Now we can only hope she gets the appropriate treatment needed (which is a whole different battle in itself).

After much more traveling to the villages, I decided to check out a health center in one of the them to compare their postnatal care to the hospitals.  I went to a village health center 3 (which is two steps below a hospital).  What I found was both frustrating and humbling.  It became immediately apparent that my project and model being used at the hospital would have really benefited the health centers.  Currently they have up to 7 mothers per day that are discharged.  They get discharged with minimal education (most of their education is given at antenatal visits) and are told to come back on Thursday (no matter the day of their discharge) for group education.  At the group education they discuss cord care, breastfeeding, family planning, and maternal care.  They do not touch on danger signs of the infant/mother or Kangaroo Mother Care for low birth babies.  The midwives have never heard of KMC at all.  This poses a problem in that depending on when mothers give birth, they could go for almost a whole week not knowing how to properly breastfeed or clean the cord, etc, especially pertinent information for new mothers.  All of this contributes to the very high neonatal infant mortality rates.  Because I am at the end of my trip there is a limited amount I can do in regards of starting the health education here.  I explained to the head midwife what should be done, when and what education should be given to the mothers and I gave her a replicate of the educational materials and resources I am using at the hospital.  I also provided her with baby blankets--to be given to low birth weight babies as I do not have enough baby hats!  The Uganda Village Project will be checking up on the project for me in the next weeks.  If I should wish to continue with infant mortality research, the health centers provide the perfect outlet for great change.  They appear to be much more receptive to changes and aid in a humbling way.

For those of you interested in US infant mortality--check out this article that proves research and quality of health care is something that needs to be continuously worked towards.

http://thechart.blogs.cnn.com/2011/08/31/u-s-ranks-low-for-newborn-survival/?hpt=hp_t2

Halfway Done

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!

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.

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!

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!

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!