Good Morning,
Mbarara Hospital had arranged for the IOP team to enjoy an afternoon at the Queen Elizabeth National Park today. With an early wake-up call of 0500, we were off to enjoy a safari adventure. We are very fortunate to have the support of our driver Simon, a native Ugandan, to drive us 3 hours north to this park. Simon is a father of four children (two sets of twins ages 8 and soon to be 4), and is a driver for Mbarara Hospital. The roads leading to the national park are very winding, and go back and forth from stone to ash fault. There are no speed limits posted on the road, and many drivers weave in and out through traffic, but Simon kept a steady pace to get the team to the team there safe and sound . We only had a few hours to enjoy the park, for we are all invited by the Dean of Mbarara University, for a farewell dinner. The temperature rose quickly today, from about 18 degrees in the morning to about 35 degrees by noon. At the national park we were so lucky to see elephants, alligators, hippopotamus, water buffalo, gazelles, wart hogs, and many species of birds. This was a lovely adventure built in to our time here in Uganda. We are back at the hotel and we are now getting ready for the Deans’ dinner.
As we were we enjoying each others company at the Deans farewell dinner, we were also celebrating Saramin and Ed’s Daughter Isabelle’s 21st birthday! We placed a call to her, and we all sang happy Birthday to the young lady!
Until tomorrow,
Marnie, Jessica & Saramin
Friday, August 6, 2010
August 6, 2010,
Hello everyone,
This is our last day in Mbarara. I went to the hospital to meet with Ivan Wong, a senior medical student from Cambridge who is here to do a feasibility study on the implementation of an ER obstetrical response team. He is working with a larger group from the UK and is here for 3 weeks. We met to discuss ways to combine our efforts since our objectives are similar and prevent a duplication of efforts. Ivan told me about an express train from Paris to London that takes two hours and goes under the channel in case I could manage a visit to meet the leader of his team Dr. Isabeau Walker. The thought of travelling along the ocean floor is unsettling and I’m not sure I could make the trip without fortifying my nerves! We shall see if I can get up my courage.
I also met with the residents of the Obstetrical department and the senior resident, Dr. Mussa who will be coming in January 2011. Not the best time to come to Canada but he is up to the challenge of the snow and cold. While at the meeting I met a McMaster medical student who is doing a month in Uganda for his international studies. It’s funny that no matter where you travel or for what purpose you are always pleased to meet someone from close to home. Often you compare acquaintances and sure enough he knew a student I had taught in first year. Last year I actually came across one of my students doing the same elective at Mulago Hospital.
Jessica, Marnie and Ed went to the Queen Elizabeth park this afternoon and had a great time. They saw lots of hippos, elephants, water buffalo, crocadiles, and wart hogs. Still haven’t seen a lion. We’ll have to keep coming back until we’re successful!
Tonight we’re all going to a final dinner with our hosts from Mbarara. It has been a wonderful and fruitful visit. Its sad to say goodbye to our friends once again. Luckily with email and skype we can keep in touch.
Til tomorrow, Saramin, Jessica, and Marnie.
This is our last day in Mbarara. I went to the hospital to meet with Ivan Wong, a senior medical student from Cambridge who is here to do a feasibility study on the implementation of an ER obstetrical response team. He is working with a larger group from the UK and is here for 3 weeks. We met to discuss ways to combine our efforts since our objectives are similar and prevent a duplication of efforts. Ivan told me about an express train from Paris to London that takes two hours and goes under the channel in case I could manage a visit to meet the leader of his team Dr. Isabeau Walker. The thought of travelling along the ocean floor is unsettling and I’m not sure I could make the trip without fortifying my nerves! We shall see if I can get up my courage.
I also met with the residents of the Obstetrical department and the senior resident, Dr. Mussa who will be coming in January 2011. Not the best time to come to Canada but he is up to the challenge of the snow and cold. While at the meeting I met a McMaster medical student who is doing a month in Uganda for his international studies. It’s funny that no matter where you travel or for what purpose you are always pleased to meet someone from close to home. Often you compare acquaintances and sure enough he knew a student I had taught in first year. Last year I actually came across one of my students doing the same elective at Mulago Hospital.
Jessica, Marnie and Ed went to the Queen Elizabeth park this afternoon and had a great time. They saw lots of hippos, elephants, water buffalo, crocadiles, and wart hogs. Still haven’t seen a lion. We’ll have to keep coming back until we’re successful!
Tonight we’re all going to a final dinner with our hosts from Mbarara. It has been a wonderful and fruitful visit. Its sad to say goodbye to our friends once again. Luckily with email and skype we can keep in touch.
Til tomorrow, Saramin, Jessica, and Marnie.
August 5, 2010
Hello All,
I hope everyone is doing well in Hamilton. Today the team went to Mbarara Hospital to meet with Dr. Ttendo, the Mbarara IOP coordinator, along with the other Mbarara team members to start our day. I was very fortunate to have the opportunity to spend yesterday and today with the day with Sister Agirie, the Senior Nursing Officer for the hospital. I met Sister Agirie in July 2009, so this meeting was our second opportunity to come together to represent nursing, while discussing and reviewing our goals and our role as a team to reduce maternal mortality.
Our main IOP goal is to focus on reducing maternal mortality. Dr. Saramin Galinski donated misoprostol to Mbarara hospital, because at times the hospital does not have medication to help women who are experiencing postpartum hemorrhage (PPH).Misoprostol is an inexpensive medication that can be stored at room temperature, and is an effective medication in controlling postpartum hemorrhage. Agirie and I reviewed guidelines for care of the unstable postpartum patient. Julie Pace, our SJHH nurse educator, sent with me, our documentation form for PPH and copies of guidelines,that help support nurses to provide care for patients with PPH.
On my last visit to Mbarara, Sister Agirie and Senior Administration express some concern about the lack of Standards of Behaviour between colleagues. I review SJHH Standards of Behaviours with Agirie, and also gave a copy of our booklets to lead physicians, so that they can have a template, so that they may create their own, and possibly implement their own version of standards of behaviour, within the maternity units (triage, labour and delivery and postpartum)
I had the opportunity to work with the head nurse in labour and delivery to discuss the flow of their patients as they come in to the hospital. Mbarara hospital delivers approximately 7000 babies each year. They have 3 midwives working on day shift, 2-3 midwives on evening shift and 2 midwives working on night shift. They have a high volume of assessment patients along with admitting patients for delivery. There were medical learners, residents and nursing students present on the unit during the day shift, and all of their help was needed to care for the volume of patients that required care. Understanding patient flow within this department is another goal that Agirie and I identified, and with the assistance of head nurse Judith, we are creating a patient flow map to try to understand how the patients flow through the department. At times patients arrive for an assessment or for delivery and because of the high volume of patients around, the staff do not even know a new patient has arrived for care. Sister Judith made a wonderful suggestion to simply move the registration desk closer to the entrance, so that all patients can be logged in upon arrival. This simple solution has many barriers, yet with the process flow map, we will make this recommendation, which will hopefully get buy-in from the entire team. This can be a small test of change as we move through the process flow map, which may help to control their work environment and the patient flow in a more effective manner. This simple change may also support more timely access to care for high risk patients that return to the hospital with PPH, or sepsis, therefore helping to support our goal of reducing maternal mortality.
After spending two days with Agirie and her nursing staff we were able to review the PDSA change mode, which will be a great framework that can be used to introduce new small test of change to this department. Jessica provided an in-depth overview of the PDSA cycle, which was embraced by the entire nursing and physician teams at Mbarara.
Sister Agirie and her team have been very welcoming and they all have been very eager to develop and support positive changes within their department.
More to come...
Take care,
Marnie, Saramin and Jessica
I hope everyone is doing well in Hamilton. Today the team went to Mbarara Hospital to meet with Dr. Ttendo, the Mbarara IOP coordinator, along with the other Mbarara team members to start our day. I was very fortunate to have the opportunity to spend yesterday and today with the day with Sister Agirie, the Senior Nursing Officer for the hospital. I met Sister Agirie in July 2009, so this meeting was our second opportunity to come together to represent nursing, while discussing and reviewing our goals and our role as a team to reduce maternal mortality.
Our main IOP goal is to focus on reducing maternal mortality. Dr. Saramin Galinski donated misoprostol to Mbarara hospital, because at times the hospital does not have medication to help women who are experiencing postpartum hemorrhage (PPH).Misoprostol is an inexpensive medication that can be stored at room temperature, and is an effective medication in controlling postpartum hemorrhage. Agirie and I reviewed guidelines for care of the unstable postpartum patient. Julie Pace, our SJHH nurse educator, sent with me, our documentation form for PPH and copies of guidelines,that help support nurses to provide care for patients with PPH.
On my last visit to Mbarara, Sister Agirie and Senior Administration express some concern about the lack of Standards of Behaviour between colleagues. I review SJHH Standards of Behaviours with Agirie, and also gave a copy of our booklets to lead physicians, so that they can have a template, so that they may create their own, and possibly implement their own version of standards of behaviour, within the maternity units (triage, labour and delivery and postpartum)
I had the opportunity to work with the head nurse in labour and delivery to discuss the flow of their patients as they come in to the hospital. Mbarara hospital delivers approximately 7000 babies each year. They have 3 midwives working on day shift, 2-3 midwives on evening shift and 2 midwives working on night shift. They have a high volume of assessment patients along with admitting patients for delivery. There were medical learners, residents and nursing students present on the unit during the day shift, and all of their help was needed to care for the volume of patients that required care. Understanding patient flow within this department is another goal that Agirie and I identified, and with the assistance of head nurse Judith, we are creating a patient flow map to try to understand how the patients flow through the department. At times patients arrive for an assessment or for delivery and because of the high volume of patients around, the staff do not even know a new patient has arrived for care. Sister Judith made a wonderful suggestion to simply move the registration desk closer to the entrance, so that all patients can be logged in upon arrival. This simple solution has many barriers, yet with the process flow map, we will make this recommendation, which will hopefully get buy-in from the entire team. This can be a small test of change as we move through the process flow map, which may help to control their work environment and the patient flow in a more effective manner. This simple change may also support more timely access to care for high risk patients that return to the hospital with PPH, or sepsis, therefore helping to support our goal of reducing maternal mortality.
After spending two days with Agirie and her nursing staff we were able to review the PDSA change mode, which will be a great framework that can be used to introduce new small test of change to this department. Jessica provided an in-depth overview of the PDSA cycle, which was embraced by the entire nursing and physician teams at Mbarara.
Sister Agirie and her team have been very welcoming and they all have been very eager to develop and support positive changes within their department.
More to come...
Take care,
Marnie, Saramin and Jessica
Thursday, August 5, 2010
August 5th, 2010
Hello Everyone,
Another beautiful day in Mbarara. It is usually quite cool in the morning and the mist gets caught in the hills surrounding the town. Along the way to the hospital we pass bicycles loaded down with Matokee. This is the local food staple that looks like a green banana but tastes quite plain. It is high in fibre and protein and usually eaten with sauce to add flavour.
Today I met with the residents. We discussed yesterday’s case ( the kidney tumour removed from the young child) as well as post operative pain management. Richard is a second year resident and is looking forward to coming to Canada in the spring of 2011. We also went to visit the young girl on the surgical ward. She is doing very well and putting out clear urine. Her family were very pleased with her condition and grateful for the efforts of the team.
Later in the afternoon we went into town to buy supplies for a newborn infant who had been abandoned by her mother after birth, In a place where hospital care depends heavily on the family for care and essential supplies, these children are especially vulnerable. She has been transferred to an orphanage in Kampala along with two other infants. We hope to see her on Saturday to drop off formula, blankets and clothes. The nurses named the child Mercy Cecilia.
Tonight my husband and I will join Dr. Ngonzi and Dr. Mootakoha at the Mbarara Rotary club. Ed and Dr. Mootakoha drove around this morning to previous water projects completed by the club and to scout out another school that needs a water cistern.
Only a few days left and still so much to do. Hello to everyone back home. I hope the days are warm and sunny,
All the best,
Saramin, Marnie and Jessica
Another beautiful day in Mbarara. It is usually quite cool in the morning and the mist gets caught in the hills surrounding the town. Along the way to the hospital we pass bicycles loaded down with Matokee. This is the local food staple that looks like a green banana but tastes quite plain. It is high in fibre and protein and usually eaten with sauce to add flavour.
Today I met with the residents. We discussed yesterday’s case ( the kidney tumour removed from the young child) as well as post operative pain management. Richard is a second year resident and is looking forward to coming to Canada in the spring of 2011. We also went to visit the young girl on the surgical ward. She is doing very well and putting out clear urine. Her family were very pleased with her condition and grateful for the efforts of the team.
Later in the afternoon we went into town to buy supplies for a newborn infant who had been abandoned by her mother after birth, In a place where hospital care depends heavily on the family for care and essential supplies, these children are especially vulnerable. She has been transferred to an orphanage in Kampala along with two other infants. We hope to see her on Saturday to drop off formula, blankets and clothes. The nurses named the child Mercy Cecilia.
Tonight my husband and I will join Dr. Ngonzi and Dr. Mootakoha at the Mbarara Rotary club. Ed and Dr. Mootakoha drove around this morning to previous water projects completed by the club and to scout out another school that needs a water cistern.
Only a few days left and still so much to do. Hello to everyone back home. I hope the days are warm and sunny,
All the best,
Saramin, Marnie and Jessica
More work in Mbarara
Goodmorning!
There is so much to update on since our trip to Mbarara began, and so little free time to blog and limited time to access the internet! I wish we could convey more details (and in a more coordinated manner); however, here is a brief overview of the last day or so in Mbarara. As we mentioned before, our first day at the Mbarara Hospital(Tuesday, August 3rd) consisted of meetings with key university faculty members and leaders, hospital administrative leaders, as well as a few of the clinicians that we would be collaborating with during our trip. Specifically, we met with Dr. S. Ttendo (SJHS IOP Coordinator), Dr. F. Kayanja (Vice Chancellor – MUST), Mr. P. Mihayo (Hospital Executive Director) and Dr. J Kabakyenga (Dean – MUST). We felt very welcomed and had the opportunity to receive a detailed update on the progress made since our last visit, as well understand a few key issues and problems that require work and collaboration. A few of the particular interesting environmental/external factors that came in up in several meetings include;
-Drug and medical supply distribution. A change in the Ugandan drug and medical supply distribution system, which is now completely centralized (National Medical Stores) has resulted in issues with coordinated distribution and access to critical medications and supplies at various points in a month since distribution only takes place once per month.
-Staffing. The hospital has noticed a strain on health human resources due to a ‘brain drain’, particularly of physicians who leave the country or the hospital after training to practice medicine elsewhere. While the hospital has no problems recruiting individuals to residency positions, they lose them after training and have several staff positions vacant.
-Funding. The current government has defined three key priorities for the country, which are security, infrastructure and energy. Healthcare is lower on the agenda and funding is allocated accordingly. In Uganda only 9%. Of government funds are allocated to healthcare (compared to close to 50% in Canada).
On Wednesday (August 4th, 2010), we arrived at the Mbarara hospital quite early to start a day of work. Saramin spent most of the day in the operating room observing and teaching. Marnie spent the day with the Head Nurse and the Nurse Educator working on educating staff and understanding process flow in the labour and delivery department. I (Jessica) spent the day working with one of the OB/GYN physicians working on setting up a data base, entering and analyzing data that has been collected in detail on each maternal death in 2010. Although the database still needs to be cleaned up, I think there is much promising information to be gained on the causes and factors associated with Maternal Mortality from the data collected so far. In addition to helping to set up a data base, we also discussed the PDSA framework used for quality improvement. There was a great deal of enthusiasm to learn more about this simple framework to test change and improvement. We also discussed various QI tools (Root Cause Analysis, Affinity Diagrams, Run Charts, Control Charts etc) that can be used during the PDSA framework. A next goal is to be able to support the Mbarara team to implement a PDSA cycle of change.
I hope this provides a clearer picture of the type of work that we are doing here in Mbarara.
Until tomorrow,
Jessica
p.s. Our apologies for any duplication / disorganization in relaying this information though this blog!
There is so much to update on since our trip to Mbarara began, and so little free time to blog and limited time to access the internet! I wish we could convey more details (and in a more coordinated manner); however, here is a brief overview of the last day or so in Mbarara. As we mentioned before, our first day at the Mbarara Hospital(Tuesday, August 3rd) consisted of meetings with key university faculty members and leaders, hospital administrative leaders, as well as a few of the clinicians that we would be collaborating with during our trip. Specifically, we met with Dr. S. Ttendo (SJHS IOP Coordinator), Dr. F. Kayanja (Vice Chancellor – MUST), Mr. P. Mihayo (Hospital Executive Director) and Dr. J Kabakyenga (Dean – MUST). We felt very welcomed and had the opportunity to receive a detailed update on the progress made since our last visit, as well understand a few key issues and problems that require work and collaboration. A few of the particular interesting environmental/external factors that came in up in several meetings include;
-Drug and medical supply distribution. A change in the Ugandan drug and medical supply distribution system, which is now completely centralized (National Medical Stores) has resulted in issues with coordinated distribution and access to critical medications and supplies at various points in a month since distribution only takes place once per month.
-Staffing. The hospital has noticed a strain on health human resources due to a ‘brain drain’, particularly of physicians who leave the country or the hospital after training to practice medicine elsewhere. While the hospital has no problems recruiting individuals to residency positions, they lose them after training and have several staff positions vacant.
-Funding. The current government has defined three key priorities for the country, which are security, infrastructure and energy. Healthcare is lower on the agenda and funding is allocated accordingly. In Uganda only 9%. Of government funds are allocated to healthcare (compared to close to 50% in Canada).
On Wednesday (August 4th, 2010), we arrived at the Mbarara hospital quite early to start a day of work. Saramin spent most of the day in the operating room observing and teaching. Marnie spent the day with the Head Nurse and the Nurse Educator working on educating staff and understanding process flow in the labour and delivery department. I (Jessica) spent the day working with one of the OB/GYN physicians working on setting up a data base, entering and analyzing data that has been collected in detail on each maternal death in 2010. Although the database still needs to be cleaned up, I think there is much promising information to be gained on the causes and factors associated with Maternal Mortality from the data collected so far. In addition to helping to set up a data base, we also discussed the PDSA framework used for quality improvement. There was a great deal of enthusiasm to learn more about this simple framework to test change and improvement. We also discussed various QI tools (Root Cause Analysis, Affinity Diagrams, Run Charts, Control Charts etc) that can be used during the PDSA framework. A next goal is to be able to support the Mbarara team to implement a PDSA cycle of change.
I hope this provides a clearer picture of the type of work that we are doing here in Mbarara.
Until tomorrow,
Jessica
p.s. Our apologies for any duplication / disorganization in relaying this information though this blog!
Wednesday, August 4, 2010
Subscribe to:
Posts (Atom)