A successful day of work

Hello Everyone,

Our second day in Mbarara started with a team meeting to organize data onto spread sheets. Dr. Joseph Ngonzi is an Obstetrician at Mbarara Hospital and our Ugandan collegue in the International Outreach Program (IOP). Some of you may remember Joseph from his visit to Brantford in the fall of 2009. He extends his best wishes to the nurses of Labour and Delivery and Dr. Stephen Bates.

Jessica Fry, from the Quality, Planning and Performance Improvement Program at St. Joseph’s Hospital in Hamilton is helping the team to create a database and input data so that we can monitor maternal mortality and our strategies to reduce peri-partum bleeding. She has been a great help to all of us in the collection and transference of data to a manageable system and this has helped us to focus in on key management issues in Labour and Delivery, using the PDSA cycle framework as well as other quality improvement tools and techniques.

Later in the day I joined the anesthetic team in the OR. The surgical team was removing a large kidney tumor from the abdomen of a three year old child. The surgery had already been delayed a week because the cautery machine had to be repaired. Preoperative lab work was unavailable as the parents could not afford to have blood work drawn.

Pediatric surgery is hampered by the lack of pediatric equipment. In Canada we would have considered an arterial line to monitor her blood pressure and draw blood to assess blood loss; but today an adult BP cuff was applied to the child’s leg. We had the luxury of Normal Saline and whole blood but these were given via adult IV tubing which made it difficult to control fluid delivery in a child who weighed only 15kg. The surgery ran for 3 hours and the tumor was removed in 2 hours. The tumor weighed approx 2.5 kg. The incision was closed with two types of sutures as they had to use the smaller pieces not used earlier in the case. Currently sutures and gauze are at a premium and families must purchase their own if they don’t want their case cancelled. At no time are the sponges and needles counted during the case.

Once the incision was closed the surgeons took off their gowns and layed them over the child to keep her warm. There is very little linen and blankets are supplied by the family. The OR lights were pulled down closer to the patient tohelp keep her warm as well. Once she was awake and extubated she was carried to her mother and wrapped in a blanket provided by her mother. The child will be held by her mother until awake and then taken to the pediatric ward. There are usually no monitors with the mother and no staff available to care for the child, although staff are close by if help is needed.

Today was a successful surgery and I greatly admire the skill of the team working in Mbarara. The surgeons skillfully excised an extremely difficult tumour in roughly the same time as we could have done in Canada with all our bells and whistles. The anesthesiologists used their clinical acumen to deliver a safe anesthetic, adjusting to the limited equipment available to them. I admire the continual ingenuity of the team to perform under conditions we would find almost impossible to imagine. I am also reminded of all we have to be grateful for in Canada and despite the problems we deal with at home, we are blessed with an abundance of resources that we should not take for granted.

Until tomorrow,

Saramin, Jessica, and Marnie.

Kitengeesan & Mbarara

Good morning all,
It is 0630 (Tuesday, August 3) Ugandan time and Saramin, Jessica and I are enjoying our hot African Spiced Tea with steamed milk at the Makere Guest House in Kampala. We are about to leave for the next lag of our trip in Mbarara where we will meet Dr. Stephen Ttendo and begin our work at the Mbarara University of Science and Technology.
As wait to depart, I thought I would reflect on our experiences yesterday and submit a blog for you to read. The road system is slowly improving in Uganda. The main highway from Kampala to Mbarara is under construction, and there are still many kilometers of rock and gravel roads, but with the new addition to ash fault, it makes this trip much more enjoyable. We also noticed that there are now 2 traffic signals in Kampala – although they are not always on – depending on availability of hydro. Another difference that we have noticed is many more traffic police stopping cars, boda bodas (motorcycles), and truck to ensure that all cars and drivers are licensed. Again – everyone is so welcoming – even the traffic police ensure to welcome us and ask if we are enjoying our stay!! One less-enjoyable part of the drive is the rest stops. At times there are toilets (with or without seats), but most are outhouse-like, with just porcelain holes in the ground. With our hand sanitizers in hand, we trek along…..
Yesterday (Monday, August 2, 2010) we were very fortunate to visit the Good Samaritan School for the Deaf in Kitengeesan, which was a three and a half hour drive fromour residence at Makere University Guest House to view a water project which includes two cistern systems that captures rain water off the school roof and also a water filtration system. This water project was installed with the support of the Caledonia,Ontario Rotary group and the Rotarian group in Muanga, Uganda. In the past, the students of the school had to walk approximately 2 km to a ground water reservoir, to gather water they then had to boil the water to be able to use it for drinking water. We observed how the water filtration system works, which is a simple cement structure with sand in it. The water percolates through the sand and as it comes out of the filter cleared of 99 % impurities. The school head master was very thankful for the addition of the water system because now that the children are drinking clean water, there has been a dramatic decrease in the number of children suffering from gastrointestinal issues.A retired engineer from Calgary invented this simple water filtration system called Biosand, and it using all products and resources from Uganda, therefore this product is easy to build and sustain here in Uganda. It was an amazing trip and one of the most eye-opening experiences so far this trip. While we were at the school, we also gave out pens, pencils and soccer balls to the students (Thank you to all the staff who donated pens and pencils!!) The appreciation and thanks were evident from the headmaster, teachers, and most importantly, the children who greeted us with big smiles and the sign language applause.
OnMonday evening, we went out to Saramins favourite restaurant in Kampala – a delicious Indian restaurant called Speke. We were joined by Joseph (our SJHS IOP liaison and good friend), Deborah and Hood (Rotarian fellows from Kampala). Great food and conversation – we didn’t get back to our residence until 10:00pm!
Now onto our account of today, Tuesday, August 3rd, 2010. As mentioned above, we awoke early (5:30am) to have a quick tea and be on our way to Mbarara. The drive took us 6 and a half hours on a combination of dirt, gravel and some paved roads! After a stop at the equator (Jessicas first time across the equator!!) for some pictures and souvenir shopping , as well as a few traffic police stops, we arrived at the beautiful Lakeview Guest House in Mbarara. We had a quick stop to get changed and have a bite to eat, before heading to the hospital for meetings and a through tour of the current campus, as well as a brief view of the new 600 bed building in progress. We will update more on the specific initiatives that we are working on and the Mbarara Hospital team tomorrow.
Now off to dinner for some Matoki (traditional Ugandan dish made from plantains – delicious and satisfying!)

Saramin, Marnie & Jessica

Arrived!!

We're here!

We arrived in Entebbe last night at 9pm after a 6 hour flight from Toronto to Amsterdam, a 4 hour layover in Amsterdam, and 7.5 hour flight to Entebbe. We were greeted by our amazing hosts Joseph and his son Jimmy. It was fabulous to be greeted by familiar faces after a long flight! We had a 1 hour drive from the airport to the Makere University Guest House in Kampala, where we had a lovely fresh dinner and met Dr. Stephen Ttendo, who will also host us while in Mbarara.

We only have a bit of time connected to the internet here, so I will quickly leave a few first impressions! Uganda is a beautiful country - with so many valleys and hills and it is SO green! People are very friendly and giving (when we needed to make a phone call at the airport, someone was so quick to lend us their cell phone!). Driving is a new experience, not only because we are driving on the left side of the road, but also because people drive very fast and in all sorts of vehicles, motorbikes, vans and matatus (buses). Our residence at the Makere Guest house is beautiful - very well kept grounds, so clean and very yummy food. I really like the African spiced tea, with steamed milk!!

Time to head out to get our money exchanged and then head to Mbarara to get to work!! Thanks again for checking in!

Jessica

Please note that the views expressed in this blog are those of the author and not necessarily those of the St. Joseph’s Health System or the St. Joseph’s Health System International Outreach Program

Preparing for your trip to Uganda

As I am making final preparations to depart for Uganda tomorrow, I thought I would add a quick post to let you know what is involved in preparing to travel to Uganda. Our preparations started in December when timing and duration of the current trip was being negotiated. Here are a few things that took place between December and now to plan our trip to Uganda.

-Obtain entrance Visa from http://www.ugandahighcommission.com/consular-services/visa-application
-Obtain vaccinations (keep documentation for entry into Uganda): Yellow Fever, Meningococcus, Typhoid, Polio, MMR, Hepatitis A & B, Tetanus-diphtheria.
-Obtain and fill prescriptions for traveler’s diarrhea and anti-malaria medication.
-Renew passport if needed.
-Book flights (our route is Toronto – Amsterdam – Entebbe), transportation and accommodations.
-Obtain travel and health insurance.
-Register travel itinerary online with the Canadian Government office.
-Anticipate financial needs and obtain local currency. (USD is the best currency to use in Uganda. Recent, large and new/crisp US bills will get the best exchange rates).
-Get documentation to verify that any medical supplies being brought into the country are solely for donation and not for resale.
-Obtain letter of permission from our hosts in Uganda outlining the purpose of our visit.
-Make careful choice of clothing that is culturally sensitive and also appropriate for warm weather, sun, prevention of mosquito bites, and functional enough for very full and active days of work.
-Gathering of information: I have reserved almost every book from the Hamilton Public Library on Uganda and Africa. One favorite is a Lonely Planet publication called The Africa Book. While it only gives a high level synopsis of each country (and I am not sure if it the authors are African), it is a large hard cover book that shows amazing pictures and provides a taste of the varied cultures, regions and landscapes in Africa. http://shop.lonelyplanet.com/Primary/Product/General_Travel/Pictorials/PRD_PRD_1996/The+Africa+Book+Pictorial.jsp I’m sure there are plenty of other great books too! And tons of great websites too.
-And finally, create blog and learn how to ‘blog’!

Along with the usual packing list for any international trip, here are a few of the additional items that are recommended:
-Mosquito net (depending on accommodations and nature of travel)
-Scarves to wear as shawls
-Flashlight in case power goes out briefly
-Towel Tabs (These little beauties look like Rolaids, but when you run them under water, they conveniently turn into a cloth for wiping hands and face! Available at Shopper’s Drug Mart).
-Plenty of antibacterial hand wipes and hand wash
-Malarone
-Rehydration salts
-Ciprofloxacin
-Multivitamins as we might possibly be eating fewer fresh fruits and vegetables
-Immodium

For someone like myself who comes from a long line of list makers, double checkers and over packers, preparation for this trip has been no small task! :) But worth every second spent planning!

Now back to the suitcases! Have a great long weekend and thanks for checking in!

Please note that the views expressed in this blog are those of the author and not necessarily those of the St. Joseph’s Health System or the St. Joseph’s Health System International Outreach Program.

Two more sleeps!!

I would like to begin our ‘Uganda Blogumentary’ with a brief introduction of the team travelling to Uganda as part of the St. Joseph's Health System (SJHS) International Outreach Program (IOP), as well as a bit about the IOP history, accomplishments and ongoing objectives.

The team soon to depart for Mbarara, Uganda from July 31st to August 8th, 2010 is made up of Dr. Saramin Galinski, Ms. Marnie Buchanan, and myself, Jessica Fry. Here is a quick bio of our team!

Dr. Galinski can be found in the Operating Rooms at the Brantford General looking after patients as a staff anaesthesiologist. She also works in Hamilton as an associate clinical professor at McMaster University. Dr. Galinski has been a key member of previous trips to Uganda and this year she is the team lead of our trip to Mbarara. We are lucky to have her steering the ship!

Marnie Buchanan is the Manager of the Labour & Delivery as well as the Triage and Assessment departments in the Women’s and Infants’ Health Program at St. Joseph's Healthcare Hamilton. Marnie has been on one previous trip to Uganda and brings a wealth of clinical and management experience to our team. Marnie will be working hard on the current trip to further relationships and nursing initiatives that were started during her last visit to Uganda.

Last but not least, I am Jessica Fry. I also work at St. Joseph's Healthcare Hamilton as a Performance Improvement Consultant in the Quality, Planning and Performance Improvement Program (QPPIP). My objectives are to provide training and information exchange in the areas of Quality and Process Improvement, as well as Measurement and Analysis. This is my first trip with the SJHS IOP - and my first time to Africa! I am honoured to be a part of this team and this program, and am SO excited to begin this journey!!

To provide you with some context for the current trip and our blog (which I hope you continue to follow!), here is a bit of background information about the SJHS IOP:

The St. Joseph’s Health System has proudly engaged in international outreach to global communities since 1986. The primary programs at this time are in Haiti and Uganda, though prior programs include Russia, Yemen, Romania, Domenica and others. International Outreach is funded by the Sisters of St. Joseph of Hamilton, Canada and supported by member organizations and friends of St. Joseph's Health System. Projects complement sustainable work already underway in our partner countries, and outreach teams include the Sisters of St. Joseph, doctors and nurses, biomedical engineers, and lay people. SJHS has also trained 50 doctors from Uganda and Haiti at hospitals in Canada, including St. Joseph’s Healthcare Hamilton.

Uganda is a country with a population nearly the size of Canada (nearly 28 million) in an area less than a quarter of the size of Ontario. The country is ranked 144th in the Human Development Index of the United Nations. A previous British colony, its medical schools retain the structure of the British model. Like other countries in the region, Uganda faces many health challenges including Malaria and AIDS. Basic medical equipment, training and supplies can have a dramatic and immediate impact on the people of this nation.

What St. Joseph’s Does In Uganda:

The SJHS IOP focus was initially the provision of medical equipment and supplies but now includes education and training of medical residents and fellows.
-St. Joseph’s sends needed medical equipment to medical and teaching centres in Kampala and Mbarara. Previous shipments have included thousands of items including medical equipment like ultrasound and anaesthesia machines, medical supplies including gauze, stretchers, syringes, and lab supplies, and oxygen and pharmaceuticals.
-St. Joseph’s provides education opportunities in Canada for Ugandan Doctors
-St. Joseph’s brings biomedical engineering expertise to these communities to repair donated equipment, and teach equipment maintenance to Ugandan colleagues
-St. Joseph’s supports research activities through a pool of PhDs in Canada who review and advises on Ugandan colleagues’ work. At the present time the focus of research in Uganda is: HIV, Malaria and Tuberculosis.
-St. Joseph’s investigates potential sources of funding for research in Uganda
-St. Joseph’s supports an international outreach coordinator in Mbarara and Kampala, Uganda
-St. Joseph’s sponsors internet access at medical education sites

In closing, I would like to thank all those who made this trip possible and helped us in the preparations for this endeavor.

And thank YOU for reading our blog! I will try to update twice each day!



Please note that the views expressed in this blog are those of the author and not necessarily those of the St. Joseph’s Health System or the St. Joseph’s Health System International Outreach Program.