Sunday, November 11, 2007

Presenting a Cholera Workshop

A No GUNS sign, a revolver with a red slash thru it sits directly beneath the No SMOKING sign in the fancy hotel where we have come for the international health conference. Good idea, I think to myself, I wonder if that sign is also sponsored by the WHO!

A couple of my students are presenting a workshop about cholera at the conference. The workshop is based on their visit to a fishing village with a medical health officer. As often happens, they had about 15 minutes to prepare for the visit before hopping into the back of the health center truck. The cholera outbreak provided a wonderful opportunity for them to try out what they had learned from a case study we had just completed on responding to a meningitis outbreak in Ethiopia.

Following their visit to the fishing village, they wrote up their insights and from this we have developed a workshop. When the network of community-oriented medical schools, now called Towards Unity for Global Health (TUGH ) or The Network held their conference in Kampala in September this year, we submitted our workshop.

The medical students involved in the cholera outbreak are now interns based in various sites around Uganda, but Simon, working in Kigezi, a couple of hours south of Mbarara, is able to come up on a weekend so we could refine the workshop and practice the presentation. Denis, the other student, can't get away early so will be coached when we get to Kampala.

Universities in the Network are encouraged to send students to TUGH meetings and many students attend from all around the world. African students especially have been encouraged to come to this workshop by having local doctors billet them, so many were able to attend. This mixing of students and teachers creates a very vibrant atmosphere for the conference.
For several days Denis and Simon polish their presentation on the laptop in my hotel room. We know we are in the big city because when they first come up to my room, we are told they need a special pass. But after the first visit, the staff seem to know who they are.

The day before the workshop, the students try to arrange for a projector and learn to their chagrin that they should have booked it months in advance. This is an eye-opener as well as a great disappointment since the slide show was pertinent to the case study as well as providing an introduction to Uganda. The conference organizers have no other projectors available, can offer no suggestions and indeed seemed stumped by the ongoing difficulties of keeping things running smoothly.

We were beginning to organize the workshop without a projector the next morning when one of our faculty suggest that we check with our computer technician who was doing some tapeing at the conference. He just happens to have a projector stored at his friend’s place in Kampala. We now have just one and a half hours till the workshop. As time was short and Kampala traffic dreadful, it is decided that the friend will bring the projector on a motorbike or boda boda, which will be faster as it can weave in and out of traffic and avoid the noonday traffic jams. Participants are just fileing into the room as the projector is being set up.

We like to complain about what can’t be done in Uganda but often, as has happened this time, we are able to accomplish the impossible with no time to spare under the most adverse of conditions. I would love to tell you that everything went smoothly but unfortunately for my story, the bulb was partially burnt out—maybe because of the hectic race through town and the colours of the slides are a tad muted.

The cholera workshop attracts more than 45 participants, all possible seats are taken and we don’t have enough handouts for everyone. Simon and Denis succeed in getting full and active participation of the whole room, as they take turns alternating between presenting and recording responses seamlessly while making effectively use of the rich details of their own experience to embellish the case study.

At the time they visited the village, the outbreak had been going on for several months. A number of children had died previously but what had brought the issue to the medical health officer was a complaint to the local authorities about the death of an older man on the weekend.

As a result of their visit they learned that people in the fishing village were collecting drinking water from the Kazinga Channel frequented by hippos, water buffalo, elephants and a multitude of birds. Boiling was not regularly done because wood and money for fuel were in short supply. Oral rehydration packets in the health unit had all been used up. Juices were being made from unboiled water. Handwashing was not done regularly and latrines were available in only one-third of the homes. So there were many possible sources for spread of cholera and much need of health education.

The need for autocratic leadership during disasters was dramatically demonstrated by a former military leader who lived in the village. He decreed that everyone should build latrines and much to the student’s surprise, villagers, many of whom were without latrines, followed his instruction. The importance of listening to people’s concerns in a disaster was brought home during a village meeting when the people agreed to provide the health worker with food to ensure she stayed in the village until the epidemic stopped. Such stories stay with people much longer than lists of what to do in an outbreak and helped to make this case study memorable.

After the workshop an American medical student tells me how impressed he was that the African students were able even given the lack of information available to take effective action. In his small group the Europeans and North Americans had been stunned that no laboratory confirmations were possible and little in the way of supplies were available. Many in the group had wanted to give up, but were spurred on by the African students who felt something useful could still be done despite the difficulties.

He is also impressed that the students presenting are so confident facilitating a complex interactive case study. I think it has to do with all the preparation they have been doing but I am prepared to admit that confidence also comes from competence in handling a cholera outbreak well with scarce resources. Whatever, I am bursting with pride.
Photos: Signs in Africana Hotel lobby; Interns facilitate workshop at TUGH; Animals in Kazinga Channel



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