As I am leaving Uganda in a week a quick visit has been arranged for me to the student placement sites a week after they have settled in. I will travel with Clotilda, a skilled community facilitator whom I work with in training health workers. She also works for the university assisting in the field placements and is a skilled linguist. For the last month we have been launching our initial training on community facilitation. None of the facilitators have university education, while the participants do, yet they have managed to pull this off with aplomb, earning gratitude and praise from the participants.
We are taking with us on our tour, four hour-long sessions I have prepared for the students that are based on the interactive training we have done with health workers. We will have 1- 2 hours at each site as the sites are widely scattered on a route that takes us beyond Kabale on the road to Rwanda from our base in Mbarara. We hope to visit three sites each day and overnight in a hotel in Kabale, the Switzerland of Uganda.
As the site supervisors have little time to spend with the students, my hope is to package the material so someone like Clotilda can facilitate them. Clotilda trained a long time ago in a three month course as a nursing assistant but she is very bright and has great depth and breadth of practical PHC experience from her years as a university facilitator.
Clotilda and I take turns being the lead facilitator. We use the same training techniques and tools as we have used for our health workers. We ask somewhat different questions and we respond with connections to examples related to the student's clinical work.. Clotilda easily picks up the additional material I am adding for the students, only occasionally referring questions to me to respond or give an example. We try all four of the sessions, mix and match them after asking the students what they would like to do. Originally we planned to leave out teamwork but as one of the groups identified that they were having trouble, we felt it was a teachable moment.
The only thing limiting us at each site is the time. The enthusiasm of the students prompts us to overstay at every site. We are able to do two full hours in all but one site. We leave additional handouts for them from all the modules at their request. Clearly we have sparked their interest.
Our first stop is Kinoni, about an hour from Mbarara, where there is a large group of students including four German medical students. It takes a while for them to gather as they have to turn their clinical duties over. It would be better if Clotilda and I arrived in the afternoon as patients would have returned home by then, but we have little control over this on our short tour. We then head on to Rubanda where the students are waiting in their lab coats for us. Although all groups have not received their kerosene for cooking, both the first groups are settled in and close to water and markets.
Our next stop is Rubaare, a faith-based health unit. The grounds are well kept, the equipment is rudimentary but available. As it is Uganda Martyrs Day and a national holiday, their preceptor joins us for our session. We spend some time at each site listening to their problems and helping them to solve some of them. From here we head directly south to Kabale. Just before reaching we drop in on the group at Bukindi. It is late in the day and they are far from the market so after our session, several of them grab a lift to the market. We find a hotel in Kabale and have a late supper. The next day we visit a small but dedicated group at Humurwa.
We arrive first thing in the morning so are able to have a short chat with their preceptor. An experienced rural clinician, he is enthusiastic and has helped the students to settle in and get organized, but outside his door ranges a long line of patients. We do get to talk about record keeping and he shows us the largest register I have ever set eyes on. This is surely a place for computerized records! We head south of Kabale to reach the farthest site at Muko. Here the students have no electricity and some of the windows are broken so it is cold at night. Clotilda negotiates with the administrators for them and we get promises to make needed improvements to their accommodation. As we leave, four of them jump into our vehicle so they can recharge their computers about 10 km. down the road.
On our way back to Mbarara we pick up the DVD Outbreak that I left overnight with one group. We had hoped to discuss it with them, but they have copied it but not viewed it yet. We arrive back in Mbarara at 11 pm after two full days on the road. We make a final stop just outside Mbarara to drop off some onions, carrots, and potatoes we purchased at greatly reduced prices by the roadside in Kabale. The project secretary meets us on the road after a short cell phone call. We need to haul out the flashlight to separate the various bundles of vegetables. A couple more phone calls and a detour down a side road to a deserted building, locates a bunch of matooke set aside for Clotilda to take home.
Even the short time with the students has been useful. they tell us. Their written evaluations of the sessions are very positive. Mainly, our visits serve as a reminder that they and their education are important to all of us. At each site they have requested a photo of the group and our visit.
Clotilda and I discuss the possibility of spending a week based in Kabale and going out to visit a couple of different groups each day. We think it would work and give us more time at each site. I am convinced a set of reading materials for each session could be arranged using print and internet material if we could solve the problem of electricity. We need to continue to work out ways to make it happen.
Photos: Kinoni students; Rubanda students, Aids Register; Muko students