Thursday, November 22, 2012

HMEF Student Prizes at MUST

Friday was taken up with examining the 40 multidisciplinary student groups who did rural field placements at Mbarara University of Science and Technology.  Examiners in 6 groups of 4-5 faculty members listening intently as 6 - 7 student groups provided their projects and findings for 15 minutes followed by 10 minutes of questions.  The marking grid was long and complex with students required in a short time their challenge model, the fishbone analysis, the activities they undertook and why.
All the student groups who presented to our group involved all members of their groups.  Questions were often fielded by several of the students with all of them intent in showing the most appropriate chart or info to back up the answer.  Their enthusiasm was apparent as was their commitment to being part of the team. 
The Leadership Development Program at MUST involves some advance training prior to going to the field, not only for the students but also for the faculty.  The faculty workshops include the field preceptors and because of their focus on leadership have been instrumental in engaging MUST faculty with the rural placements.  Nursing, Laboratory, administrative, Physiology faculty enthusiastically supervise the placements and take part in the examination that occurs at the end.  In my experience this involvement across all faculties is almost unheard of in Medical School.  When I asked several faculty why they were so committed to community field work, they said straight off that they found it a chance to build and develop their own leadership skills. 
This faculty-wide commitment owes a lot to the originator of the Leadership Development Program, Dr. Samuel Maling, the assistant dean at MUST.  His interest in the rural placements began when he was one of the few field supervisors used in the early days of the program and spent time in a Batwa community near the Rwanda border.  It was clear when I talked to him shortly after this experience that he saw the tremendous potential of the field placements not only for students but for staff.  Since then he has introduced the LDP program, seen it extended to field preceptors and watched the program flourish.
The other key people in the rural field placement program are Gad Ruzaaza, the coordinator of the Community Based Program and his assistant Moses Ntaro.  I have worked with Gad for since I first started going to Mbarara more than ten years ago.  In the early days when my visits coincided with the field placements, I would stay at Rugazi with the students, so I too know how powerful these learning experiences are for the students.  Gad has watched the program grow and expand, always interested in incorporating new ideas and new people.  His enthusiasm and dedication have never wavered.
It is exciting to see the program flourish.  This year we have received a small grant from the Hillman Medical Education Fund that will allow us to provide cash prizes to be used for presenting their experience to the top three groups.  To choose the top three groups, each of the 7 faculty groups of markers select their top student group.  These seven “top” groups gather the following day to make their presentations to the HMEF Award Judges.  I am one of those judges, along with Moses Ntaro, Angella Tumuhimbise, a community facilitator, a member of the nursing faculty, Dr. Wilfred Arubaku, head of curriculum development committee and  a physiology faculty member.
The student groups draw lots for the order of presentation.  They are nervous at first but rapidly gain their feet.  The charts are put up and taken down swiftly as one member presents.  To keep it on a level field no computers have been allowed.  Many of the winning groups have clear, colourful charts and several have photos that have been blown up. 
For some reason it appears that pit latrine covers have been a popular intervention as three of the groups not only used them but have provided labelled examples that were used.  During question period I probe several groups on why latrine covers were chosen but fail to uncover the appreciation for community development which I seek. 
All the groups who have presented are wonderful and it is difficult to chose winners.  But finally we come up with a 1st prize   2nd prize and 3rd prize.
Congratulations to all the student groups and most especially to the Community Based Program at MUST!


Banquet in Bushenyi

A group of us in Mbarara was invited to the home of a colleague in Bushenyi, Dr. Celestine Berigye.  Dr. Berigye was a wonderfully effective District Medical Officer before he was promoted to the Ministry of Health in Kampala recently.  His family is still in Bushenyi so he commutes regularly on weekends.  
This visit was arranged in part as a celebration of Dr. John Godel’s involvement with Celestine and with Bushenyi.  John is a pediatrician with a long history of working in the aboriginal communities in the Western Arctic and Mackenzie River.  He is now in his 80s.  He has been coming to Mbarara for a month or two each year since I began in 2000.  In fact it was because of John that I first came to Mbarara.  John spent most of his time on the Pediatric wards teaching residents while I was mainly in the community with Healthy Child Uganda but most recently John has joined us in the community. 
John and his wife Marj overlapped with me in the medical education project begun by the Hillmans at Makerere in the 1980s a part of the reconstruction following Ida Amin’s reign.  I met him at an international conference in the late 1990s and heard about a new medical school in SW Uganda that needed help from him.  He gave me a contact name and address as email was not readily available at the time and I was there within the year.  Occasionally John, Marj and I would overlap, often we stayed at the same staff house. 
John had come without his hat this day, so our hosts found a flower-bedecked sun hat for him, which did the job of shading his head.  He jauntily wore the sunhat throughout the banquet on the lawn.  It captured the practicality and spontaneity that John brought to hi work in Uganda.
We didn’t have reliable information gathering in the beginning of our work in community.  One of John’s forays  into community was to investigate reports that 17 infant or child deaths had occurred in a short period in one community.  Even in our areas with high infant mortality, this was shocking.  John found among other things that there was no available health unit in the area and that many of the children had died from easily preventable causes.  He talked to the District Medical Officer who was Celestine about the situation.  Soon there was a health center built, staffed by the District which was called by the community the Godel Health Center.  I never heard John claim so or even to mention it but I am pretty sure that faced with the inevitable delays of the system, John made a substantial contribution to ensuring the health unit was in place quickly.  John also paid for a young man selected by this remote community to get further training as a health worker.  Celestine and his wife also contributed to support for this young fellow who stayed with them. 
During our visit to Celestine and his lovely wife, Ruth, we were provided with a banquet of delicious food, given a tour of his new home, viewed his garden and met his family.  During a scrumptious meal provided by Ruth,  a touching thank you speech was made by the soon-to-graduate laboratory assistant.  Ruth glowed with pride mentioning that he not only communicated in English but spoke so confidently, so clearly and so well.  The rest of us were touched by his heart-felt expressions of gratitude, something Ugandans excel at in general. 
We were taken on a tour of the local winery in Bushenyi, met the owner and viewed not only the vineyards but also the processing plant, a remarkable production, one of the first in Uganda run by an 80 year old Uganda gentleman with a powerful presence.  It was a wonderful, moving day for all of us.


Monday, November 12, 2012

TBA Training for Baghicha

Using Pictures
Frontier PHC will begin a Safe Motherhood Project for 3 years in Baghicha and Ismailia in December, 2012 funded by the Hillman Medical Education Fund.  The project builds on FPHC’s extensive experience in training and follow-up of TBAs.  Frontier Primary Health Care will be utilizing their recently acquired expertise in participatory action research to document the successes and challenges of the project and attempt to tease out the key factors to sustainability for TBAs in rural Pakistan through interactive methods before and after the project.  
Young mothers
Some of the recent reports about TBAs as skilled attendants have been less than supportive however groups such as FPHC with long experience in supporting them report much success.  The reason for this divergence of opinion appears to lie in two main features: TBAs need to be linked with the local health system and they need to receive ongoing supportive supervision.  While such conditions are required by all health workers, many TBAs, once trained have been virtually left on their own.  Frontier PHC, recognizing the key role TBAs play in ensuring safe motherhood and their value to the community, has provided strong links to the health services as well as ensured ongoing supervision by midwives and lady health visitors. 
TBA Training in Groups
Candidates will be drawn from the community with preference to those currently working in their own community as traditional birth attendants and recognized by the community as birth attendants. Twenty TBAs will be trained and followed for three years along with 20 male CHWs.  TBAs and CHWs will be provided with basic kits consisting of for TBAs- soap, gloves, Mama Kits, ties, razor blades, rubber sheets.
Practice Models
The Frontier health unit in Ismailia will be used as a base MCH center, equipped ad supplied to serve an anticipated 5400- 6000 deliveries over the 3 years (1800-2000 per year ) coming from Baghicha Refugee camp, Ismailia and the surrounding area.  The MCH center will function as a 24 hour community delivery center.

Trainers Confer
TBAs will be encouraged to work in pairs.  At the end of their training they will be provided with a cell phone so they can be easily contacted.  Their phone numbers will be publicised in the target community.  It is expected they see pregnant women at regular intervals during the pregnancy and contacted by family members when labour begins. To ensure retention of the TBAs small financial incentives from the community and from the project will be provided.    Additionally basic literacy will be provided during the training.  Recognition by the community is expected to be a motivator in addition to the ongoing supportive supervision and close link to the health care system.


Tuesday, November 06, 2012

Peer Group Drama at Namitanga

A drama is being held at Namitanga Senior Secondary Schools in Mbarara town for us.  A local NGO, Health and Development Agency Uganda (HEADA) established by former students has set up a project for Peer Groups in six secondary schools.  Namitanga is a Muslim school not far from the town center.  It hosts a few boarding students and a larger group of day students.  The Peer Group project meets regularly each month.  At Namitanga the group has grown in numbers from month to month.  Last year in preparation for the start of the program, a Ugandan colleague, Angella, and I provided some training for the Trainers on weekends.  This is our first chance to see how the peer groups are doing.

Today is a visiting day for parents so there is a guard at the gate.  Most boarding schools in Uganda have visiting days each term when parents can visit children who are boarders.  Snacks and drink are brought, teachers are quizzed and family groups sit together in the compound.  Groups of students, dressed in spotless school uniforms stroll hand in hand on the grass; raffle tickets are sold; greetings fill the air.  Namitanga has few boarders and it is just a couple of days before exams for the higher classes so a more muted atmosphere prevails.  However once we are in the classroom where the play will be held, the excitement is quite palpable. 

A cornflower blue curtain has been stung across the front of the room.  It has a small hole to the left of the middle where various eyes peer out at us.  The play is introduced by the female teacher who acts as the Peer Group sponsor.  She explains the male teacher is unable to attend.  Although the full play has 16 scenes and touches on most of the contemporary issues faced by students today, for the sake of brevity it has been edited to 4 or 5 scenes.  The writer and director, a member of the Peer Group, is also one of the actors in the play.  It seems almost all the members of the Peer Group have been given a role in the drama. 

Besides my colleague Angella, our small group includes John Senoga, coordinator of the Peer Group project and Dr. Sharif Mutabazi, Exec. Director of HEADA.  We all have seats inside.  At the windows on both sides of the room, watching intently as the play unfolds is almost every one of the boarders at the school today.
The title of the play is The Dud.  It seems a play of words on Dad, but Ugandans do interesting things with the English language, playful things, so we are not fast to come to consensus on what it could mean.  The many actors in the play are wonderful, a step mother, two stepsisters, a brother all vying for the attention of the father.  At school there are a set of allegorical characters, Salacious, a youthful, would-be womanizer; Degree, a serious type wanting to be part of the group but with his eye set on the future; and Temperature, a hot, joyful, bon-vivant, who has fallen for the serious, studious but lovely Cinderella.  Salacious, Degree and Temperature cavort about the stage with their outrageous comments, their gaiety and their wonderful depictions of teenage boys.
The costumes and props are few but clever and worn with panache.  Temperature has a mammoth, heavy lock on a chain around his neck, a spoof on the heavy gold of street gangsters.  On his head a close fitting toque of turquoise blue with a pink scarf flung around the neck of his white jacket.  He loops and glides across the stage, his movements a dance with Salacious and Degree that appears choreographed by a master, bringing guffaws and ringing laughter from us all. Temperature,  along with his fellow Peer Group Members, is clearly a gifted actor and also the writer and director of the play.
The players touch on all the sad, trying moments of keeping on the straight and narrow; maintaining relationship with peers and parents; the temptations of being part of the “in” crowd and the sheer joy of being alive.  We are kept on the edge of our seats.  Kept wondering what else happens in the ten or more scenes we are not to see today.  There is great applause at the end with the students beaming with the pleasure their performance has brought us.


Monday, November 05, 2012

Visit to Nyamitanga's Peer Group

A new local NGO I work with in Mbarara, Health and Development Agency Uganda (HEADA) has a modest Peer Group project in 6 senior secondary schools in the town.  During my recent visit I was invited to view a drama put on by the peer group at Nyamitanga Senior Secondary School.  We are met just inside the gate their female patron, one of the teachers, Ms. Saubah Kengalagwa, the student leader of the group Imran Muhumuza, who is a Senior 1 student and  the peer group coordinator, John Senoga. 
John and his fellow coordinator, Collins Sebufu both received their original facilitator training through the Healthy Child Uganda project.  Since that initial training they both have continued to develop the program and their own leadership skills. After introductions to the school, John gives us a concise overview of the Peer Group program in this school.  The Peer Groups are given 11 specific sessions with a theme for each one.  But the specific themes appear to be just the starting point and the gatherings a focus for their enthusiasm and interest.
 We learn that the peer group has 27 members and membership continues to grow.  As students learn about what they are doing, they become interested.  It is obvious the students at this school are active as they have posted messages on the bulletin board and even have a logo.  The Peer Group project is in its second phase which started in July 2012 following training of the trainers and the Peer Group Educators.
This Peer Group has been very active in recycling.  They show us a variety of items made from recycled paper and plastic, several of which have been used in the drama.  The group appears very organized, with positions and roles that allow many to take part.  Many of the students who aren’t boarders, stay on after school to take part in Peer Group Activities. 
 During the play a group of young girls perch on benches at the side in white hijabs.  There are not enough places or chairs in the classroom so many students press up to the windows on both sides to watch the play.  As it is Saturday, only boarders remain at the school but from the look of things all of them have their places at the windows.   
After the drama there are numerous speeches.  Dr. Sharif, the executive director, tells them how pleased he is with their drama.  The Peer Group Leader thanks us for coming. Even I share my delight.  Amazing how much can be accomplished by an inspired group of students given some direction


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