Saturday, July 11, 2009
Friday, July 10, 2009
project outline
I know that I promised an update about the work that we’ve been doing here in Iganga for the past 5-6 weeks or so and today I’m here to fulfill and deliver. I can’t believe that so much time has passed! Only 21 days left. (Not that I’m counting or anything…) Actually, to be quite honest, despite the difficult time I’ve had here for a multitude of reasons, I do not regret coming at all. The things I’ve been taught have not been exactly or anything close to what I thought I’d be learning but I have learned so much just the same. Informal learning, I believe they call it.
This is not going to be the most riveting post but here is an outline of my 2009 summer activities and responsibilities with the eCare project so far:
1. Project Management. I’ve been coordinating all the activities of the eCare team which, for most of our time here thus far, has consisted of myself, two second year medical students and two undergraduate students, one a chemistry major and one a peace and conflict studies major. This has been challenging but a good experience. Now the founder and former director (now assistant director) of UVP has arrived and she is also on our team so it has taken a bit of the burden off of me. This is nice as it turns out its difficult to complete your own tasks when you’re in charge of organizing everyone else’s.
2. Investigations on the field. As many of you know, the project that we originally came and intended to carry out kind of fell apart as soon as we arrived on the field, if not before. We had to spend a lot of time on the front end of the summer determining where the heck we should invest our efforts. In other words, who was already doing what and where? This required meetings with individuals doing similar work in Iganga district as well as with district officials to figure out how to best collaborate with the Ugandan government, other NGOs and larger studies.
3. Assessment tool development and administration. I have spent a good chunk of my time here utilizing several existing assessment tools to develop four different survey instruments for various purposes. One of these is a focus group guide to determine awareness and perceptions surrounding emergency obstetric care among the women in the villages. We held one focus group which was fairly successful and hope to conduct a few more during the rest of our time here. This discussion also includes a component of perception of and barriers to use of the health facilities. A second assessment tool was designed to be used to interview patients in the health center itself to determine similar information regarding health facility perceptions along with facilitators and barriers to use of the centers. One of the biggest problems that we’re facing is that we tell the women in the villages about the importance of having a skilled provider present at their delivery but then the health facilities we are telling them to go to are not equipped to handle the deliveries, particularly if they emergencies. The women don’t have money for transport or supplies (since the health center is lacking them). To address this we are also working to strengthen these health facilities.
4.Health Center assessment. Currently, there are five UVP teams of students living and working in five different villages that feed into five different government funded health centers in Iganga district, the same health centers that the eCare team decided to work with. The Health Villages Initiative teams, as they are termed, have filled out fairly extensive assessments for those five health centers. These assessments have given us a lot of quantitative and some qualitative data. I am using this information to create health center profiles which include a needs assessment and intervention targets. These will help UVP prioritize and target fundraising efforts and ideally be used to advocate for the health centers at the district health office. We have already created a list of durable items that each health center needs and have asked the staff to create their “wish list” and hopefully we will be able to at least purchase some of these items. I have also created an interview guide/survey to obtain some more qualitative information to supplement the data already collected so that we can create more concrete quality initiatives for the health centers. Currently, we are working on obtaining IRB approval before the use of these surveys.
5. Emergency obstetric care knowledge and skill confidence assessment & health center workshops. The final survey that I created, using several existing assessment tools, is a knowledge assessment to be administered to any midwives and nurses etc. who attend to deliveries at the health centers. The information gathered from the staff at the five health centers, which includes an assessment of knowledge and also takes into consideration the skills that they would most like to learn, will be used during the next month to implement workshops within those health centers. This has proved a challenging endeavor but hopefully we will be able conduct at least one workshop in each health center by the time we leave. We have already administered the survey at all of the health centers we are working in but it is taking awhile to get all of these back.
6. Safe motherhood community education. In my opinion, this has been the most fun and rewarding part of our project. Using the WHO’s mother-baby package and the material used to train community health workers here in Uganda, our team has created a safe motherhood presentation that we are doing in the villages. We have done four presentations thus far and they have gone really well. These sessions include everything from family planning to proper nutrition to complications in pregnancy and the postpartum period to proper immediate newborn care. We do a role play regarding the specific complications and danger signs to watch out for during pregnancy and get the women in the village involved in this. They really get into it and are hysterical! I am going to post some photos on here of the presentation. It is soooo much fun! And the questions that the women (and men) ask afterwards are really great and reveal the necessity of this type of education. You’d be amazed at some of the misconceptions.
7. Collaboration with Saving Newborn Lives Project. Those running the SNL project have asked us to follow up on a pilot study with community health workers that they conducted earlier this year. We are currently determining whether this is something that UVP can do. We are also having discussions with the principle investigator of the study to figure out how else UVP can help carry out some of the objectives of the project. A formal coalition would be nice but may be difficult to pursue at this point in time.
Other than that, we’ve also just done a lot of observing within the villages, health centers, Iganga district hospital etc. which has been useful to inform our interventions and target our efforts. I could go on but this is getting long and boring so I’ll end here and promise no more outlines. As I mentioned previously, I am currently working on an IRB proposal so that our eCare project can be expanded and continued after we leave for the summer. I appreciate your prayers about all of this because it is safe to say that I’m a bit stressed out at the moment. I need major infusions of wisdom.
This is not going to be the most riveting post but here is an outline of my 2009 summer activities and responsibilities with the eCare project so far:
1. Project Management. I’ve been coordinating all the activities of the eCare team which, for most of our time here thus far, has consisted of myself, two second year medical students and two undergraduate students, one a chemistry major and one a peace and conflict studies major. This has been challenging but a good experience. Now the founder and former director (now assistant director) of UVP has arrived and she is also on our team so it has taken a bit of the burden off of me. This is nice as it turns out its difficult to complete your own tasks when you’re in charge of organizing everyone else’s.
2. Investigations on the field. As many of you know, the project that we originally came and intended to carry out kind of fell apart as soon as we arrived on the field, if not before. We had to spend a lot of time on the front end of the summer determining where the heck we should invest our efforts. In other words, who was already doing what and where? This required meetings with individuals doing similar work in Iganga district as well as with district officials to figure out how to best collaborate with the Ugandan government, other NGOs and larger studies.
3. Assessment tool development and administration. I have spent a good chunk of my time here utilizing several existing assessment tools to develop four different survey instruments for various purposes. One of these is a focus group guide to determine awareness and perceptions surrounding emergency obstetric care among the women in the villages. We held one focus group which was fairly successful and hope to conduct a few more during the rest of our time here. This discussion also includes a component of perception of and barriers to use of the health facilities. A second assessment tool was designed to be used to interview patients in the health center itself to determine similar information regarding health facility perceptions along with facilitators and barriers to use of the centers. One of the biggest problems that we’re facing is that we tell the women in the villages about the importance of having a skilled provider present at their delivery but then the health facilities we are telling them to go to are not equipped to handle the deliveries, particularly if they emergencies. The women don’t have money for transport or supplies (since the health center is lacking them). To address this we are also working to strengthen these health facilities.
4.Health Center assessment. Currently, there are five UVP teams of students living and working in five different villages that feed into five different government funded health centers in Iganga district, the same health centers that the eCare team decided to work with. The Health Villages Initiative teams, as they are termed, have filled out fairly extensive assessments for those five health centers. These assessments have given us a lot of quantitative and some qualitative data. I am using this information to create health center profiles which include a needs assessment and intervention targets. These will help UVP prioritize and target fundraising efforts and ideally be used to advocate for the health centers at the district health office. We have already created a list of durable items that each health center needs and have asked the staff to create their “wish list” and hopefully we will be able to at least purchase some of these items. I have also created an interview guide/survey to obtain some more qualitative information to supplement the data already collected so that we can create more concrete quality initiatives for the health centers. Currently, we are working on obtaining IRB approval before the use of these surveys.
5. Emergency obstetric care knowledge and skill confidence assessment & health center workshops. The final survey that I created, using several existing assessment tools, is a knowledge assessment to be administered to any midwives and nurses etc. who attend to deliveries at the health centers. The information gathered from the staff at the five health centers, which includes an assessment of knowledge and also takes into consideration the skills that they would most like to learn, will be used during the next month to implement workshops within those health centers. This has proved a challenging endeavor but hopefully we will be able conduct at least one workshop in each health center by the time we leave. We have already administered the survey at all of the health centers we are working in but it is taking awhile to get all of these back.
6. Safe motherhood community education. In my opinion, this has been the most fun and rewarding part of our project. Using the WHO’s mother-baby package and the material used to train community health workers here in Uganda, our team has created a safe motherhood presentation that we are doing in the villages. We have done four presentations thus far and they have gone really well. These sessions include everything from family planning to proper nutrition to complications in pregnancy and the postpartum period to proper immediate newborn care. We do a role play regarding the specific complications and danger signs to watch out for during pregnancy and get the women in the village involved in this. They really get into it and are hysterical! I am going to post some photos on here of the presentation. It is soooo much fun! And the questions that the women (and men) ask afterwards are really great and reveal the necessity of this type of education. You’d be amazed at some of the misconceptions.
7. Collaboration with Saving Newborn Lives Project. Those running the SNL project have asked us to follow up on a pilot study with community health workers that they conducted earlier this year. We are currently determining whether this is something that UVP can do. We are also having discussions with the principle investigator of the study to figure out how else UVP can help carry out some of the objectives of the project. A formal coalition would be nice but may be difficult to pursue at this point in time.
Other than that, we’ve also just done a lot of observing within the villages, health centers, Iganga district hospital etc. which has been useful to inform our interventions and target our efforts. I could go on but this is getting long and boring so I’ll end here and promise no more outlines. As I mentioned previously, I am currently working on an IRB proposal so that our eCare project can be expanded and continued after we leave for the summer. I appreciate your prayers about all of this because it is safe to say that I’m a bit stressed out at the moment. I need major infusions of wisdom.
Saturday, July 4, 2009
Fourth of July with the Brits
Today was so relaxing and sort of surreal. Happy fourth of July everyone! The only thing that could have completed the celebration for me would have been some fireworks. Fireworks are right up there with warm summer night thunder and lightening storms and mint chocolate chip ice cream for me. Maybe I can find a photo of some online and post it on here to pretend that I saw some. And maybe I'll take a trip down to South Carolina and buy a few and set them off on my own when I get home. Anyone want to join?
So I am spending this weekend up in Mbale, staying at the CURE guesthouse, the place where I came when I first arrived in Uganda. Getting here was a tremendous and very frustrating adventure, one in which I ended up crying as I waited for two hours on the side of the road for a taxi/matatu, but it has been completely worth it. I have my own room. I have internet. I have a shower that is actually taller than me and has warm water coming out of the shower head. Life is good. I slept in this morning and then Derek and Julie made breakfast, probably the most amazing omelet I've ever had. AND BACON. MEAT. Oh my goodness. And by the way, omelets with avacado are simply to die for. I eat about an avacado a day here; I don't know what I will do about that when I get home since they're quite expensive in the States. Anyway, after that, Julie, Rachel, Tom and I spent the day by the pool at the Elgon hotel. I forgot to bring the USB cord for my camera up here to Mbale but I will post photos of it soon. Beautiful. Around four we headed over to Derek's place for a fourth of July cookout to celebrate our independence. The hilarious part... There were about 40 people there, mostly missionaries, the majority of which were from the UK. They had a blast bashing the US with that oh so dry and charming British sense of humor and we made sure to be extra obnoxious with the American flags everywhere. All of this in the middle of Uganda. And did I mention more amazing food? Wait until I post photos of the spread.
Next time I write, maybe I'll tell more about the lastest eCare team happenings and work efforts; I'll at least pretend I'm doing something productive here.
Friday, July 3, 2009
The White Nile
As I mentioned in my previous post and in the e-mail update that I sent out, rafting on the Nile was INCREDIBLE. We went with Nile River Explorers (NRE). The link is somewhere below. I don't have an photos of the actual rafting since I don't have a waterproof camera and probably wouldn't have taken it anyway as there would have been little to no chance of that thing actually staying in the boat. (We certainly didn't.) I will, however, post some photos of the Nile itself, views from the NRE campsite. I'm sorry I don't have any better!
Our day was a full day of rafting, about six plus hours on the river. (Don't worry Dad, I applied and re-applied plenty of sunscreen.) Such a great workout! I hurt my knee pretty bad 'cause I smashed it on a rock but other than that, no injuries or even near-drownings. This was my first time rafting and I don't know why I haven't done it before because it was probably one of the most fun things I've ever done in my life. I'm up for more whenever anyone wants to go! The rapids were fun and exciting, lots of grade 5s but I also just liked paddling on the glassy water, 30 km of river I believe. It actually wasn't scary at all, even though I thought it would be based on what people were saying. And the scenery! So green and peaceful... :) Fun day.
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