Hospital Experiences

Mulago PICU

Along with conducting my research, I have also been able to shadow doctors and nurses in the Mulago Hospital. Most of my time there has been spent in the Pediatric Acute Ward or the Pediatric Intensive Care Unit. In the states, patient care areas are usually called “Units,” but in Uganda they are called “Wards.” This was tricky for me are first because “Ward” spoken by a Ugandan can often sound like “World.” Being told to go to the “Acute World” made me a bit confused the first day. The Female Ward, the Male Ward, Operating Theaters, the terms and organization are a bit different, but not difficult to get used to after being here a few days.

Direction signs at Tororo.

This acute ward has a triage waiting area, a resuscitation room, the floor (where less acute children go), a small neonatal intensive care unit and a small pediatric intensive care unit. Every morning the children on the floor are determined to be stable enough to move to a specialized ward, such as cardiac or GI, or they stay with us a bit longer.

Mulago Pediatric Triage

I spend most of my time in the resuscitation room, which functions most like an American emergency room. We see many children come in with respiratory distress from bronchial pneumonia, malnutrition, and suspected malaria. The room has 5 beds, between 2-5 residents, usually one nurse, and anywhere from 2-10 patients (the little ones share beds). It is interesting to see that the residents conduct many of the assessments and interventions done by nurses in the states and the nurses either focus on stocking the room or telling the doctors what to do.

Mulago Peds Resuscitation Room

Family and friends of the patients perform all the personal patient care, such as feeding, bathing, washing the linens (if they have them), and even purchasing medications when the hospital does not have them available. Though it’s hard to know there is limited available to offer our patients in need, there is some comfort in the fact that there are many well stocked and accessible pharmacies nearby. Slightly less comforting is that there are no prescriptions required, but at least meds can be accessed when they’re needed. 

Laundry being done by family of patients at the Tororo Hospital.

I’ve been able to experience quite a few hospital environments: Tororo District Hospital, Cure Hospial, Kanginima Hospital, Benedictine Eye Hospital and Mulago. My first real exposure to health care systems in a developing country has been truly eye-opening. At first it is heartbreaking to see how little doctors and nurses have to work with, the environment they have to work in, and how hardened they’ve become to losing their patients. But those feelings are quickly replaced with awe and encouragement when you see what all they CAN do with how little they have, what all they CAN do in less than ideal environments, and how hard they DO work to provide life saving measures to their patients. I think westerners sometimes come with the thought that we will bring our skills and technology to make it better here, but in the end, we are usually the ones who come away learning skills we carry throughout our life.

Tororo consultation room.

Research Time

It’s about time to tell you about what I’m actually doing and why I’m in Uganda! After Dr. Giordani got me moved into Mulago, I quickly settled in with the Global Health Uganda (GHU) Computerized Cognitive Rehabilitation Therapy (CCRT) team. Michigan State University has a partnership with GHU and Makerere University to conduct this study. The main goals of this study are to determine the effectiveness of CCRT on improving neuropsychological and psychiatric outcomes in Ugandan child survivors of severe malaria and if severity of malaria is predictive of the effectiveness of CCRT.

One of the programs on a training computer.

The computer "mouse" used to control the game.

CCRT is a type of computer intervention that is often used in the states for elderly individuals or children with ADHD to improve their memory and attention skills. In a similar way that this program is used stateside, the hope is that CCRT will improve the cognitive abilities of children following severe episodes of malaria. Testing is done by Mariah, Titus, and Ethel pre-intervention, post-intervention, and one year post-intervention. Our trainers, Michael, Irene, and Richard take laptops with the program to the participants’ schools 3 times a week for 8 weeks.

Two of our trainers, Michael and Irene, administering CCRT. To have a slightly less distracting environment, it is done in our car.

When I say severe malaria, it entails cerebral malaria (CM) and severe malaria anemia (SMA). In CM, the parasitic load of malaria becomes so great, they actually settle into the ventricles of the brain and begin affecting brain tissue. SMA occurs because the parasite attacks the red blood cells. When this happens the cells ability to carry oxygen to the brain and other areas is impaired. As you can see, children who are fortunate to survive can, unfortunately, suffer cognitive deficits, either from lack of oxygen or direct tissue destruction, impacting many areas of their lives.

There is clearly a lot going on here and it is a well-established study. But one aspect that is not being directly explored is the relationship between CCRT, neuropsychological testing and academic performance. That’s where I come in! I am currently working to standardize school reports from study participants and record that information in a reliable database. My hope is to identify any differences in academic performance between children in the CM, SMA, and CC (community control) groups at baseline and their one year follow up. We will also be looking at whether the neuropsychological testing is predictive of those differences.

This is our little office with Mariah, JP, Irene and Barbara!

The study has been going on for a few years with a total of 300 participants, so there are lots of school reports, and more continuing to come in. My goal is to have as many children as possible with both baseline and one year school reports to analyze and develop a conclusion.

One of the schools we visited to train.

The time has been flying by so quickly. To think, I am already half way through my time in Uganda! At times that is a comforting thought because it means home is not so far away, but when I’m at work, I often feel I could stay here a few more months to accomplish everything the way I want. It is a lot of work, learning a new research and health care system. I am enjoying every moment though. Not everything is easy, but that’s what makes it fun. I love the challenge and Kampala definitely keeps it coming!

Mulago, Sweet Mulago

My front porch for the next few weeks!

What a good feeling it is to settle in a place knowing you won’t have to repack and move again for some time! After spending 2 weeks bouncing from guest house to guest house, I have finally unpacked my bags in the Mulago Guest House. “Home” for the duration of my time here, I’m quite content. It is a big guest house with 6 rooms, two beds in most, and there are two other buildings for visitors. Door to door, it is about a 10 minute walk to the hospital office where I work. There’s a little café and a restaurant on the guest house grounds for when I don't feel like making dinner. If I take a left out my drive, instead of a right towards the hospital, there are many people selling bananas, mangos, g-nuts and other things, so that is a quick and affordable place to grab a snack. For comfort and exercise, it’s about a 20 minute walk to the nearest coffee shop with wifi.

The common area, the kitchen where I make dinner is just through door on the left.

My room!

The majority of my time so far, I’ve been the only guest. There were 3 anesthesiologists my first night, 5 students for one night a few days later, and a young family just moved in for the week. People have been coming and going, not staying for very long, but I have been able to make friends with many of the people who work here, making it a little less quiet when I’m the only one around. Sarah is the woman who makes me breakfast every morning and who I spend the most time with. I gotta say, fresh fruit, juice squeezed that morning, Ugandan tea, eggs to order, avocado, she is a great cook and successfully sends me to work with a satisfied tummy every morning. I went with Sarah to the Wandegaya Market the other night to get food for the next morning and that was definitely an adventure! We walked there as the sun was setting, which means it was completely dark on return, my first night out in Kampala! That’s one thing about Uganda nights, there is very little dusk. Sunshine to pitch dark. Because it was dark and our arms were full of groceries we took a taxi back to the guest house.

My first time in a Ugandan taxi deserves a special explanation. I don’t know about you, but when I think of a taxi, I think of New York streets full of yellow cars taxing 1 or 2 people around. In Uganda, taxis are large vans that have a licensed maximum of “14” passengers. Yes, 14 is in quotes, because many drivers don’t remember that number if it means they can get a few extra shillings. Oh and it only costs 500 shillings, no matter the length of the trip (from my understanding). $1 US is equivalent to approximately 2,900 UGX. If my math is correct, that made my taxi trip under 25 US cents. No complaints from me.

Some other friends I’ve made are the animals that often make me feel I’m at the zoo. The turkeys usually wake me up in the morning, they’re louder than the roosters. The hawks and black and white crows stay mostly to the trees out front and are usually pretty active in the evening when I come home from work. Little lizards are common. One that I’ve named Fred, is particularly fond of my bathroom walls and curtains. We have an agreement that he can stick around and eat all the mosquitoes he wants, so long as he stays out of my bedding and clothes. My rarer animal visitors are the monkeys, I’ve only seen them one morning so far. They were so fun and cute! At first. I stepped onto the porch and saw them in the bushes and trees, so naturally I took some pictures. Then the babies ran onto the porch posing for pictures, cute. Then the moms came. Not so cute. The sneaky babies were distracting me while the moms tried to get in my backpack and then in the house! Sarah was still here, thankfully, and she came and shooed them and made sure I could leave the house without getting attacked by the monkeys. She warned me to be careful, for as cute as the little ones can be, the bigger ones can be dangerous. As we were walking around the house we saw about 7 more, so I think there were at least 15 around our house that morning!

Fred chilling in the bathroom.

I call them Tom and Jerry because they always seem to be chasing each other around.

Monkeys in the distance.

Babies up close.

They were pretty curious of me.

Overall, it really is a nice place to settle and call home for the next few weeks. I feel truly blessed to be surrounded by such beauty and friendly people. It can be hard to be alone sometimes, especially in a foreign country, but I’m learning to value the quiet time as well as putting myself out there to make friends. It's not always easy for the introvert in me, but the friendships I've already started to make are already showing me it's worth it. Taking a small step of kindness can go a long way to make a friend.

Kanginima Nursing School

I have only been in Uganda for two weeks, but I have had many opportunities and am continuing to experience just how important nursing is for positive patient outcomes. Their ability to care for and adapt to wide and varied diagnoses is crucial. As clear as the importance of the nursing role is, I have seen there is still a great need to increase the number of nurses and improve quality of institutions producing nurses.

In the previous post, I promised to talk more about the Kanginima Hospital and nursing school, so that is what this post is dedicated to.

As mentioned earlier, Dr. Mutono worked hard to access fresh water, decrease malnutrition, and foster a community that was safe, both socially and medically. He has recognized the value of quality nursing care and dreams to train and equip future nurses. From the beginning of his endeavors, Dr. Mutono knew nurses to be the frontline of healthcare. Because of this, he built the Kinginima hospital with a wing specifically dedicated to one day becoming a nursing school.

This wing is equipped with classrooms for instruction and lab rooms for clinical practice. It is even directly attached to the operating theaters for convenient observation hours.

The vision is to bring in 150 students who will become the newest cadre of safe and excellent care providers. Before this dream can be met, a dormitory needs to be built. As Kanginima is far from major cities, the school would need to be able to house the students. This need for housing is, unfortunately, one of many trials that the Kinginima nursing school faces. Funding and support are in short supply, making this dream be placed on the back burner for now. Delaying the opening of the school only perpetuates the low numbers of adequately prepared health professionals available to the many people requiring care. A catalyst needs to incite change somewhere in the health system.

But how does change come?

I had an amazing conversation with a Ugandan physical therapist who is a professor in the States, developing a program to bring students to Uganda. Together we explored what brings about sustainable change in a country such as Uganda. Although donations and gifts can be helpful, what truly lasts is a partnership based on shared values and a commitment to follow through on projects. Uganda doesn’t need a “hand out,” but a hand to come alongside and stand against the injustices of poor healthcare accessibility.  

A dormitory, textbooks, faculty… There are many pieces Kanginima requires before their doors can be opened to students, but there is one key factor that will overcome these small road blocks: passion. There are passionate individuals, here in Uganda and a few in the states, longing to make this dream a reality. I, for one, can say just how excited I am for the day Kinginima celebrates their first graduating class of nursing students. The necessity for quality nursing care is great, not only in Kanginima, but across Uganda, and it is the commitment of those dedicated to taking a stand against subpar health care that will truly bring about change.

I know you may wonder why I felt led to write a whole blog on a school that isn’t even open yet, but I couldn’t help it. Walking into that building, I didn’t see empty desks and dusty beds. I saw classrooms filled with young men and women eager to learn about the foundations and implications of nursing care. I saw a space that would equip Ugandans to care for their own. I saw a step being taken to make healthy living the standard, not the exception. I may have only finished my own nursing degree a month ago, but the pride I feel for this profession fuels my desire to advocate for others who long for the opportunity to join me in this life changing career. 

Time in Tororo

Our team spent most of this past week in a city called Tororo.

The Global Health Uganda building with the Tororo research team works.

Even if GHU is partnered through Makerere University and Michigan State, the Ugandans know whats up ;) 

On our way to Tororo, we stopped over a night at a place called Sisiyi Falls. It was a small village and we arrived at night, so we were not able to see exactly what our surroundings looked like. But when we woke up on Sunday morning, we found ourselves in a beautiful garden at the base of rushing waterfall. We understood, then, why our professors called this place Eden. It was absolutely gorgeous and almost completely natural (seriously, no running water or electricity). We had a quick sunrise breakfast and then began our hike up the falls! I was told it wouldn’t be a hard hike, but I was in a skirt and converse shoes and it had been raining the previous two days, haha, but despite being poorly prepared, we made it up and down all in one piece. The whole trek took about 3 hours, with some stop time at the top with the local village kids.

A view of Sisiyi Falls from the base.

Our faithful guides, William and Ronald, helping us up and down the falls safely.

Following that adventure, we continued on to our lodgings in Tororo, Café Davis. It was right next door to a Pentecostal Out Reach Ministry, so we got to hear their worship service all day long, which was pretty cool. The purpose for our visit to Tororo was to drop off the students who will be working at Tororo District Hospital through our partnership with Global Health Uganda (GHU). This study location is looking at providing an intervention for caregivers. HIV and cognition are the main focus in this study. I was able to go into the field with one of the trainers to do follow up with one of our mother-child participants and this was truly an amazing experience. It was probably the most rural setting I have been to thus far, but seeing the positive relations between trainer and participant was such a sweet thing.

My very sweet new friend, Vero, who took me to do field work with her.

This little one was scared up us at first, but then just very interested in my funny hair!

The rest of our time in Tororo was spent touring the other medical and research related centers in the area. Our first visit was to the Bendictine Eye Clinic. Started by a group of Bendictine fathers, this location is reknown for the care they provide to Africans with all kinds of disabilities. Our guide, Lucy, was very inspiring and reminded us that Ugandans are smart, and when they are told that (instead of money just being dropped off), they are motivated to better their country through education. We went to The AIDS Support Organization (TASO) and learned about the work they are doing to supply resources and counseling to that population. The IDRC (Infectious Disease Research Collaboration) office. They are doing a lot of interesting work with malaria in pregnant mothers and children up to 3 years. The next day, we visited Cure Children’s Hospital of Uganda. Their specialty is neurosurgery and they see thousands of cases of hydrocephalus and 100-200 cases of spina bifida every year. They have pioneered a unique procedure for hydrocephalus and offer training to pediatric neurosurgeons from all over the world.

The next place we went was the Kanginima Hospital. It was started by a local doctor who lived in America for many years following his medical training, but felt called back to his home village to begin healthcare reform in Uganda. Starting with capping wells for bring fresh water to lower infant mortality, to developing a strong agricultural system to fight malnutrition, to building churches to counter the prostitution and gambling that came with increased resources, Dr. Mutono and his wife have been actively taking concrete steps to improve their community and their country. Another one of the ways he hopes to do improve healthcare availability is through starting up his nursing school, but I’ll be talking about that more in the next post! His passion has gotten him all the way to parliament where he hopes to continue improving healthcare outcomes in this country. 

Kinginima Hospital 

The supply closet for the operating theater.

One of the largest capped wells built through Mutono's program. We acquired quite the little entourage on our drive there =)

One of the tilapia ponds started to fight malnutrition.

After those visits, we found this great little coffee shop in Mbale called Endiro. With wifi, lattes, and cheese grater chandeliers, I almost felt like I was back in Ann Arbor, haha. Our last day we had a tea to say goodbye to the Tororo team and the students staying there and then we made our way back to Mama Riba’s until I move over to the hospital on Saturday.

Endiro coffee shop for lunch and lattes.

Martyrs Day

Today is a national holiday in Uganda. It is Martyrs Day, when Ugandans remember converts to Catholicism who were killed because they would not renounce their faith. There are no Catholic churches immediately near where we are staying, but traveling around today we saw many people heading to and from mass for prayers. This holiday is also a time for pilgrimage from all over Uganda. It was very enlightening to be here while this was happening and experience, firsthand, all Ugandans take this day away from work and school to remember those who lost their lives. I thought this day and post would be the perfect platform to share some of the different faith cultures I have been able to experience in Uganda.   

Upon first landing in Entebbe, Monica, a lead researcher for the Mulago CCRT team lead our group in prayer, thanking God for our safe travels. This openness in prayer is something I have seen many places in Uganda, even academic and research settings. It was very strange to me at first, for I have felt that faith and academia do not often like to mix in the American university culture. Here, however, it appears normal and welcomed in many places.

Pastor Micah, Mama Riba's husband, let me join him in coffee and quiet time on their beautiful porch in Kampala.

In the previous post I mentioned a Baha’i Temple that we were able to walk around and learn about. We learned things like this faith places strong emphasis on equality and science, also that this location is 1 of only 8 Baha’i temples in the world.

A Christian church.

A Muslim Mosque,

A unique encounter I had was with a family in a more rural setting while conducting a home visit with a Tororo research team member. This family did not speak English, but they did have a radio that was playing a Christian program in English. Later, the mother and daughter prayed before beginning their meal together. This made me wonder if they were of the Christian faith because of the radio and prayer or of another faith and it was simply coincidence to have the radio on that station.

Along with personal interactions of people of the Christian and Baha’i faith, we have also seen a multitude of worship locations throughout our travels. Mosques, Catholic churches and clinics, Baptist churches, Jewish medical centers, Pentecostal churches and many more line the roads of Uganda. The ample amount of faith centers and worship locations have shown me how important faith is to Ugandan culture. It provides a close-knit community, which I am learning is very important here.

One faith aspect that I have heard mention of, but not experienced directly, is the utilization of witch doctors and traditional healers to ward off illness and bad spirits. Seeking this kind of care can, unfortunately, cause problems in the healthcare environment. It can delay people going to hospitals for care, allowing time for their condition to worsen. Thankfully, people no longer consider many illnesses, such as HIV, to come from bad spirits so they are accessing healthcare sooner and receiving effective treatment.

I found this wall in a great coffee shop in Mbale called Endiro.

I am only beginning to scratch the surface of faith in Ugandan culture and enjoying it so much! 

The Adventure Begins!

Hello!

We (Dr. Giordani, Dr. Boivin, James, Tory, Ronak and myself) arrived to Mama Riba’s safely and have had a very full first week here in Uganda! Before I go into the details of all we’ve done this past week, I want to explain a little bit about this blog and the research I’ll be doing while here.

I decided upon the title “Anyplace” and the quote by Augustine of Hippo with the hope of sharing some of my heart with the readers of this blog. Since high school, I have developed a passion to go where there is need and serve however I can. This is why I chose to pursue nursing, why decided to continue my education with a PhD and why have found myself in Kampala today. I plan to use this blog to document my research experience, but also (and maybe more importantly) to communicate my personal experience of being in a new country. Please feel free to comment or send me questions about things I blog!

The research project is based out of Mulago Hospital in Kampala, Uganda. This study is looking at the use of a computerized cognitive rehabilitation therapy (CCRT) to improve cognitive outcomes of children who have survived severe episodes of cerebral malaria, causing impairments to certain areas of brain functioning. I’ll offer more details later on!

Before setting us to work, our professors thought it was important we have a few days to experience Uganda at its finest. So on May 25^th we went to Ngamba Island Chimpanzee Sanctuary. It was quite the choppy boat ride across Lake Victoria, making us rather damp upon arrival, but it was well worth it. We were able to arrive for the chimps’ feeding time and that was quite the sight. They were smart little ones, using sticks to get food out of reach and raising their hand when they wanted more!

May 26th we started out for Ziwa rhinoceros Sanctuary. This was too cool. We were driven out into the fields and went on a walk with the guide where we were able to get quite close to at least 6 of the 14 rhinos there. Turns out, however, that would not be the closest we get. While eating lunch, two young female rhinos decided to join us! We also made friends with a little warthog who loved our attention.

May 27th we made our way to Murchison Falls National Park. We had just enough time to ferry across the Nile and hop on a safari boat cruise. The view of the falls and animals was absolutely incredible. That night we had a little bit of trouble finding our hotel, but once there, we found beautiful little huts with a great view of the sunset over the Nile. The 28th we went on morning and afternoon game rides through the park to see the big animals (lions, giraffes, elephants, water buffalo, etc.) and we took a short hike up to top of Murchison Falls. The creation we were able to experience that day was truly indescribable.

May 29^th we drove back to Kampala from Murchison. Before dinner we were able to get in a quick walk to see the Baha’i Temple and a local soccer game. After dinner we went to see a cultural singing and dancing show. It was a really fun way to see a few of the differences among tribes.

It has been a very full week with many hours spent on very bumpy Ugandan roads, haha, but so far this country has done nothing but win over my heart. From the people to the scenery, I see beauty at every turn and I feel so blessed with the opportunity to be here!