Report Dr Frankie Dormon Lira Uganda October 2016
Report on Trip to Lira Uganda October 2016
This was my fourth visit to Lira. I had planned to visit for 4 weeks to co-ordinate the larger team. This was because originally the University had asked that we only visited once per year. They have now asked that we should visit twice a year so future trips will be for 2-3 weeks, depending upon the team members.
My objectives were
To co-ordinate and lead the team for the first and last week, Hilary Fenton Harris took on this role during the middle 2 weeks.
Co-ordination includes team safety, planning and logistics of teaching at both the University and Hospital, support for team members, particularly those who have not visited before.
I had been asked to support the hospital in their objective to open the ICU facility. To that end, I have been to Hong Kong and am now a recognised trainer for the BASIC DHS course. HDU in developing countries. This is designed as a 4 day course, to include time to train trainers from the country where the course is being held, however, I had planned to run this on a modular basis, because there are not enough doctors in Lira to take several out of the system for an Intensive course. I had visited in April to plan this course and the University teaching.
I had a new copy of our MOU which I wanted to have signed and agreed.
Networking is very important for our visits, I hoped that we could widen our network, primarily to explore a future link with Bournemouth but also to widen our network of contacts, including a visit and support for a local orphanage.
The 10 team members worked very hard and succeeded in achieving their individual objectives in the most part. The travel arrangements worked reasonably well, although it was challenging to be in Lira without a driver, when our driver was taking teams back to Entebbe and picking up the next group. The hotel was clean and the food perfectly adequate. The location in town makes it easy to visit the market to buy lunches etc, although we have to use the van after dark. Nobody was seriously ill during the visit. Our driver was both transport and odd job man, arranging photocopying, copying keys, buying sim cards, all tasks which would have been challenging without him. He also provides security as he keeps abreast of any local incidents should they occur. The 4 am flight out from Entebbe was a challenge, we may need to look at different flights next trip.
We have signed an MOU between Poole Africa Link and the University. There are plans to also agree an MOU between the University of Bournemouth in future. We had several useful meetings with Professor Jasper, Vice Dean of the University. He remains excited about our link and wishes to extend such a link further. The new University Hospital is being built and is up to the second storey, the initial plans to open a small maternity hospital in the current structure are nearing completion. Staff are being appointed, though currently working at Lira
Regional Referral Hospital.
The BASIC DHS course was a significant commitment, with formal lectures, skill stations and workshops. Manuals need to be sourced and in addition there is a pre course and post course test. We had most of the necessary equipment to run the skill stations, which we have taken out previously and for this trip. The manuals were delivered to Kampala, and finally released when the import duty was paid! We were flexible on the number of participants and finally achieved complete tests for 16 participants. Others joined for part of the course but did not complete for a number of reasons. I was thrilled at the general attendance, in that the majority of participants attended over 80% of the course. Considering this was a modular course over nearly 4 weeks, for 2 hours each afternoon, such attendance showed huge commitment. The pre course test was completed during the course, rather than in advance, but the post course test was completed under exam conditions on the last day. This course is intended for doctors, preferably with an interest in working in HDU, however, the majority of the participants were senior nurses, clinical officers from the Out Patient department or medical officers. Unfortunately only one of the doctors was able to complete the final test. This should not be interpreted as a problem; I believe that the attendees benefitted significantly from the course.
In addition to the formal part of the course, we discussed the role of HDU/ICU, the issues surrounding staffing, equipment and patient selection. For the participants it became clear that we were not going to be able to open the unit during my visit.
The team were generally experienced with previous visits either to Lira or Wau, in South Sudan. We have a model that ensures no time is wasted. We arrange a formal teaching programme at the University, this should be finalised before we visit if possible, to ensure that students are clear on our teaching programme. We have a copy of the curriculum and endeavour to fit our teaching around the curriculum, sometimes loosely, depending upon the expertise of the individuals on the team. This trip we had two Consultant Paediatricians, one a neonatologist, the other a general paediatrician, and they concentrated on neonatal and paediatric resuscitation, with scenarios, which are always popular. Our midwifery tutor was very busy with several groups teaching both normal midwifery and complications of midwifery. Unfortunately, as this was early in the school year, there were a few changes early in our visit due to the complexity of fitting in with other new tutors. Hopefully we can avoid such difficulties in future, as our visits are short and need to be very intensive. I am an Anaesthetist and delivered a short introduction to anaesthesia to both Yr 3 and Yr 4 of about 6 hours.
The remainder of our time is spent at the hospital. We have always received a very warm welcome from all ward areas, and individuals tend to work within their area of expertise and teach whoever is available. On the medical and surgical wards, there are always plenty of student nurses, both from the University and the other schools in Lira. We teach anyone who is interested. I spent several mornings in theatres, teaching the importance of observations, anaesthesia and theatre etiquette. In particular I was teaching about improving safety and patient dignity. We try to suggest small steps that are achievable and sustainable. I hope that in future the patients will continue to have their names written on them for identification when anaesthetised using Zinc Oxide tape. We also had some patient gowns made in the market, so that patients could remain covered while awaiting their spinal anaesthetic and caesarean sections. Other small improvements can be read about in individuals reports.
Overall the trip was hugely successful and we felt that we were warmly received. The feedback from students was once again very positive and the relationships we have built with the local staff, the Americans from the Peace Corps and VSO volunteers were very valuable. We also formed a relationship with a Surgeon, Dr Patrick Opio, who runs a small not for profit hospital in Lira, he teaches at the University and I spent time with him on the BASIC DHS course. In addition we had a couple of team visits to a local orphanage, Otino Waa, which was both educational and interesting. We supported the orphanage by eating at their restaurant once a week, which is staffed by children who have been through the orphanage system.
We have been invited back again around March/April, rather than wait for another year, so I hope that this can be arranged.
Dr Frankie Dormon
Medical Lead for Poole Africa Link, Consultant Anaesthetist.