Report for Team 1 Visiting Lira October ’24

REPORT FOR TEAM 1 VISITING LIRA OCTOBER 2024

TEAM MEMBERS
Dr Antoinette McAulay – Consultant Paediatrician and Team Lead
Dr Pasco Hearn – Consultant Microbiologist and Project lead for iAIMs
Emily Seddon – Maternal Mental Health Specialist / Midwife
Rebecca Savage – Consultant midwife
Dr Shreya Chugh – Wessex Paediatric Trainee
Dr Louise Roper – Health Psychologist
Lindsey Osborne – Medical scientist

1. LOGISTICS
PREPARING FOR OUR VISIT
Team 1 had two planning meetings before the trip and also prepared their objectives.
The team consisted of three main sections: iAIMs led by Pasco Hearn, two midwives (Emily also helping with the iAIMs project) and two paediatricians.
We liaised with Lira University and the Referral Hospital several weeks before leaving, and had a planned meeting at the University on the first morning.
Kit was mainly packed individually and finalised before departure

TRANSPORT
Rwandair flights were booked via Trailfinders. Unfortunately, the flight home was cancelled at relatively short notice so we had to leave Lira a day earlier than planned. A taxi was ordered for transport to and from Heathrow via Dorset Airport taxis.
Flights both ways were uneventful. On arrival at Entebbe, we were told that we were unable to bring in the donated bras and reusable cloth nappies. We had to pay a $20 fine. This did delay our departure to Lira.
Our driver Arnold welcomed us at the airport and looked after us extremely well during the entire visit. We had safe journeys to and from Lira, However the journeys were longer than usual due to the Karuma bridge being closed to traffic
HOTEL
We stayed at the familiar Hotel Kanberra. Our accommodation was clean and comfortable, with excellent service from the very friendly staff who are used to our teams visiting regularly. Unfortunately one of our team had dollars stolen from her room. After reporting to the hotel manager, the money was anonymously returned before our departure.

ORIENTATION
On the first day, the paediatric and midwifery teams visited the University to meet with Samson Udho (Senior Lecturer in Midwifery) and Eric Murungi (Critical care nurse) to discuss a timetable for teaching over the next two weeks. Samson also gave us a tour of the University and enabled us to have WiFi access. We were provided later that day with suggested teaching slots, and the contact details for tutors and year leads for both undergraduate and Masters student groups. We also looked at the University visitor accommodation. In the afternoon we visited Lira Regional Referral Hospital (LRRH) and visited Dr William (standing in as Medical Director) to orientate new team members
The iAIMS (Integrated Antimicrobial Stewardship, Infection Prevention and Control and Microbiology Services) team had meetings and orientation with their project partners at Lira Referral hospital on the first day, and planned their timetable for the trip.

MAXIMISING INPUT
Our teaching time this year was reduced because of Independence Day and having to leave a day early because of the cancelled flight. We were however able to do some informal teaching on the mornings of Independence Day and Saturday morning at LRRH. In addition, Pasco and Lindsey did local radio presentation on two evenings.

FEEDBACK
We used a QR code for feedback as in 2023. This proved challenging at the hospital due to lack of internet access. We emailed staff the weblink for the feedback instead which was not as effective as getting feedback done immediately after the teaching. See xcel sheet for feedback results

PERSONAL REFLECTION
This is my sixth visit to Lira with Poole Africa Link. Each time that I visit I can see improvements both at the University and LRRH. This year however was different as the paediatric team were only allocated two teaching slots at the University (and these were to masters rather than undergraduate students). As a result, we spent very little time at the University and concentrated our efforts at LRRH. We did visit the paediatric ward at the University Hospital which seemed in comparison well-equipped but with very few patients. I was pleased to see that the ward was using observation charts with an early warning system, albeit not exactly the same as the final version we had developed last year.
Our formal teaching at the University was:
1. Maternal Nutrition
2. Infant malnutrition
3. Neonatal Examination
4. Congenital Anomalies
The Children’s ward at LRRH continues to be exceptionally busy. We were told that this single ward often had 60 patients with 2-3 patients sometimes sharing one bed. This year medical staffing was considerable better. There were two consultant paediatricians in regular attendance (Dr Florence on the children’s ward and Dr Juliet on the NICU). In addition, there were 3 interns (one on the NICU) and a general practitioner. There were also doctors taking their Masters in paediatrics who were away taking exams during most of our visit. Nursing staffing remained the same, generally with one nursing sister per shift, other trained staff (but not necessarily paid) and a multitude of student nurses.
Although paper medical notes with individual hospital numbers are now part of normal practice. Drugs charts are still not being used, nor the observation charts that we previously developed. Observations are still mainly being performed once a day on the ward round. Observation and drug doses are recorded only in the notes. Although this is disappointing it was not unexpected. I discussed the lack of observation charts with both senior medical and nursing staff, who explained that the government is introducing an electronic system for both drugs and observations.
The paediatric department now have regular meetings (which I was not previously aware of): department meeting Monday morning to discuss any issues, Mortality meeting and CME meeting. The meetings although extremely useful progressed very slowly and significantly delayed the start of the ward rounds.
Much of our input was informal teaching and case discussion on ward rounds, particularly with the intern doctors. We also had discussions on individual cases, on palliative care approach and high dependency care issues with the consultants.

Our formal teaching at LRRH was as follows:
Paediatric Doctors: CME meeting on Diabetes and DKA
Medical Students (4th years attached to paediatrics from Kampala University)
• Taking a paediatric history and examining a child
• Paediatric Resuscitation
• Neonatal resuscitation
• Respiratory Illness
• Ward round teaching on admitted cases
Nurse Students
• Safe blood transfusion
• Triage and ABCD approach to paediatric assessment
• Neonatal resuscitation (in small groups throughout stay)
• Ward teaching on admitted cases
Trained Nursing Staff
• Using a Glucometer
• How to use new Oximeters
• How to use Spacers

Even though I have been several times beforehand, I am always affected by the significant lack of resources that the hospital is able to provide in comparison to what we are used to in the UK. The paediatric medical and nursing staff have such a challenging environment to work in. Patients often present extremely late as lack of money prevents then making the journey to the hospital in a timelier fashion. If the hospital is lacking in a drug or piece of equipment (even such as a syringe) parents will be asked to buy this which they often can’t afford. Alternative sources of health advice and treatment are sought in their villages, including a village tonsillectomy (sometimes cutting the uvula rather than the tonsils). Tragically, we saw several children die as a result of these procedures and late presentations.
I felt that concentrating our time on the Children’s ward really enhanced our relationship with staff and all levels of staff were grateful for our input.
We also took out small items of equipment including digital thermometers and clip oximeters, Spacers, Bag and masks, Glucometers and BNFc’s These were given directly to Sister Helen (senior sister). In addition, larger pieces of equipment from fundraising (digital Infant scales and continuous ward oximeters were presented to the Hospital Parliament.
Some of the team attended the LRRH Parliament (attended by senior staff). I was able to talk to the meeting about Poole Africa Link to raise the profile of our charity. I also met with Dr Francis, lead for Internal Medicine, to discuss future joint working.
Overall this was a very cohesive team, who supported each other well. Much was achieved by team members who have both contributed and individually benefitted from the visit.