Dr Jo Harvey October 2025
Dr Jo Harvey – PAL visit Lira October 2025
As a GP I felt apprehensive regarding what my role would be on this trip. There was very little information as to how teaching would be organised and with which groups of health care professionals. As a result, it was difficult to plan, although I did prepare a number of educational topics in the hope that they would be suitable.
Our welcome at Lira Regional Referral Hospital was warm and showed the pride and hard work of the hospital teams. It was clear that we needed to establish a partnership to share information and that our role should be seen to compliment existing teaching.
It was challenging to organise teaching with the different groups as they were extremely busy and as a GP for the last 30 years, I did not feel that I could just pick up a topic on the ward to teach in that way. The doctors, medical students and midwives including students had teaching plans in place already, so it became clear that careful and sensitive liaison regarding teaching was needed. The level of knowledge was excellent and would our teaching be appropriate?
I was very glad that I had sat in on some clinics early on, so I could get an idea of local services for women’s reproductive health and their provision. It became very obvious that there were many differences and that I would need to adapt the prepared topics to incorporate this. This meant I was able to involve the groups in discussion about the different challenges faced in and around Lira and discuss differences with the UK.
We were also met with a warm welcome at the School of Midwifery at the University and made a plan for teaching sessions during our stay. This planning enabled us to make a timetable. However, it soon became obvious that plans were subject to change, sometimes without informing us! We had some great sessions including a communication skills session involving our smaller team and our health psychologist Lou Roper. We also ran workshops for suturing, miscarriage/ectopic, shoulder dystocia and practical skills for coils and implants. The 3rd and 4th year midwifery students were very engaged and feedback for the sessions was really positive.
Our visit coincided with a 3 day women’s health ‘camp’. This was to encourage uptake of screening and health checks and was offered as a free service. This resulted in an excellent turn out and whilst Judy and I performed breast checks and taught breast self-examination, Jo and Shonagh helped with the antenatal checks. Judy and I had created a large sign in the local language which we read to the women as they came in which helped with communication and really improved our knowledge. The opening ceremony ran 2 hours late which did mean rather a delay to starting the clinics!
I was extremely lucky to work with Judy and the Lira Breast Team to deliver a camp for women with breast problems. This started with an advertising campaign and we were invited to be on the local radio. This was great fun but we were thrown in at the deep end. No preamble or preparation, just straight into the show with a discussion followed by live unvetted calls. Talk about thinking on your feet!
The breast camp followed and there was a huge turnout, around 250 women registered. It was an honour to work alongside local clinicians who were so dedicated and we worked into the night despite a generator failure! Phone torches were essential! We feel that we picked up some significant pathology and as a result of previous links set up with the cancer institute in Gulu samples could be collected and sent for testing. The team also offer help with transport for patients requiring treatment at the centre. Exhausted, we all returned to Lira to unwind over a Nile and sodas. It was a wonderful day.
Another highlight for me was visiting the COTS (Creating Opportunities Transforming Societies) foundation. This is a group supporting vulnerable young women set up by a local couple Grace and Richard. The ethos is to empower young people through comprehensive interventions in health, nutrition, livelihood and protection to enable them to build resilient and sustainable communities. The group make reusable sanitary products for disabled young women and have been taught how to use sewing machines. We ran a ‘drop-in’ session for the young women to promote breast self-examination, talk about any early pregnancy and antenatal issues and offering contraception advice and other issues.
We had a fantastic team overall. Pasco and the iAMS team had a very different daily structure but we met in the evening and chatted through our days over a Nile or two (although those bottles are big!) and supper. Our sub team of 4, led by Judy, was cohesive and supportive and Judy worked so hard to try to coordinate our teaching which at times was difficult. As a group our skillset fitted together so well, and I felt we were able to offer a broad coverage of the different aspects of women’s sexual and reproductive healthcare.
The hotel was comfortable and welcoming, and we were very well looked after by Daisy and the other staff. Arnold was a superstar and was excellent at rounding us up when needed and helping us with anything from changing money to choosing the best pineapple (and then cutting it up for us at the roadside!).
I thoroughly enjoyed my 2 weeks in Lira. It was a challenge, and I did feel out of my comfort zone at times but always supported by the team. I felt I learned so much about the challenges in and around Lira and Uganda’s more remote communities in accessing and delivering healthcare and the level of activity trying to improve this. As anywhere, resources played a key factor and the withdrawal of US aid recently had had significant effects which were devastating in some areas of healthcare.
Moving forwards, I feel that using links made on this and previous trips could facilitate more preparation for the future teams. We need to assess learning needs and ensure that we incorporate our existing knowledge of Lira Referral Hospital and the University. A teaching timetable could be drawn up in advance of the visit making appropriate use of the skills of the clinicians in the PAL team and incorporating the local needs on each visit. This would result in a more streamlined visit enabling us to deliver our teaching sessions in a less ad hoc manner.