Combined condensed report for the PAL visit clinical team in October 2025
Combined condensed report for the PAL visit clinical team in October 2025 (full originals are available)
Judy Mella (surgeon), Shonagh Gibb (midwife), Jo Gyngell (midwife) , Jo Harvey (GP).
Shonagh
I was excited to be returning to Lira with PAL and looking forward to meeting previous contacts and progressing work started previously, without the reservations and fears felt during the first visit.
On arrival at LRH, we were met by David and Doreen, who took us on a tour and introduced us to lots of useful people. This felt positive and felt much more organised than my previous visit, leading me to believe that this was going to be the case throughout the visit. Unfortunately, I very quickly realised organisation remains a huge and frustrating challenge!
The contacts we had made 2 years ago had moved on to other placements, and I was not relishing the feeling of “cold calling” that I’d experienced on previous visits.
Interestingly, this was even more difficult than previously, as we were not as free to wander into clinical areas, as there was much more emphasis on privacy, respect and dignity. There were even curtains up in the labour ward area!
This felt like a very positive improvement and continued to be very apparent throughout the visit.
The next 2 days we were kept busy, being involved in the health camp at the university hospital, where we witnessed people very committed to accessing health care, travelling huge distances and waiting for hours and even days to be seen by knowledgeable, skilled health professionals, from all disciplines, who were totally committed to providing an excellent, holistic, caring, service to all.
Especially encouraging was the inclusion of partners in antenatal clinics, Midwives using the opportunity to provide health promotion information, discuss gender-based violence and the importance of fidelity and contraception. None of this was apparent 2 years ago.
I was reminded of where we were 20-30 years ago in the NHS, and the challenges and frustrations we as professionals faced when trying to facilitate change. It took time, education and patience. Uganda is at the beginning of this journey, and in my opinion, will navigate their own journey of transition with knowledgeable professionals who truly understand the challenges and constraints of its own unique culture.
Despite the challenges faced, I did feel that we had a very productive and rewarding visit. Everywhere we went, whether in the university or LRH, we were made very welcome and our input was really well received. After a slow start, I’m very pleased to say that I did achieve most of my objectives.
Looking forward to future visits: I suggest there is ongoing input from previous team members to maintain contacts and assist with arrangements for future teams; meeting with these teams in the UK to prepare and manage expectations and discuss ongoing projects and how to progress and support.
Setting up a 2-week program before leaving the UK, with inclusion of COTS and rural ANC clinic, and how we can support these initiatives in a positive, productive way?
I would be very happy to meet with future teams, prior to visits and discuss my experiences and share what I felt was helpful with overcoming challenges.
Jo Gyngell
This was my second trip to Uganda with Poole Africa. I approached this trip with a certain amount of nervous anticipation, excitement and determination to be a useful team member. On this trip, I felt far less overwhelmed by the surroundings and conditions witnessed within the clinical settings.
I frequently found staff and patients thanking me for just being present in our burgundy scrubs. This was very humbling but a recognition of appreciation for the teams that had been before myself. It was good to meet some staff who had been students on my previous visit and were now very competent, enthusiastic staff members.
It was great to see noticeable improvements at Lira referral hospital; I was very excited to see functioning privacy curtains in use in the Labour ward. Another noticeable change was the inclusion of partners in the labour ward and in clinics. Some were very happy to be there, and others were encouraged; certainly, a more holistic approach was witnessed in the hospital clinics.
I did speak to a large number of Midwives who were ‘volunteering’ as midwives at the referral hospital, performing the same procedures as paid staff. waiting for jobs to become available in the future, often working in a paid job such as marketing and volunteering on the same day, so many passionate staff wanting improvement and changes.
Teaching: This was my primary goal, attempts to arrange an allocated space to teach was challenging. On my previous visit walking onto a ward and providing ad hoc teaching was very easy, this was not the case on this occasion, I feel this a positive step, again an improvement in protecting privacy and dignity.
As a small team we did manage a couple of successful days of teaching at the University, the most well received sessions were the workshops we ran involving practical elements and role play, talking to the students there is a very comprehensive academic programme in place, for example, the students had studied the theory of manging a Shoulder Dystocia but had not had the opportunity to practise described manoeuvres, used in the event of a shoulder dystocia, there is a very well stocked skills lab which were a source of lots of useful props to enable us to run a Shoulder dystocia scenario.
The Masters Students enjoyed discussing case scenarios. It is good to go with a wide range of pre-prepared subjects, students particularly enjoyed practical workshops. From a Midwifery perspective, emergency scenarios and role play were very well received, the majority of students are willing to participate and become involved. I also found staff and students were open to discuss bereavement and pregnancy loss, and self-care for staff, something that could perhaps be developed further on future visits.
One of the many highlights of my visit was a visit to a rural-based health clinic improved by a former university student who is now studying for her master’s degree, working as a Midwife in charge of the health centre and is a mother herself; her energy and enthusiasm was exceptional. Once again myself Shonagh and I were being treated like VIPS, and our presence drew a large crowd at the health centre and women were very keen to be examined by us in the antenatal clinic under the watchful eye of Sister Jennifer! I also delivered a baby at the health centre …. unexpectedly as Jennifer was transferring an unwell lady we had found in clinic just as a labouring lady decided it was time for baby to arrive, fortunately, quick thinking, Shonagh located gloves and there was a happy outcome! The health centre was well organised in Basic conditions, and we witnessed a happy, safe environment, far from perfect in conditions and available equipment, but remarkable in their goals and achievements.
Another highlight was a visit to the COTS Foundation centre (Creating Opportunities Transforming Societies).It is a ‘Safe place’ for vulnerable woman established by another inspiring lady Gloria and her husband Richard, once again we were made to feel so very welcome, and I found myself running an impromptu clinic with a translator, during this time I met a 16 year old who was heavily pregnant, I sat and spoke with her for 45 minutes and drew terrible pictures trying to explain the process of labour, I felt humbled by her bravery and wished I could have been present for her labour, I still think about her now.
Gloria teaches the girls /women who attend the COTS foundation how to sew ad make reusable sanitary products, aiming to keep menstruating girls at school, and providing young women and mothers with an employable skill, just an amazing sustainable project!
I did witness sad situations on the wards (that I would probably never see in the UK) and heard many heart-wrenching stories of domestic abuse, limited resources and personal struggles from staff and patients but also many success stories, it was certainly a very mixed experience!
The team camaraderie was just brilliant, and contributed to the overall enjoyment of the visit, a very varied mix of skills and roles, I enjoyed meeting the IAMS project team and hearing about the project. I enjoyed working closely with Judy, Jo H and Shonagh between us we covered many areas of women’s health. We enjoyed sociable nights in and out of the hotel, which alleviated some of the frustrations and challenges experienced during the days.
Thank you for giving me the opportunity to return to Uganda; once again, it was a truly memorable experience. I hope I have given some support to staff and students and helped to influence a future generation of midwives. I believe I have gained from Uganda as much as I have given.
Jo Harvey
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 complement 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 I wondered if our teaching would 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 engage,d and feedback for the sessions was really positive.
Our visit coincided with a 3-day women’s health camp at the university. This was to encourage uptake of screening and health checks and was offered as a free service. This resulted in an excellent turnout, 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 meant a rather long delay in 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,with 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. The group make reusable sanitary products for disabled young women and has 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 and supper. Our sub team of 4, led by Judy, was cohesive and supportive. 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.
Judy.
A wonderful and rewarding trip overall with a lovely team.
Lira referral hospital (LRRH)
What a huge change since my last visit 2 years ago. Notably in the clinical efficiency: certainly for surgery and obs & gynae, there are early morning department meetings with active auditing of patient care from the previous day or two, and troubleshooting challenges. The gynae ward too showed excellent resuscitation of a collapsed patient that was brought in. The clinical leadership is palpable. The OPD department has now been restructured along the new integration plans where patients are triaged into acute and chronic and directed accordingly to the appropriate clinics. It seemed much less chaotic in the waiting areas due to this. This is rolled out into the community to increase more efficient referrals the appropriate days. Partly this is triggered by the “trump effect” ( withdrawal of the US funding for the HIV clinics)
There is now piped oxygen to all clinical areas – the only exception is NICU where they use the oxygen concentrator we gave them.
The big difference in infrastructure is the new laboratory. This is an MOH satellite lab funded by the World Bank as part of the preparedness project (UCREPP). LRRH did particularly well with its management of COVID, and the minister of health is local so was selected for good funding. There is a state-of-the-art histology processing equipment – for years the north has had absolutely NO histology let alone a pathologist, so this is a huge game changer for cancers amongst others. No reagents or pathologist yet, but will come soon.
The whole hospital is computerised now.
Teaching in the LRRH: As the infrastructure is changing quite fast we as a charity also need to change with it. We cannot just turn up now and teach on the wards and I echo the others in underlining the importance of pre-visit planning and liaison with key staff.
I have met 7 previous students we have taught out in the community now. They remember us very well. They are all high calibre and making a huge difference. A particular shout for Sr Jennifer who has taken on a failing level 3 clinic and completely transformed it onto a thriving clinic with plummeting maternal death rates and high uptake for earlier antenatal care.
General teaching. I found a lot of our teaching is being done by the school and university. In order to really add value we need to focus carefully on the type of teaching we offer to avoid duplication. I think we are best at the scenarios and workshops. I think the days of teaching subjects outside our own expertise have gone. There is a big call for practical procedures such as chest drains, 3rd degree tears, obstetrics emergencies, paracentesis, clinical assessment of sick patients, contraception( IUCD insertion), splinting a fractured femur, etc. Screening, communication and bereavement are really good areas for covering.
In the community, we had a great day in Dokolo health centre IV with an awesome team checking 250 women ( and a few men) for breast screening. The message is getting through to the community and patients are now coming in earlier with their lumps. (See individual report).
Looking forward to the role of PAL. I think we need to :
- Focus on teaching practical procedures to fill gaps rather than duplicate already excellent academic teaching provided.
- Continue our presence in both hospitals as it is clearly hugely appreciated
- Focus on specialist exchanges( maybe through Wessex global health).
- Encourage externally funded parallel projects running in parallel such as the SICRA antimicrobial and the Breast clinic which are both recognised and appreciated and strengthen the PAL linkage.
- Have dates for the next visit already planned by the current team to facilitate efficiency of teaching and have up to date lists of the medical staff to liaise with, and 1 or 2 key people to liaise with .