A Trainer’s Perspective- Bwindi Crew – March 2012
With our upcoming trip to Uganda this month, we wanted to share this post from Vivek Kalia, an ITW trainer who traveled with us this past March. He had a wonderful experience and we are thrilled that he has written something to capture it. A perfect setting for a relatively simple, yet profoundly effective healthcare intervention for mothers and babies, Bwindi presented a fortuitous backdrop for ITW to set up imaging capabilities and train local healthcare workers. In March of this year, a group of 8 of us, later joined by 4 more volunteers and trainers, embarked to Uganda to set up ultrasound capabilities using the ITW paradigm in rural Uganda. The broad goal was clear: capacity-building for improved health outcomes in maternal-fetal health. The exact means by which we would do it, and all the obstacles (technical and otherwise) we would have to overcome were more uncertain at the time. We would do several things on this trip: (1) set up a makeshift classroom in Bwindi and invite trainees from the 4 sites we had chosen to come for classes, (2) teach the 8 healthcare workers (2 from each of the 4 new sites) basic information about ultrasound and its proper use and technique, , and anatomic and radiologic terminology, (3) teach basic information about how to operate the Philips ultrasound machines and how to troubleshoot, (4) have sonographers and other volunteers from the US instruct and observe the 8 trainees on proper use of the ultrasound probes and how to perform the exact captures required by ITW (i.e. how to follow the protocols), and lastly, (5) take the 8 trainees back to their home clinics to set up the ultrasound systems with backup batteries, and optimize workflow planning and documentation. A tall order indeed for a 2 week trip, but one that we would find very fulfilling and feasible in the end.
Many of us first-time travelers to Uganda, the enthusiasm in the group on the journey in was palpable, a culmination of months of preparation, thoughtful planning, and communication with the four new clinics we planned on equipping with ultrasound for maternal-fetal health: Bushenyi, Byumba, Nyakatare, Nyamwegabira.
We arrived on March 09 in Uganda and quickly became acquainted with our Ugandan ITW comrades Picho, Allen, and Collins. We roughly divided ourselves into two teams: the clinical team, and the technical team, though for much of the trip we traveled and worked at the same sites together. We were also blessed to have Sister Angela, an advanced trainee in the ITW program, along with us for the journey. Sister Angela, a gentle woman of immense wisdom and compassion, was a central figure throughout our journey through southwest Uganda, providing us each with sips of her knowledge and wisdom wrought through her own experiences. Her words sank in with us all, little by little through the days as we marched onward, leaving an indelible impression on me to this day. She is the type of woman you could confidently say you meet once in a lifetime, and I’m honored to have had that chance. The love and compassion emanating from her eyes and heart have benefitted countless women and children, with many more slated in the future. We are proud that ITW is one of her vehicles for offering so much good to the world. After a brief stay overnight in Ntinda, we made our way to towards Bushenyi through the city of Mbarara. In Bushenyi, we arrived at the Bugongi Child Development Centre, which we learned had cared for and reared over 1,000 orphaned children from all over Uganda. This incredible orphanage brought orphaned children in and guided them all the way through to University, with the Director of the Centre regaling us with stories of children who had gotten married, gotten jobs, and now even had their own children. With our work waiting for us here in Bushenyi and at 3 other sites, we made haste to set up the wireless network we would need to transmit the ultrsound images for interpretation. After many hours of work, the network was up and we retired for the night.
On day 3, we were on the road towards Bwindi by 9:00 AM, heading to our “home base,” which would be the Buhoma Community Rest Camp (BCRC), a wonderful tribute to nature situated in the heart of the town of Bwindi. The rest camp is located inside Bwindi Impenetrable Forest, so to say the views were spectacular would be an understatement. Sleeping in our tents & cabins, we heard wildlife all around us in the thick tropical forest, which we knew from our readings housed much of the world’s remaining mountain gorilla population, which totaled only about 790 in the spring of 2010. After getting settled at BCRC, we had some lunch, and a group of us headed to Bwindi Community Hospital (BCH) to start setting up our teaching areas. Our goals at BCH, as stated before, were really twofold: (1) didactic education pieces about ultrasound, ITW, and operating the ultrasound machines, and (2) practical hands-on training with the machines. The didactic sessions went smoothly for the most part, and after many rounds of questions, short assessments/quizzes, and discussions, the trainees moved on to the hands-on training. Over time, and with much practice over several days, the other trainers and I were very pleased to see the progress the trainees had made. We noted which trainees seemed to be having more trouble than others and gave them special individual instruction, training, and attention.
After our training at BCH, we began our circuit of trips to the 4 sites from which the trainees came, with the clinical team trailing 1 day behind the technical team to allow the systems to be setup and fully operational once the clinical team arrived. As part of the clinic team, our goal was to really help the trainees figure out how they would fit this new diagnostic imaging tool into the current workflow in their clinics, how they would maintain standards of quality, and how they would document and report problems and cases. We had each site’s trainees do dry runs of obstetric ultrasound scans on practice patients to ensure that the training had been effective and retention was high. We were very pleased to see how well the trainees remembered what they needed to.
As an overall assessment: each site presented many of the same problems and challenges (unstable wireless internet networks, power cuts, logistical challenges, etc), though each site also had its own individual challenges (non-ideal room setups for ultrasound exams, shortages of basic materials needed such as towels, etc). We were, in the end, able to successfully set up systems in all 4 clinics with appropriate training, security, and sustainability issues addressed and discussed. The trip had been a resounding success!
Back in the US now, I think frequently of the trainees I spent time with in such a close setting, and I think of all the patients who may be benefitting from the ITW model in the 4 new sites we were able to set up. I think of the compassion for their patients that I saw in all 8 of our trainees, and I think of the tremendous, unending good that Sister Angela must be doing, even as I write this, at her site in Nawanyago. I have enormous hope for these sites and others that are set up. I am very thankful to have gone on the trip and look forward to the opportunity to contribute more in the future!