Active Collaboration Wins Every Time
Stakeholders MeetingKampala, Uganda
The stakeholders meeting was a success on many levels. Having such a diverse group of individuals come together to discuss the ITW breast-imaging project in Uganda provided an opportunity for discussion that allowed a variety of issues to unfold as the day progressed. There were many obstacles and opportunities that were presented by Dr. Destigter, Dr. Merry, Dr. Michael Kawooya, Dr. Alphonsus and Dr. Moses Galukande during the meeting. Many factors had already been identified but others came to surface as a result of the discussion portion of the meeting. The project is multi-faceted and there are many details to work out, but the energy and collaboration in the room gave a clear indication that individuals are willing to break down barriers that may exist to find a common ground to move the project forward. The support was palpable.
One key issue that came out of the meeting was the underlying fear that many women from the rural villages have when they need to seek care in a large city like Kampala at Makerere Hospital. Clearly there are affordability issues, but we also found that many women have not been outside of their villages and thoughts of having to take a taxi to the city, navigating their way to the hospital, and finding out where they need to go, are terrifying. Some cannot overcome this fear and never seek the care they need. Dr. Moses Galukande from Makerere Hospital informed us that currently the breast clinic is only held on Wednesdays. Quite commonly many of the women that find the courage to overcome their fear will make the journey to the clinic discover to discover that they have arrived on the wrong day. Or they may arrive on the correct day but not receive any services because approximately 50 other women have come to the Wednesday clinic seeking services and the clinic cannot support this volume in one day. Many women are lost to follow up at this point; they feel frustrated and defeated, accept their situation and do not seek diagnosis or treatment. It is clear that a more efficient streamlined system needs to be put into place to overcome some of these underlying obstacles to access. The idea of creating a “breast care coordinator” was discussed. There was clear agreement that this will be a key position to the success of the breast-imaging algorithm. This person would be the link between the clinic in Nawanyago and the Makerere hospital, arranging all services needed at the hospital and communicating this back to the rural clinic so the patient is informed prior to her arrival of regarding all aspects of her visit and individual concerns can be addressed prospectively. This personalized care would decrease miscommunications, unclog the current system and improve patient care. Creating an algorithm for this role will be one of our next steps; it will lay the foundation to a successful implementation of this project in rural Uganda.
-- Mary Streeter