About UNC Project-Uganda

In 2004, a group of UNC physicians established the Amal Murarka International Pediatric Health Foundation in memory of their colleague, Dr. Amal Murarka, who died unexpectedly in 2003. The foundation sent a medical team to Kampala to establish the country's first pediatric intensive care unit at Mulago Hospital, Makerere University, where Dr. Murarka had previously conducted research. Subsequent work in 2007 and 2008 focused on pediatric cardiac surgery. The foundation not only built a cardiac ICU, but also performed a total of 21 life-saving pediatric cardiac surgeries.

In 2008 the foundation partnered with the Institute for Global Health and Infectious Diseases to establish UNC Project-Uganda.


The UNC Project-Uganda was established to support sustainable delivery of compassionate and competent health care to infants, children, and adolescents in Uganda; to improve the medical knowledge of the Ugandan health care workforce through in-country training and a physician exchange program; and to provide advanced medical equipment, medications, and services necessary for the delivery of compassionate and competent pediatric care in Uganda.

Thursday, October 23, 2008

Home from Africa

This was my first trip to Mulago Hospital with the heart team. My role, working side by side with the Uganda nurses, receiving and caring for children after their open heart surgeries, proved to be eye opening and sometimes heart wrenching. We taught and mentored, building on their knowledge from previous visits and watched them assume the primary nursing role with increasing confidence. They are so eager to learn.

As you've probably read, the first days were spent unpacking supplies and organizing the CT PICU (Thank you to all the many generous donors!). I met all the Ugandan nurses and physicians, understanding immediately the love our team has for these people. Prior to the first cases, we taught formal classes but most learning occurred informally as we teamed with them in the minute to minute post-op care of the kids. That being said, I learned as much from them as they learned from me. As with all things new, there were a few kinks to work through but each case got smoother until it felt almost like home.

The work was hard and the hospital environment less than ideal but in the end the mission was successfully accomplished. All the children did remarkably well--only two required short term ventilation; the rest were able to be extubated in the operating "theater" (thank you Gene Freid). The gratefulness of the families, staff and Mulago Hospital administrators touched me deeply. They understand the needs of the Ugandan people. What we achieved in this far away country was a mere drop in the proverbial bucket and they realize the need to be able to continue the program after we are gone. It is a big concern.

As I reflect back, I feel a lump rise in my throat. I am so humbled by their generosity and kindness, especially in the face of such deep needs. The bonds formed with the nurses and families will last my lifetime. And it was hard to say good-bye... we pledged to see each other again.

Thank you to Keith, Craig and everyone who made this possible. This is why I went into nursing.

Sandra Hawkins, RN

Wednesday, October 22, 2008

Our dear friends

It seems incredible to me that we have just completed our third mission to Mulago Hospital. I would never have imagined when we first headed off in 2005 with all our equipment for the trip in our luggage, that in such a short time we could have completed 21 pediatric cardiac surgeries and set up a PICU and cardiac ICU. There are so many people to thank for helping with this great accomplishment, but I would like very much to mention the staff that received the equipment and showed such enthusiasm to learn how to use it and become educated on how to better take care of the children.

From our time in the PICU acute care Sister Jolly has always been such a formidable and generous Nurse leader. Her hope for the PICU was as she said an answer to her prayers, and even with the chronic staff shortages and constantly high acuity of the children that fill the unit every day, which by western standards would constitute a disaster code, she takes it in her stride with a realistic compassion that is an inspiration to observe. My dear Friend (and I hope she will forgive me for mentioning) has recently suffered some setbacks, which upset me greatly to see. While she was in Bangladesh recently, studying malnutrition in children and how to use resources to overcome it, she fell and broke her hip. Although it has healed somewhat, she is in need of a hip replacement and is currently walking with the use of crutches. Her indomitable spirit is still present, but her own pain seems to be making her understandably tired. Not only are there so few resources for the sick children, there are few for the caregivers, as Jolly is trying to save for her hip replacement surgery, while still working.

Sister Grace is the Senior Nursing Officer of the Heart Institute, she has one of the kindest and most gracious people I have ever met. She has a very infectious laugh and cares deeply not only for the children, but also for her Staff. While she really wanted to be at the bedside learning how to care for the post op. cardiac patients, she realized that her role was to oversee and manage the smooth running of the Unit, and when there were any problems she was always at great pains to ensure they were rectified quickly. She is obviously much loved by her staff, and when only nine Nurses could be chosen for the "Camp" as they referred to our visit, she was very concerned and saddened that she could not have had more involved. Something I had a real sympathy for as we have a limit on staff that we take to Uganda and I increasingly have a hard time to help choose from our own wonderful PICU nurses.

Anna is a excellent nurse and very dear friend. She is very quick to grasp new ideas and will be found teaching the other nurses as well as using the new methods very quickly. I firmly believe that Anna without much more education could function very effectively in the US. She is a future leader at Mulago. After our last visit, Karla and I received an email from her. Her Nephew had been born with a cardiac defect and he died in India from post-op complications after a Truncus repair. I have been inspired since then to see Anna's diligence and calm demeanor, knowing her own family's loss.

Modena was pregnant on our last visit to Mulago and her due date was the week after we left. We heard that she gave birth to a healthy boy, that she named Keith. (Much to our pride and amusement, she told us she was to call the baby Lupe if a girl) She brought in photos of the baby with her other four children. We were all surprised to see a very handsome and healthy picture of a smiling baby with Downs. She didn't mention it, and only told us what a wonderful and good baby he was. She beamed as she spoke of him and proudly showed his pictures. My admiration for her was great last year when she was so heavily pregnant and worked so hard, but to see her photos and love for her children increased it greatly.

It is only a couple of days since our return, and I have yet to go back to the PICUand see all my dear nurse friends, that I have greatly missed. But I know that the courageous and kind nurses at Mulago who worked so hard during the "camp" will be very close to my heart and frequently in my thoughts. I am already thinking of ways I can help them, and planning our next trip. There are so many stories to tell about our camp this year, and other blogs have mentioned how wonderful the children have been and how good it was to see the healthy children visit, that had surgery with us last year. But the inspiration from my very dear friends is the one I feel most compelled to tell. I hope they will forgive me for mentioning such personal details of their lives, but their love and courage is an inspiration I really wanted to share.

Katherine Desrochers, RN, PICU

Wednesday, October 15, 2008

Hard to believe its time to go already....

Our time here is coming to a close, and it is so hard to believe. Looking back at our days here, there have been so many thoughts and emotions. We arrived to many boxes that were shipped months ago, with so many supplies to be unpacked for our mission. The day was long and took a toll on those of us who were first timers here, but it would only be the beginning. Over the next two days, we operated on 2 children per day, keeping us late into the evening. Our days consisted mainly of eating, working and sleeping little before getting up to do it all over again. After those first few days, our bodies and minds acclimated themselves to our environment, allowing us to continue through the rest of the cases, seeing all 10 children do very well with their operations and recovery.

Today, we finished putting away all of our supplies, taking an inventory for the next time we come. We've made our way through the hospital to see the other ICUs, and distribute supplies. We've also taken many pictures and said our initial goodbyes to many new friends. Tonight, they are having a cocktail party for all of the staff at the Ugandan Heart Institute, as well as the staff from the mission. It will be the last time we see them, as we leave early tomorrow morning for Tanzania. I foresee an emotional & exciting evening ahead.

It has been a true honor for me to be a part of this trip. Dr. Kocis and Dr. Sable do amazing work with organizing and executing this incredible undertaking. We've had a wonderful staff of healthcare workers from UNC, DC childrens and Jacksonville, that have worked well together and showed the staff of Uganda what true teamwork looks like. I will miss this place and the people, as I am also excited to come home. I am also thankful to all who have supported us on this mission.

Jennifer Ditto, RN MSN

Tuesday, October 14, 2008

Meeting Uganda's First Lady, Janet Museveni

Yesterday I had the privilege of being part of small delegation from Mulago to travel to Entebbe to the new "White House" for President Museveni and his wife Janet, who is also a member of Parliament representing her home region in southwest Uganda. The White House is perched atop a hill that overlooks Lake Victoria with 180 degrees of breathtaking views. After passing through strict armed security we were led down marble hallways and open air passages to a large open pavilion with views of the lake, flatscreen tv featuring CNN, and high tea service. It really was spectacular!

All of this beauty helped to pass the time as we waited 1.5 hours to see the First Lady. But we have learned that "africa time" is usually approximate at best. The wait was worth it. Hon. Janet Museveni is a tall, statuesque African woman who is regal in her carriage and as warm and intelligent a person as we have met here. She listened with great interest about the medical mission and the growth of the Pediatric Heart Program at Mulago and thanked us many times for coming so far to help so many.

We presented her a photobook featuring the 2007 Medical Mission and she was so pleased that she could see the children who's lives have been saved. We told her that her husband's commitment of support to help the Mulago Heart Institute grow was very important to our leveraging other support for Mulago and Uganda. We also discussed the promise of telemedicine for expanding our teaching and consulting capacity between Mulago and UNC. She was very interested in this and hopes that eventually telemedicine will be able to connect rural clinics with Ugandan urban hospitals like Mulago.

We invited the First Lady to come to UNC to give an address on global health and the challenges of rural health access worldwide, but especially in developing nations. I promised to send her an invitation when I return and hope that she will visit us in North Carolina when her husband attends the United Nations meeting in 2009. As we departed the White House, we were blessed with a beautiful sunset over Lake Victoria which I hope signifies a glorious future for Uganda.

Helen Snow, UNC Team
October 14, 2008

Monday, October 13, 2008

Meeting with Ugandan Minister of Health

Last week I was able to meet with The Honorable Dr. Stephen Mallinga, Minister of Health of Uganda. I was surprised to find that Dr. Mallinga had studied and practiced medicine and was hospital chief of staff in Chicago for over 20 years. Three of his children are still pursuing professional graduate degrees in the United States.

So it was with real pleasure that we shared some of our hopes for the future of Mulago's Heart Institute. Dr. Mallinga, a OB-GYN specialist, discussed the challenges in a country such as Uganda which has so many competing health priorities. And he was also able to speak of some of the problems in the US healthcare system, such as the high cost of liability insurance that is driving good doctors to abandon their practices. He asked that the American doctors, nurses, and administrators, also instruct Mulago about how to better address the politics involved in hospital administration and I assured him that we face the same challenges in our US hospitals.

Still, I found that this very wise and well-educated leader has the perspective to bridge between his developing country's needs and the improvements and pitfalls that western cultures present as we hope to help Uganda's health crisis. I was so impressed with his questions and observations and am reassured that Uganda has outstanding and capable leadership in its Health Minister.

In working with Mulago Hospital, which is the national urban hospital for Uganda, several times we have been questioned about whether our efforts were best spent in the city or in the rural regions where there are no doctors. Its a good question and not unlike the question we face at home at UNC. Is it better for the State of NC to invest more in UNC Healthcare and empower it to reach out to the rural areas from Murphy to Manteo or to invest in many smaller clinics.
Uganda faces the same question and so I spoke with Dr. Mallinga about the promise of telemedicine for use between specialty hospitals and general practice clinics in rural NC and rural Uganda. He is very interested in our pursuing a telemedicine pilot between UNC and Mulago that will explore its potential for rural health access.

As I talk to Ugandans who work in the health system, I am struck that we all have the same concerns, just vastly different resources to address them. I hope our team can bring back some suggestions for maximizing our outcomes during our limited time here in Uganda. We know our work has not only saved lives, but has leveraged others to invest in the Mulago Heart Institute's future.

Helen Snow
October 13, 2008

Sunday, October 12, 2008

What a difference a week makes

While sitting here on-call here in the Mulago Intensive Care Unit ward, I have time to reflect on the past week. I think that others have captured quite well the atmosphere here in the hospital and in Africa. However, what amazes me the most is how much progress has been made. I have seen how much more comfortable the Ugandan medical staff caring for these patients have become with the patients in their charge. Witnessing the passive assimilation of knowledge and information presented to them transform to active acquisition of information, active processing of information and engaging our team to integrate this into their daily practice has been inspiring. It proves to me that all of our efforts have not been in vain and gives me great hope for the future and what we can accomplish.


Saturday, October 11, 2008

The children and their heart defects

We have had such adjustments in the OR schedule that it has taken me until now to post the children and their cardiac defects.

Oct 7
Patricia G...2.5 yrs...PDA ligation
Kato N...13 yrs...secundum ASD closure

Oct 8
Edwin K...3 yrs...perimembranous VSD and sub aortic membrane repair
Linet K...10 yrs...Coarctation of the aorta repair

Oct 9 (Ugandan Independence Day)
Caroline K...11 yrs...secundum ASD closure

Oct 10
Dickson N...5 yrs...secundum ASD closure
Ryan K...3 yrs...secundum ASD with partial anomalous pulmonary
venous return (repair with baffle)

Oct 11

Oct 12
Sam T... 3 yrs...perimembranous VSD closure
Rogers B...17 yrs...secundum ASD closure

Oct 13
PDA ligation (TBA)

The skilled surgeon and his OR team

The years of planning, screening patients, organizing, arriving, and preparing are all necessary for the critical 60 minutes of bypass time and 30 minutes of cross clamp time necessary to correct the child's intracardiac defect. During this time, all the pieces of the team must come together in complete synchronicity and harmony for Dr. Michael Mill to surgically heal the child on the OR table. Closest to him is Jenn Ditto, OR Scrub nurse, and Ruben Bocanegra, physicians assistant, while Bill Nicotra runs the bypass machine and Dr. Gene Freid keeps the patient unconscious, immobile, and pain free. This team that works so well at UNC hundreds of times a year, is now displaced to a foreign land some 7900 miles away. They are in the final stages of preparing their Ugandan counterparts to continue these procedures independently with their own team once we depart. The handoff has occurred....Drs. John Omagino, Tom Mwambu and Michael Oketcho are the Ugandan Cardiac Surgeons; Obwin John the Scrub RN; Sam Wambuzi the perfusionist; and Dr. Cephas Mijumbi is the anesthesiologist.

The cardiologists

Dr. Craig Sable has been coming to Mulago Hospital since 2002. He has screened thousands of children over those years with his dear friend and colleague, Dr Peter Lwabi, aUgandan Pediatric cardiologist. Together these two had the vision then, for what the program is NOW. Drs. Stephanie Lacey, Lowell Frank, and Laura Olivieri enter the hospital each morning to see a waiting room full of children and their families. Along with Samaritan's Purse volunteers, they register the patients and gather extensive clinical histories and demographics. Complete physical examinations are performed followed by echocardiography. The days are full. In between these patients' visits, they are called to the operating "Theatre" for transesophageal echo's. A long growing list of children in need of curative heart operations now exists. We will complete 11 operations on this mission, but many, many more are needed.

Saturday in Uganda

I can hardly believe it is Saturday..... The Uganda, UNC and DC teams have been working extremely hard since we all came together last Monday. Initially, we located the medical equipment and supplies that were shipped over, began un-packing and organizing equipment, and set up the ICU in order to take care of the patients. We then started education and training for the Mulago Hospital Staff, screening patients for surgery, and are now taking care of patients in the ICU.

Today we have one Cardiac Surgery case, that is now in the "theatre" (operating room). This will be the 7th patient since our arrival. The children are all doing very well. They have wonderful families, and the most beautiful smiles I have ever seen!

Yesterday, we were able to visit the Pediatric ICU that we came over in 2005 to set up. We took medical equipment and supplies to the unit, and were greeted by several smiling and familiar faces that we met during our 2005 mission. The PICU had two very sick babies when we visited. We arrived just in time to round with the PICU team. One of the babies had been diagnosed with meningitis, the other with renal failure.

I have been spending time in the Neonatal ICU as well. We shipped medical equipment and supplies for that specific area. Un-packing and organizing equipment, as well as teaching and training for the Neonatal ICU has been a great success thus far. The Neonatal ICU is a large and busy unit with approximately 80 babies. They have two nurses to care for all of these babies as well as admissions. The mothers are encouraged to stay with their babies and care for them around the clock.

We have much more to do in the days that lie ahead...Continue to keep us in your thoughts and prayers.

--Tiffany Mabe

Friday, October 10, 2008

Focus on the task before you

Having been on the UNC Medical Mission to Mulago Hospital last year, I thought that things would be easier this year. Some things have and others haven't. The Mulago Heart Institute with whom we work has made substantial improvements in the past year especially in their equipment and OR/ICU set up and personnel training. Thanks to a one-time grant from a private foundation, the Heart Institute was able to purchase new equipment for both the OR and ICU which has dramatically improved their ability to use these machines while we are here as well as when we leave. Unfortunately, without the technical support that is usually available for us in the US, they are still faced with challenges to the efficient use of the equipment. While we are here we hope to help Mulago set up some mechanisms for outside support after we leave.

So though we see very tangible evidence of improved facilities and better-trained health professionals, the obstacles that still remain on a daily basis are overwhelming. We brought lots of donated medical supplies from the U.S., and we pushed the cart loaded with these goods up the hill to the Pediatric ICU at Mulago to deliver these much needed goods.The numbers of families waiting to be seen or staying by the bedsides of their sick children, reminded us that we were dealing with a small part of a much larger health crisis in Africa. It is discouraging to me but I can only imagine how those who face this in their daily lives must feel. And yet, the Ugandans that we have met do not seem hopeless or in dispair; quite the opposite. They are patient and grateful for any assistance offered to their families.

A close friend of mine traveled in India a number of years ago to work with Mother Teresa in one of her "death houses," but upon arriving my friend and her companions were overwhelmed at the conditions and needs. Mother Teresa advised them not to look around them, for they would only be successful if they focused on the task in front of them--no matter how small or mundane--because doing small things to affect one person was the first step in healing the whole. I have tried to keep this advice in mind, as our team has worked to heal the hearts of 13 small children who will receive life-saving surgery while we are here as well as the 100's who will be screened and treated for their heart conditions in other non-surgical ways as well.

So as we watch the financial meltdown of developed countries around the world on CNN,
things don't change much here in Uganda. Life goes on and we must all focus on the small things that we can do to improve the world, no matter the obstacles here or at home. I am grateful for lessons that the Ugandans are teaching me about patience and determination to move forward even though the journey may zigzag, plunge and crest.

I hope that these lessons will still be with me as we return to our country that has been shaken by the chaos of financial markets and uncertainty of our financial futures knowing that there are far worse conditions with which a majority of our world's population deals every day.

Helen Snow, UNC Medical Mission Team Member
October 10, 2008

Wednesday, October 8, 2008

We rejoice in our successes but remember what surrounds us

We have had such a wonderful few days, meeting the Ugandan children and their families before surgery when apprehensions are running high and the tears run freely. We are later met with smiles, words of thanks, and tears of joy when the families reunite after surgery. But as I lay in bed, contemplating tomorrow, my thoughts are broken by the screams that cry out in the night in the open air Mulago Hospital. We are surrounded by others who have not been as fortunate as the children we operated on today. Instead, families are grieving in the most profound way over the loss of those dear to them. We are traveling with Dr Cathy Partyka, an old friend of Drs Sable and I (we were pediatric residents together in Washington DC), who is spending her vacation time in the neonatal ICU on the 5th floor of Mulago Hospital. Her first day was not as joyful as ours...She was greeted first thing in the morning by the deaths of 3 newborns. She has been introduced in a harsh way to the realities of Ugandan Medicine; knowing what and how to save a child's life but being unable to accomplish this in the austere conditions we work in. We hope and pray that tomorrow will be another successful day for our team and a day of healing for those around us who are infirm......Good night...

Before I lay down to sleep......

Take 2...

First look from Uganda...