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.
MissionThe 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.
Tuesday, October 27, 2009
Thursday, October 15, 2009
One of the things I noticed on the drive from Entebbe to Kampala that first day was that the roads were busy with people walking, riding or driving. And though they emerged from modest or poor neighborhoods with unpaved roads, almost everyone dressed well. And though the shop fronts and roadside businesses ranged from shabby to modest, they were bustling. Both in and out of the hospital people were using the available resources to get the job done, without complaint.
Arriving in Mulago what most impressed me that first day and every day after was the warmth, openness and humor of our colleagues and hosts.
With our Ugandan colleagues there was also an exchange going on that first day. I needed to learn how to work in a new setting, with new people and equipment that was not completely familiar. I also needed to learn which of the ideas and practices I brought with me were useful and applicable. Similarly, the Ugandans needed to get to know those of us who were there for the first time and what we had to offer. Anytime a new team is brought together there is a sizing up of strengths, weaknesses and personalities. So the first couple of days were a bit awkward for me. By day three things were noticeably easier as we began to coordinate better, draw on each other’s strengths and to appreciate each person’s contribution.
At the Samaritan’s Purse dinner I finally got the chance to talk to my Ugandan co-workers in a purely social setting. This was a treat. We talked about sports, politics, families and travel. We talked about life in Uganda and life in the US. It’s strange, but I never felt or was made to feel especially like a foreigner. The shared language helped tremendously but I think the main reason this was so was not language but the welcome we received and the mission we shared. There is nothing that pulls people together like having a common, important purpose.
This brings me to my last impression, formed while caring for the children and their families. Watching them progress from the pre-operative period of anxiety and waiting, through post-operative disorientation and pain, and finally back to a state of well-being and happiness was remarkable. I have been down this path many times before but to witness it play out in Uganda was unique.
The experience is the same for these children and families in many ways as for patients and families at home but it is also different. They are placing their faith in strangers from far away and we are trying to reach across that distance and demonstrate skill and compassion. To see the children begin to relax and open up, to see their intense and very individual personalities emerge, was a joy and a confirmation of success I will always treasure.
I owe many people thanks for this journey: my family for their love and support; Katherine Desrochers and Karla Brown for inviting me to join them and for their guidance; and Dr. Keith Kocis, the driving force behind this mission from its inception. This mission is a tribute not only to Dr. Amal Murarka but also to Keith. My special thanks to our Ugandan colleagues. I miss them the most.
Lastly, I thank the organizations who have shared our vision and made it possible to realize. Samaritan’s Purse and HVO have supported us in so many ways and their representatives in Uganda were wonderful to work with and know. May we continue to build on the successful missions behind us.
John Bryson, RN
Monday, October 12, 2009
This trip was characterized by our toddlers, Joan, Hellen, Joachim, Babu, Jesse, Reagan and Anna Grace. The largest volume of two and under, I think I have ever taken care of in one sitting. This appeared to have a whole new set of challenges for our team, not least how were we to keep them all in bed, (we had no cribs available). Their bravery and stoicism was every measure of their teenage counterparts, Peter, Ruth and Mary. To see the little ones sitting up in bed, playing, and walking with chest tubes , wires and a sternotomy dressing, made me realise how pampered we all are.
Rounds had the added entertainment of these little ones, always watchful and serious, (our night shift nurses Susan and Jeannie were the only ones to consistently get smiles.) But their antics were a delight to watch. Hellen who could see us rounding on Joan, the team gathered around her bed. Joan was sitting quiet and regal in her stunning knitted pink hat, looking for all the world like the Queen at a gala. Hellen was watching everything very intently. I then noticed that Hellen had taken a washcloth, from the end of her bed, and was doing a wonderful job of fashioning it into a hat for herself, first trying to put it on her head and tie it around the back, then realizing that it wasn't quite big enough, she placed it squarely on top of her head, and sat just as proud and regal. While we rounded on Anna Grace she took her beanie baby that had been given to her and a towel, wrapped her baby and rocked it in her arms, looking down at the baby as a doting mother, so very precious. Joan was by far the most talkative and even after some analgesia and sedation, she was giving Karla down in the country as she had her tubes and wires removed. Goodness only knows what she said all I could catch was "muzinga" ("white person") but the Ugandan nurses were highly amused. They recovered nicely as you can see by the pictures of our toddler troop, where Joan is still to be seen in her wonderful pink hat.
On our last trip to Mulago, I had spoken in the blog about Matron Jolly. She is the head nurse in the pediatric acute care and PICU. On a trip to Bangladesh last year where she was at a conference on malnutrition, she fell and broke her hip. She was walking on crutches when we were visiting in 2008 and in a lot of pain. She has since had her hip replacement surgery, performed at Mulago. She suffered a post operative complication of foot drop and is now undergoing physical therapy. I went to visit her at home and she was in excellent form. She can walk short distances, is pain free and hopes to be back at work in the New Year. She wanted me to thank everyone for their generous donations and was very grateful for all the prayers and good wishes.
I cannot express with any justice how proud I am of the Ugandan nurses. In the three years we have been to Mulago and taken care of the post-op cardiac children they have become confident and autonomous. Setting up bedspaces to receive a post-op, noticing EKG changes, giving medicines and understanding their uses. Even the nurses that were new to this "camp" such as Lillian and Edith performed exceptionally well and presented in rounds better than some Residents, having the confidence to ask questions and challenge the modes of treatment that were to be followed. I am so looking forward to seeing them again next year, to know how much further they are in their practice.
There is always a great deal of sadness when I return from Uganda, my jet-lagged body may be here in Chapel Hill, but my heart stays in Kampala for a long time before it is ready to be back.
Katherine Desrochers, RN
Sunday, October 11, 2009
That leads to your door
Will never disappear
I've seen that road before
It always leads me here
Lead me to your door
Over the next several days, ten children were able to have their congenital heart defects repaired. They all recuperated beautifully and with their own personalities shining through on the ward. Mary, who was one of the first to undergo surgery, is a stunningly, beautiful teenager who was very quiet. Peter, another teenager, who was very stoic, perked up when he was given a baseball cap to wear! The two of them loved to have competitions, however, when spurred on by our nurse John. And we discovered that Peter had such great artistic abilities ---a fantastic drawer---one to keep our eye out for in the future.
The younger ones, Regan, Joan, Hellen, Babu, Jesse, Joachim, and Grace all had their own way to tell you what they were feeling even if you didn't understand their words. You still knew what they were trying to tell you. And finally Ruth, who was the last one to have surgery on Monday, and the one we didn't get to know as well. She still was apprehensive of the entire goings on, but aware that her heart was fixed and she was on the mend.
On to the nursing staff, who each time have brought us many laughs, challenges, and learning experiences in return. This year was no different. New and old staff were set to go with their schedule just as busy as ever. They have shown great progress each time. This year they had such great organization in their approach from setting up the bedsides, deciding on who would receive the patient, getting report, giving sign out to each other, and keeping up with changes with the children. An added twist to their repertoire from Dr. Dorostkar, was to give report on the children "resident style". They did this beautifully and without hesitation.
It was impressive to see along with the questions that arose from these interactions. It has been like watching flowers blooming from seedlings....slowly but surely and with such grace, beauty, and wonderment. And to the rest of the Ugandan team including the surgeons, OR nurses, anesthesiologists, perfusionists, and physical therapists, your efforts have not gone unnoticed. If there is one thing that we have seen in Uganda, is that there is a group effort in many settings, this one not withstanding.
I can't thank all of the UNC staff enough for all of their hard work over the last two weeks. We couldn't have done it without you. And to Stacey Peterson-Carmichael, Jeannie Koo, Parvin Dorostkar, and Gene Freid who took time away from their different hospitals and lives to work with us. You were wonderful to work with these past two weeks.
And so the long and winding road lead us to this door. This door that we hope will be open for many years to come as this program grows. The door that leads us to help the Ugandan Heart Institute and its team to repair and care for more complex heart defects. A long and winding road, the one that I have been fortunate enough to have been on twice before and continues to lead me right back to a country full of gracious, welcoming people. And if I remember correctly, the lyrics to this song written by McCartney have been described by him as coming from his inspiration of his home in Scotland. It has been an honor to come to Uganda. A home full of inspiration, away from my original home.
Karla Brown, PNP
With input from the nursing staff of Mulago we were able to direct our teaching and training efforts to areas of post op care that they felt most in need of. This included reviewing the pathophysiology of congenital heart defects and the indications for and uses of cardiac medications, calculating and preparing cardiac medications and infusions, discussing a variety of cardiac case scenarios, interpreting chest xrays and ECG wave forms, treating post operative pain and discussing cultural differences in providing pain control, and demonstrating physical assessment and discussing and treating the findings.
All of this teaching was done while the nurses provided excellent bedside care to the ten patients and their families. All teaching was done at the bedside during both day and night shifts. The Mulago and UNCH nursing teams were enthralled by the teaching and learning and could have spent many more hours discussing the nursing care involved in treating children following open heart surgery.
Over the ten days, we reconnected and strengthened our bonds with the staff nurses. These nurses were so very keen about practicing and refining the nursing skills they had learned during the past 'pediatric cardiac surgery camps' that it was both a privilege and a pleasure to be with them as they worked to perfect their nursing care. It was quite obvious from their practice and their questions that they have incorporated much of what has been presented to them in the 'camps' UNCH and other groups have provided. I look forward to continued collaboration with the Mulago nursing staff developing and implementing further educational resources.
-- Diane Yorke, PhD, RN, Clinical Education Coordinator for the UNC Project-Uganda
Wednesday, October 7, 2009
We continue to advanced the abilities of Team Uganda towards independence and skill in increasingly more complex surgeries. The goal is long-term sustainability of the pediatric congenital heart surgery program so they can successfully and expertly correct the wide variety of cardiac defects found in the children of this country.
We depart from Kampala today leaving behind unforgettable memories of new and old friends and colleagues. Most importantly, though we sent home from the Mulago Hospital ten children who now look at their lives with hope, excitement, and new-found energy to face the rigors of childhood, school, and life in this developing country.
Tuesday, October 6, 2009
-- Stacey Peterson-Carmichael, MD
Monday, October 5, 2009
What strikes me about this mission is the outstanding teamwork amongst the UNC team members and the Uganda Heart Institute staff with a common goal to provide safe surgical and postoperative conditions. There have been numerous tribulations this year ranging from illness in both the US and Ugandan team members; several children with respiratory infections and 3 of the children with active malaria. The anesthesia delivery system failed in the middle of one of the cases requiring completion of the case without it and a late night anesthesia machine repair “party” to repair it as replacement parts were not available. Drs. Mijumbi and Ejoku, the Ugandan anesthesiologists have demonstrated excellent clinical skills and are close to functioning independently.
Through all of the adversity team members have tirelessly pitched in- nurses, Respiratory Care Practitioners, biomedical engineers, surgeons and ICU attendings alike - to assist the anesthesia team in providing safe intraoperative care of the children. Separate thanks need to go to Karla, Katherine, Jen and Rueben assuring that all needed supplies were on site and Dr. Kocis for his energy, enthusiasm and effectiveness in coordinating such a large scale project.
-- Gene Freid
This year we did the largest number of small children: 7 children under 10 kg. Without a mom sitting continuously by the bedside at post-op, the babies would act like babies and cry. The nurses had a whole slew of tricks to keep them pain-free and comfortable.
Saturday, October 3, 2009
In Uganda, the role of the Respiratory Therapist (RT) remains elusive. Despite 3 previous missions, we have not been able to establish a firm partnership between our RT's and their personnel. We have tried physical therapists, nurses, anesthesiologists, etc. Our work remains undone. Fortunately, Lupe Haynes (on her 3rd mission) and Sheila White (a newbie) have taken the task head on. They have provided expert respiratory support to these children from the moment they return from the OR following cardiopulmonary bypass. Miraculously, all children have been spontaneously breathing within minutes of arriving in the ICU (save 1..who was ventilated for about 2 hours). They have been teaching different levels of healthcare providers about basic and advanced respiratory support. Our results would not be what they are without their endless efforts.
But is the lobster shift in Uganda the day shift in Durham?
Friday, October 2, 2009
Patrick Kahuma (pictured above), was brought to UNC-Chapel Hill where he underwent a successful balloon valvuloplasty of his pulmonary stenosis and ASD closure with an Amplatzer device. These minimally invasive procedures were performed in the pediatric cardiac catheterization laboratory by Dr. Elman Franz with anesthesia by Dr. Peggy Dietrich.
Lupe Haynes Respiratory Therapist
Thursday, October 1, 2009
My own children, Kyra and Connor, helped select books for the children as well. The older children received the High School Musical activity book. I was pleasantly surprised that they knew of the movie and one had even seen it. The smaller children have Sesame Street books, with the middle aged children choosing either Pirates of the Caribbean or The Chronicles of Narnia. The country has primary education for all.
(As an aside, we have learned on this trip that even Uganda has "universal" health coverage. . .)
The four patients done so far are doing extremely well. Two will transfer to step down status today. Two more patients to OR today with the first case having just gone back. The teams are working well together. The knowledge transfer continues. We are expecting a VIP tomorrow