UNC Project-Uganda

Working "up the hill"

2011-04-27T11:49:00.000-04:00

   As a team member in 2009 I can second some of the comments already made, particularly regarding the contrasts between previous missions with the Uganda Heart Institute and our work this year in “peds acute”. I had not visited any of the other pediatric areas scattered throughout the hospital and across the medical campus in 2009 so my adjustment to our new setting was almost as great as for the first timers.
   Working in peds acute meant a dramatic increase in the number of patients, the severity of illness and the types of illness at the same time that there was a decrease in the resources available in material, facilities and personnel. Managing one’s own stress in this situation required a dramatic lowering of expectations and a focus on those goals that might be attainable in a short time frame.
   The successes we can claim are a result of hard work, a focus on physician and nurse education, modeling a systematic, problem solving approach and the readiness of our Ugandan colleagues to accept our contributions of energy, expertise and ideas, and to patiently decipher our American accented English, including one New York variation.
   If we helped bring the attention of administrators to this under-resourced area of the pediatric service more good may come. The needs for both basic and advanced pediatric health care extend far beyond Mulago Hospital though, as the team that visited Mbarara can attest.
   My respect goes out to all of the Ugandan physicians and nurses, who work day in and day out under these difficult conditions, and to all of the volunteers, who contribute measures of time, concerted effort and resources at Mulago and elsewhere.
   The UNC team that made the trip this year was a combination of old and new members, including our first librarian, Mellanye Lackey. It is incredible to work with such strong, positive, resourceful individuals.
   Each evening we processed the day behind us and planned for the day ahead. The challenges we faced were difficult physically, mentally and emotionally. It is a tribute to every member of the team that we engaged these challenges vigorously, constructively and supportively. As a result we grew in our understanding of and appreciation for one another and left Uganda with a sense of accomplishment despite the failures we also witnessed.
   We are not under any illusions about the small scale of our contribution in the face of such great needs and deficiencies. But any one of us could talk at length about what more we could do in partnership with many of the wonderful Ugandans we met.
   How this mission proceeds in the years ahead is an ongoing question. The progress of the Uganda Heart Institute reflects what is possible when resources are available and applied to a complex but limited problem. Working “up the hill” will require a longer time frame, a greater investment of resources and effective partners within the institution. Like any project in a poor country, this is a great undertaking.

John Bryson

What a rude awakening!

2011-04-24T20:37:00.002-04:00

I am a Ugandan born and raised in the "Pearl of Africa". The green grass, juicy fruits, beautiful clouds, raw nature, cloud formations and animals will take your breath away. I have always gone back to visit family and had good times at the beaches, resorts and parks. But nothing prepared me for a professional experience that I just had.

This was a different kind of Visit. One that made me hold my breath. Just never thought that the kind of experience I had would be from a country I grew up in.

When I signed up for the mission, it was a lifetime opportunity. It never occurred to me that I would walk away feeling helpless, defeated, angry, and more appreciative of the life I have in the United States.

How could I be so helpless just like the children and parents I met at Mulago Hospital? After all, I was there to help!
Its amazing what happens when you are stuck in a situation where you have to work with what you are given. Unfortunately, the poor parents, children and health care providers are not just in a moments situation. It is their way of life.

With healthcare providers at Mulago Peds, Triage, Rresuscitation, Acute and PICU stretched thin, lots of desperate children awaiting care could hardly get any services. When it came to respiratory distressed patients, limitations were endless, such as;

All Peds areas used two pulse oximeters with the same probe moved from one patient to another
Masks and nasal cannulas were re-used
No infection control between patients and providers whatsoever
Could not determine how much oxygen was delivered later on liter flow per minute since a water bottle was attached to a flow meter on an H-cylinder and various needles and IV tubing were used to connect nasal cannulas.
Masks were re-used for breathing treatments, Non-re breather masks had been used for God knows how long
Resuscitation was more harmful than useful. Basic CPR skills were not practiced
Parents were not part of their children's care and were actually afraid of their sick children
Use of BiPAP was the most we attempted to non-invasively Ventilate. And the list is endless.

With that said, the minimal impact we made, doctors, nurses and technicians were all eager to learn and were very gratefull for the education we provided. Parents were also grateful for our presence and some attributed survival of their children to our presence there. And as much frustrated as I felt during my experience at Mulago, the connection I made with the people I met was rewarding. Visits by relatives at the guest House were a great distraction from a day's frustration. Palm sunday with Donna, Kristi and Sue was a distraction as well. And with much more needed work, there is a light at the end of the tunnel which requires a lot more than mere words can say.

Judith Phillips.

The pretty green and clouds

A refreshing moment with a healthy child

Palm Sunday at Lubaga Cathedral

Judith with Prima at the Guest House yard .
Prima is in desperate need for surgical removal of
her enlarged tonsils and adenoids.

Our reasons for being so quiet....

2011-04-24T08:14:00.001-04:00

Hi All,
Now that we arrived home safely, I did want to explain to those following us why we could not be more outspoken and communicative and why we could not send more pictures until now...Well the story begins months ago when we were forced to change our travel dates to avoid an always controversial Presidential Election. This finally occurred in February and so our trip was rescheduled to commenced in April. Of course, the world became aware of all of the neighboring countries, particularly those in the Arab World, who were undergoing revolutionary change in their governments. If one looks at a map of Uganda, you can see ALL the neighboring countries in conflict. Thus for the safety of our team, we kept our travel dates secret and posts/broadcasts quiet. We arrived in Uganda with news of local and limited protests and conflicts in the capital, Kampala. Our US Embassy kept our team informed by sending email alerts and in speaking to us nearly daily throughout stay.

Warden Message

Kampala, Uganda
April 14, 2011
Opposition Walk-to-Work Protest Turns Violent
Opposition party-led demonstrations over rising costs of living reportedly are turning violent. Witnesses indicate that police are firing into the air and using tear gas to disperse the crowds. Injuries have been reported. American citizens are advised to exercise caution and avoid any large gatherings. Areas currently affected include Gayaza Road, Jinja Road, Kalerwe, and Bwayise (all in greater Kampala).

U.S. citizens are strongly encouraged to enroll in the Smart Traveler Enrollment Program (STEP) to receive the latest security information. You should keep all of your information in STEP up-to-date, including your current phone number and a current email address where you can be reached in case of an emergency.
U.S. citizens should also consult the Country Specific Information Sheet for Uganda and the Worldwide Caution, both located on the Department of State’s web site. Up-to-date information on safety and security is available toll-free at 1-888-407-4747 from within the United States and Canada, or at regular toll rates at 1-202-501-4444 for callers from outside the United States and Canada, from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

Our friends and partners at Samaritan's Purse had a network of individuals on the ground throughout the country with their ears to the ground sharing real time information with us. SP provided us with multiple local phones that were essential in communicating as we had GREAT difficulty in using our Sprint or Blackberry phones in country. It took a week to establish voice communications though we were severely limited in text and data services. We could receive but not send text messages. Our friends in Uganda and back home had other important information and daily updates for us (THANKS SUE B). We felt quiet safe and secure in the country, though we had daily security updates and discussions with the team while creating a series of contigency plans "just in case." As it turns out,we ended up being in the middle of escalating protests which turned violent. One summary of the conflicts lead by President's opposition leader, Dr Besigye (the former physician of President Museveni) is described below.
http://www.newsfromafrica.org/newsfromafrica/articles/art_12482.html
Mulago Hospital, where we were working, received many patients who suffered from a variety of injuries including gunshot wounds and the ill effects of tear gas. We saw innocent babies and children in the Peds Acute who were caught up in the protests. Sadly, on the day we left, we read that a 2 year old was shot in the head and chest and killed, reportedly by the police supressing protests. This year, unlike years in past, there was a constant wailing of the sirens of ambulances, day and night. While receiving a security update from Samaritan's Purse, I saw a protestor being chased by numerous policemen in camaflouge and carrying machine guns through the edge of the hospital complex into town. The police presence throughout Kampala was obvious and dense. We were stopped by a policeman as we departed the city, who detained us briefly because he saw us take a picture of him and he wanted to be certain we were not foreign journalists. It was unclear what his intentions were, though he did state that he could arrest us for taking the photo. Our internet access was severely limited this year. It was unclear if this was intentional stemming from the protests or from fiscal constraints that shut down access from the ISP's. We were able to obtain a satellite modem that allowed us to send and receive email, though pictures could not be sent. News reports over the TV and in print varied widely, though apparently none reached major news outlets like CNN. This was good from our vantage point as we wished not to distress our family and friends. We all cheered as we landed in Atlanta and went through US Customs and Boarder Patrol where we were greeted by the kind officers "WELCOME HOME!" This year these two words were even more salient and comforting. We are so blessed and privileged....

Home Safely! Our inspiring and humbling journey concludes....for now...

2011-04-24T07:28:00.000-04:00

Hi All,
We all arrived home safely on Saturday night at 8pm, greeted by all our loved ones we left behind for the past 2 weeks. We have so many stories to share, many of contradictions. Life and death; health and sickness; new and old friends; hope and despair; accomplishing so much and doing so little; beauty and ugliness; exotic scents and disgusting smells; and the list goes on.... Once again our team was spectacular in all of our endeavours: healing, caring, teaching, empathizing, and being FLEXIBLE (like Gumby)! We have all been transformed in our individual and collective ways...Thanks to all for your love and support..

Rude Awakening

2011-04-19T13:55:00.000-04:00

Our mission is coming to a close. The experiences will never be forgotten. From lost baggage for 5 days to being locked out of my sleeping quarters for 24hrs. Then my entire team drove off without me at the Mall. Its a good thing I have a little sense of humor. Overall its been a journy of sorts. Trying to keep kids alive long enough to get them over the hump using Bipap to the realization that some were not going to saved, the long hours are worth it wihen you see those faces a few days later. The first missions trip I went on in 2009 was well planned but also gave me a false sense of hope. On this current trip would be the same. Instead it was like a peditric MASH unit. The more we tried to help the more the news got out and this brought even more patients. We covered peds ed, triage, acute care, 28 day and greater neonatl unit and of cousre the PICU and we still had patients lined up from the wards that needed PICU. In the mornings 75% of the beds in acute care are empty the patients are discharged overnight. By 11am there is no room in the inn, by 4pm its overwhelming it seems there is no end in site Every child admitted was started on oxygen and had an IV placed. Not sure of the reason behind this. Because there is a shortage of flowmeters, pulse ox's its difficult to determine who needed what until you wlak by and notice a child struggling to breath. Up to five child at a time will be place on one flowmeter using a water bottle with needles stuck in it to bleed oxygen to who ever needs. In the end it does not matter as long as evrey pattients needs were meet.

Sheila White RRT.

Oh what a difference....

2011-04-17T10:15:00.000-04:00

While this is my third trip to Uganda with the team, so many things differ this time. Without being able to find a heart surgeon, the mission took on a new life by focusing on the Peds Acute/PICU areas, teaching a structured course for all of the staff, and meeting up with the heart and peds surgeons here to see if we could operate with them or help in whatever way they needed.

The start of the day Monday, differed only in the area where we were unpacking supplies, and of course the lack of drinks and lunch until late in the afternoon. Other than that, business as usual....separate the supplies for different areas, take them there and put them away. As I trucked my supplies "down the hill" to the Heart Institute however, the differences came to light. Our home away from home here in Kampala, was full of the usual hustle and bustle of patients waiting for care, but the actual ICU that we had established had no patients, and there were only a few staff around, caring for the patients in the adult ICU. Though I brought supplies down for "possible" cases, we had no set time to operate, no patients designated to operate on, and no connection at this point, to the pediatric general surgeons here at Mulago. The simple atmosphere, smell, number of patients and supplies & equipment that surround us in the heart institute, after coming for several years, is worlds away from what my colleagues are facing "up the hill." It is not easy either, to take what you need from one area, to serve another, simply because you need it...despite the fact that we've brought most of those supplies, and there were patients dying "up the hill" without them. As is the case in the US, the Heart institute is looked at as the spoiled child, who is getting funding and support from many sources, while other areas of the hospital go neglected with DRAMATICALLY less. Lets be clear though, they don't have state of the art equipment and endless supplies......but, they are able to take vital signs because they have the equipment to do so, weigh a patient for appropriate medication dosing because they have a scale, and actually care for the patients because they have staff there. The care is documented so everyone knows what has been occurring with the patient, and the nurses are well educated through great collaborative efforts, to understand how to provide that care.

I'll describe more of my surgical experience at a later time, but my job here this trip was much shorter and much less involved than years past. I've tried more, to help the rest of the team cope with the disparity they are seeing. Many, including some who have gone on missions before, were having a really hard time knowing where to begin and why we were here, when all of the expertise we bring with us gets lost in the fact that there aren't any nurses or doctors available to take care of those in the greatest need. The shock has stabilized over the first week, and I've been able to watch my colleagues go back day after day with the attitude that today they will make, if nothing else, a small difference. They are simply amazing.

"Down-time"

2011-04-17T06:56:00.000-04:00

It's Sunday and most of us are only working 1/2 day or have the day off. I went to the pediatric Acute care unit that exists next to the Pediatric ICU to check on our patients (they had been moved from the PICU to the acute ward due to the fire yesterday). I went with mixed feelings. It's all a double-edged sword - I am well meaning - but I went hesitantly, because I knew that I could easily be sucked into the unending whirl of need and patient care (and though eager to work, ... I have limited energy also). The most frustrating thing was and is and continues to be: LIMITED SUPPORT. Limited supplies, suboptimal education, overwhelmed and overworked staff, limited access to clean water, virtually no infectious disease precautions, cultural beliefs that hinder delivery of "western medical care" (be it treatment of hydration or infection), care delivered by a combination and mix of spotty staff and a variety of family members (making continuity and consistency a HUGE problem), language barrier, and inability to assess and address basic patient needs (such as hydration or fever), lack of follow-through and the seemingly un-ending number of very sick kids are enough to make anyone just stop and cry.
Never-the-less . . . you try to make a difference. One baby at a time - just one
Parvin

It's okay to shout FIRE in a crowded PICU

2011-04-17T05:14:00.001-04:00

Our Saturday came to a dramatic ending yesterday when an electrical fire broke out from the air conditioner box right as we were preparing to leave. First, it helps to know a few things about the picu at Mulago. It's required to take your shoes off prior to entering the very narrow door into the unit. So, more often than not, I have to climb over a pile of shoes to get through the door. Once in the picu, you are standing in small square room with 5 beds (maybe 6, if you have a couple of infants) lining 3 of the 4 walls. There are windows, so the light is good, but they don't open, so ventilation is poor. A table sits against the 4th wall, and is usually covered with so much stuff that is hard to tell what's what. Above the table sits 2 wall electrical boxes, one with switches to the lights, and one with a switch to the AC. One of our goals this week has been to help the Ugandan staff organize what limited resources they do have in a way to be efficient, and for them to be able to see the supplies that they do have. However, with the overwhelming patient load, and critically ill and dying patients just appearing in the unit, organizing supplies has fallen down on the priority list. But, on this morning, there was some time, so I spent about an hour creating a "code cart" for the unit and cleaning off the table.

All of that was destroyed however, when smoke started emerging from the electrical AC box, and sparks started flying. I immediately thought, "fire extinguisher"....... and then quickly realized there is none. So, we turned off the power, and quickly turned off all the oxygen to the patients, and removed the patients from the unit, and ushered everyone in the acute care area (which is adjacent to the PICU) outside. Then I began assessing the patients out on the sidewalk to make sure that when we could return, the sickest were let back in first.

Maybe not surprisingly, the patients and their families did not seem that alarmed or frightened by the whole event. They calmly went outside and waited. There was no yelling, no crying, no running. When I asked one of the matrons (that's what they call their nurses) if this kind of thing happens often, she said "No, this has never happened". So, why was I the only one who's heart was racing? Struggle and calamity...... death and tragedy are an every day way of life for the people here. Yet, there is a resilience and hope and light that can be seen in the eyes of the people. They find joy in the simple pleasures of life -- a song or a nap on the grass in the sun. I am humbled to be witness to the rawness and purity of humanity in this place.

Jenny Boyd

Mosquito repellent is the new Chanel no. 5

2011-04-17T01:06:00.000-04:00

An easy conversation opener for any traveler to SSA (Sub Saharan Africa) is anything having to do with mosquitoes. How bad they are this trip compared to the last? Does your bednet fit? How did any mosquitoes get inside the bednet? and maybe there are more inside than out? We're comparing notes on which anti-malarial is better, and where it's cheapest to buy at home. Mostly, we reassure ourselves that getting bitten is really okay, because not all mosquitoes carry malaria anyway.

Parvin kindly schooled me on all the details of bednets, bednets, bednets. My first lesson in how to use a bednet was that they should not rest on the floor, rather they should gather on the top of the bed to form a tighter seal. This means that you brush up against them at night, which feels weird on my skin. Also, it means that the size of my bed is now smaller than before. My second lesson was a much needed safety pin to close the gap in the front of my netting. My amateur status shone like a new sheriff's badge! The first night, I felt a bit like a princess in a canopy bed or a really tall tent. The next morning, I wondered if I could get away with not using it at all. My mind quickly changed when the buzzing in my ears started.

I've asked several of the Ugandans I've met if they use bednets. A few yes, a few no. One said, "No, because it [malaria] affects children much more, besides, our blood is strong." Okay, I thought, but I've heard it does a number on adults, too. Another person told me it's just too hot to use them and he doesn't have a fan. Fans cost money to buy, and electricity is expensive. Also, this is a tropical climate, so the fan would be running all year, every day.

In another nod to public health interventions that prevent clinical situations, my Health Behavior Health Education (HBHE) training kicked in, and I wondered how to convince someone to change their sleep environment. Are you willing to give up your bed, your comfy sanctuary, your place of rest to live under a dome of netting for the rest of your nights, every night? Maybe it's an economic decision. Maybe it's just really hard to change habits. The bednets themselves are low hanging fruit, but the willingness to adopt is that last puzzle piece that's hiding under the table.

I remember growing up reading recommendations on how to not get bitten by mosquitos. This advice included a) don't wear light colors b) stay indoors at dusk and dawn and c) don't wear perfume. These recommendations were written by people who were not living out of a suitcase and had plenty of air conditioning. They had the choice to be inside our outdoors, with vented stoves and clothes dryers. The reality is that you wear what you have; here it's cooler to be outside than in and the heavy fragrance additives in most spray repellants would induce nausea if mixed with other scents.

And, with that, I wind this post down. I think there are one or two of the little skeeters in my net tonight. Hopefully they'll find their ways out just like they found a way in - without tasting this mzungu juice.

oh boda boda

2011-04-16T05:10:00.000-04:00

Wearing helmets while riding a boda boda (a motorcycle named because it used to rocket from border to border) would do much to prevent head injuries after collisions. Here's some bkgd on the issue. Helmet laws are fairly easy to enforce. Tickets, fines, confiscations all do the job. But, health behaviors are really hard. Convincing people to break out of their habits is one of the toughest jobs I know. Women object because it messes their hair. Helmets heavy and bulky when you're walking around during the day. Helmets aren't free, and Ugandans aren't rich. Excuses all, but just one more challenge for health educators. I heard a rumor that the president stepped in and halted the program, that it oppressed his people.

Only having one or two people on each boda boda would also improve the accident situation. We've seen boda bodas carrying three people, plus children and bags. On our way to Kampala from the airport, an accident between a boda boda and a full taxi happened right beside our moving bus. No helmets on any of the drivers, of course.

Also, talking on a mobile phone usually requires one hand to hold the phone, which means that only one hand is steering the boda boda. Add in that the potholes on these roads eat tires for breakfast plus, well, staying in one's own lane is just so restrictive!

Unfortunately, boda boda's are an economic necessity for many. Cheaper than a car to buy, to fuel and to repair, they meet the needs of many in a tight economy.

Mellanye

Q: Why bring a librarian to a global health medical mission?

2011-04-16T04:51:00.002-04:00

Day 2: This is a medical mission. 17 doctors and nurses are saving lives, healing children, training nurses, residents, physicians, and learning so much in return.

What is a librarian doing on this trip? Indeed, #whatalibrariandoes is a mystery to many. Besides finding internet solutions, my role on this trip involves 3 things: technology, education and training. I'm investigating 1) what would be needed to establish regular, online trainings session for the Mulago pediatrics department, 2) if it's possible to link into current telemedicine efforts to share cases and consult with patients across land and sea by asking lots of questions about how telemedicine and tele-education happens here at the Mulago Hospital, and 3) conducting trainings on HINARI and PubMed. I'm also meeting with librarians at the Albert Cook Medical Library, the Infectious Disease Institute Library and the Makerere University Library. Three different foci, three different clientele groups and three radically different environments. I've also been taking every opportunity to talk at length about my new favorite subject: using web 2.0 to improve health.

These are things I never expected to do as a librarian, but I'm so glad I have the opportunity now. The tasks I have before me for this week and next are far from my days manning the reference desk at the public health library at the School of Information at the University of Michigan. My few short days here have led to conversations that show me, more than ever, how important information and public health are in this country. I know this trip will make me a better librarian and an even better public health educator.

Mellanye
Global Public Health Librarian at the Health Sciences Library

So, why should librarians be a part of global health teams?

A: Tech support
B: You'll need someone on the team to crack jokes after working all day in Peds Acute and Surgery
C: Librarians know things and know how to find things - invaluable in another country and culture.
D: A #hashtag means what?
E: All of the above

There are so many less priviledged and less fortunate in this world

2011-04-14T15:25:00.000-04:00

It is Thursday afternoon and we have been here since Sunday. Monday was an "unpack", set up and scope out the environment day. Since Tuesday - we have been working hard - very hard. There is soo much need and soo much poverty here. The kids and families of need for SIMPLE support such as basic nutrition and clean water, BASIC medical attention, (never mind more advanced care) is ENDLESS. It is a seemingly unending ocean of need. There is soo much potential for help and making a difference. These kids and families have sooo little - basically they have nothing - yet there are NO complaints and just HOPING, dark brown eyes from a desperate baby with its mom in despair. My heart goes out to them and my soul weeps. I do so little while I want to do so much more.

I count my lucky stars and my "blessings" - I am so fortunate. If we could just have more support to do more. If I could just find a way to be more committed to this / be more giving / be more creative with the little resources available, I could contribute more.

We have an awesome team. I remain silent and in awe as I watch us all TRY and make a difference here.
Parvin

2011 UNC Project Uganda Team Members.

2011-04-13T14:28:00.001-04:00

Team Leader: Keith Kocis, MD

Pediatric Cardiologist: Parvin Dorostkar, MD
Pediatric Critical Care: Jenny Boyd, MD

Pediatric Surgery: Tim Weiner, MD
OR Scrub nurse: Jennifer Ditto, RN PNP

ICU Nursing (6)
Jeannie Koo, RN PNP
John Bryson, RN
Katherine Desrochers, RN
Anna Freeman, RN
Kristi Page, RN
Sue Parish, RN

Pediatric Emergency Medicine: Donna Moro-Sutherland, MD

Respiratory therapists (2)
Sheila White, RRT
Judith Philips, RRT

Mbarara Team (3)
Pediatric Critical Care: Benny Joyner, MD
Family Practice: Thomas Koonce, MD
Pediatric Surgery PNP: Robin Deloach, RN PNP

Global Health Librarian: Mellanye Lackey, MS
PR/Development: Helen Snow, MBA

UNC Project Uganda Team Update: Wed April 13

2011-04-13T14:20:00.001-04:00

Hi All,
Sorry for the paucity of communications as the internet has been out at our guest house and at the hospital. Mellanye Lackey was able to work out a satellite communication modem card that we are now using. Well the team is in HIGH GEAR after arriving Monday am. Tuesday morning was spent trying to organize and develop our strategy for all that the team is doing. Jenny Boyd has taken the HUGE task of transforming the PICU space (now 6 years old located "Up the Hill") into a FUNCTIONAL PICU, with all the limitations that come with doing this in a resource limited environment. With all the PICU RNs (John, Kristi, Anna, Jeannie,Sue and Katherine), immersed in the formidable task ahead the PICU was transformed in a matter of hours. Shiela and Judy worked on establishing oxygen therapy and noninvasive ventilation, which we needed before lunch ever arrived. SO, the next in the list of FIRSTS for our team is putting a child with severe respiratory distress onto BiPaP....Fast forward 1.5 days and that child is alive on a nasal cannula, thought still recovering...The team has been thrown into the fire and have acted with great resilience. Tim Weiner operated with our long time friends and colleagues at the Heart Institute on 3 babies with PDA today. All are extubated and doing well in the Cardiac ICU ("Down the Hill"). He is scheduled to operate on a child with imperforate anus and another child with Hirshsprung's disesase. Jenn has got the OR restablished to allow for these surgeries to proceed. We've reconnected with old friends and made many new. Donna has spearheaded an intense pediatric resuscitation and clinical skills course for our Ugandan colleagues. Parvin is the 'jack of all trades" again this year working in the PICU, Cardiac ICU and cardiologist on call. All members of the team are participating in that training, which runs for 5 days. Mellanye gave Grand Rounds to the Dept of Peds unveiling access to UNC's AHEC digital medical library and other available electronic resources for them. Benny, Tommy and Robin left today for Mbarara. It was a longer ride than expected (5hrs) but arrived to very comfortable housing and a plan for an extensive evaluation of the facility while providing expert educational opportunities.

More to follow by all the new and old team members. We're all doing well and the only downer has been the lost bag. we're still hopeful as another KLM flight arrives tonight.

UNC Project Uganda has Landed in Kampala for their annual medical mission.

2011-04-12T03:48:00.000-04:00

A team of 19 healthcare professionals left RDU on Saturdy April 9 and arrived in Kampala on Monday morning. We set up 3 main areas that we will focus on this 2 week mission. Peds Acute is the area similar to our Pediatric Emergency Dept. Last 12 hrs they saw 55 children and 50 were admitted to the Pediatric Wards this am. Dr Donna Sutherland is leading our efforts to serve, learn, and teach our Ugandan counterparts. The Pediatric ICU that we established in 2005 with 6 beds is our second focus for this mission. Dr Jenny Boyd along with 6 PICU nurses from UNC are tackling that specialized area. Already this morning a small child with severe respiratory failure arrived and is being resuscitated and kept alive on BIPAP, a new non invasive form of respirtory support for the Ugandans. Finally, Dr Tim Weiner, pediatric surgeon is establishing our partnership with the Ugandans and will be operating this week. More to come. We are all doing well. One lost bag, but 1 ton of luggage, equipment, meds, and supplies has arrived. Communications are very spotty now but we are establishing those as we speak.

Dr Nancy Chescheir, UNC Professor of Obstetrics and Gynecology, joins UNC Project Uganda

2010-09-23T13:24:00.006-04:00

Dr Nancy Chescheir, Professor and Vice Dean for Special Projects, joins UNC Project Uganda to improve maternal health and perinatal care. Dr Chescheir will be joining the team on its next mission, Spring 2011.

UNC Project makes first telemedicine link to Mulago Hospital

2010-09-23T11:43:00.006-04:00

UNC Project Uganda with the support of the National Institutes of Health, has established its first telemedicine link to the School of Medicine at Makerere University. This crucial next step is part of the expanding goals and objectives of UNC Project Uganda to incorporate telemedicine and distance learning to improve the health of the Ugandan people by improving the education and training of Uganda physicians and healthcare providers. Dr Benny Joyner, Dept of Anesthesia, Division of Pediatric Critical Care Medicine is leading this initiative for UNC Project Uganda.

UNC Project Uganda Partners with Mbarara University of Science and Technology

2010-09-23T11:29:00.015-04:00

UNC Project Uganda with support from the GE Foundation has expanded its reach & committment to the People of Uganda by training healthcare providers from the Mbarara University of Science and Technology (MUST). Dr Keith Kocis traveled in May 2010 to Mbarara to formally create the partnership. The goals of the program are:

1. Connect Ugandan physicians to UNC's Health Science Library to allow access it's vast repository of electronic journals, books, and learning modules. This effort is being lead by Ms Mellanye Lackey MSI, Director, UNC Health Sciences Library Global Inititative.

2. Foster regional health care delivery and training between MUST and Mulago Hospital in Kampala.

3. Train a core team of physicians and healthcare providers from MUST at Mulago Hospital while the UNC team is in country for it's annual pediatric cardiac surgery mission (Spring 2011).

4. Dr Tommy Koonce, Assistant Professor of Family Medicine, will lead a team from UNC to MUST in Spring 2011 to train Ugandan healthcare providers on site. He will be accompanied by Dr Benny Joyner (Dept of Anesthesia, Division of Pediatric Critical Care) and Ms Robin Deloach, RN PNP (Dept of Surgery, Division of Pediatric Surgery). A comprehensive long term plan will be developed following this mission.

5. Explore telemedicine applications for distance learning and improved patient care. This effort is lead by Dr Benny Joyner, Assistant Professor of Anesthesia.

UNC Project Uganda Partners with the GE Foundation

2010-05-25T08:27:00.002-04:00

UNC Project Uganda announces an important partnership with the GE Foundation to continue to advance the clinical and educational goals of the program. Funding will allow the team to organize a 5th mission in late Winter 2011 to continue to provide corrective surgery to children with congenital heart disease and to train the Ugandan healthcare team to perform these operations independently. In addition, the first steps in creating a regionalized healthcare delivery system are being established. These initial efforts revolve around providing joint educational programs between UNC, Mulago Hospital, and Mbarara Regional Hospital.

The 10 Children Who Had Their Hearts Fixed with Love, Kindness, and Expertise...

2009-10-27T13:59:00.003-04:00

Tuesday 9/29
Mary Mamande
Peter Kabuye

Wednesday 9/30
Hellen Babiyre
Regan Tawoda

Thursday 10/1
Joachim Dingiro
Joan Owemigisha

Friday 10/2
Grace Apio
Jesse Wambi

Saturday 10/3
Hussein Babu

Monday 10/5
Ruth Kyomukam

Reflections from a first-timer

2009-10-15T09:52:00.004-04:00

I cannot summarize all that I have taken in during our stay in Uganda but I will try to convey a few impressions. One overall reality is that people here are living and making do without many things that we take for granted. But there does not seem to be a shortage of hope or effort.

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

Mission accomplished, #4

2009-10-12T06:52:00.007-04:00

I would never have imagined how much we could accomplish in just a few years. On our first trip to Mulago in 2005 there was no PICU and no cardiac ICU to speak of. This year there is a fully functioning cardiac ICU with staff that have exceeded in everything we have asked of them. The PICU was full when I went to visit, and although their staffing ratios are much more dire, with acute shortages, there were children there that were to thrive because of the more intense monitoring available.

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

A long and winding road

2009-10-11T12:51:00.018-04:00

The long and winding road
That leads to your door
Will never disappear
I've seen that road before
It always leads me here
Lead me to your door

And that is how it feels to me. This time we had a winding road that started much earlier and continued even up until we left, but we still made it to the door of Uganda and the Ugandan Heart Institute nonetheless. We saw our supplies being carried on to our flight from Amsterdam to Entebbe which made their final arrival on Monday afternoon for unpacking.

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
CT Surgery

Sharing education at Mulago Hospital

2009-10-11T11:01:00.007-04:00

The team is back in the United States, home from another full mission of interdisciplinary exchange at the Mulago Hospital of Makerere University in Kampala. We taught, directed practice, and learned much about delivering health care in Uganda.

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

The pediatric cardiac surgical mission concludes

2009-10-07T01:24:00.006-04:00

We left UNC 12 days ago to travel to Uganda to train Ugandan health care providers to perform one of the most complex and difficult surgical therapies: open heart cardiac surgery. Building on the work and success of the last two years, Team UNC quickly reestablished, restocked, and reorganized the operating room, cardiac bypass perfusion, and ICU into a fully functional state. During the first four days, two operations were performed each day by Dr. Michael Mill, with the final two cases concluding on Saturday and Monday. The results are that ten Ugandan children from ages 2 to 14 have had their severe cardiac disability corrected, for a lifetime. These children leave the hospital with a scar on their chest as a sign of the work that was done, but free from disability, heart failure, and multiple daily cardiac medications. Their spirit, energy, and appetites have already markedly improved.

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.

My experience as a newbie

2009-10-06T08:17:00.005-04:00

Coming to Uganda, I had no expectations about what our mission would entail. It has been an amazing trip to date, with a busy ICU, lots of teaching (and learning) in the most welcoming environment I have ever encountered. To interact with the patients and their families both preoperatively and post-op has allowed us to bond and not be strangers. It has warmed my heart to see our patients now out on the general ward, ready to go home and continue life with a new outlook. The teamwork between the UNC group and the Mulago healthcare team members has been enjoyable, productive, and fun. This is a resilient and resourceful group and I have learned a lot about Uganda, its people, and its healthcare system. Thank you to everyone from the UNC team who were gracious enough to invite me to participate, and thank you to everyone at the Mulago Hospital for welcoming me into their workplace.

-- Stacey Peterson-Carmichael, MD

Dr. Gene Freid's thoughts

2009-10-05T10:21:00.003-04:00

This is a second year providing anesthesia care at Mulago Hospital and Uganda Heart Institute. This year has brought added complexity with smaller and younger children and more complex congenital heart lesions. All 10 children have had surgery and are recovering nicely. It has been rewarding to see the children recover and walk about the halls knowing that their heart is repaired and they have a chance for a normal childhood.

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

The Toddler Troupe

2009-10-05T02:04:00.007-04:00

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.

When the night comes. . .

2009-10-05T00:58:00.010-04:00

The night team is often less recognized, not for the lack of impact or importance, but merely the fact that the sun has set, the moon has risen and quiet has come to the city....everywhere except the ICU. Jeannie Koo, Susan Van Fleet, Diane Yorke and the 3 PICU Docs (yep....that included Gene Freid) keep things going after a long day of activity in the OR and ICU.

Just breathe. . .

2009-10-03T10:18:00.009-04:00

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.

(By the way, my favorite song, "Breathe," is on Anna Nalick's album "Wreck of the Day")

The Blue Devil connection

2009-10-03T10:09:00.006-04:00

We are so pleased to have Dr. Stacy Peterson Carmichael (former Tar Heel) and Jeannie Koo, RN, PNP, join us on this mission. Both have brought their knowledge and skills from the other end of Tobacco Road on the Road to Uganda. Stacy is staffing the PICU while Jeannie is working the "lobster shift" to keep the kids recovering.

But is the lobster shift in Uganda the day shift in Durham?

Samaritan's Purse leadership visits UNC Project-Uganda

2009-10-02T11:21:00.013-04:00

Mr. Kenny Isaacs, VP for Projects at Samaritan's Purse, visited UNC Project-Uganda today. He was accompanied by Associate Director for Projects, Mr. Edward Bensham and Ugandan Country Director, Mr. Chris Blacham. We have worked very closely over the past three years with Ugandan's Doreka Shemsande, Children's Heart Program Project Manager and Samantha Nuwagaba, Children's Heart Program Coordinator (both pictured above). Ms. Cindy Bonsal, based in Boone NC, heads the Children's Heart Program. Her leadership and support has made this program possible.

Samaritan's Purse is a Christian humanitarian aid organization based in Boone, NC with an extremely successful Children's Heart Program. They have arranged for the correction of hundreds of children with heart disease by partnering with U.S. physicians and hospitals. This past spring, six Ugandan children were brought to the U.S. for repair of their defects as part of a larger program co- sponsored by the Gift of Life.

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.

We let Dr. Freid practice in BOTH the ICU and OR

2009-10-02T10:47:00.007-04:00

Views from the PICU

2009-10-02T10:28:00.005-04:00

Glad to be back!

2009-10-02T04:12:00.006-04:00

Well it's Friday and all the surgeries have gone well. It's been a joy to watch these children transition from very sick children, to awaken to a better chance at living life to the fullest. There are smiles given that just make your heart melt. At times the communication lines are hindered because of language barriers but smiles and hugs say so much to them. I may not be able to speak their language but I can communicate and a better meaningful way. Even though this is my third trip here, I'm always taken back by their appreciation and gratefulness. Things that we define as a hard or difficult way of life for us, is mere richness to them. I'm reminded that I need to thank God for all that he has blessed me with. Whether if it's using my talents or skills to bless others, I dare not waste what has been given to me to help others in need. The staff here at Mulago Hospital are wonderful people who also are thankful for our help. They have grown so much in the past 3 years and are blossoming into confident health care givers. They can help their country and a way that is meaningful to them. For those that read this entry, make sure that giving to others becomes a way of life for you and just know that the return of doing so will bless your life as well.

Lupe Haynes Respiratory Therapist

Views from inside the OR

2009-10-02T02:05:00.011-04:00

An update from the "pearl of Africa"

2009-10-02T01:08:00.010-04:00

The broken anesthesia machine is now FIXED (at midnight). THANKS, Elizabeth!

Wonderfully six children have been healed. They are recovering and their families are glad. This has not been without challenge. Twenty-four hours a day the team is caring for the children. Twelve hours a day someone is fixing the equipment- and that would be me. The equipment at the Ugandan Heart Institute is quality equipment but has not been without problems. Some functions have needed to be enabled on the devices. Those are the easy problems. Some problems have been typical electronic problems like reseating cables and connectors. Others have been more serious and parts have been replaced by scavenging from defective machines. Yesterday a part was needed to repair a machine. I asked Melad the technician here to call the equipment's service representative here to request the part to be delivered overnight... as if. Unfortunately access to parts are not readily available and other options had to be explored and delivered. The equipment here is supporting great work and great people. My hope and prayer is that it continues.

The internet is back up (at least for now) so expect some posts

2009-10-01T07:36:00.005-04:00

But we think we figured out what was wrong: somebody has been monkeying around with the cables!.

Gifts for the children

2009-10-01T02:10:00.007-04:00

The team brought gifts for the children to have after their surgeries. Brightly colored bags are filled with pencils, notebooks, crayons, bubbles, kazoos, etc. The bubbles and kazoo are wonderful for improving their lung function. The favorite seems to be the Beanie Baby stuffed animals. The children are asking for them immediately after they wake up during the day and evening post op. They are most comforting.

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. . .)

Thursday update

2009-10-01T01:45:00.005-04:00

Hello all, we are still with very limited (and slow) email access. Hopefully this will improve today. The team finished in the OR at 8:30 pm last night and we had a pizza party to relax. The infirm members of the team are getting better each day, hopefully to return back to work in the next 24-48 hrs. Sleep is improving, though still erratic. Luckily the Ugandan coffee is STRONG.

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

More later.

Wednesday Update

2009-09-30T11:46:00.006-04:00

So far the cardiac surgeries have gone fairly smoothly. The first two patients had correction of their surgical defects without any difficulty and both are eating and recovering in the ICU. In fact, we left the OR at 9 p.m. last night, which is awfully good for the first day. The first patient for day two is in the ICU recovering, while the surgical team is in the OR with the second patient. It will be another 9 p.m. evening for the team.

The team has been fatigued by jet lag and varying illnesses (flu, GI upset, dehydration, etc.), but we have rallied around each other to support our sick colleagues and pick up the necessary work loads. We will continue to monitor our team's ability to complete the 10 scheduled surgeries. Thankfully, we came well prepared with a wide spectrum of medications to treat every possible ailment. IV fluids have been given without problems. We hope all of us will soon return to our healthy state and that no one else becomes ill.

Sorry for the lack of communication

2009-09-30T11:44:00.006-04:00

We have had no internet access for the last 2 days. We have brief power outages, particularly during rain storms and late at night. Fortunately Greg Griffin, our perfusionist, had prepared the bypass machine for battery operation, so the surgery could continue without complication. Access to our hospital email web accounts has also been sporadic. SORRY!

Dr. Dorostkar from Univ. of Minnesota joins Team UNC

2009-09-29T04:57:00.009-04:00

Dr. Parvin Dorostkar, a pediatric cardiac intensivist from the University of Minnesota, joined our team for this mission. She will be assisting Dr. Kocis with final cardiac evaluations and care of the post operative patients.

Travel Directions: RDU to Entebbe

2009-09-29T01:29:00.005-04:00

TEAM UNC Arrives in Kampala Uganda

2009-09-28T05:29:00.003-04:00

17 team members boarded an airplane @ RDU Saturday at noon carrying 900 lbs of additional medical equipment and supplies. Sunday evening at 8pm (local) (1 pm EST) we arrived anxious to begin our mission. We stayed at a hotel outside Entebbe airport due to safety concerns of traveling at night and more importantly the recent riots in Kampala sparked by a disagreement between the the president of the country and a tribal king. We drove into the city early this morning, spending 1.5 hrs on the main road from Entebbe, then veering off to back roads for the final miles into the Capital due to gridlock. We have checked into our modest housing on the perimeter of the Mulago hospital complex. It will be our home for the next 10 days.

Our heavy/large equipment, which was shipped in August, has finally entered the country last night in the belly of our plane, but is still in the process of clearing customs. We need that equipment to proceed with our planned surgeries. We are hopeful the shipment will arrive by 5pm today. It will be a late night unpacking that shipment. We are all scurrying about reorganizing the pediatric cardiac ICU (4 beds) and stepdown unit (4 beds). Much of our organization system from previous missions remains intact. The OR team is unable to enter the OR now due to an adult esophageal surgery that is underway. We expect that operation to end soon and the OR to be transformed into a Pediatric Cardiac OR. Drs. Lwabi, Dorostkar, and I will begin the final screening of patients now. We have narrowed the potential pool to 12 to fill the 10 planned surgeries. Patients vary in age from 11 months to 14 years. Our new team members are quickly orienting to their new environment though jet lag is present in all.

We are still planning on having our joint cardiac surgery case conference this afternoon to review the patients. There's a lot to fit in today.

Repairing the Ugandan Children's Hearts

2009-09-18T16:36:00.009-04:00

Our colleague, Dr. Craig Sable from Children's National Medical Center, has screened hundreds of children in the previous years. We have identified 17 patients for consideration for surgical repair, although we only have space for 10 operations on this mission. The cardiac lesions we will be repairing this year are ASD (atrial septal defect), a hole in the upper chambers of the heart, and VSD (ventricular septal defect), a hole in the lower chambers of the heart).

1 Mary N
2 Peter K
3 Oliver N
4 Asasire M
5 Joachum D
6 Atwib S
7 Anna Grace
8 Jovita K
9 Regan T
10 Hellen B

With Alternates:
A1 Joan O
A2 Faith K
A3 Fahad M
A4 Matovu Hussein
A5 Ethan K
A6 Jesse W
A7 Pheona A

Final determination will be made at the time of our last preoperative evaluation on Monday and Tuesday September 28-29.

A prayer card has been created by Samaritan's Purse (attached) for those interested in praying for the successful repair of these children's heart defects and our team's safety.

UNC Project Uganda Sept. 2009 mission

2009-09-16T21:58:00.007-04:00

16 members from UNC will travel on Sept 26, 2009 to Kampala Uganda for the next Pediatric Cardiac Surgery Mission. We will continue our ongoing efforts to train Ugandan Health Care Providers (MD, RN, RT, perfusion, biomedical engineering) in treating children with complex congenital heart defects. Since our last mission in Oct 2008, our partners from Children's National Medical Center have returned in April 2009 and operated on an additional 10 children while advancing the Uganda Heart Program. The Ugandan team in-country has successfully repaired 3 additional children. We plan to operate on 10 children with increasingly complex heart disease while preparing the Ugandan Team to continue this work after our departure. We are again blessed by the generous support of Samaritan's Purse and UNC Institute for Global Health & Infectious Diseases.

Team Leader: Keith Kocis, MD
Pediatric Cardiac Surgeon: Michael Mill, MD
Pediatric Cardiac Anesthesiology: Gene Freid, MD
Pediatric Intensivists: Stacey Peterson Carmichael, MD, Parvin Dorostkar, MD
OR Nurse: Jenn Ditto, RN, PNP
Physician's Assist: Ruben Bocanegra, PA
Perfusionist: Greg Griffin
Cardiac ICU Nurses: Karla Brown, RN, PNP; Katherine Desrocher, RN; Diane Yorke, RN, PhD; Susan VanFleet, RN; John Bryson, RN; Julie Fields, RN; Jeannie Koo, RN, PNP.
Respiratory Therapists: Lupe Haynes, RRT; Sheila White, RRT.
Biomedical Engineering: Elizabeth Smith

A big day for Patrick

2009-05-20T15:59:00.002-04:00

Our colleagues over at UNC Health Care have a new post with an update on Patrick's condition, as well as links to local media coverage of the heart repair procedure. Read it here.

Repairing the heart of an 18 year-old Ugandan here in North Carolina

2009-05-18T10:24:00.005-04:00

Cross-posted on the UNC Institute for Global Health blog.

The institute’s UNC Project-Uganda has brought an 18-year-old young man, Patrick Kahuma, to UNC Hospitals to repair a narrow heart valve. They are inserting a balloon into the vProalve to widen it. In the U.S. and other developed countries, this procedure would have been done before Patrick turned 2. Patrick has lived with this heart defect for 18 years. He had to drop out of school because he couldn’t make the 6K walk from his village to the school.

He traveled to Chapel Hill with his aunt (he is an orphan) and an interpreter. The procedure is taking place now, and IGHID is live on Twitter during the procedure.

Home from Africa

2008-10-23T08:39:00.004-04:00

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

Our dear friends

2008-10-22T09:34:00.010-04:00

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

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

2008-10-15T07:34:00.002-04:00

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

Meeting Uganda's First Lady, Janet Museveni

2008-10-14T05:57:00.007-04:00

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

Meeting with Ugandan Minister of Health

2008-10-13T06:49:00.003-04:00

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

What a difference a week makes

2008-10-12T12:36:00.006-04:00

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.

Keith

The children and their heart defects

2008-10-11T16:46:00.005-04:00

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
Rest

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

2008-10-11T10:46:00.011-04:00

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

2008-10-11T09:58:00.013-04:00

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

2008-10-11T04:31:00.008-04:00

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

Focus on the task before you

2008-10-10T09:49:00.010-04:00

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

We rejoice in our successes but remember what surrounds us

2008-10-08T18:13:00.005-04:00

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......

2008-10-08T17:54:00.005-04:00

Take 2...

2008-10-08T17:13:00.006-04:00

First look from Uganda...

2008-10-08T15:45:00.008-04:00

Belated update from Keith

2008-10-08T15:12:00.006-04:00

Hi All,

Thanks for following along with us while we return to Uganda with our dear friends from DC Children's and UF Jacksonville. A special thanks to our former UNC colleague, Dr Gene Fried, now at UF Jacksonville, who jumped in at the last moment to provide cardiac anesthesia to the Ugandan children. Our trip over here was uneventful (mostly) but tiring (as usual). We had a wonderful rest at a Hotel on Lake Victoria Sunday night before getting on two buses Monday morning at 7 am for the trip in to Kampala. Despite having most of our supplies shipped over ahead of time by Samaritan's Purse (THANKS CYNDI AND JIM), we still accumulated 26 bags/boxes of luggage and supplies. The bus was packed. We had an interesting "off road" experience getting to the hospital since the main thoroughfare was blocked.

We arrived at the Mulago Guest House again (THANKS SO MUCH KATE and JOSEPHINE), where we are all staying. Such comfortable modest housing (except for the lack of hot water each morning...a terrible way I start each day). I continue to be amazed by our team. We so quickly converted the Cardiac ICU and Cardiac Intermediate Care units into fully functional (well mostly) units. we still have some work to do but it's OK...We have already operated on 4 children and each day presents itself with a new suprise. Day 1, was suppose to be a warm up for our first timers (Dr Mike Mill, CT Surgeon, Dr Gene Freid, Cardiac Anesthesia, Jenn Ditto (OR Scrub RN), PICU RN's Bren Sparling and Sandi Hawkins, and our loveable fellow, Dr Benny Joyner. But of course this changed. The first case, a PDA developed pneumonia and was canceled so we proceeded with another PDA ligation and added on a cardiopulmonary bypass (PUMP) case.

The team jumped right in and did a fabulous job. But we're always gerry rigging something or moving onto PLAN B (or as Spongebob's nemesis would say, PLAN Z). It's great to work with such resourceful, "CAN DO", "NO IS NOT AN OPTION", types....The second suprise came today when we added on a Coarcation repair that was seen at Tuesday's Clinic by Dr Sable. For some reason, they don't "see' coarctations here in Uganda, so we decided to show them.....AND the super suprise was a baby seen on monday with Transposition (and PS/SUB PS) who had O2 sats of 40...we put together the necessary equipment to bring him into the CICU, intubate, line him, and Dr Sable performed a life saving balloon Septostomy. While this buys him some time, surgery is the only long term survival option. Unfortunately, this is NOT something that can be done at this stage of the program here in Uganda. We're still working on options.

I'm here on call, swatting the mosquitos away thinking about my two beautiful children, Kyra and Connor, who I miss so much. Well the team will keep you up to date with events as the week proceeds. Tomorrow is independence day here in Uganda (YEP...they broke free from Britain too, sans the tea in the Harbour). So we will try to just operate on one child (and be half way done with our planned 10 cases.....), but who knows what tomorrow will bring.

Miss you all much.
Keith

We're here!

2008-10-07T01:43:00.005-04:00

It is my great privilege, pleasure, and honor, to be traveling with the team this year. I listened to reports of the previous missions and hoped that one day I might be able to journey there with the team. That day came Saturday and we arrived in Uganda late Sunday evening and we've been non-stop busy ever since.

Monday was spent unpacking boxes and boxes and boxes of supplies and then setting up the OR and the ICU. The cardiologists screened and echoed the potential patients and chose two for surgery today. When we got here this morning though one of the kid's Xray indicated he had pneumonia and his surgery has been postponed until later this week. He's been started on antibiotics and another patient has been chosen.

Nursing lectures are about to start and with good fortune one of us will be able to get back on to blog some more later today.

Diane Yorke PhD RN
Clinical Assistant Professor
UNC Chapel Hill School of Nursing

Jennifer Ditto, RN MSN

2008-10-04T07:02:00.006-04:00

My name is Jennifer Ditto and I am the scrub nurse going with the team to Uganda this year.I have been a nurse for 10 years, working in the operating room at UNC for 9 of those. I love to scrub pediatric heart procedures because of the challenge they present, but seeing such a small piece of what these kids go through wasn’t enough for me at one point though. I wanted to expand my view of the journey these kids take, so in 2005 I decided to further my education, going back to school to get a pediatric nurse practitioner degree. While I learned an incredible amount that I carry with me everyday caring for these children, I haven’t been able to get myself to give up being a part of the surgical aspect of their care.

As the hours dwindle away, and the fury of preparation for the trip is coming to a close, I find myself a little overwhelmed with the thought that tomorrow I will be in Uganda. Never having been out of the country before, I feel blessed to have the opportunity to be a part of this year’s trip to Uganda. I hope to teach the operating room staff there, about the congenital defects, as well as the procedure that we will use to repair them. Being a part of this team has been amazing so far, as we have been meeting together to plan the trip and gather supplies and equipment. Before even getting there, I am realizing how fortunate we are for the technology that we have accessible to us, and the people we work with that come together for a cause as big as this. I can’t imagine how this is going to change my life in a few days.While I am grateful for the wonderful colleagues that are also taking this journey, none of this would be possible for me without the support of my family and friends. A special thanks to my son, and my parents who are staying with him, while I head off for an adventure around the world. And as a humorous aside, to those of you who have offered up some of your most prized possessions, should I need them to get home safely, I’ll miss you while I’m gone!

Jennifer Ditto, RN MSN - Uganda Mission 2008

Bren Sparling , PICU RN

2008-10-03T15:50:00.007-04:00

On the eve of this mission trip, I find myself nervous, excited and in somewhat disbelief that I am headed to Uganda in the morning. I have been a PICU nurse since 1991 and have been at UNC for the last 5 years. This will be my first mission trip. I feel so honored to be part of this caring team of people and realize that my life will be forever changed.

While in Uganda I will be caring for post-op patients in the ICU. I also plan to give lectures and precept the Ugandan nursing staff. I am grateful for this opportunity to share my PICU knowledge and experiences so that perhaps these nurses will grow to love being a PICU nurse as much as I do.

I am so thankful for all of the support and encouragement from my family and friends. I am especially grateful for this opportunity to be a role model for my three wonderful daughters.

Bren Sparling, RN, BSN

Benny Joyner, MD, MPH

2008-10-03T08:38:00.008-04:00

My name is Benny Joyner and I am a 3rd year pediatric critical care fellow at UNC. I, like others on this mission, have always held a deep desire to reach out beyond our geographic and national borders to help children in need. In fact, my entire professional career has been focused on children-starting out as a high school teacher, until circumstances dictated that I change tack. As a result, a pediatrician was born.

After attending obtaining both my medical degree and my master's in public health degree from UNC Chapel Hill, I left the comforts of home and went to the bright lights of New York City where I completed my internship, residency and Chief Residency at the Children's Hospital at Montefiore in the Bronx. While I have always had a love of international travel for recreational purposes, it was during my chief year that I first got a taste of international travel with an altruistic aim. Working with the cardiac surgeon at Montefiore I was invited to accompany his team to El Salvador to participate in the care of post operative cardiac surgery patients. While this trip was by far the most exhausting experience of my life, it was also one of the top 5 experiences of my life and, quite honestly, the most rewarding experience of my professional career.

Seeing the impact that I could have on the lives of the children for whom I cared was a gift but, by far, the biggest gift that I received was the renewal of my spirit and belief in my decision to go into medicine. In a time of increasing responsibilities and pressures of trainees in the US medical system, the opportunity to go abroad and apply what I have learned thus far, to realize just truly how blessed I am to have the life I have, to work in the US medical system and to have the opportunity to support and partner with other medical staff around the globe could not have come at a more perfect time. I returned from that trip physically exhausted but more alive spiritually and emotionally and ready to tackle my fellowship.

How fortunate that this opportunity to work abroad-supporting others as they build their programs and to make the difference in another child's life half a world away-comes at a time as I make my next transition from fellow to attending. It is for these reasons that, when asked if I was interested, I leaped at the opportunity to go. I look forward to working with all of the staff in Uganda and acquiring experiences and memories that will last a lifetime.

Tiffany Mabe, RRT

2008-10-02T15:25:00.004-04:00

My name is Tiffany Mabe. I am the Pediatric Manager for UNC's Women's and Children's Hospital. I am a respiratory care practitioner and a neonatal pediatric specialist. I have worked at UNC Hospitals since April of 1996. I came to UNC to specialize in pediatrics. When I began at UNC I worked in both the neonatal ICU and the pediatric ICU. I then trained, and worked full time, and continue to work as a pediatric flight therapist with Carolina Air Care. I also trained and continue to work as an ECMO specialist

Pediatrics has always been near and dear to my heart. My big interest has always been pediatric cardiac patients. I am very grateful to be able to go over on this trip to help with these cardiac patients.

I was with the first group from UNC to go to the Mulago Hospital in 2005 to set up the PICU. It was a wonderful experience that I will never forget. The people are absolutely wonderful and it truly makes you want to go back and help as much as you can.

When we visited the first time, we were allowed the opportunity to spend time in all of the areas of the hospital, including the Burn ICU, Neonatal ICU, and the cardiac clinic. This really allowed us to see where we needed to focus efforts to help out at the Mulago Hospital. The cardiac clinic really caught our attention. The physician would see many patients in clinic and truly make a diagnosis and treatment plan by looking at the patient, listening with a stethescope and follow-up appointments with medications. It was amazing to see how they were working with these children, who were in dire need of cardiac surgery, and managing them as best as they could to help them to have a somewhat "normal" life.

This in turn led to Dr. Kocis taking on the challenge of "beefing up" our efforts to help the children of the Mulago Hospital, and Africa on a much bigger level. Teaching, training, and gathering supplies for the first trip over to begin pediatric cardiac surgery. This first trip was a huge success in 2007, and the efforts have continued since the return of the team.

I am very thankful for the opportunity to go on this trip to help the children in need of pediatric cardiac surgery. I feel the need to give as much as I can to others, since I have been given a huge blessing. That blessing is having both of my parents alive and well. My father had a major heart attack in March of 2006, underwent the placement of a Jarvick Left Ventricular Assist Device, and now has been given a second chance at life with a new HEART! God has blessed my family over the past couple of years.

I hope and pray that I can give some of the knowledge that I have to the staff of the Mulago Hospital in order to enable them to grow, and take care of these wonderful children that are in need of cardiac surgery.

Tiffany Mabe, RRT

Uganda Fall 2008

2008-10-02T11:56:00.002-04:00

Well, it is that time of year again. The UNC group has been preparing for this Uganda trip since early Spring by acquiring donations of equipment from many vendors, establishing personnel, and discussing the general preparations needed for such a huge endeavor. I am excited to see the Ugandan staff again, especially the nursing staff who were so eager last year to learn. I still think about that trip, and find myself amazed at how much they learned and so desperately wanted to soak up more. This year has been a bit more organized on our part. The unknown is not as prominent in our thoughts as we are now building on what we did last year. We are going armed with multiple lectures, hands on opportunities, and will be able to leave them with the ability to reinforce what we have taught with CDs, jumpdrives, and handouts full of information. We have books donated to start a little "library" for the nursing staff thanks to Diane Yorke, our nurse educator who made it all happen. While I currently work as a Pediatric Cardiothoracic Surgery PNP, I quickly return to my bedside PICU nursing role that I had done so many years prior. I like the ability to combine the two roles in this environment. I can go back to my "roots" and yet have it enhanced with my PNP skills. I hope to impact not only the postoperative patients, but also the nursing staff through lectures and precepting. And like Lupe, I have found this to be such a rewarding experience in so many ways. I hope one day, the nurses will be able to come to the US to further their education and be able to take that back to Uganda to "pay it forward" to the rest of their community.

Karla Brown, PNP
UNC Pediatric Cardiothoracic Surgery

Lupe Haynes, RRT RCP

2008-09-27T11:51:00.005-04:00

I've been a respiratory therapist for 12 years now and I've been employed with UNC Hospitals for twelve years as well. I initially worked primarily with adults and didn't have much interest in the pediatric population. In fact, sick children terrified me! However, over time I felt I needed to challenge myself further in my career and I knew I would obtain further growth and exposure to new things in the pediatric realm. And boy was I challenged! I have come to love what I do and my role in helping children on their way to recovery. Every story doesn't end on a happy note but when they do, it motivates me to continue to strive to deliver the best respiratory care possible. I pray that God give me the wisdom to make the right decisions involving my management of my patients.

Over time, I have learned so much and was so blessed to be involved in the first heart medical mission in Uganda October 2007. When I was invited to attend the mission , I was so honored but at the same time terrified because this was another crossroad decision for me. This would be a great opportunity to give to those that were less fortunate than me. That alone was the best reason to go but the difficult part was would I be able to perform my job to the fullest? Would the experience and exposure I've had in the PICU be enough to help guide my decisions in the management of the patients in Uganda?

The trip was a great success and every health care professional that volunteered their time and compassion for the patients in Uganda left as better human beings. I've learned to be so grateful for what we have available here in the US and that it is so much better to give than receive. Because in giving you get out of your selfish mode and realize that it could be me on the other end and that alone makes me so grateful for what I do have.

I've been invited to go again this year and I"m so excited and can't wait to see my Uganda family again. My goal this year is to be able to educate the staff on ventilator management and the role of the respiratory therapist. My hopes are that I can build on the knowledge the nurses and doctors obtained last year and get them a step closer to being more self-sufficient in the respiratory management of pediactric heart patients. I will not only be performing patient care but aiding in establishing the role of respiratory care within the Uganda Heart Institute.

Lupe Haynes, RRT RCP

Our third medical mission to Mulago Hospital, October 4-16 2008

2008-09-09T12:07:00.010-04:00

The UNC team returns next month along with our partners from Children's National Medical Center and University of Florida, to continue to advance the Pediatric Cardiac Surgery Program at Mulago Hospital with the near term goal of self sufficient, sustainable care for Ugandan children with heart disease.

UNC Team
Keith Kocis, MD - team leader and cardiac intensivist
Michael Mill, MD - cardiac surgeon
Benny Joyner, MD - intensive care fellow
Karla Brown, RN, PNP - surgical nurse practitioner
Katherine Desrochers, RN - ICU nurse
Bren Sparling, RN - ICU nurse
Sandra Hawkins, RN - ICU nurse
Jennifer Ditto, RN - OR nurse
Diane Yorke, RN, PhD - clinical education leader
Tiffany Mabe, RRT - respiratory therapist
Guadalupe Haynes, RRT - respiratory therapist
Ruben Bocanegra - cardiac surgery physician assistant
Bill Nicotra - cardiopulmonary perfusionist
Helen Snow, MBA - patient and donor delations

CNMC Team
Craig Sable, MD - team leader and cardiologist
Lowell Frank, MD - cardiology fellow
Laura Olivieri, MD - cardiology fellow
Justine Nalubega, RN - cardiology nurse
Ozzie Rivera - biomedical engineer
Lynda Dattilio, RN - ICU nurse
Christa Cato, RN - ICU nurse

UF-J
Stephanie Lacey, MD - team leader and cardiologist
Eugene Freid, MD - cardiac anesthesiology

Also
Cathy Partyka, MD - neonatologist

Alisha: 3 months post-op

2008-01-30T10:14:00.003-05:00

The kids: 1 month post-op

2008-01-19T11:02:00.003-05:00

Pictures from the trip

2007-11-26T11:24:00.002-05:00

http://picasaweb.google.com/kzzzzz40/UgandaHeartInstituteOct2007?authkey=qc-mSgmzoy4

A letter from Edward's grandmother

2007-11-05T10:24:00.002-05:00

Dear Edwards friend,

Thanks be to God for the wounders God did to my grand son Edward Kasajja through the wounderful operation at MULAGO HOSPITAL UGANDA. PRIASE GOD.

Edward is doing very well and on thruday went back for review and Dr Lwabi said the boy is doing well and he will be fine.

Let me hope u are fine and pass my message to all members who contributed towards our Uganda children and i pray that God bless u.

Let me hope to hear from u soon. The phote i have sent u that was after 10days of heart operation. and i hope it will make u happy.

God bless u.

Thanks

Kamanyire margaret Edwards grandson.

Ahsante Sana

2007-10-30T16:36:00.000-04:00

Its been 48 hours since landing in RDU from Africa, but the experiences are as vivid as ever. One thing is for sure: this trip exceeded my expectations in every way! From the moment we walked into the Mulago Hospital intensive care unit until we departed the beautiful city of Nairobi, we were surrounded by colorful, friendly people. Each one of them touched us in different ways but all were eager to make us feel welcomed as honored guests in their countries. The dignity and warmth of the African people were an inspiration to all of us.

To all of them, I say "Ahsante sana" for all you gave us and we learned from you.

This medical mission was made possible through the generosity of many and I'd like to thank the following sponsors of our UNC Team:

The Family of Dr. Amal Murarka
UNC Hospitals
Health Volunteers Overseas
Samaritan's Purse
GE Healthcare

We are very grateful for their support and commitment to our mission. We literally could not have been successful without their help all along the way--both before, during and after the trip. They were our partners as well as our supporters.

Finally, on behalf of the entire UNC Medical Team, I'd like to thank Dr. Keith Kocis for his enormous leadership, encouragement and unfailing good humor throughout the trip. To say that we were met with many challenges is an understatement; but Dr. Kocis always kept the faith and inspired us to solve the problems. He led by example, staying up later and sacrificing his own comforts for the sake of the children and our team. It was a privilege to work with him. Thank you, Dr. K, for being there for all of us!

Afrique, natumaini tutaonana tena--

Helen Snow

The Ugandan children, on their way home

2007-10-30T09:01:00.002-04:00

Our safe arrival home

2007-10-29T13:48:00.002-04:00

We left Kampala and began our journey home traveling through Nairobi, Kenya. Helen Snow and Debbie Sams spent three days at UNC's Carolina for Kibera Program, an amazing experience (see Helen's Blog below). We traveled from there to Amsterdam through Detroit and finally home to RDU. We were all exhausted but glad to be home once again reunited with our families and our children. I thank my two children, Kyra and Connor for letting me leave them for two weeks to travel far away across an ocean and several continents to help other children with greater needs and far fewer opportunities. At ages 9 and (almost) 8, I am pleasantly surprised that they understand....Of course, I rewarded them with artifacts from Africa and they were thrilled.

Overall, we had 3 people with brief GI illnesses (fever, chills and sweats) and one lost bag on the return home. We hope it will be found. We will continue to take our Malarone to prevent malaria, since we did get bitten a bit in Kampala. We have had so many conversations on the return trip and even today at work at what an amazing experience this has been for us all. We worked so hard, for many months planning this trip, but no planning could account for all that we had to face and overcome. We all adapted quickly and gracefully to make this medical mission a success.

I am so proud and honored to have lead the UNC team over the past 2 weeks. This was an amazing group of people who came together and gave so much of their time, expertise, but most importantly, their hearts, for the success of this mission...I remind myself that this is not a characteristic of a few individuals, but of our wonderful institution. Core values of all we work with who have been encouraging us and following our mission through the blog. Unfortunately, so many individuals had volunteered and yet we could not take them all with us on this mission.

These are values we live with each day in caring for the children of North Carolina. I am so happy to be home again in Chapel Hill.

The updated PICU (est. 2005)

2007-10-29T13:38:00.003-04:00

We were saddened by the fact that the PICU that we established two years ago in Amal's name, could not be used for this trip due to it's remote location from the main hospital and operating theatre. We did find time to up the hill to visit our dear friends, Matron Jollie and Dr. Justus,

Since we left, Great Ormond Street Children's Hospital in the UK donated several PICU beds. Two ECG machines were there and two non invasive ventilation (BiPaP) machines were available. Unfortunately, they were not trained on its use.

Matron Jollie's son painted the entire PICU with wonderful murals, it really cheered up the place. All of the equipment we previously brought was functional and in use. We were happy to resupply the unit to some degree. They have managed 67 kids there, but expanded use is limited due to staffing (both nursing and physician). We will not forget our dear friends or our work in the PICU on future trips.

Farewell reception: the American translation

2007-10-29T11:11:00.005-04:00

The farewell reception

2007-10-29T10:01:00.004-04:00

WOW, what an amazing evening at the Serena Hotel. We all got dressed up (Katherine wearing her Makerere University scarf) and went to the lavish downtown Kampala Hotel. There we met probably 100 individuals including the Ugandan team (all the RNs, perfusionists, physicians, administrators, etc) along with representatives from the Ministry of Health (and probably others).

We were treated to a FABULOUS African Dance troupe. They dressed, danced, and sang a whole series of native African pieces. We all joined in and added a little American "translation" to the dancing. Rain came and we ran inside to the more formal introductions and speeches. We had our group picture taken and then retired home (a little late in the evening). What a fun and exciting conclusion to our trip!

UNC's last operative day

2007-10-29T09:53:00.001-04:00

Today was the last day of patient care for the UNC team. Dr. Dabal and Dr. Tom operated on a child with an atrial septal defect. They remained focused even though the Hospital, OR, and Cardiac ICU were spinning with the arrival and tour of President Museveni. The child did well and was extubated within several hours of arriving in the CICU. The DC Children's Team will continue care until they depart home on Friday. The Ugandan surgeons will operate on the 10th child tomorrow (Wednesday), a child with a PDA (non bypass case). Dr Dabal finished his case, said goodbye to all, and dashed off to the airport for his return trip home....The UNC team will pack and say good bye to everyone tomorrow.....We were just made aware of a good bye reception for the team tonight from the Ugandan team......How generous and kind...

Carolina for Kibera

2007-10-24T10:22:00.000-04:00

October 23, 2007

Today we were met by Salim Mohamed, Executive Director of Carolina for Kibera and taken to the CFK Office in the Kibera slum on the outskirts of the centre city of Nairobi. The CFK Office is painted a cheerful Carolina blue and a guard is posted at the gate into the office area. But everyone we met was warm and welcoming. We met the CFK program directors and then set off with Salim and Hillary Omala, the Director of the Tabitha Health Clinics.

As Salim and Hillary led us through the narrow passages of clay, we ducked under many metal roofs which overhung the paths. Homes constructed from clay and straw lined the path and we were told that these fragile structures had to be rebuilt after any hard rain.

The first stop was the new Tabitha Clinic which is under construction in the heart of Kibera and where the two clinics will be consolidated once it is completed in early 2008. The foundation is complete and the framing should start soon. We've posted some photos of the construction. Many workers were carrying bags of cement or wheelbarrows full of gravel through the labyrinth of passageways--not an easy access.

Then it was on to visit the first Tabitha Clinic which was founded by the late Tabitha Atieno Festo, a widowed registered nurse from Kibera, with the $26 initial investment made by Rye Barcott from CFK. We met each of the medical team--Mark, Lucy, Julia, Angela and James-- who were busy debriefing about the 120 patients they had seen the previous day. We also met Fred (one of two pharmacists) who presides over the pharmacy.

Next it was off to the Tabitha 2 Clinic which is newer and located across the railroad tracks in the upper area of Kibera. The two clinics are very active and accessible but need more resources. When they are consolidated into the new clinic building, there will still be alot of new equipment needed to meet the communities' needs. It is our hope that we at UNC can help CFK find sources for contributed equipment.

Next we met with Caroline Sakwa, CFK Deputy Director, who directs the Binti Pamoja Center for young women. She describes it as a "safe place" program that seeks to empower and teach self-development skills to the women who have so little opportunity in the slum. Through training and education on subjects such as reproductive health, literacy, HIV, teen pregnancy and sexual abuse, the program trains a cadre of 80 young women in the various villages of Kibera about ways to protect themselves and insure their future. The program employs mentoring, photography, and drama as tools to deal with some tough subjects. Caroline said that UNC could help her program by providing mentoring program prototypes for her to use as models. We will ask the UNC Women's Center to set up regular contact with Caroline and act as a resource for her program.

Next we spent time with Cantar Abdul Hussen who directs the Soccer Program that now comprises 210 teams from all of the 12 villages. This was the first program undertaken by CFK and it has grown to over 4,000 participants. Besides the games and tournaments, the teams participate in community awareness events such as "Kicking AIDS Out" and the Clean-up Days organized in each village in Kibera. Cantar hopes that the program teaches the discipline and focus that each participant will need to lead a successful life. Among the needs of this flagship CFK program are: scholarships to reward winning teams; uniforms, socks & shoes; balls & equipment. In addition, Cantar says that UNC could provide "visiting coaches" from our own teams to mentor and inspire the players, especially the women's teams.

Medina Abakar, directs the Trash is Cash program and is a specialist in waste management. She leads 6 groups of 180 people (90% males) who work in waste management and recycling in all the Kibera villages. This is a sustainable enterprise to put people to work and meet a huge community need. Medina's motto is "Waste isn't Waste until its Wasted." The business has grown so big and fast that hauling off the collected trash has become the challenge. She hopes that they will be able to have a lorry or truck provided in the near future, and eventually be able to employ residents of Kibera in a community waste/recycling processing facility.

Directing the HIV-AIDS Prevention Program for CFK is Mary Waithera who grew up in Kibera (as did Medina). Mary works hard to do community education forums and get info into the homes about ways to prevent HIV infection. Like several of the directors, Mary is a "hometown girl" who is effective because she works with her friends and neighbors who trust her.

What struck us as we met with each of these CFK leaders was how dedicated, strategic, and caring each of them are in pursuit of their program goals. They each spoke with one voice and a strong unity of purpose. They were all careful to build a solid, sustainable plan for their respective program objectives, always being mindful that the communities of Kibera are the primary stakeholders.

The CFK organization is a model for many NGO's hoping to have sustained impact. We were touched by their commitment and humbled by their ability to leverage so much action with so few resources. We hope that everyone will investigate further how they can help these inspiring young adults achieve what few others have done.

http://cfk.unc.edu/support.php

Helen Snow and Deborah Sams

Ugandan President Museveni visits the Pediatric Cardiac Program

2007-10-23T08:35:00.001-04:00

We were all suprised to have His Excellence Museveni come and spend about an hour visiting our successful program at Mulago Hospital. He arrived with the Minister of Health and a larger entourage and went to the board room for a meeting with senior leadership at the Hospital, Medical School, Board of the Uganda Heart Institute, and the US Medical Team (Lead by Dr Craig Sable, with Dr Stephanie Lacey and myself reprenting each of the 3 institutions). But the most prominent individuals were Edward, our first bypass patient (S/P ASD), and his grandmother who cares for him. Edward was sporting his UNC tee shirt under his dress outfit and the President had a chance to see his sternal scar and the UNC shirt (see pictures below). The President went to the pediatric cardiac ICU and meet all of the US and Ugandan Nurses, RT's, and staff. He then went to "theatre" (OR) to see the last surgery (number 9) in progress. He then left the Hospital.

The night owls: nursing collaboration at its BEST!

2007-10-23T04:54:00.001-04:00

All of the nurses have been sharing the overnight (12 hr) shifts. This morning I wanted to share a pictures of the UNC, DC Children's, and Ugandan Nurses working side by side in caring for the fresh post op patients.

Durham children learning about Uganda

2007-10-21T12:32:00.002-04:00

NOTE: I received this letter on Friday from Esther Hahm....7th Grade Humanities Teacher (Duke School For Children) and with her permission I am sharing this with the group.
We are SO HAPPY that school children from North Carolina are intrigued and following our mission. We will create a presentation for these children when we return....

Dear Dr. Kocis,

Hello! I hope this message finds you well and in good spirits. I recently read an article in the UNC-CH Tar Heel Daily about your medical group's trip to Uganda. Your work inspired and intriguied me, and I was wondering, if there is any way, if a member of your group could share what you all did in Uganda with my students here at the Duke School for Children.

Our seventh graders are currently studying a unit on Africa, and one class is devoted to studying contemporary health issues that affect specific tribal groups in Sub-Saharan Africa. Right now they are reading articles and analyzing data, but I can sense that they are finding it difficult to grasp how people are affected day-to-day and to realize that people are suffering right now.

Ideally, a presentation at our school would reach the most number of our students, but if your group is already planning to present in a venue that is appropriate for our students to attend, we would love to encourage our students to be there. In any case, thank you for leading us to become a more compassionate and global-thinking community.

Esther Hahm
Seventh Grade Humanities Teacher
Duke School for Children
3716 Old Erwin Road
Durham, NC 27705

New pictures posted

2007-10-21T12:15:00.001-04:00

Sorry for the delay in uploading pictures to the blogs the team has been writing the last few days....Please, if you have read the blog, go back and see some new pictures.

And on the seventh day...

2007-10-21T10:47:00.001-04:00

Last night the UNC medical team was able to get coverage in the ICU, and gather altogether for dinner for the first time since we arrived. It was a beautiful, starlit evening and we dined alfresco at the Emin Pasha Hotel. Though everyone was tired, spirits were high and we all toasted Pablo Durana, our team photographer, who was leaving today (Sunday)to go back to the States briefly before returning to Benin to finish his assignment with the Discovery Channel. Pablo has been a beloved part of our team as well as with the patients, their families and everyone at the Mulago Hospital. Stay tuned for the film...

It was great to celebrate together the achievements of 1 week and hard to believe that our trip would be wrapping up in the days ahead.

But what better way to end this incredible week than to attend church with Pastor Appollo of the Walls of Salvation Church in the outskirts of Kampala. The Pastor had been in touch with Dr. Kocis for over a year and arranged to meet us to take us to his church by van this morning. The roads--mainly clay--were muddy with many deep potholes and puddles from the storm last night. The fumes from the exhaust of thousands of cars and scooters in a "jam" were overwhelming. Thankfully, we finally reached the destination and were led into the service which was already vigorously underway.

The Sunday service lasts from 10am-1pm with revolving preachers and singing groups.
It reminded me of an evangelical tent revival except it was held in much humbler environs. As honored guests, we sat at "the front" behind the preacher with all eyes on us through the whole service. One little 3-yr old girl wandered over and just sat down beside me and took my hand. We felt the warmth and welcome of the entire congregation of approximately 45 colorfully-dressed men, women and children.

The music was performed by various performing groups of children or young adults accompanied by an electric organ complete with sound effects. In fact everytime that the preacher shouted "halleluia!" the whole congregation said "amen" and clapped with the electronic "tinny" applause machine. After two other preachers completed their orations, Preacher Appollo welcomed us and then asked Dr. Kocis to speak to the congregation. Keith was eloquent and sent a heartfelt message to them about our hope to help them with their new church faciities.

Of course, this was met with much applause from both the parishioners as well as the applause machine! Then Appollo asked me to speak and I found myself speaking with tears in my eyes as I gazed at this roomful of people with such expectant looks of hope on their faces that our visit might somehow make their dreams for their new church come true.It was humbling and touching as each person pressed to shake our hand as we left I was so glad that we had made the trip to this cheerful church where you felt religion more deeply than in the grandest cathedral. Somehow Dr. Kocis and I hope to help this church after we return home,and so far when we have put it out there, dear friends, family, and colleagues have responded.

Tomorrow, Debbie and I leave Kampala for Nairobi, Kenya, but the memories of this place are imprinted on our minds and hearts.

Helen Snow

Wish you were here...

2007-10-21T10:31:00.002-04:00

Since we arrived here at Mulago the UNC team has been pulling all sorts of crazy shifts, morning shifts followed by a short break in the afternoon and back to work for the night shift, it is rather in the trenches, but the laughter is flowing, and singing is often heard from Nurses, patients and physiotherapists... We have special CPT songs where we do chest percussion on the children in time to singing local tunes. The friendships developing between the Mulago and UNC Nurses are some of the most devoted I have ever known and the mutual appreciation is as prevalent as the intense learning taking place. In not even a week we are seeing some wonderful ICU nurses become more confident and proficient. I am so very proud to witness such a transformation and to hope that we may be able to come back to build on this program.

The children are stoic, and proud but we are watching them gain trust in us and even the most serious are beginning to smile. Until they become like Edward our second patient who laughs with us and sings, borrowing every ones camera to take photos, which are actually very good. One of the things I love about Edward is that even though he is now out on the ward, he will visit the ICU patients, hold their hands and give them words of encouragement, he is a very kind and generous little boy.

Alicia is a 3 yr old that I have been helping to care for today, she is the cutest little girl, with a charming smile and brave personality, she gave her permission to Karla our Nurse practitioner today to go ahead and pull out her chest tube, with barely a cry.

I feel very humbled by the achievements I have been so fortunate to witness and the love and dedication from staff and patients warms everyone that has has the privilege to be here.

Katherine Desrochers, RN, PICU

Beautiful country, beautiful children

2007-10-21T06:53:00.003-04:00

After arriving several days later than the rest of the group, I was amazed to discover the progress the team had made. They converted an empty room on the 1st floor of Mulago Hospital into a fully functioning Pediatric Cardiac Intensive Care Unit. Full monitoring capabilities are in place and the patients are recovering exceptionally well after surgery. There have, of course, been occasional equipment failures, power surges, and drug shortages, but by and large the children are receiving wonderful care from the Mulago staff and our team working side by side. The Mulago nurses are learning so much from our UNC nurses. The Ugandan surgeons, anesthesiologists, and cardiologists are also gaining an incredible amount of knowledge regarding pediatric cardiac surgery and intensive care.

The children have an amazing spirit and wonderful families, all of which makes their recovery even quicker after surgery. Our first patient, Rehema, has already been discharged home and Edward and Sharon are nearly ready. Our ICU is still full with 4 patients, but Recheal, Jonathan, Alicia, and Emmanuel are all doing so well. The country of Uganda has so much natural beauty. We flew into Entebbe over Lake Victoria, the source of the Nile River.

We arrived in Kampala to find a bustling capital city of over 2 million people. Being in the midst of the rainy season, we have seen rain and thunderstorms each night, while sunshine during the day keeps everything green and lush. No need to set your alarm clock, as the roosters and monkeys just outside the window will wake you with the sunrise. Mulago Hospital and the Makerere University and Medical School are tucked into the gorgeous tree-lined hillsides of Kampala. It is a comforting feeling to know that the children we're taking care of will get to enjoy the beauty of this country for many years to come.

Brian Olsen, MD, UNC PICU Fellow

Ruben's view

2007-10-21T03:51:00.000-04:00

We have gone through the first week without any problems. All our patients are doing very well. The PICU is full and all the equipment is working well. I am very thankfull to be part of this first stage in their building heart program. The surgeons are very motivated and ready to embark in this new program.

A word from Bill Nicotra

2007-10-20T08:18:00.002-04:00

It's Saturday afternoon here and we just finished our 5th bypass case this week. What a great experience! The people are so friendly and very gracious that we are here. I have been training a perfusionist on staff here in Uganda. His name is Sam and he already had some perfusion training from India and Japan. He pumped his first case ever Friday. He is coming along very well. This trip makes you really appreciate all the little things that we, back home, take for granted. I really feel grateful that I had the chance to help out over here. I highly recommend it !!!

Bill Nicotra, perfusionist

Front-page news!

2007-10-19T16:32:00.003-04:00

Today, our medical mission's story was front page news and photo in Kampala's newspaper, The Daily Monitor.They reported that we successfully accomplished the first open heart surgery since the 1970's. The center of attention was Edward Kasaija--a small boy with a big heart defect--who walked down the corridor of the hospital today with a big smile and a video game in hand--less than 48 hours after surgery on Wednesday. He thanked us all, but his big grin was thanks enough. His grandmother, who is his caregiver since his own mother died, jumped for joy in the hall in a display of gratitude that gave hope to all the other parents waiting in the screening and waiting area. (For those of you who want the whole story, query the Kampala Daily Monitor, "Mulago performs open heart surgery"). This was a big start to what turned out to be a life-changing day.

Two additional surgeries were performed today and filled the new cardiology ICU to capacity with recovering pediatric patients. As I witnessed my first open heart surgery, I was awed by the "engineering" of the human body and its essential Heart. And I was again overwhelmed by the human factor that makes the newest technology "magical." Everyone (and there were probably 20 people in the Operating Room today) showed the highest respect for Jonathan, our 5 yr old patient, and for each other. Again, the process was seamless among colleagues of varying cultures.

After the surgery, three of us "laymen" shed our scrubs and headed out of town to an orphange for children with AIDS. The joy and spirit that these children displayed to each of us filled our hearts and made us appreciate further the enormous resilience of the human spirit. Many of these toddlers live in pain, but you would never know it. They clapped their hands and sang and smiled as their teachers/caretakers led them with drumming of familiar songs. If was hard to leave these brave little spirits who touched us so much. But we were able to leave them with a large bundle of beautiful clothes contributed by my friends and colleagues back in the states. I wish each of you could have been here to experience the gratitude.

Its hard to imagine what tomorrow will hold here in this week of miracles.

Helen Snow
by Uganda Medical Mission

Oh, the humanity of it all....

2007-10-19T14:50:00.002-04:00

Since landing in Uganda last Sunday night, we have all lost a sense of time. Besides time zone travel, our schedules have been erratic every day. Some days we get some sleep and some days we don't. But each day has been so exciting that we press forward with enthusiasm.

The UNC Medical Team led by Dr. Keith Kocis has been an inspiration to everyone. I have never been so proud to be a tarheel! From the moment we arrived, this incredibly dedicated group of medical professionals has done whatever it takes to get the job done. Many went without sleep for days but always worked with smiles on their faces for the patients and their families. Not only have they worked long hours each day, but they have generously and patiently mentored and instructed their counterparts in the heart center in the use of new equipment and procedures.

Our team is joined by a medical team from DC Children's Medical Center led by Dr. Craig Sable.
and our lead surgeon from the University of Florida at Jacksonville--Dr. Bob Dabal (a UNC alum '91). These 20+ doctors, nurses and medical specialists are all volunteers but you would never know it from the devotion and hours that they keep.

Each day there are three staging areas covered by our collaborative team and the Ugandan team:

At one end of the hall our team is meeting with patients and their families to screen children to diagnose their heart condition and determine who are current and future candidates for heart surgery or other treatments; simultaneously,
A combined group of UNC, DC, FLA and Ugandan doctors, nurses and medical professionals are conducting heart surgeries, usually 2 per day; while
The UNC, DC and Ugandan doctors and nurses and med specialists are covering the intensive care unit, caring for the recent surgery patients (age 26 mos.-15 yrs so far) and readying for the next patient as they come out of surgery. They literally constructed an ICU on Monday to be ready for the Tuesday surgery.

I guess what has struck me as an observer is the enormous team work that is evident. We all talk of teamwork as a concept to be embraced, but until you see a group of professionals who have never worked together, have many cultural differences, not to mention different resources, accomodate all of this with a singularity of purpose-- to save a small child's life-- can "teamwork" be seen in technicolor!

I have to say at times that it has been intense--there's a lot on the line. But there has also been some comic relief in the sometimes absurd circumstances in which the collective spirit prevails.
Moved by the good wishes and generosity of so many before I left for Africa, I remarked that the phrase "it takes a village had taken on new meaning to me." Little did I know what an understatement that was. To say I am humbled by all the colleagues who have surrounded me on this mission from the US and Uganda does not begin to describe the enormous respect I have for everyone involved. For every hour I witness people acting with purpose and effort that is so inspiring that you just have to keep asking what more can I do.

I've gone on too long but will continue with my "headline news" in the next blog report. Stay tuned and keep those prayers for our patients flowing our way.

Helen Snow

How many days?

2007-10-19T04:41:00.000-04:00

Well, we are all doing well. It is now day 5 into this trip with surgery starting this past Tuesday. We can't seem to keep up with what day it is, but each has definitely been filled with plenty of work. The cases are not always straight forward postop, but we have worked hard to get these children through. The nursing staff are like sponges, all crowding around you when something is being done no matter how big or small it may seem to us. They are a sharp group of nurses with various levels--Sister Grace is the head nurse of the area, Sister Medina is similar to a charge nurse ( if I have gotten it right!) and then a sundry of other level nurses and finally interns who are recent nursing school graduates who are spending the next year going to all areas of the hospital to learn the work. We have managed to teach them about HP monitors , IV pumps, syringe pumps, blood gas machine use, ventilators including suctioning and retaping ettubes, arterial lines and drawing labs from them, and just the basic head-to-toe assessments with correlation to what they are putting down on the flowsheet. It is amazing how much they have absorbed in such a short period of time. One of the girls is a strict, but comedic nurse who told Katherine she must have missed the class on how to write well--you know, penmanship class. I have given her the name Teacher at which she smiles and gives a little laugh. Needless to say we are having a very rewarding experience with 5 more days to come!

Karla Brown, PNP

The experience so far

2007-10-19T03:35:00.001-04:00

Words can't explain the experience I'm having here in Mulago Hospital. I'm finally setting in and learning the routine here. It has been such a great honor to help the intubated patients and to get them a step closer to recovery. A few have been a little challenging but I'm so grateful that the challenge was only a temporary issue. As a respiratory therapist, I had to learn how to run a new ventilator and discover new ways to adapt to the hospital's environment. For me, I know I have taken for granted the resources that we have in the U.S. This experience has truly humbled me and the nurses and doctors here in Mulago Hospital have taught me to be grateful for what I have available to me. The nurses are so eager to learn. There are no respiratory therapist here, so the nurses will have to learn the role of a respiratory therapist as well. I have met such wonderful and kind people that they constantly overwhelm me with such peace and joy. My days here are long (12-13 hours) everyday and yes by the end of the day I'm exhausted. However, when I walk in the next morning and a patient remembers my name, grabs my hand, and smiles, it reminds me of why I'm here.

Lupe Haynes RRT RCP

The cardiac ICU

2007-10-19T00:21:00.003-04:00

The team has created a highly functioning pediatric cardiac ICU. The four bed unit is now fully monitored (one monitor was needed for Theatre, so we pulled in one that was shipped from UNC via Samaritan's Purse. Electrical connections are problematic...different plugs (2 prong, 3 prong, BIG prong), voltage (120 vs 220), Hz (50 vs 60) and power surges. Jim Morris (Samaritan's Purse) fortunately sent about 10 transformers...we needed them all.....then we need power extensions and power strips to fit the equipment into...it's a series of connections...definitely NOT UL listed....but it works.

We need to be careful in the morning, when the cleaning staff come in with buckets of water and dump buckets of water and soap on the floor to scrub.....CLEAN FLOORS! 2 Ventilators were purchased by Uganda Heart Institute for the mission. They are simple....too simple for patients that require weaning (CPAP mode only)....but SIMV is working well. Our 5 ventilators are on standby and being made operational for use on more complex patients, the PICU and NICU. The IV pumps are working well though we have lost several for no apparent reason. All the patients are coming back with arterial lines ( a first for the Staff). Differences between the couplers for cabling and the transducers has an issue, but we have a workaround for that too. We have central suction.....except when it doesn't work..clogged filters or outage...We have portable suction on standby....ALL is functioning well for the patients though.

One final problem (which we haven't found a solution for) is that the beds don't have side rails....but fortunately the Ugandan children sleep still in the middle of the bed..... As we cross from the main hallway into the ICU (and then the hallway to the Theatre)....there is the DMZ..... two yellow lines with about 5 feet between them. One one side are the street shoes...you remove your shoes there and walk across the DMZ.... On the other side are a variety of boots (fashionable white ones) and flip flops (see Jen's matching toe nail polish in the above picture) or sandals. Everyone shares and then you can walk in... I'm planning on wearing socks each day...

The operating theatre

2007-10-18T13:02:00.002-04:00

Hi Everyone,

Internet has been out all night, but here we go to catch up with our activities...

We have completed 3 days of surgery, operating on 4 children, 2 requiring cardiopulmonary bypass. All the kids are doing well, having had excellent repairs from Dr Dabal. The OR has been transformed. The equipment has been working......but with some quirks that the team has had to learn about and develop work arounds for. Home made cardioplegia, OR monitors suddenly failing, anesthesia ventilators that stop working, etc etc. Power surges and outage are frequent. Dr Duane Stillions has been fabulous in training the Ugandan Anesthesiologists. Arterial lines are now being used. Significant changes in anesthetic approaches, etc. Bill Nicotra and Jerry Mikesell have been training the Ugandan Perfusionist and that has gone extremely well. Tracey Clapp has gotten the OR nursing modernized and running (more) efficiently. We will try for 2 bypass cases tomorrow.