Mosquito repellent is the new Chanel no. 5

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

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?

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

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.

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

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.

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

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

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

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.