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.

UNC Project Uganda Partners with the GE Foundation

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...

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

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

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

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

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

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.