Working

I've had some time (traveled to Kampala), electricity (none when I returned to Mbarara), and internet (none in the village) issues so no posting last week. I’m circling back to describe what I’m actually doing here in Uganda (besides going to game parks)! My assigned task was to evaluate how well the health care system works in preventing maternal and newborn death and to set up systems for health care quality improvement. I’m not doing direct patient care; I’m diagnosing and treating ‘the system’. ‘The system’ includes community health workers, health centers, and a referral center (the referral center has medical officers capable of doing surgery in addition to other staff- By the way, with 3 years of training after high school and 1 year internship they do C-sections and laparotomies among other surgeries and treat newborns, children, adults, and pregnant women and I am humbled by their capabilities). Staffing is low (e.g. 2 midwives to cover 24/7 at some health centers and no other support staff in the middle of the night) and resources are very limited (imagine, e.g., delivering a baby when the gas for the lantern is stocked out and the attendant is holding a candle) but the building blocks of the system are in place. I completed the baseline assessment in about 8 weeks. What looked like a narrow job description has broadened since almost every part of the health care system affects quality of care in maternal and child health. So, I’m working on a number of projects and in the last two weeks have …. met with midwives at 3 of the 6 health centers to organize quality improvement teams (it is an unfamiliar idea for staff at this level to improve quality so it is a SLOW process); organized the medication and supply room at the project office, restarted a bin card system, and talked to the New York office about finding an open source computerized medication inventory system- this is part of a larger project to improve the supply chain of medicines and other supplies to the health centers; met with a health facilitator to design a program to track and follow up HIV+ mothers and their babies; continued analysis on the cause of stillbirths; helped develop a list of indications for ambulance transfer to a hospital for mothers in labor with complications and a format for communication; developed a training on estimating blood loss; and went on more home visits with community health workers and student interns- in other words, a little of anything that might be relevant! The photos are of two of the very hard working midwives, a meeting with community leaders to discuss ways of increasing the number of women who deliver babies at health centers, and two of the student interns dressed for the weather (upper 50’s).