Tuesday, 23 September 2014

Leaving Uganda

Wow, where did those 10 days go?!  Monday and Tuesday have been a whirlwind, visiting DFID and the Commissioner for Nursing and Midwifery at the Ministry of Health then finally facilitating a workshop with the external stakeholders of the midwives' association.  This included representatives from various universities, the Ministry of Health, the Nurses and Midwives Union, the Ugandan Nurses and Midwives Council, The White Ribbon Alliance and various NGOs such as White Ribbon Alliance and AMREF.
The room at UPMA's office where they are going to install their new E-learning centre so Enrolled Midwives can updgrade to Registered Midwives

Workshop was supposed to start at 0930.  This is what it looked like at 1015... African time!

Lovely Andrew, UPMA's Project Administrator, organising all the handouts etc.

Groundrules!

Finally everyone arrived, just in time for coffee!

Disan outlining the background to the workshop

Once we got going it went really well

Group work to assess the capacity of the assocation with the external stakeholders

More group work

Rebecca, Deputy Chair at the Uganda Nurses and Midwives Council, feeding back

Elizabeth, Head of Midwifery at Uganda Christian University, feeding back

I'm flying home tonight and going straight from Heathrow to the office where I'm meeting a delegation of high level health representatives from Malawi, including the President of the Association of Malawian Midwives (AMM).  Jacque Gerrard, the RCM's Director for England will be joining our meeting and we're really excited as we have just submitted a bid for some work in Malawi with the AMM.  After the meeting I'll be travelling to Birmingham by train to attend a two day conference hosted by our donors, THET.  I'm doing a 3 minute presentation at the conference so may have to re-hash our project song! Click here to hear Uganda midwives singing our project song at last year's workshop  I'm looking forward to staying with my friends Helen and Andy Tidy whilst at the conference - Helen and I studied nursing together in 1984 and have stayed in touch ever since.

I'll finally arrive home on Friday evening and am really looking forward to seeing my family and friends and sleeping in my own bed without mosquitoes keeping me awake!  The following 2 weeks are very busy with writing a bid to continue our work in Cambodia, Nepal and Uganda, writing a big report and then flying to Cambodia on 15 October.  I'll go straight onto Nepal and won't be home until 8 November by which time it will be well into winter!

Saturday, 20 September 2014

Saturday... pausing for breath

I have moved out of the hotel to stay with my long-time friends Deborah and Philip Betts and their lovely family who live here in Uganda.  Deborah and I went to school together and our parents were friends long before that, so our ties go way back.  Such friendships are so precious.  Their beautiful house and garden in the suburbs of Kampala is providing a much-needed oasis for me to gather my thoughts, reflecting on the achievements and challenges of the past week and planning my last few days so that when I step on the plane in the early hours of Wednesday morning we will be on track to achieve our objectives here in the last six months of our programme.

Deborah, with husband Philip, chopping home-grown lemons for marmalade over coffee and birthday cake

The Betts' beautiful home in Makindye, Kampala

My 'bloggers' view from the Verandah
Last week continued to involve delicate negotiation, ensuring that I can achieve what is necessary during my short time here without compromising the programme for our volunteers. By nature a capacity building project means that the Ugandan Midwives Association has limited capacity... the imposition of four UK midwives on short-term placements plus the programme manager certainly presents challenges!  However it has been good to share accommodation with everyone until this point so that we could talk and plan together.  I'm sure they're now grateful to have some space without me!

We spent Tuesday at Kiwoko Church of Uganda Hospital (approximately 3 hours' drive from Kampala), meeting some inspiring midwives and midwife teachers and leaving Sue, one of our volunteers, there for a few days to work with the Midwife Training School and the Maternity Unit, to help assess their capacity for learning and teaching in clinical practice for student midwives and newly qualified midwives.  Sue and Patricia will return there next week. The highlight was seeing their nice (by Ugandan standards) labour ward and neonatal intensive care unit, providing high quality care to mothers and babies and training for student midwives.  We also met some beautiful Ugandan women who had recently given birth to twins and triplets normally, a rarity in the UK these days.

ALL PICTURES TAKEN WITH PERMISSION
With medical director and staff at Kiwoko, under the banner 'We treat, Jesus Heals'!

Newly born twins

Mum of triplets, born normally, cup feeding one of her babies

With the midwife teachers at Kiwoko School of Nursing and Midwifery
On Wednesday Professor Ann Thomson, one of our volunteers, was visiting speaker at the Midwives' Association's Research Interest Group, something that has developed during our project.  Eight Ugandan Midwives and two of UPMA's staff gathered to learn about midwifery research and Ann helped them to understand the process involved in conducting a randomised controlled trial, and how to read a research paper.  I joined in some of the meeting and also met with the Global Health Foundation who are providing Solar Suitcases for midwives clinics.  These brilliant cases provide light and power to midwives working in rural areas enabling 24 hour care.  More on solar suitcases . They include a hand-held doppler and a mobile phone charger, so midwives can always phone for help and advice. They have already been installed in 17 of UPMA's clinics.  Our twinning project has given the midwives' association the skills and confidence to develop links with organisations such as these and others.

On Thursday we held a workshop with the Midwives Association to assess their current capacity and determine how they have developed over the past 2 1/2 years since our project began.  Though I helped to plan it and did a presentation, it was mostly facilitated by the President and the Executive Director, who have really grown in confidence to take the lead at events such as these.  We broke into groups and 'enjoyed' a beige (all the food was decidedly colourless!) take-away lunch from a local restaurant.  The workshop was very successful and included prayers and singing.  Uganda is such a great example of religious tolerance: one of the workshop energisers was a rousing chorus of 'Give me oil in my lamp, sing hosanna' led by a Muslim Midwife!  It was an exhausting day but also very encouraging and shows that real progress has been made.  See more on assessing the capacity of midwives' associations

Ugandan midwives learning how to read a research paper

Discussing how the association has developed during the lifetime of the twinning project

Lamla, UPMA's secretary, fully engaged with the workshop and presenting at the plenary feedback.  She is a hidden gem, full of institutional knowledge
Friday was also very busy!  We went out to Mukono, approximately 1 hours' drive from Kampala, to meet Jemima, Elizabeth and Faith, midwife teachers at the Uganda Christian University.  One of our volunteers (Aine Alam from Maidstone and Tunbridge Wells NHS Trust, currently undertaking her PhD) has helped to develop UCU's Masters in Midwifery Curriculum which they hope will be approved in January, ready to teach in May 2015. Aine will return there in December to help develop the clinical assessment tools and support the teachers as they prepare to teach at Masters Level for the first time.  There is only one other midwifery masters programme in Uganda and UPMA hope that many of their midwives will be able to graduate from UCU in due course. We then met with Dr. Jean Chamberlain from Save the Mothers to see how UMPA and STM can collaborate with the 'Mother Friendly Hospitals' initiative, bringing safe and dignified care to mothers in Uganda.  After delicious smoothies in the hospital's cafe, we travelled back to Kampala to meet with AMREF who are installing computers at UPMA's office so that enrolled midwives can study online and upgrade themselves to become registered midwives. It's a really impressive programme and through our project UPMA was enabled to meet AMREF and set the ball in motion. Two UPMA midwives are already enrolled on the project and many more will be starting soon.  The E Learning Centre will be open to other midwives for a small fee, generating income for UPMA.  It can also be used to help midwives search for evidence to support their practice.  We had a great discussion about mentorship and engaged AMREF to work with UPMA in helping the Uganda Nurses and Midwives Council to develop standards for learning and teaching in practice.

Next week I will be meeting with DFID and facilitating another workshop with UPMA's external stakeholders to discuss the way forward.  Look out for the next and final blog from Uganda in a few days!

Monday, 15 September 2014

Fried Blobby Fish and other Ugandan Stories

Here I am in Uganda for my fourth visit in 18 months.  I was feeling particularly anxious prior to my trip as we approach the end of our programme and need to show that we have achieved our objectives and provided value for money.  I have travelled previously with other members of RCM staff or external consultants; this time I have a dauntingly long list of objectives to achieve my myself.  However, I am happily overlapping with four of our UK midwife volunteers, two of whom (Tricia and Sue) flew out with me from Heathrow.  It's great to be staying in the Kolping Hotel together and to have arrived in the middle of the night with other people rather than on my own.

Ebola defences were in evidence at the airport; we were met by a wall of nurses in uniform, wellies, masks and gloves who made us sanitise our hands and checked our temperatures before we passed through immigration.  We also had to complete a long checklist to rule out any suspicious symptoms of disease! Thankfully UPMA's staff members Andrew and Bonny were there to meet us and drive us back to Kampala from Entebbe airport (approx 1.5 hours drive) arriving at 1am.  I am staying in the same room as my previous visit which is a mini suite (of sorts) and very comfortable.

After settling in and reconnecting with Ann and Kate, volunteer midwives who have been here for 1 week already, we went to the UPMA's office this afternoon for a meeting to discuss everyone's workplans and my objectives and ensure that everything dovetailed into our project plan.  This required much skillful cross cultural negotiation and I was quite tired at the end!  Back at the hotel we continued our discussions over dinner - it's lovely all being together but sometimes difficult to switch off!


Meeting at UPMA this afternoon

Having experienced the hotel buffet for lunch (starch, starch and starch) we decided A la carte was the best option for dinner.  Here is the fish menu - I was briefly tempted by the 'English Style Blobby Fish Fillet - look big, delicious but fish certainly' but decided to leave that delicacy for another night.
Yum yum, blobby fish

Kate, Tricia, Ann, Sue - lovely RCM midwife volunteers rehydrating at the end of the day

Tomorrow we are heading for Kiwoko to leave Sue there for the rest of the week and start collecting data towards developing a tool for supporting learning and teaching in midwifery practice.  More stories soon!

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