ONP Addresses Urgent Problems (On-the-Ground Update from Josh)

Women at health center with ONP health education posters.

Women at health center with ONP health education posters.

As you know, PHP recently launched the Omukazi Namarara Program, thanks to the generous support from all of you. I’m pleased to be able to report that the program is continuing to go very well. The people in Kashongi and Kitura, our partner communities, have fully endorsed the new services, and we’re laying a strong foundation for the future as we aim to improve maternal and neonatal health.

Despite the progress, we’re still far from solving all of the maternal and neonatal health issues in Kashongi and Kitura. In this message, I’d like to share a story with you which I feel provides a good illustration of the enormous problems we’re up against. I think that those of us who are interested in eliminating maternal and neonatal health disparities can learn much from this story. The story follows.

One day a woman, who I will call Jessica (who has given me permission to tell her story), arrived at the government health center in Kashongi to give birth. She was 17 years old and had been working as a maid for a wealthy family in the community. This was her first pregnancy, and she had just had her first antenatal visit about one week ago. She was one month premature, and her membranes had ruptured before labor. The midwife instructed her to go to the Mbarara Regional Referral Hospital, located about 45 minutes away by car, because she could not handle the case.

The man who had impregnated Jessica had left her. She was completely alone at the health center. Her family lived about 30 minutes away by car, and she had no way of communicating with them. With the little money she had, she paid a motorcycle driver to visit the family she had been working for and ask for help. The family told the motorcycle driver that they were completely finished with Jessica and had no interest being involved in her life.

Jessica stayed behind the health center, in pain, at times laying in the grass and at times standing with her arms folded — scared, ashamed, and lonely. My colleague and I had a car, so we decided to take her to Mbarara. On the way, we picked up her mom. When my colleague went to the family’s home, her mom hesitated, complaining that she had just been in Mbarara with her own sick baby, and now she did not have a single shilling. My colleague assured her that we would handle the costs, and she then came quickly.

As one reaches Mbarara, the first thing he or she will see is Lakeview, a huge luxury hotel. Most people from “the village” — that is, the rural areas — never come to Mbarara. I could only imagine what Jessica and her mother were thinking as we drove into the city. I always knew a significant disparity existed, but this occasion put it into stark relief for me.

When we reached the hospital, we brought Jessica to the admitting doctor on the obstetrics ward. “Do you have a plastic sheet?” were the first words out of his mouth, referring to one of the many supplies women themselves were expected to bring for their deliveries. He then told us that there were no beds left in the antenatal room, so Jessica would need to sleep on the floor and would therefore need a mattress. As Jessica and her mom got “settled”, my colleague and I left to buy a mattress and sheets.

When we returned, her mom was holding a sample of blood that had been drawn from Jessica. They were waiting for us so they could figure out what to do with it. We spoke to the doctor, and he said that a complete blood count and a blood smear to test for malaria were needed. The hospital did not do those tests, we learned, so we would need to take the sample to a private lab. I asked whether the doctor could use the Poor Patients Fund, which I knew was available at the hospital, to cover the cost. He responded that the Poor Patients Fund was only available on the medical ward and that the obstetrics ward was predicated on “survival of the fittest.”

We first took the sample to a discounted lab affiliated with the hospital that was located on the same grounds. But we were turned down because the lab’s machine was broken. We then drove the sample to a private lab in the middle of town and received the results within about an hour. At this point, if not earlier, a poor person from the village would have been utterly lost. Mbarara was like a foreign country to them, with many people speaking English and a completely different way of life. Moreover, the class differences between the health workers and the villagers were striking.

We brought the test results back to the hospital. It appeared that Jessica had a bacterial infection, but a doctor would not be available to interpret the results until the next day. When I visited Jessica the next morning, she still had not given birth. The ordeal had now been going on for over 30 hours. I began to lose hope. I asked a nurse to please make sure she was taken care of, and I left for work. I returned in the evening; miraculously, I found Jessica and her newborn baby. They were doing well, all considered.

In addition to showing the paucity of basic public health services in Uganda, Jessica’s story shows what it is like to navigate the healthcare system as a poor patient. With all of the obstacles poor people have to confront, virtually every element of the system is stacked against them. These are the kinds of problems that PHP is working to address.

Jessica was extremely fortunate, but other women are not as lucky. There is no reason why, in the 21st century, so many women should continue to die from childbirth-related causes and so many children should have to grow up without mothers, all because of simple, solvable problems. PHP is exerting all of its power to implement solutions to these problems — because accessing decent healthcare should not be the monumental challenge that it currently is for the poor.

As we enter the holiday season, let’s be thankful for everything that we have and make commitments to support the betterment of people’s lives elsewhere. PHP continues to deeply appreciate all of your generous support toward this end.

Mosquito nets at health center installed by PHP.

Mosquito nets at health center installed by PHP.

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Omukazi Namagara Program Begins

Training of Village Health Team.

Training of Village Health Team.

Progressive Health Partnership is happy to announce that the Omukazi Namagara Program (ONP) was officially launched last month in Kashongi and Kitura Sub-Counties in southwestern Uganda. The program consists of three primary components: (1) improved provision of antenatal and postnatal health services at local government health centers, (2) an education campaign on reproductive and child health by community health workers, and (3) home visits to pregnant women and mothers by community health workers.

Before the start of the ONP, PHP decided to nearly double the number of community health workers participating in the program, from 14 to 26. This step has helped to build more capacity within the community and will allow the community health worker team to cover a greater number of women with increased attention. In June, PHP program facilitators carried out a one-week training of the expanded team of community health workers, utilizing many programmatic materials and tools that had been months in the making.

Currently, the health education campaign, which has reached hundreds of men and women throughout the community, is coming to a close. The community health workers are now beginning to focus exclusively on their home visits. Through the home visits, they will not only be advising pregnant women and mothers on their health and the health of their babies, but they will also be collecting and compiling data so that they themselves can analyze the health problems in their villages.

PHP has also taken steps to improve the quality of care at the local health centers. By outfitting the beds at the health centers with mosquito bed nets, purchasing equipment such as complete delivery kits, and ensuring that the health centers have appropriate supplies and medications, PHP hopes to both improve the working environment for the health workers and make the facilities ideal locations where women can give birth. So far, the response from the community has been very positive. Over the coming months, PHP will be working to gauge the effects of the program and to identify areas for improvement.

Thanks to your generous support, we have already been able to take these steps to address maternal and neonatal health in our partner community, and we look forward to building on these achievements as time goes on.

Village Health Team member during training.

Village Health Team member during training.

Health education talk.

Health education talk.

Health education talk.

Health education talk.

Women during health education talk.

Women during health education talk.

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Introducing: The Omukazi Namagara Program!

Progressive Health Partnership’s Safe Motherhood Initiative now has a new name: the Omukazi Namagara Program. Literally translated from Runyankore (the language spoken in Southwestern Uganda) as “the woman is life”, Omukazi Namagara not only illustrates the key role of a woman in the life of a family, community, and society but also illustrates the woman’s ability to give life by fostering the growth of a baby.

PHP developed the new program title to better capture the purpose and components of the program. In recent months, PHP has created a significant postnatal emphasis within the program, which accompanies the program’s already strong antenatal emphasis. Now the Omukazi Namagara Program will not only focus on taking steps during pregnancy to promote women’s health but will also focus on taking steps after birth to ensure the continued health of the woman as well as the health of her baby.

PHP is also excited to report that it has hired two new Ugandan staff members to work on the program: Angella and Alex. Both Angella and Alex come to the team with computer science backgrounds, making a substantial contribution to the technical capabilities of the program. Angella, the assistant program coordinator, will focus on working with Village Health Team members, getting feedback from community members, and overseeing the electronic medical records system. Alex, the data manager, will work on collecting records and data through the medical records system as well as a survey of pregnant women. Together, Angella and Alex help demonstrate PHP’s commitment to building more capacity within Uganda.

Among other tasks, the Omukazi Namagara team is currently preparing to train Village Health Team members, strengthen the services at the local health center in Kashongi, and implement the electronic medical records system. We are excited for the months ahead!

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Safe Motherhood Initiative to be launched soon

Village Health Team members at a training workshop

As they say in Uganda, Kurika Omwaka — Happy New Year!

As we bring in the New Year, PHP is excited to report that the organization and its partners are gearing up for the launch of the Safe Motherhood Initiative in the coming months! After several months of preparation work, PHP hopes to soon begin implementing the program in its partner communities, Kashongi and Kitura Sub-Counties in southwestern Uganda.

Currently, PHP is putting the final pieces of the project into place. First, we are excited to report that the electronic medical records system we will be establishing at the local government health center has recently been improved substantially; new features will now allow us to set up text messages that will automatically be sent to women at certain points during pregnancy to remind them of upcoming visits to the health center and to provide important educational content. We are excited to put these innovative features to use.

In addition to the medical record system, we are working to build further capacity by expanding and training the program staff in Uganda, strengthening our collaboration with both the local and district governments, and continuing to train members of the local Village Health Team to conduct an education campaign and make follow-up visits to pregnant women in their homes.

We are very much looking forward to the start of the program and will continue to keep you updated on the progress!

Village Health Team members practice recording health data

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Rainwater Harvesting Tanks: One Year Later

Access to safe drinking water has long been one of the most pressing concerns for community members in Kashongi.  To address this serious issue, PHP and MMHF coordinated the installation of rainwater harvesting tanks at 74 public buildings throughout Kashongi in 2010 and 2011.  One year after the construction of the first 37 rainwater harvesting tanks, we returned to the communities to learn about the current state of the tanks and identify areas for improvement.

Committee Follow-Up Visits
DukeEngage participants Genny and Mark conducted follow-up visits with rainwater harvesting tank oversight committees, groups of community members responsible for maintaining and allocating water from each tank.  The purpose of these focus groups and interviews was to evaluate their effectiveness and identify problems associated with any of the committees or tanks.  Along the way, they met several committees that went above and beyond to manage the tanks – a prime example of how sustainable solutions can be made through community involvement.

Rainwater harvesting tank oversight committee members attend a focus group. Photo courtesy of Seth Napier.

Community Focus Groups
Katie and Helen conducted focus group discussions with beneficiaries of several rainwater harvesting tanks, in order to assess the utilization, accessibility, and impact of the tanks.  These focus groups were a valuable opportunity to listen to the community members’ perspectives about the tanks.

A rainwater harvesting tank in Kashongi. Photo courtesy of Carrie Ho.

Community members save their place in line to fetch water from a tank. Photo courtesy of Seth Napier.

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Summer 2011: Maternal Health in Kashongi, Uganda

For the past three years, maternal health has been a primary focus of PHP’s work in Uganda.  The past summer was no different; we spent eight incredibly fruitful weeks working on various projects relating to maternal health, some of which were in preparation for a safe motherhood program which PHP and Mayanja Memorial Hospital Foundation (MMHF) will institute in Kashongi from Fall 2011 through Spring 2012.

Education campaign
DukeEngage participants Adrienne, Max, and Stephanie developed a maternal health education campaign that encompasses education at health centers during antenatal care visits and health outreach activities.  Among other accomplishments, they developed culturally appropriate informational pamphlets and posters, created a manual for Village Health Team (VHT) members to use during home visits and community outreach workshops, and executed a safe motherhood educational workshop for VHT members.

VHT members attend the safe motherhood workshop. Photo courtesy of Seth Napier.

Medical Records System
In order to provide a faster and more efficient form of collecting and storing patient information, DukeEngage participants Carrie and Joan spent the summer implementing an electronic medical records system which harnesses innovative technology and takes advantage of the growing popularity of cellular phones in the region.  When VHT members conduct follow-up visits expectant mothers in the field, they will be able to record information and send forms to a computer at the health centre – all using the FrontlineSMS application on their cell phones.

VHT members practice entering data using their cell phones. Photo courtesy of Joan Nambuba.

Safe Motherhood Survey
After spending several months designing a pre- and post-intervention survey for the safe motherhood program, Duke Master’s of Economics student Katherine traveled to Uganda to finalize the survey and conduct pilot testing with pregnant women at Kashongi Health Centre III.  The survey will collect detailed information about the women such as health education levels, underlying economic characteristics, and antenatal practices in previous pregnancies.

Expectant mothers receiving health education during their antenatal care visits at Kashongi Health Centre III. Photo courtesy of Seth Napier.

Community-Based Asset Mapping
In Kashongi, maternal care is often provided by Traditional Birth Attendants (TBAs).  Duke Service Opportunities in Leadership (SOL) student Anastasia and East Brunswick High School student Lisa therefore spent the summer interviewing TBAs throughout the sub-county in order to gain an understanding of their practices and identify ways in which collaboration between TBAs and PHP could be achieved.

Interpreter Ephrat provides translations to Lisa and Anastasia during a focus group with TBAs. Photo courtesy of Seth Napier.

Child Health Focus Groups
In order to gain understanding of the current state of child health in Kashongi, DukeEngage participants Katie and Helen conducted child health focus group discussions with men, women, and health workers in the community.  Topics discussed included the most prevalent child health conditions, child health knowledge, care-seeking norms, and accessibility of health services for children.  A wealth of information was gathered, which we will use to inform future projects related to child health in Kashongi.

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