Training by VTT begins

After a brief inaugural session by Philip and I , the trainees dispersed into two groups of 29(Clinical officers and  Nurses) and 8(lab techs) .The trainers stood out because of the T-shirts that we had worn (designed and procured from Mumbai by our team)The labtechs were taken over by Beth and me ,while Sujata and Mohan trained the lot of 29..Most of the labtechs save one (Cissy)were all those who had participated last year.The day went offvery well.The model of the cervix designed and made by Dr Mohan was the hit of the day.Each participant got to do a hands on on the model made up of stuffed socks cleverly mounted on a wooden frame that could be dismantled.Beth’s never ending supplies of cytobrushes ,Spatulae and cytobrushes used for

Pap smears were very useful.Sujata kept scuttling to and fro with small groups of clinicians and nurses to the cervical cancer screening rooms as and when the aptients arrived.She screened 5 patients in all.I could cover an overview of cancer screening ,anatomy and histology of the cervix and HPV infections.The lab techs were very eager to know about the cells and we had to gently remind them that that would come in later.  Accompanied by purcahse officer Florence from  AIC ,I had to make a qucik dash to Kampala city to check out  microscopes that needed to be urgently purchased.The bargaining was quick and in addition to 2 binocular microscopes  we could also manage to buy 20.Coplin’s jars ,all these had to be in place by tommorow when the hands on training will start in the lab.The day saw a memorable Ugandan lunch and ended with fellowship at the RC of Namugongo.Mohan promoted hugging as his club Culture and did not miss any hugging opportunity much to the amusement of the Ugandan Rotarians.The post meeting fellowship was really a riot.Exotic whole Tilapia fried fish was the main course with fries and salad..All kinds of spirits abounded.We needed to check out of our hotel early tomorrow and hence had to politely excuse ourselves for the night.

 

 

Pre VTT Preparatory phase

Today was a day of intense dialogue between the dedicated organizing team of the RC of B-N and the VTT and the team members themselves. The meeting was held at Hotel Shangrila The dedicated Rotary team of RC of Byowegerere-Namboole with VTT at AIC,Kampala can be seen in the photo.The Rotarians were very involved in taking great care of us and we had a very fruitful discussion on all our roles . Beth and I designed our program schedule topic wise ,as also Mohan and Sujata. Phil was all set with his meticulous M&E module as he explanied to all of us.
We were allotted Rtn Charles as our escort for the day.He had accompanied us along with a driver just to be sure everything was fine .The Rotary moment for us was when we were conversing with the very affable and polite Rtn Charles as he took us around for a brief drive .Talking about families we veered around to asking him about his children. He then mentioned about his8 month old grandson who was undergoing surgery right then for an inguinal swelling . He was anxious about the outcome. Here was Charles doing his duty for Rotary. He said this would keep his mind off the stress and he would also honour his committement .Well we were speechless. Then came the visit to AIC where we interacted with Marion our woman Friday who helped us coordinate with the personnel there and helped us budget our supplies and plan on procurement of reagents and microscopes.We missed PDG Stephen Mwanje throughout and I was wondering what had held him back.A phone call from Rtn Sam gave us the reason.Stephen had taken ill and had to be hospitalised, no wonder i could not get through to him on the phone .Hope all is well, we plan to look him up tommorrow and are going to miss him at the inaugural day proceedings.After all he is the father of RFHDs!!

Back again to sustain and connect

The new combined  VTT team from District 5500 and 3140  are back in Uganda for a new training as per demand on cervical cancer screening. Three of us from Mumbai District 3140, Drs Sujata Dalvi, Mohan Chandavarkar and I were warmly received by President Immaculate and Rtns Fred, Daniel and Sam from the host club (RC of Byowgerere and Namboole)we were transferred to our hotel Shangrila, a branch of the hotel we stayed in last time. The team was separated: Mohan ,Sujata and I were at this new place, about 15 minutes drive from the original Shangrila where we were put up last year. We hope that coordination will not be a challenge. Phil who arrived last night and Beth Cox who will be arriving by midnight are at one place.

We were whisked away to attend the weekly meeting and fellowship of the host club (B-N). A well attended event, we met up with our leader PRID Phil and PDG Stephen Mwanje , the duo who never cease to inspire. They introduced the teams. The most poigant moment was when Phil dedicated this VTT and GG to TRF co-ordinator of our Grant to the young Mary Howard who abruptly left the world, dying of cancer less than a couple of weeks ago..This was the last GG she worked on.

Tomorrow we are all set for the morning session of fellowship and discusion on our POA followed by a visit to AIC. Looking forward to meeting the dymanic duo Dr Raymond and Marion 

The Final Day….

As they say “All good things must come to an end”, but for Rotary and Healthcare in Uganda,this years RFHDs with TRF involved , it is a new beginning !! I write this blog for yesterday as it was day of airports and airplanes and delayed flights ………

Above: The Wonderful Stephen family who hosted me.

After the splendid three days of RFHDs and the gala evening ,the last day in Uganda  saw the three of us from Dist.3140, Sujata, Rima and I  getting all set to depart for Mumbai by the 2.50pm flight.

Above: With host Rtn Angella and husband Nyombi Thembo( Minister of state for Information and Communication Technology)

We said our good byes to our gracious hosts……..The Mwanjes (who hosted me),Angella and Nyombi Tembo(who hosted Rima and Sujata).Dana and Phil had already said their goodbyes to their hosts Joseph and Christine the evening before .The other hosts who made it happen were Dan who hosted Anil and President Godfrey Byewasko who hosted Jack and David.

Mixed emotions  seized me 

Will the efforts we put in translate into a small but definite progress in terms of enhancing skills of healthcare workers and percolation of the same as their shared their knowledge?

A sense of not having spent enough time with our hosts due to our hectic schedules……….

A sense of  satisfaction at having imparted knowledge to those who were looking for it ……….

A deep sense of happiness at having interacted with the Uganda family of Rotary who were very generous in their affection and love ……..and who gave off  themselves most selflessly

A sense of deep gratitude to all those who made it happen………………

Pride in The Rotary Foundation

I would not think this experience complete if not for the wonderful people

PDG Stephen Mwanje, the pioneer of RFHD
Dr Raymond Byaruhanga, the nucleus of the Training of trainers at AIC, Kampala
President Godfrey Byewasko, the host club of GG 26306
Rtn Godfrey Ssebukulo, The RFHD country chair
VTt chair Rtn Florence for her arrangements for the VTT
Rtn Marion, a young Rotarian who would make things happen as if by magic
All our terrific hosts
The VTT members : co-leader Philip Silvers, Drs Jack, Anil, Sujata, Rima, Senior nurse practitioner Dana, Lab manager David. Each of them played their role superbly to create a cohesive team that functioned in tandem to train and educate .The challenge faced by this VTT was that they were from two different continents ,that one half never met with the other half or had preparatory meetings as it would have been with other single district VTTs. So our actual ground preparations began when we met and interacted with each other .Our cultures, education systems reflected two different worlds .We were to function in a third different world …….but all eight of us knew that mankind is our business and that was the glue that bound us together. As with all teams that think and are professionals, our differences and deliberations brought us together and made the whole experience lively and significantly meaningful. Phil with his dogged determination to develop a sustainable model and make the RFHD-TRF association strong, “cool”Jack who was always ready to adapt to any situation ,Anil for his invaluable role in training trainers in SMCs, pleasant Sujata for her contribution to training the HCWs in cancer detection of breast and Cervix and Tubal ligation , the young Rima for being there for training and working in the dental part of RFHDs, dynamic Dana who played a pivotal role in helping out with cervical cancer detection with her group of midwives whom she had literally adopted, David with his flair for interacting with people and helping out at registrations .
The Rotary Foundation for giving me this privilege to lead such an erudite, august team and also giving me this opportunity to use my expertise to train lab technologists in varied areas …………..
Districts 9200,7890,5500,3140 for making it happen

MOH for being a sturdy partner in executing RFHDs

Stephen dropped me off after a fond family farewell at Angella’s home from where we were all driven to the airport in their Range Rover. As we took off from Entebbe and Lake Victoria grew into a dot, I knew that something in me had changed for ever…………….

The third and final day of RFHD: May 11th

Rotary Family Health Days Uganda Day Three, 11 May 2013

Guest Blogger: Dr Philips Silvers

This day finished with a flourish. For our VTT, it was a day of climax and transition. Members from U.S. and Anil from India packed their bags in the a.m. David, Jack, and Anil departed for home; Jack after he worked all day in Kisowera. Phil adn Dana’s host family Nuwabeine were leaving for a 2-week out-of-country holiday, hence they checked back into the Shangri-la in Kampala (shortening their commute by 4 hours a day).

The first stop of the day was the Dental Department of Makerere University where the RFHD, hosted by Kampala North RC was doing free dental and SMCs. The dental services were provided in a room furnished by a TRF 3-H Grant(2007) with 20 dental chairs and accoutrements. All chairs were full, and were staffed by upper-level dental students and Rotary volunteers. On the stairway up, there was a sign offering SCMs pain-free. A second sign, however, delivered our humor for the week.( the pic below).

We laughed all day over this one. The Dentistry Department Head, Rtn Dr Issac was impressive. When he learned that we needed Rotary registration forms for the RFHD clients, he literally sprinted to get the required copies. After this visit, Anil left for his flight home.

National RFHD chair Godfrey Jjooga Ssebukulu was our driver to our next sites. We saw a cramped inner-city site that had about 30 clients in attendance. They were doing HIV testing and counseling, and SMCs performed with three operating tables. Godfrey explained that the site was not optimal but the clients are reluctant to go out of their environment to the closest hospitals.

Above: Indu Performing an on site HIV test.

I was with the solitary lab tech, checking out the registration and algorithm of procedure and actually doing some tests herself. The last two days had seen 40 and 58 tests for HIV detection respectively with 3 being positive .This being the third and final day,around 70 patients were expected, the tech informed us .I was getting more and more impressed by the openness of the Ugandans to get their HIV status tested .Entire families , mothers with their kids coming for HIV T&C had by now become common sights for us at RFHDs .

Our VTT had a great insight into RFHD and club involvement : Uganda RFHD relies on the sponsor clubs to raise funds and devise the best strategy for mobilization of needy clients. Godfrey Ssebukulo expressed that if the club had inadequate fundraising and promotion, it inevitably showed in the attendance. Ideally, an effective club will have creative fundraising(dance competitions, Musical nites etc) andl devise appropriate methodologies for publicity and visibility

Our next halt was at a RFHD site of Rotary club of Makindye at a hospital in Uaco. It was an attractive location, with an impressive turn out of Rotarians. HIV testing, maternal and child health screening,distribution of condoms and mosquito nets with prior counseling sessions were in brisk progress. This site also was recording contact information for client follow-up in three months. I had a quick handing over of my club flag to the club president, who promised to see that I got their club flag !

(Above: VTT with Rotarians at work)

Meanwhile, Jack and Dana were back in Kisowera. Jack and his new partner, ophthalmic clinical officer Rose, did more than 100 eye screenings and prescriptions before Jack needed to leave for his flight home. For her part, here is Dana’s graphic report:

Below is a picture of the wonderful group of midwives whom Dana assisted the day before. They were doing incredibly difficult jobs working by flashlight in a dark room.

The women were examined for cervical lesions as they lay down in lithotomy positions on 3 sets of church pews. Preceding this a breast examination was done for Cancer screening . Examinations were done by flashlight! The detection of possible cervical cancer and/or infections was done by wiping the cervix off with vinegar and waiting to see colour change to greyish white denoting disease. Those were referred to local hospitals; Infections were treated by the Health care workers.

Above: VTT distributing medicines with local Rotarians.

A grand evening get together was organized by the President of the host club of Kiwatule at his ancestral home in the village .Here ,Rtn Marion had got the attractive certificates of completion for the 28 participants in the preceding train-the-trainer week which Phil and I signed . Drs Sujata and Rima and Dana were also present at the gala night . After a few short speeches and recognitions, the music began and the 300+ Rotarians and volunteers lined up for a typical Ugandan buffet dinner. Rtn Godfrey Ssebukulo had organized a video documenting of the VTT on this final day of RFHD. We had our visits to various cites recorded and the climax was an on the spot interview at the fellowship dinner asking us to give a small capsule of our impressions of RFHDs

After dinner the whole place was reverberating with music ,laughter and dance . Rima, Sujata and I bade good bye to Dana and Phil as we were to leave or India the next morning .We departed at about 10 pm, arriving back to our hosts . The evening was a delightful treat for those who had worked hard for months to prepare for, and staff, the RFHDs.

For the next several days, Phil will remain in Kampala to catch up on the Monitoring and Evaluation Component, and to assess the transfer-of-training aspect in the regions. Dana will travel to Jinja to conduct seminars for midwives and medical officers. They are doing these functions “on their own dime.”

My gracious host PDG Stephen had the whole family waiting at home to greet us. His elder son Paul had come home after 4 months from the university. We had a great time making family pictures amid bonhomie and laughter. Dorothy, Stephen’s lovable, bubbly partner was a delight to talk to. She worked long hours, but none of her fatigue showed as she attended to the needs of each of the five children from Penny to Peter. Their lovely home among sprawling lawns was truly blessed. I retired to bed after the mandatory packing ,taking in all the sights and emotions of this hectic day.

A packed Rotary Family Health day: Day 2

Day Two of RFHDs Uganda

10 May 2013

 

We spent most of our day in the rural community of Kisowera, the boyhood home area of Kiwatule RC President Godfrey Byekwaso who submitted the Global Grant/VTT on behalf of his club.

 

The setting was beautiful on the grassy grounds of a Christian church, and the first  350 clients were already waiting when we arrived.  The Rotarian leader was giving an overview of the screening and treatment stations, and introduced the medical professions, including the VTT.  We found this introduction particularly meaningful.  The volunteer leader, Sylvia, asked us what we needed and we told her about our data collection/evaluation requirements.  She immediately had her second-in-command Rinet get copies made, and assigned several volunteers to get the clients to provide the interview/interpretation services to get the Rotary forms completed.  Lastly, they did a demonstration of the proper use of treated mosquito nets.

 

By 9 am, all of the services were underway:

 

Dental—where our team member Rima Singh joined two other dentists in administering anesthesia  and extracting diseased teeth on clients from 4 to 90.

Kids watching the eye/dental action through an open window

Eye exams.  Dr Jack Aaron worked with a local colleague all day—with no break for food—administering to scores of clients.  The Lions club contributed a collection of reading glasses which were dispensed at no cost.

Safe male circumcisions.  Dr Anil Bradoo supervised two surgical theatres, instructed the clinical officers in more efficient and effective techniques and ably demonstrated the surgical steps that were of great help to the clinical officers/nurses doing the technique. An almost full term pregnant health worker (nurse) Victoria was on the job, till dr Anil told her to take some respite and took over .  They did 30 circumcisions, and Dr Anil verified that all of their clients were instructed that SCMs are not a panacea—that they still need to practice abstinence and safe sex.“What can I do to repay you?” one young adolescent asked  Dr Anil after his circumcision. He had peacefully slept through the whole procedure and had to be actually woken up!!

HIV Testing and Referrals.  The laboratory was set up in a corner of a classroom , Dr Indu was there during the process, going through the algorithm the lab techs were to undertake and verified the availability of all the three different kits, required in case of HIV positives for confirmation. Once everything was set, there was no looking back and  the Lab techs by 3 pm, had 106 tests were conducted, with 6 showing  positive.  The positive cases were referred to the nearest hospital serving HIV cases. 70% of those tested for HIV were females only ,one of the 6 who  tested positive was a male .  After intensive pre and post counseling, clients received male condoms.

  

Distribution of medicines and mosquito nets.  These were done only on prescription, along with counseling. The VTT including Drs Sujata, Indu and Senior nurse practitioner Dana were on the job with fellow Rotarians .

 

We found this RFHD site exceptionally well-prepared and well-managed.  Everything from the space allocation to the music to the signage (in Ugandan) was well done.  When the several downpours happened, there was plenty of cover for people.  By 3 pm, we had registered 686 people.

 

After a brief lunch, hosted locally by PDG Stephen Mwanje by all but Dr Jack, the team returned to their duty stations, while Drs Indu and Phil went with Stephen to visit Naggalama, a site managed by Stephen’s Mukono Club. This was attached to a local hospital where all the services were carried out .The patients were registered under a large outdoor tent . By 3 pm, all of the services had concluded there, and about 50 people were seated under tent waiting to received prescribed meds and mosquito nets.  The Rotarian supervising this site, JimmieWandera, had seen to it that they had recorded all of the appropriate contact and informed-consent information to do our 3-month follow-up interview. They has smartly captured all the prerequisite data including consent  for  follow up in a register book, much to our satisfaction.

 

Each of these sites will operate again tomorrow—with even more patients and clinical staffing because it will be Saturday.  This is the first time both of these communities are participating in the RFHD.  We have been highly impressed with the gentleness and patience of the clients.  They are so patient and so grateful for receiving free services.

 

Over the past several days, some of our team had an hour or less commute to the action.  For half of us, we had a 6.5-hour round-trip commute.  Today, our round-trip was just shy of 7 hours, plus 1.5 hours waiting for a ride after  our site was closed down.   You can imagine how tired we can get—being en route and working for 13 hours.  Dr Jack was our hero—he ate a small breakfast at 6 am, hit the road and preferred to see patient after patient without a break and complete the work. He was looking forward to coming back the next day and attend to the eye patients before he  left for the airport at 4pm to return to Arizona.

 

We have no access to the internet this evening (almost 2 a.m.), so we will send this report out tomorrow…maybe late because we have a very full day going into the late evening.

End of Day Two—waiting for our rides to home-hosts.  Dana, Indu, Phil, David, Stephen Mwanje, Jack, Sujata, Stephen’s son Peter, Anil, Rtn Fred, Rima.

Dr Jack working through an interpreter helping an elderly patient

The Rotary Family Health Days 2013 at Uganda launched

An eventful day indeed! Today morning saw the inaugural launch of the Rotary Family Health days 2013 at the Coca Cola bottling plant ,Namanve .

Inaugural launch : The minister of Health Rtn Sarah Opendi to my right and Vice president of the republic of Uganda Edward Sekandi

A great annual  initiative started by PDG Stephen Mwanje in 2011, RFHD has snow balled into a highly publicized, national mega event in Uganda.Partnered by USAID,Coca Cola,Foundation Africa,Ministry of Health ,Uganda,AIDS information centre, Rotary Clubs and The Rotary Foundation.

Long Queues of patients lining up!

Below : The Malaria Screening Program

 

At 8 am the patients had started lining up in queues for the services at RFHD.The set up was very systematically organized under makeshift sturdy tents .The inauguration was a very high profile affair with the following celertities to flag off the launch

• The Vice president of the republic of Uganda Edward Sekandi
• PDG Stephen Mwanje(Fondly called Godfather of RFHD)
• Minister for Health Sarah Opendi
• The MD of century bottling plant (Coca cola) Norton Kingwill
• The representative of the US Ambassador(Mr Scott DeLisi) Ms Virginia M.Blaser

Below: The Team at the Health Day

• Today 800 patients  visited the RFHD at the launch site,for various services that included testing for Malaria,HIV counselling and testing ,Cancer cervix screening , Safe Male circumcisions ,Screening for Diabetes and Hypertension,,dental and eye check ups,distribution of Insecticide treated mosquito nets, condoms, sanitary pads and medicines.Our team participated in all the aspects .We visited various sites,escorted by the affable, enthusiastic PDG Stephen Mwanje  to educate the Rotarians on the filling up of the new registration forms for the patients created for Rotary clubs to enable follow ups .We also had special follow up forms for those revisiting RFHDs .This was an instrument that\Phil and I had worked on to be able to document the measurability of the RFHDs and its sustainability .More than 100 sites were simultaneously carrying out the RFHDs. It will be exciting to know the total turn out …………………………..

Time off !

Sunday through Wednesday on our schedule were officially interim days between our training of trainers and the launch of Rotary Family Health Days.  These are days to allow our trainees to go back to their regions and train all of the health professionals who will be participating in RFHDs.  We intended for our team to do some tourism completely at our own expense as well as to get to know some of the rural areas where the RFHDs will take place.  Yes, we did some very fine tourism, but we continued to work on the project each day.  Determine for yourselves whether some good things happened during the interim days.

 

A Bollywood pose with Drs Sujata, Phil, and Indu on a rock in the West Nile River

 

On Sunday, we hired at our individual expense, a 10-passenger  tourism van and driver, and we headed north to the West Nile district where RFHDs will also take place.  Our specific destination was the Paraa Safari Lodge located on the West Nile River within Murchison Falls National Park.  On Sunday after lunch, we took a guided safari up the Nile River to the spectacular Murchison Falls, on the way seeing elephants, crocodiles, and scores of hippopotamus.  On the return trip to the Lodge, Drs Indu and Phil planned the evening dinner meeting .  That night the team met to brainstorm measures of behavioral changes that we might expect from clients and families who participate in the RFHDs.  Our follow-up questionnaire began to take shape, as well as the new registration form which Rotarians and Rotaracters will administer during the RFHDs.  That evening we sent the registration form to Dr Raymond at AIC who will be responsible for making and distributing 100,000 copies for use at the events this week.

 

The next morning we took a land safari within the Park, and saw thousands of gazelles, several herds of elephants, a dozen clusters of giraffes, and plenty of wart hogs and water buffalo. 

 

 

A chimpanzee at the sanctuary

Above : Weaver birds busy at work! 

Our return  6.5 hour trip to Kampala was challenging and problematic as we endured a 30-mile stretch of construction with extensive waits, rush-hour traffic, and nauseating diesel exhaust from the vehicles ahead of our non-air-conditioned van.  Host club Kiwatule president Godfrey Byekwaso hosted us for dinner at our hotel, and we were able to firm up our schedule and objectives for the remainder of our VTT and the RFHDs.

 

Today (Tuesday) was another tourism day as we drove in a van to Entebbe and took a launch to Ngamba Island Chimpanzee Sanctuary on Lake Victoria during which we crossed the Equator—coming and going. 

The sanctuary is a testimony to the Ugandan government’s support for endangered animals as well as the fragile ecosystem of the island.  Visiting with “man’s closest relative” was informative and entertaining.

 

 

Team leader, Dr Indu; Health Minister Sarah Opendi, Dr Phil, and Dr Nywabana Denson

 

This evening, Drs Indu and Phil met with the Minister of Health, Hon. Sarah Opendi, and retired Associate Health Commissioner, Dr.  Nyabwana  Denson, a Rotarian with whom we had previously met.  It was a serious meeting focusing on TRF and Coca Cola Africa Foundation requirements for sustainability, Uganda’s resource and referral network, recent assessments on Maternal and Child Health, and Rotary’s research design for impact/sustainability assessment.  Health Minister Opendi  and Dr Denson agreed to support and advise us as we implement the research and evaluation design.

 

Tomorrow our team gears up for our role in the Rotary Family Health Days and we meet with the host sponsor club for the Global VTT grant, the Rotary Club of Kiwatule.  During the RFHDs, our team will assist in the registration process; monitor the screening, counseling, and treatment activities; and conduct a pilot test of the draft instrument for the 3-month follow-up evaluation of the RFHDs.  We will test the instrument on those individuals who participated during one of the previous two RFHDs—thus giving us some evaluative data on those events, and more importantly validating our instrument for the evaluation of the 2013 event.  In the coming days, we will obtain informed consent from all 2013 clients in order for Rotarians and Rotaracters to conduct a three-month follow-up to assess behavioral changes and client satisfaction.

Day 5: The Training Train Chugs Along… and new interesting developments!

In the Medical Officers/Nurses group, Dr Jack Aaron started the day’s events with a highly engaging exercise in doing vision-acuity exams.  We learned where the USA term “20/20” comes from, how to screen for vision acuity, and how to detect various impairments of the eyes.  Class members practiced by screening each other. Group members received eye charts, exam flashlights, and a supply of test swabs.

Above: Dana presenting her information packed talks

He was followed by FNP Dana Smith and her highly informative/creative presentations on diabetes and hypertension.

(Above: Raymond concludes the VTT program for the day)

After supervising more male circumcisions, Dr Anil returned to do an illustrated instruction on vasectomies.  Dana, who witnessed the highly detailed presentation, offered that she was inspired to go out and do them…just focus on the white tube (vas);  if not white, do not cut it!  Meanwhile, Dr Sujata was taking more students through a demo of cervical cancer screening.  She returned to the large group to provide a graphic instruction on tubal ligation.

(Above: After a successfully completed course of Training)

In the parallel track, David and Dr Indumati were introducing the lab techs to some very serious issues:  HAART and ART related to HIV, and the difference between documents and records.

At the conclusion of the day, Drs Phil and Raymond provided a wrap-up…on the next steps—training their colleagues back home, and support for Rotary Family Health Days.

(Above: A group photo with the trainees)

Two highly significant things happened as we were wrapping up the day:  Drs Indu and Phil met with Rtn Dr Nyabwana Denson, retired Assistant Commissioner of Health. We came to understand the utter complexity of the Uganda Health Care delivery system and the nation’s Public-Private Partnership policy and requirements.  We devised what we believe to be a workable plan for assessing the impact of RFHDs, as well as issues related to the sustainability deliverables that both our Rotary Foundation and the Coca Cola Africa Foundation consider non-negotiable.  We immediately conferred with AIC Director, Dr Raymond.  He enthusiastically agreed with our proposed approach, and he will provide staff support for the printing of the instrument and for distribution to the regions.  We will develop instrumentation and instructions, and implement the data collection during the RFHDs.  We will meet with the Minister of Health, Sara Achieng, on Tuesday to confirm the partnership.

In order to provide time for our team to do continuing, relevant training of Rotarians participating in the RFHDs, we have moved up our interim days to a Sunday night overnight to the source of the Nile (which, of course, is at our own personal expense).  This change will permit us to return to negotiate with the Minister of Health and observe/evaluate/advise on the training which our trainees will be doing in their districts.

We are scheduled to return to our hotel on Monday, and to move to our Rotarian host-families on Tuesday.  The RFHDs begin on Thursday, however, we have learned that on the islands (in Lake Victoria) they will begin as early as Monday.

We will be out of internet range for the next two days…back with you after that.

Day 4 : The training Continues…

The general shift of focus from Day One to Day Two was from research findings, epidemiology, and general medical principles/guidelines to “hands-on” operational applications. 

 

 

(Above: Anil supervises a SMC)

Highlights of the day were:

 

• OB/GYN Sujata Dalvi demonstrating cervical and breast cancer exams at a local hospital for the clinical officers and nurses.
• Lab Technicians receiving in-depth training in Cytology, an overview of HIV testing technologies, Ethics in HIV  work, and lab safety provisions by Dr Indumati and Lab Manager David.
• FNP Dana Smith’s animated and colorful lecture on diagnosis and treatment of diabetes, followed by a dynamite role-play session between the patient (Dana) and the Doctor (one of our best students).
• Keen interest in Dr Rima’s dental hygiene practice session—lots of questions.
• Urologist Dr Anil Bradoo’s supervision of students doing 8  safe male circumcisions, including penile blocks.  Eight more are scheduled for Saturday.  He kept telling them:  take your time—there is no rush.

 

Unlike Day One of the training, not everything went smoothly.

 

• All of us—faculty and students—we delayed in arriving at AIC headquarters by the heavy rains and clogged traffic.
• Several of our faculty were relegated to support roles for much of the morning…an almost unavoidable scheduling shortcoming.
• We had some work-arounds on technology issues—compatibility, connectivity, and power sourcing.  AIC tech staff were helpful.

 

The day, however, finished with a flourish.  We all participated in the meeting of the Rotary Club of Ntinda—a lovely suburb of Kampala.  Word about us must have gone out, because half of the large, filled room was make-ups from other clubs.  Dr Indu introduced her team and “Dr Phil” described the origins of the VTT and acknowledge the work and financial support of local Rotarians and Rotary clubs. We surprised a member of the club, Florence Tinkamanyire, who is arranging our home hosting and travel—with a Paul Harris Plus One award.  The entire room burst into a round of “For she’s a jolly good fellow…”.  Lastly, members sang a lovely anthem at the conclusion of the evening.

 

But our VTT evening did not end with the beverages-only Rotary meeting.  We went to the Lotus Mexican restaurant, quite near our Shangri-la Hotel, for much-needed bonding and laughter.  The three Arizonans on our team found the food authentic and very tasty, except for the rather weird tortilla chips, a flour/corn/whatever combo that we could not quite figure out.  The salsa and the guacamole, however, sang a delightful duet.  We returned to the hotel at 11:30.  Tomorrow will be an intense day of wrap-up to the training, and planning for our monitoring of our trainees doing training at their Centers, as well as beginning to implement our Monitoring and Evaluation design.