Log, February 28th to March 6th

Monday, February 28th
On Monday, I met with Dr. Hugh Cameron at Makerere University to discuss the development and progress of the software to be used on the VHTs’ mobile phones. Later, I met with Alexander Kasendwa at MTN headquarters to discuss the phone set specifications for the basic screening of the VHTs.

Tuesday, March 1st
In the morning, I met with Hon. Sylvia Ssinabulya at the Ugandan Parliament in Kampala. Subsequently, we went to meet with Rosemary Nabifo Wamimbei, Secretary of the NGO Board, regarding expanding Life for Mothers’ mission into other districts of Uganda.

Rosemary Nabifo Wamimbei, Secretary of the NGO Board

Wednesday, March 2nd
I went to the Health Center IV in the Parish of Mwera where we spent the entire day screening 25 VHTs (50 CHWs) and another 4 community health workers. Each individual was assessed for basic competency in the use of the data-registration mobile technology. Prior to the screening, briefing sessions took place amongst all of the teams. Unfortunately, less than a third of the teams were deemed competent and therefore our search continued for additional VHTs.

During this visit, I met with Immaculate, a midwife and friend, at the Health Center IV who showed me a non-functioning blood pressure machine – non-functioning due to the unavailability of batteries. This is an unfortunate example of how weak infrastructure and supply shortages negatively impact the resident population’s access to health services.

 

Midwife Immaculate showing me defunct blood pressure machine

Thursday, March 3rd
Regarding the search for a new Program Manager, I met with the supervisor of Winfred Namireme, a potential candidate, who works for the African Health Education Initiative, a join collaboration between Johns Hopkins University and Makerere University. We discussed her work history, etc. I was impressed with her past work performance and therefore I suggested she come on Sunday to screen for the additional VHTs who could acquire basic competency skills to use our  mobile health technology.

Friday, March 4th
As mentioned in previous entries, LfM wants to secure the support of the Village Chairpersons of the initial 25 villages working as part of our pilot project. On Friday, I was able to meet with twelve of them (all men). After introducing them to Life for Mothers’ pilot project and mission, I gave out our Life for Mothers pins. If you look closely you can see the Village Chairpersons wearing them.

Village Chairpersons being introduced to the pilot project

Village Chairpersons wearing LfM pins

Saturday, March 5th
On Saturday, I was a guest on Radio One’s Health Net show (9am-10am) and was interviewed by Dr. Henry Ddungu, from Makerere University. The interview involved questions regarding the specific pilot project in Busujju county as well as the substantive issues regarding maternal/neonatal mortality in Uganda.

Dr. Harry being interviewed on health talk show, Health Net on Radio One

Dr. Harry being interviewed by Dr. Ddungu on Health Net, Radio One

Sunday, March 6th
Winfred Namirembe and I travelled to Mityana to screen additional VHTs in order to complete the full complement of 25 VHTs in the basic use of mobile health technology. After witnessing her work during the entire day with the VHTs, we finalized our decision to hire Winfred Namirembe as our new pilot project Program Manager. She has accepted to be the Program Manager for the pilot project in Busujju county for Life for Mothers.

Winifred demonstrating how to use LfM's mobile health technology

The VHTs who were screened

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Log, February 21st to February 26th

Monday, February 21st

I spoke with Hon. Sylvia Ssinabulya regarding the role of William Nabangi, Clinical Officer and Coordinator of the Village Health Teams (VHTs) in the recruitment of additional community health workers (CHWs) to complete the necessary number of VHTs. This will require an additional six men, ultimately resulting in a more balanced gender ratio of 22 men to 28 women (forming 25 VHTs). Additionally, I asked Hon. Sylvia Ssinabulya to confirm through William Nabangi that the recruited CHWs are all able, at the very least, to send an SMS text message to one another. Though at a later date they would be additionally screened, sending an SMS is a minimum requirement to be considered for training in the use of mobile health (mHealth) technology.

View of Kampala

Later that afternoon, I had a meeting with Herbert Zake, Head of Corporate Affairs at Standard Chartered Bank, regarding potential sponsorship with Life for Mothers (LfM.) I explained the scope and nature of the pilot project and also gave him the informational DVD. Mr. Zake recommended a meeting with Annie Katuregye and Deus Turyatemba at 5pm, that day, regarding a potential alliance. At the meeting with Annie and Deus I listened to the extremely emotional story of her life. She is truly an amazing person: she is HIV-positive and her husband died of AIDS 20 years ago. She is also the mother of 3 HIV-negative children. She does extensive community work to sensitize people to the realities of those living with HIV/AIDS. She also works to combat stigma, discrimination and denial and urges women and men to get tested so, if they test positive, they can be treated as soon as possible. During her talks she frequently mentioned “HIV is not a death sentence,” a sentiment that I endorse. I introduced her to LfM’s pilot project and we are pursuing options as to whether the bank will support her efforts in working with LfM.

Annie Katuregye

If you would like to read her story, click here: (link to follow)

Tuesday, February 22nd

Tuesday morning, I met with Dr. Francis Runumi, the Commissioner for Health Planning of the Ministry of Health. I gave him the letter he had requested the previous week regarding increasing drugs, supplies and equipment to Mwera Health Center IV (HC). The reason for this increase is that the pilot project would trigger increased demand for medical supplies beginning March 1st. He requested additional information regarding the project proposal and its budget.

Later that morning, I had a two-hour meeting at MTN’s headquarters in Kampala. This was my initial meeting with the person responsible for MTN’s Corporate Social Responsibility (CSR), Ms. Rukh-Shana Namuyimba. I briefed her regarding the nature and scope of the pilot project and also showed her the informational DVD which we began to watch together when the MTN CEO, Mr. Themba Khumalo, came and greeted us. Firstly, he assured us that he is completely behind the project in principal, however he expressed concerns regarding potential interaction between our software applications and their phones. Therefore he asked Brian Kataka (our software designer) and myself to meet with MTN’s IT people. After he left, I continued to talk to Ms. Namuyimba regarding our project. Subsequently, a meeting was tentatively scheduled for Thursday, the 24th, for 10:30 am because Wednesday was a public holiday (mayoral races would be happening throughout the country, including in Kampala). She promised to confirm the meeting that afternoon or Thursday morning.

Brian Kataka, software designer

In the afternoon, I met with the newly re-elected Hon. Sylvia Ssinabulya, who assured me (now that the elections were over) that she would devote much more time to ensuring the pilot project’s success. She also promised to arrange a meeting with the respective 25 Village Chairpersons as well, again with the assistance of William Nabangi.

After my meeting with Sylvia, I met with Simon Kaggwa whom I met on previous trips to Uganda. Mr. Kaggwa is the host of a daily political show on Radio One, the premier Ugandan radio station. After I briefed him about Life for Mothers, he was very moved by the project and its significance, and recommended I meet Jaime Byarunhanga, the host of a weekly health show called Health Net, which airs Saturdays on Radio One. He set up a meeting for the two of us in order to discuss the possibility of my appearance on Mr. Byarunhanga’s show.

Wednesday, February 23rd

Despite the public holiday (mayoral races throughout the country), I was able to do some work, including interviewing Benjamin Byarugaba for the position of Program Manager. I then met with Dr. Hugh Cameron, Visiting Professor, Networks and Software Innovations, at Makerere University, regarding the software development and the timeline of the project. That same day, I also met with Brian Kitaka, the software designer who works with Dr. Cameron. Brian demonstrated the software prototype that will be used to screen CHWs for their mobile phone competency. He was also able to upload the prototype software onto my Motorola phone and I was able to access the form on my own.

Finally, I connected with Ms. Namuyimba who told me that since it was a public holiday she could not confirm the meeting and that she’d do so the following morning.

Dr. Hugh Cameron and I at Networks and Software Innovations, Makerere University

Thursday, February 24th

Thursday morning Ms. Rukh-Shana confirmed the meeting would take place at MTN headquarters at 10:30 am. Brian Tataka and myself arrived there and I gave a presentation regarding LfM’s pilot project and its specific requirements regarding the telecom aspect of the project. Brian described how the software application would be used and the IT people requested specifications for the server and the phone sets. We promised to supply them later that afternoon. I sent them to Rukh-Shana and she was able to confirm receipt later that day. However, she stated she was required to brief Mr. Khumalo regarding the pilot project, but since he was out of the country she would have to wait for his return.

From left to right: Peter Kakoma, Rukh-Shana Namuyimba, Allan Kizito, Eve Araduha, & Dennis Musinguzi

Friday, February 25th

I had a 7 am meeting with Dr. Olive Sentumbwe-Mugisa, Family Health and Population Advisor from World Health Organization (WHO) Uganda, whom I met numerous times in the past. I informed her of the status of the pilot project and also gave her the informational DVD. She stated she would be able to conduct a 2-day workshop on maternal/reproductive health with the VHTs and Health Staff at the HC IV in Mwera. I also mentioned our need to recruit a Medical Officer and a midwife; Dr. Olive said she would assist in their recruitment.

Dr. Olive Sentumbwe-Mugisa, Family Health and Population Advisor for the World Health Organization, Uganda

Late in the afternoon, I had an extensive meeting with Jaime Byarunhanga, Managing Director of Mystic Multimedia and the host of Health Net on Radio One. We went through the informational DVD and the objectives of the pilot project. He agreed to host me on the next show on Saturday, March 5th, in advance of national and global events surrounding International Women’s Day on March 8th.

Today, Saturday, February 26th

I went over to Mulago Hospital (have not visited in a year or two) and had my blood pressure checked. It was normal!

Sister/Nurse Mabel checks my blood pressure at Mulago Hospital
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Log, February 14th to February 16th

Monday, February 14th, 2011

In the morning, I drove up from Kampala again to the Mwera Health Center IV. I met with Honorable Sylvia Ssinabulya (the female Parliamentarian from Mityana and, also, an LfM Board Member). She took time out of her campaign schedule to meet with me and I briefed her on the Life for Mother’s pilot project to reduce maternal/neonatal mortality. I explained its holistic properties and the time frame of the project as well. I also gave her the informational DVD that is currently being televised in the US through February 2011. We scheduled another meeting for February 21st, after the Presidential & Parliamentary elections.

Hon. Sylvia Ssinabulya and I at the Mwera Health Center IV

Later the same morning, we held an orientation meeting for the recruited 25 Village Health Teams. Each VHT comprises two Community Health Workers (CHWs) per team. Mr. William Nabangi mobilized these teams over the weekend. He mobilized 44 CHWs, divided into 28 women and 16 men. He was only able to get 44 CHWs due to the short period of time. We told him he needed to recruit an additional 6 men to complete the recruitment of the 50 CHWs. The orientation meeting lasted over 3 hours where I emphasized the importance of the CHWs’ role in making the project succeed. I explained the holistic strategy we were employing as well as the use of mobile health technology. In addition, I made the following points:

  1. The pilot project would take between 4 and 6 weeks.
  2. The goal of the project was to register as many households during this 4-to-6 week period as possible, as well as increase the number of antenatal visits and births that take place at the Health Center IV. I made them aware of the fact that 40% of all the deaths of children under the age of 5 take place in the 1st month of life; therefore it was necessary for the VHTs tand HC lV to closely monitor newborns during this critical time period.
  3. All VHTs will be given comprehensive intervention training in the following areas: family planning, HIV/AIDS, maternal/reproductive health, & child survival.
  4. Each team will be given, and trained to use, mobile phones to register all households in their respective villages. Initially, after the software applications have been placed on these mobile phones, the VHTs will be subjected to a simulated session where each VHT will act as an interviewer and the other as patient. During this time, the IT director will determine which teams can be trained in the usage of these phones; he will be assisted by a Peace Corps Volunteer who is stationed at the Health Center IV. The teams unable to be trained to use the phones will be replaced with new recruitments. Those teams will go through the same process. Once we are reasonably confident that they can be trained in the usage of the phones, they will receive the educational training previously mentioned.

After returning to Kampala, I met with the Commissioner of Health Services Planning, Dr. Francis Runumi, at the Ministry of Health and gave him the informational DVD. The meeting was extremely positive; I re-introduced him to the pilot project and he recognized the significant impact the project could have on Uganda’s health care system. Earlier at the HC lV, during the Q&A with the VHTs, I was asked what Life for Mothers would do to address the gaps in human resources, drugs, equipments, and supplies that women of reproductive age encounter when they come to the HC IV. I communicated the VHTs’ concerns, and Dr. Runumi asked me to return to Mityana and meet with the District Health Officer, Dr. Francis Kigongo. He told me I should ask Dr. Kigongo to write a special request for additional drugs, supplies, equipment because of the increased demand that would be generated by the implementation of the pilot project study. After receiving this letter, Dr. Runumi would request these additional provisions from the National Medical Stores.

Dr. Francis Kigongo, Mr. William Nabangi, Clinical Officer and Coordinator of the Village Health Teams, and Immaculate, the most dedicated nurse/mid-wife and dear friend

Tuesday, February 15th, 2011

I visited the AIDS Information Centre (AIC) to discuss LfM’s pilot project with Dr. Raymond Byaruhanga. Unfortunately Dr. Raymond Byaruhanga was not available and I met with two of his trainers. Since 1993, the AIC has been providing family planning services in addition to comprehensive AIDS/HIV counseling, testing, and treatment. Regarding Family Planning services, we discussed long-acting and permanent method procedures (LAPM.) These included the following: IUDs, the placement of Norplant, inject-able hormones, tubal ligations, and vasectomies. Dr. Proscovia Namuwenge (one of the trainers) and I agreed that she would be able to train the clinical officers and/or nurses in the placement of Norplant procedures.

After arriving back in Kampala, I met with Dr. Hugh Cameron (PhD), Visiting Professor and Department Head of Innovations of Software Development, Faculty of Computing and Information Technology of Makerere University. I introduced him to Life for Mothers, explained the pilot project, and gave him our informational DVD. We discussed the utilization of mobile phone applications to collect health data and register all households in the field. Dr. Cameron recommended that LfM create a very user-friendly prototype for the initial mobile phone data collection. He further recommended that we work with the VHTs with this prototype to determine their capability to be trained in the usage of this technology. LfM will be working very closely with Dr. Cameron’s team to design questionnaires to be used as the prototype. Once developed, the software would be uploaded onto the phones, and we would meet with the VHTS to go through a trial period to determine who was capable of being trained in this technology.

Wednesday, February 16th, 2011

I drove up to meet with the District Health Officer of Mityana, Dr. Francis Kigongo, and discussed the prior conversations that I’d had with Dr. Runumi the previous day. I also met with Dr. Robert Balikudembe (the Medical Officer assigned to the Health Center IV in Mwera.) We worked on drafting the letter to the Permanent Secretary of the Ministry of Health requesting the additional supplies due to the pilot project study.

After I returned to Kampala, I had another meeting with Dr. Cameron to further discuss the development of the questions to be used on the mobile phones. He introduced me to his team and related to me that they would be working on a daily basis, throughout the Presidential election period.

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Log, February 7th to February 10th

Monday, February 7th, 2011

After I finally arrived in Uganda (arrival delayed due to the cancellation of BA flight), I met with Dr. Francis Kigongo, District Health Officer (DHO), that evening in Kampala. It was my first meeting with him because the previous DHO is on leave. In addition to giving him an informational DVD, I explained the nature and purpose of the project, as well as providing him with a formal PowerPoint presentation. We planned to meet on Thursday (the 10th of February) at which time he would introduce me to Mr. William Nabangi, the Clinical Health Officer and Village Health Team (VHT) Coordinator of the Mityana district.

Tuesday, February 8th, 2011

I met with the CEO of MTN, Mr. Themba Khumalo, regarding their potential partnership with Life for Mothers. I also met with additional software programmers that had been previously introduced to me by Orange Telecom.

Wednesday, February 9th, 2011

I met with Dr. Raymond Byaruhanga of the AIDS Information Centre (AIC) to discuss the pilot project and AIC’s partnership with the project. I also met with Mr. Rogers Kasirye (Executive Director of the
Uganda Youth Development Link) to help in the search for a Ugandan Program Manager; I was introduced to Mr. Kasirye through Dr. Al Osborne from our Advisory Board.

Thursday, February 10th, 2011

I drove to the Mwera Health Center IV and appreciated the differences from my last trip a year ago. The roads have been widened but were unpaved and consisted of cracked red clay. The main road – a single lane – was riddled with potholes and blocked off at numerous points by construction equipment, making the trip even more arduous than I had previously experienced (Videos to follow).

I met with Dr. Kigongo and he introduced me to Mr. Nabangi. I explained the pilot project to both of them in detail. We planned to have an orientation meeting on Monday, the 14th of February. Over the next three days Mr. Nabangi would mobilize 25 Village Health Teams (VHTs) and I emphasized the need for him to recruit as many men as possible. In addition, he informed me that the teams that would be required to travel more than 6 km would have to be compensated for their trip (these VHTs come the immediate surrounding 25 villages).

A team of Community Health Workers

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Photos from Life for Mothers (LfM) Trip to Uganda

Below are numerous photos I’ve taken since my arrival in Kampala, Uganda on February 7th. So far, twenty-five Village Health Teams have been chosen and their orientation has begun. The pilot project is going smoothly and I will send regular progress reports to our New York office. A log of what I’ve been doing the past two weeks will follow in coming posts.


Due to the political climate, I am staying home today (Friday, Feb. 18th) so my friend Dr. Justus Barageine and his wife came to visit me

And from the last two weeks…


Dr. Francis Kigongo, the District Health Officer, and a student, Prosie

 

From left to right: Dr. Francis Kigongo, Mr. William Nabangi, Clinical Officer and Coordinator of the Village Health Teams, and Immaculate, the most dedicated nurse/mid-wife and dear friend
Maternity Ward patients waiting outside the Mwera Health Center lV

Hon. Sylvia and I in her campaign van!

The entrance to Mityana Hospital



An HIV/AIDS prevention campaign outside of Mityana Hospital


People waiting for outpatient treatment at Mityana Hospital

 

Mityana Hospital operating room


Mityana Hospital Children's Ward

Child with broken leg being treated

Here I am explaining the pilot project to LFM's 25 VHTs; Vincent Mujune provided English-to-Lugandan translation

Village Health Team Coordinator and Clinical Officer, Mr. William Nabangi

The Q&A part of the presentation

My wonderful driver without whom I’d be stranded


From left to right: Dr. Robert Balikudembe, Medical Officer assigned to Mwera Health Center's Medical Clinic, myself, and Dr. Francis Kigongo, District Health Officer


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Pakistan: Short training for Women Workers Goes Far in Saving Newborns’ Lives

An IRIN News article entitled “Pakistan: Short Training for Women Workers Goes Far in Saving Newborns’ Lives.” According to a study in The Lancet, in regions that “Lady Health Workers” with only short- term training were present still births decreased by 21% and newborn deaths decreased by 15%. We at LfM understand the important role of trained community health workers in ensuring the health of the mother and child before, during and after birth. We also understand the essential role of a healthy mother in providing the sustenance and support that the newborn needs to survive. For this reason, Dr. Harry Strulovici felt compelled to respond to this article:

“The study that Donald McNeill references from The Lancet (Jan. 14) demonstrates the effectiveness of employing community-based strategies to reduce newborn deaths. Overall in developing countries, 40% of all deaths of children under 5 take place during the newborn period. In Pakistan, the percentage is 57%! Utilizing the simple techniques of warming (kangaroo mother care) the newborn and provide basic education for (mouth-to-mouth) resuscitation can significantly reduce these deaths. Unfortunately, many of these births take place at home or in the field. Mothers need to deliver at a facility where a skilled birth attendant can help save the mother from dying as well as assist in the newborn’s care. Integrating this strategy along with using lady health workers to educate women and men will maximize health outcomes. Unfortunately, the study did not comment on the health outcomes of the mothers.”

-Dr. Harry Strulovici

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Ugandan Who Spoke Up for Gays is Beaten to Death

David Kato, a gay activist in Uganda spoke out aggressively against the “Anti-Homosexuality Bill” which recommends the death penalty when homosexual behavior is confirmed. The bill also imposes fines on men and women who do not choose to reveal themselves as homosexuals. We at LfM believe in the acceptance of homosexual individuals into society. We believe that homosexuals being at the highest risk for HIV contraction should feel secure enough to protect themselves by using condoms without condemnation from their government or fellow citizens. Dr. Harry felt compelled to respond to the IRIN News article entitled “Uganda: Murder of gay activist ‘needs urgent investigation.”

“The tragedy that resulted in the death of David Kato reflects the continued intolerance and respect for human rights. People, whether they are gay or HIV+, sex workers have been subjected to stigma, discrimination, and severe harassment and has led to many of them being killed. Uganda along with other nations, e.g., Kenya, Nigeria must exert political will and condemn these actions. In Uganda, a bill has been submitted to Parliament to criminalize homosexuality with a death penalty. These are medieval measures being enacted in modern times. President Museveni promised to scrap the bill a year ago to assuage the pressure from American and European governments. Now facing re-election after remaining in power for 25 years (Museveni amended the constitution), the bill may become law. Again, the world and human rights organizations must align to ensure that people’s rights to live without fear are respected and anything less is unacceptable.”

–  Dr. Harry Strulovici

 

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