Fashion Aid

I saw this over on Refinery29 this morning and thought it was awesome: Threadless, a t-shirt company and Justin & Christine Gignac, two artists, got together to create a line of shirts to benefit UNICEF and the work it does in Africa.  The price of each shirt is the price of the humanitarian aid item on it and 100% of procedes go directly to UNICEF. While the cargo plane for supply drops is going for $300,000, an insecticide-treated mosquito net is priced very reasonably at $18.57. Kind of more fun than trick-or-treating for UNICEF with those little orange boxes, isn't it? (I would always put mine at the bottom of my candy bag and forget about it until the end of the night.)

via Threadless

Uganda Coverage

With some friends - can't get enough of the one in the Mickey Mouse sweater.  And yes, my skirt matches their uniforms.  Photo by R. Gruver.

Lots of Uganda coverage in The New York Times this weekend. First, a very interesting article about maternal mortality and the third delay. While sobering, the issues discussed do not come as a surprise given all we’ve seen and learned while here this summer (especially the tour of Mulago Hospital's maternity ward!).  I was particularly struck by the statement that, “Poor people surged into Uganda’s public health system when the government abolished patient fees a decade ago. Increasingly, African countries are adopting similar policies, and experts say that many more people are getting care as a result. But Uganda’s experience illustrates the limits of that care when a system is poorly managed and lacks the resources to deliver decent services, experts say.”  Really makes you think about what a functioning system should look like - it has to have staff and resources for one!  Ironic that this article should come so shortly after the coverage of Sierra Leone's recent switch to fee-free deliveries.

Second, an article about the Ugandan Little League team that unfortunately will not be able to participate in the World Series this year. In many ways, the issues of not having formal birth certificates and young people not being raised by their parents directly relate to having a safe delivery, whether in a hospital or not. Hope they have a chance to qualify again next year!

Focus Group, Focus Group, Focus Group at Lunch

This morning the Qualitative Research Team conducted the last focus groups for my project.  Data collection is done!  Above is the women's focus group that we facilitated outside one of the clinics.  Even though I couldn't understand what was being said (the moderator conducted the group in Luganda), I was glad to observe and see the question guide I created in action.  Now it's crunch time and I have to analyze all my data and write up my results.  Three weeks to go!  Below, all the bikes that patients rode to the clinic today.

Photos by Oh MG.

Are You Sure You Don't Know How to Draw Blood?

Once every month each of the 13 Rakai Health Sciences Program satellite clinics have what they call a "bleeding day" when most patients come to have their blood taken and tested for things like CD4 levels, viral load, and other infections.  On Friday Leigh and I went to a clinic hub to help staff organize patient files during their bleeding day.  When we arrived we were given two options: 1) looking through patient files, writing down the blood tests each person needs, and labeling vials (the job we thought we were there to do), or 2) drawing blood.  Obviously since we are public health students (not medical or nursing students) and not equipped with the clinical skills to draw blood, we opted for patient filing.  The clinic staff really wanted us to try taking blood though.  One nurse in particular kept saying, "just try it, I'll teach you!"  Later she came back and said, "are you sure you don't want to try?"  This seemed to speak to the strong culture of teaching and learning, as well as the fact that sometimes when the clinic is short-staffed literally all hands are needed on deck.  While we were appreciative to the offer of phlebotomy lessons, we stuck to the files.

We labelled each vial with the type of test to be performed as well as the patient's ID number.  After all the blood was taken, it was loaded in coolers to be taken back to the lab at RHSP headquarters.  Next, lab techs will perform the necessary blood tests, the results will be communicated to the satellite clinic, and the next time patients come in they will receive their results and/or have their ART regimen modified if necessary.  Quite the complex system.

Incident Report: Food Poisoning at Lake Bunyonyi

Everyone said it would happen at some point.  As we prepared for our trip we were repeatedly warned that we would get some type of food-borne bug while traveling in Africa.  Elizabeth was felled early on while in Kampala, but it took until Friday night to reach Leigh, Rachel, and me.  To set the scene: on Friday afternoon we left Kalisizo at 1:00 PM to make the 5-hour drive to Lake Bunyonyi, a picturesque destination in western Uganda.  Upon arrival we settled into our accommodations at the lovely Kalebas Campsite.  There was some sort of mix-up when I made the reservations and rather than having two single beds in each room, there was one double bed in each.  Sharing beds is not a problem of course, unless you are violently ill.  Oh, and to make matters worse: there was no door on en suite bathrooms – there was just a curtain.  This also might not be an issue unless you have food poisoning.  Below is a photo of how the lovely Lake Bunyonyi looked upon our arrival.  Little did we know how the night would work out.

At 7:30 PM we settled in at the camp restaurant to have dinner.  We essentially had the same food items, but Leigh, Rachel, and I had some red wine, while Elizabeth had a glass of white wine.  Almost as soon as the meal was over, I started to feel sick and I became Patient Zero.  I threw up from after dinner until 2:00 AM, and just as I was getting better, Rachel, my bedmate started throwing up.  She became Patient 1.  By the time Rachel was better, two rooms down, Leigh got sick.  She was Patient 2.  By Saturday afternoon all we could do was drag ourselves it to a shady spot on the shores of Lake Bunyonyi and rest, though we could barely keep down water.  Many thanks to Elizabeth, the only one of us not to get sick, who tended to our every need and literally caused a stock-out of Sprite at Kalebas by buying up all of it, even the sample bottle on the front of the bar.  Leigh was sick all the way through Sunday, though Rachel and I felt better enough to take a boat ride with Elizabeth that morning (will post photos later this week).

As good public health students we worked to investigate the epidemic.

While we can't definitively say it was the red wine, all signs point to it being the culprit (that or the glasses we used had been washed with dirty water).  Here is a 2x2 table charting the exposure and disease incidence.

Conclusion: Individuals who ingested red wine were 100% more likely to throw up than the individual who did not ingest red wine.

Lessons learned this weekend: everyone will get sick at some point in Africa; always travel with Pepto Bismol and a friend who will bring you Sprite and plain bread; and stay away from glasses of Cellar Cask boxed wine.  Also, Lake Bunyoni is indeed beautiful, at least what we were able to enjoy of it.

All photos by Oh MG.

Everything Looks Better in PowerPoint

Today Elizabeth, Leigh, Rachel, and I presented our project plans to the management team of the Rakai Health Sciences Program.  The team includes some of the preeminent researchers behind pioneering HIV/AIDS research in Uganda - like this, and this, and all of this.  Needless to say, I was a bit nervous.  Luckily, everything looks better in PowerPoint! Actually though, the meeting went well and our work is underway.

Hello from the town of Kalisizo

On Tuesday morning we drove down from Kampala, the bustling capital of Uganda, to Kalisizo, the town in which we will be spending our summer while interning at an HIV/AIDS research and treatment center, the Rakai Health Sciences Program (RHSP).  Over Tuesday and Wednesday we settled into our accommodations (a lovely guest house), went on a tour of the various units at RHSP, met our summer supervisors and discussed our projects, and even went dancing in the nearest town with our new co-workers.  After all that activity it was nice to get a day off today - it is the Ugandan national holiday of Heroes Day, an event commemorating heroes of the guerrilla war of the early 1980s.  Below check out our new digs and what we've been up to.  Photos by Oh MG and Leigh Bernstein.

On our drive south we crossed over the Equator.  Nothing like having one foot in the northern hemisphere and one in the south.

This is our new street.  RHSP is about a ten minute walk away and we are staying in a guesthouse used to house visiting researchers.  There is a lovely housekeeper named Tao here who makes our meals and takes great care of us.

Overview of our new neighborhood.  RHSP employers over 400 people and is comprised of a series of buildings which include a state of the art lab, clinic, operating theater, research library, and the offices of many researchers.  Here we are following our guide Goretti on a tour of all the facilities.  The town of Kalisizo is small and dotted with houses that are nestled among banana, papyrus, and corn crops.

Blood samples waiting to be analyzed in one of the RHSP labs.  Not only is blood taken to ascertain someone's HIV status, but patients receiving antiretroviral treatment (ART) have their blood consistently tested to monitor CD4 levels and have their treatment regimens modified.

Part of our tour included a trip through the operating theaters for which we had to don scrubs.  Looking good, aren't we!

A sign directing patients to the clinic where hundreds of people receive ART as well as medicine for opportunistic infections that are a side effects of HIV (like TB and malaria).  The biggest clinic is here in Kalisizo but RHSP also runs 13 satellite clinics in various villages, some of which are much more rural.  My project this summer will consist of traveling to the various clinics and talking to service providers and patients about their experiences ... and then doing qualitative analysis and writing a big report on what I find.

Me, Elizabeth, and Rachel in front of our house.  Two of us have rooms on the left and two of us have rooms on the right.

The bandas, lovely thatched-roofed and open-air structures in the middle of the RHSP compound.  Many meetings are held there and we have been told we can use them as our offices for the summer - not a bad place to work!

Day 2 - Public Health!

Since we are in the city this week I get to post two days in a row!  We'll see what it's like the rest of the summer.

Anyway ... after a fantastic introduction to the city of Kampala yesterday, today we focused on health and public health in Uganda.  Our first order of business was a meeting on personal health and safety issues to keep in mind during our visit (i.e. how not to get malaria, Ebola, bilharzia, or avian flu).  The bottom line: use common sense, take your malaria medicine, don't touch dead bodies or people who are bleeding from the eyes (the way you get Ebola), and don't swim in fresh water lakes.  We then proceeded to the Makerere University School of Public Health for a tour and a meeting with the Dean, Dr. William Bazeyo, followed by a tour of Mulago Public Hospital.

View of the suburbs of Kampala from Kololo Hill.

The School of Public Health sits on the  Makerere University Health Sciences campus which also houses the medical school, nursing school, infectious disease research unit, and Mulago Hospital.

Chart of various forms of antiretroviral therapy.

View of Kampala from the School of Public Health.

At Mulago Hospital we received a comprehensive tour from Senior Nurse Christine Namukasa who as worked there for over 30 years.  This is a public hospital that serves as a referral point for several district health centers.  Anything that a local health center cannot treat is referred here - this includes obstetric complications, cancer treatments, and surgeries.  The facility also has an emergency unit where trauma victims are bought.  No patients are turned away - in certain wards hospital beds filled the hallways.  On another note, this is where they filmed the hospital scenes from The Last King of Scotland.

Here we are with Nurse Christine.  She is absolutely fantastic and spared nothing as she took us around the hospital - we even went right up to the labor suite where 70 babies are born each day.  She asked us if we "feared blood" before she led us into the emergency room, luckily we weren't faced with any.

Photo courtesy of Leigh Bernstein

From the hospital we proceeded to the School of Public Health's Kasangati Annex on the outskirts of Kampala.

The annex is adjacent to the District 4 Health Center where local residents receive primary care including family planning, routine pediatrics, and non-complicated obstetric cases.  The center is theoretically equipped with an ambulance in case any patients need to be transported to Mulago Hospital, but the vehicle was currently at another center.

Following our tour guide Simon to the maternity ward at the District 4 Health Center.

I was surprised by this sign at the maternity ward, but Elizabeth told me that new research shows if the mother is receiving antiretroviral therapy, the nutritional benefits of breast feeding outweigh the risk of mother-to-child transmission of HIV.

It was truly a fantastic day that gave us a great look at the health system in and around Kampala.  Tomorrow we head to Jinja!