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Daily Reflections from a Nursing Student’s Community Health Elective Exchange in Uganda

Filed under: GEMx Regional Exchanges

Post by Akingbohungbe Oluwatosin Sonia, a nursing student at University Of Ibadan. Department Of Nursing, College Of Medicine, in Nigeria, who completed a elective exchange in Community Health through Makerere University, College Of Health Sciences, Department Of Nursing, in Kampala, Uganda.

 July 2019

All thanks to God for this opportunity, I was privileged to be one of the students selected to participate in the exchange program in Makerere University, Kampala Uganda by the Global Education in Medicine Exchange (GEMx). The exchange school was the Department of Nursing, College of Health Sciences, Makerere University, Uganda.  The program started on the 17th of June 2019 and I joined them on the 22nd of June 2019 due to logistics. We took off from Lagos Murtala Muhammed International airport on the 21st of June 2019 by 12:40 P.M, We had a stopover in Nairobijomo Kenyatta International Airport By 11P.M and board another airplane to ENTEBBE by 12:55 A.M on the 22nd of June 2019. The plane landed in ENTEBBE by 02:10 A.M and we were picked up by Mr. Martin the driver to the department from where we were taking to the prepared accommodation where we slept over for the night. The following day we were taking to Ms. Lydia Kabiri at the department of nursing around 11a.m for proper welcoming, recognition and further directives on how the program will run. Afterward we left for Mpigi to join the rest of the students in the Mpigi Health Center IV where we were also welcomed warmly by Katumba Lawrence and kwikiriza Grace followed by the rest of the students Gerald, Olivier, Innocent, Sonita, Janet, Francine, Shilla and Clement the leader of the group. The students were on a recess posting which includes Domiciliary midwifery and community health as subset of Public health nursing. The Health Centre had different units, the General ward, Out-Patient Department (OPD), Antiretroviral Therapy Department, Maternal child health Department and the Labour ward. Alongside the posting into the ward, we also took part in Continuous Medical Education (C.M.E) undertaken by health practitioners in the Mpigi Health Center IV, the forum is a productive and an interactive one which affords everyone both students and the health workers to brainstorm and learn new things through researches and new discovery for rendering health services to the people.

Day 1

24/06/2019

The day started with meeting with the senior nursing officer, in charge of the health centre and she welcomed us and then there was a brief orientation to the setting of the health facility, visiting the various units of the health centre. The various units include the Out-patient Deapartment, the General ward, the Maternal and child health unit, the Maternity unit and the Anti-retroviral (ART) clinic. Day 1 started with posting to the General ward of the health facility. The ward included the male, female and paediatric wards and conditions found there includes malaria, pneumonia, injuries and other minor health conditions. On the ward, orientation was given and the nursing duties peculiar to the ward was explained to us. Observation of the assessment of patients, administration of medications and admission was carried out.

Also, one of the students from the university, Akwanya Innocent, gave a health talk to nursing mothers and we were all in attendance. The topic was on Danger signs during postpartum and it was delivered to the nursing mothers and women who came for antenatal clinic at the maternity unit of the health facility. The student nurse spoke in English language while another student helped to translate in the local language Buganda. The education was for about 20 minutes. Mothers asked questions about the topic discussed and they were duly answered.

In the evening, it was a period for discussion among the students and the topic on Community and Prevention-oriented population-focused practice: the foundation of specialization in Public health nursing. Discussion was on what public health nursing is, the core functions of public health which includes assessment, policy development and assurance. Categories of public health workforce competencies was discussed and also health services pyramid with the largest base being population-based health care services, Clinical preventive services, primary health care, secondary health care, tertiary health care and finally the benefits of public health nursing was discussed.

Day 2

25/06/2019

Work continued at the General ward today. Admission and discharge of patients was carried out. Administration of medications was also carried out and patients were given adequate care.
Health talk on Family planning by Egwela Clement was given to mothers and women who came for antenatal and postnatal clinic respectively, they were shown pictorial guides and models were also used to explain further the various method of family planning.
Due to the unavailability of adequate data on the population and logistics of the different settlement of the community we were yet to visit the community.
In the evening, there was group discussion and it was a continuation of the topic discussed yesterday on changes and continuation that has occurred in public health nursing and also Perspectives in Global healthcare. We discussed the topic with sub-topics on primary health care, nursing and global health, major global health organizations. We all discussed the topic, questions were asked and they were duly responded to.

Day 3

26/06/2019
The day started with a attendance for a Continuous Medical Education (CME). This is an in-service program to enhance the continuous learning of staffs in the health facility. The topic was on new drugs for Anti-Retroviral Therapy (ART).
I worked at the maternity unit of the department. There were women in labour and the newly delivered mothers. The mothers were taken care of, reassured and also the newly born were taken care of and immunized with BCG vaccine.
I accompanied one of the students, Katumba Lawrence who went with one of the ‘mothers’ a newly delivered mothers as they are called to the house for postpartum care, this is done in respect to their Domiciliary Midwifery. They plan to go see their selected mothers daily for seven days. We visited Nakilebe settlement where the mother resides, at the house, the student nurse measured the mother’s abdomen to get the level of involution. He also health educated the mother on the care of episiotomy site. Since the mother could not afford to carry out sitz bath, he decided to teach her a local method in which the mother gets warm water and adds salt, she bends over it exposing the suture site over it. Also, he health educated her to urinate in a bucket and discard for the first seven days and not to use the pit latrine. He also advised she should abstain from stressful positions and abstain from sexual intercourse for the first six weeks. He examined the neonate had and all conditions was normal.

Day 4
27/06/2019
Katumba Lawrence gave health talk on Breastfeeding to the women who came for antenatal clinic and postnatal clinic. The health education session comprised of teaching the women the correct positioning during breastfeeding, the various methods of breastfeeding and a model was used to demonstrate all of this.
I went with one of the students, Nalubega Shillah at Bunamweri village to meet the mother she is using for her domiciliary midwifery. During the visit, the health condition of the child was assessed, the vital signs of the baby was checked, the weight, respiratory rate, temperature and the baby was also assessed for jaundice, he was cleaned properly also. The mother’s vital signs were assessed to know her health condition. Health education on correct positioning for breastfeeding,good hygiene, cleaning of the umbilical cord with normal saline which can be made locally with cooled boiled water and salt.
At the maternity ward, I joined on the ward round and cases of incomplete abortion, gynaecological cases and women in labour were attended to. I also witnessed the delivery of a male neonate by Nansikombi Janet, one of the students. Observations made included the fact that babies are just cleaned with a clean cloth after delivery and they bathe them after 72 hours, this is being practiced to avoid the baby having hypothermia, the placenta was disposed off by the midwife at a designated place in the hospital. There were so much of improvisation of instruments, cleaning materials and many more. Also, the infection prevention practices of the hospital are very low.

Day 5
28/06/2019
We were visited by two lecturers in charge of the course the students are doing in the community, Madam Mariam and Mr Charles. Everyone gathered and there was a round table discussion on issues being faced so far by the students on various aspects. They discussed domicilliary midwifery, community health nursing and then research. The various challenges and what they had achieved so far were discussed about. Concerning the community health nursing which was of a major concern to us, the challenges were on the fact that they could not get secondary data from the District Health Officer to know the prevalent conditions being faced by different communities so they resorted to using the information gotten from the Village health teams and they were more of information had on number of houses that had good toilet facilities, the conditions of the source of water to the community and so on. Though, the information is not reliable enough they had decided to go visit a selected community and do community assessment to be able to get a diagnosis.
We also went with the lecturers as they planned to assess two students for domiciliary midwifery and then continue to Gombe where the remaining half of the students were doing their Community Health nursing and domiciliary midwifery too. We went to Bunamweri to assess Nalubega Shillah whose mother for domiciliary midwifery is on her third day and Grace whose mother was far away in Bweeza outside Mpigi district.
At Gombe, there was also a meeting with the students and they discussed how well things were going and also the challenges and their observations in the health centre.
Challenges and complain by the students includes;
-Location of the mothers to the health facility
-Newly delivered mothers are afraid of being followed home as they fear being stigmatized as HIV patients.
– -Fee charges by the Nurses and Midwives for goods and services they render which is unethical. The materials being sold such as gloves, syringes are Government owned and should be free
-Infection prevention is low.
Mr charles and Madam Mariam encouraged and counseled the students to be better nurses and redeem the image of the profession. They also told them to relate their concerns and even make reports of their experiences and submit it to the Senior Nursing officers.
The students went to Bunamweri community, met with the Chairman, Local Concil one in company of the Village Health Team (VHT). They got all necessary permissions went on to do a windshield survey. The following assessment were made
-Source of water is unclean, cow dung around the well,
-Homes checked- latrine was unhygienic and unsuitable
-4 wells in the community and they do not clean it well
-No secondary schools in the locality
-Most homes had coffee and banana plantation
-Bad roads during rainy season and tree cutting have been the norm which affects the properties of people during heavy rain storm.
-No health facility or pharmacy. Emergency cases will not be able to get adequate health care
-The roads to the stream are bad and bushy, children do not wear foot wear, they step into the water barefooted.
-Some houses do not have toilets and bathrooms
-Rain water left in buckets serve as breeding grounds for mosquitoes
With the above information, we decided to have another form of assessment through the use of questionnaires we will make out from the observations above.

The Senior Nursing Officers and some sisters from the health facility have been assigned to assess the students for domiciliary midwifery. They were followed to see the mothers they were taking care of postnatal. They carried out two basic procedures- care rendered to the mother and care and bathing of the new born which was done on the third day. I followed one of the students, Katumba Lawrence for his assessment. The senior nursing officer joined us and we went to the home of the mother and baby. They were both fine. Vital signs assessment was done for the mother, she was asked about how breastfeeding has been going, she was examined and also health educated on proper positioning of the baby during breastfeeding and also on post natal exercises. Her episiotomy site was checked , lochia checked and all was in good condition.
The baby’s vital sign was checked, she was examined for pallor, jaundice and she was fine. She then had her first bath after which cord care was carried out using Normal saline. The nursing sister scored the students as he carried out the various procedures and she commented and gave her observations. she told the student not to overexpose the baby next time during bath and she commended his efforts despite the fact that he was a male and he was bathing a baby for the first time.
After the assessment, we proceeded to go check a second mother at Maya, the baby was running fever and a medication was prescribed for him and the mother was reassured. The mother was also examined and she was doing fine.

Day 6
01/07/2019
It started with a health talk by one of the students, Nakkazi Olivier on Postnatal exercise to the expectant mothers that came for clinics. It was an interactive and demonstrative session.
I worked at the Out-patient Department of the health facility. There was orientation to the operations carried out in the clinic and the various sections of it. I was stationed at the Pharmacy department where we dispensed drugs to the clients that have been seen by the physician.
I also went with one of the students Egwela Clement at Kyasanku for domiciliary midwifery care. We went to see the mother and child, it was the second day of life of the neonate. Health education was done on breastfeeding and also care of the baby to ensure baby is not exposed to cold. She was also reminded to get ready the materials needed for the bathing of the baby the next day and feeding the baby was also emphasized as baby showed signs of dehydration. Also the environment and personal hygiene was assessed.

Day 7
02/07/2019
Posting continued at the Out-patient Department. Later, went to the community to visit one of the mothers whose baby is on the third day. The mother had prepared the baby for bath. The student, Egwela Clement was being assessed by one of the supervising nurse from the health facility. He first assessed the condition of the mother, then to the baby, checked for vital signs and then the baby was bathed. It was observed that the mother’s breasts were full and that she was not adequately breastfeeding. She was encouraged and healths educated to breastfeed well and ensure she is using the right positioning. She was also taught some post natal exercises and sitting positions that will help relief pain from the sutured episiotomy sites.
We also went to visit his second monitored client, she was doing well and child was fine. He had brought an Insecticide Treated Net for her and she was very happy for it because she had been bothered about her baby’s condition and she has been covering her up. The baby was assessed and all parameters were good.

Day 8
03/07/2019
The day started with plans for visiting the community for data collection. Questionnaires were ready for the data collection and by noon, we went to visit Bunamweri community in Mpigi district.
We attended the Continuous Medical Education and the topic was on Postnatal care services utillization by Dr Muhezi Alex. He said himself and his colleagues did a research on the topic and he is presenting based on the findings. He discussed the definitions of postnatal services and the reasons why it is not being utilized efficiently by postnatal women and the possible solutions
For the visit to Bunamweri Community, we went to see the Village Health Team, and they accompanied us as we sampled 50 households and we got all necessary information was on the questionnaire.We divided ourselves into two groups, a group went to one half of the village while the second group went to the other half of the village. Within the groups we paired ourselves and the pairing was done to ensure someone who understands the local language Buganda was with someone who does not for effective communication and teamwork. I was paired with Katumba Lawrence and we went to about 10 households.
We analyzed the data same day one after the other so we can move on to the next stage of prioritization and then planning.

Day 9

Session of Health talk

Session of Health talk


04/07/2019
The day started with health talk by Nalubega Shillah, the participant were pregnant women, nursing mothers and some also came with their partners. The health talk was centered on lochia changes after birth, she taught that the first five days bleeding of postpartum is a called lochia rubra which means a bright red bleeding is present, the 5th to the 9th day is called lochia serosa which is the combination of the blood with fluid and the stage is the lochia alba which extends from the 9th day till almost 6weeks. The mothers asked questions and they were duly responded to by Shillah and more explanation was given by the staff nurse present.
I visited a mother and her baby for domiciliary midwifery care with Egwela Clement. The condition of the mother and the baby were fine and she was encouraged to continue breastfeeding.
We continued with the analysis of the response from the questionnaire we received.

Day 10

At The Equator


05/07/2019
Attended a health talk by Mwitende Francine, she discussed Neonatal jaundice and it was an interactive session and questions from the mothers were answered
Visited a mother early for domiciliary midwifery care .
We went on a tour to see the Uganda Equator in Kayabwe. It was an interesting experience and excursion. The students from Gombe too were present and it was a joyful moment.
We had a meeting on prioritization of the diagnoses from the community data collection we did. We found out their strengths and weaknesses and drew out points. The points were classified into three which includes; Health Education on preventive measures for malaria, Interventions in the home to promote hand washing, hygiene and sanitation and finally on promoting the quality of water source by clearing the pathway that leads to the water source and then cleaning the spring
With the above, the VHT was consulted and we planned on when we can visit the community to carry out our proposed interventions.

Day 11
08/07/2019
There was a meeting with the senior nursing officer and the nurses in charge of various units in the health facilities this morning.
We went into the community after highlighting some of the area to focus on based on the data that were collected from the community. We also planned to inform and mobilize the villagers of the intended interventions we plan to carry out with their collaborations which includes making of a tippy tap, latrine covers. We also health educated them on the various preventive measures against malaria. . Afternoon we moved to the community after highlighting some of the area to focus on based on the data that were priory collected from the community. We went to the different homestead health educating them and telling them that there will be need for community participation to implement the intervention for the identified problem. The health education was focused on malaria
Some team mates also visited the source of water and they found out that the condition was not hygienic as there were clogs of algae and spirogyra growth which made the water source unsafe for domestic use. The surrounding of the spring was also bushy and not well taken care of.

Day 12
09/07/2019
There was health talk to women that came for antenatal and postnatal clinic by Nalukenge Sonita on the topic, Neonatal Sepsis.
We continued on the plan and analysis of the intended projects we want to implement in collaboration with the people of the community. We made enquiries on the resources that will be needed and how to get them and they were more of materials that will be gotten from and around the homes.

The team and some members of the household.

The team and some members of the household.

Day 13
10/07/2019

I gave an health talk to all the mothers who were present for antenatal clinic and post natal clinic on the topic Personal and environmental hygiene. I spoke English while one of the students, Katumba Lawrence translated in Buganda, their local language. It was an interesting session , the women responded to questions I asked and at the end of the session, they asked questions and it was well responded to.

At mid-day, we had a discussion on Gynaecology ,the topic was Vaginal discharges presented by Akwanya Innocent . We discussed the topic extensively and questions were answered.
We set out for the community at around 3pm, we were set to implement the tippy taps for hand washing and the latrine covers for prevention of communicable diseases. The Tippy Tap is a simple device for hand washing with running water. A container of 5 liter with a small hole near the cap is filled with water and tipped with a stick and rope tied through a hole in the cap. As only the soap is touched with the hands, the device is very hygienic. A gravel bed is used to soak away the water and prevent mosquitos. When the container is empty, the cap is unscrewed and the container is removed from the stick. The container is then filled again at a water pump, and reassembled. The pit-hole cover is made by nailing a log of about 50c.m on a flat wood a little bigger than the pit-hole for total covering
We got to the community and set out for one of the homes we have earlier sampled and they were aware of our coming. We got there and we asked for the necessary materials we needed to construct the tippy taps and latrine covers after explaining to them and showing them what we intend to do. We then set out to do the construction with their assistance. The tippy taps were made and latrine covers. The families were happy about this and they appreciated it . We also emphasized the importance and the benefits of the materials and how they can be maintained.

Day 14
11/07/2019
There was a health talk by Kwikirizi Grace on ‘Care of the exposed baby’.
Report writing and compilation of the community health service project commenced today and it was all a joint effort with input from everyone. The team leaders were myself and Lawrence. We were assisted by Saamson and Innocent.

CONCLUSION

It was an awesome experience on Community Health Nursing with the student from the Department of Nursing,  Makerere University, Kampala Uganda. I appreciate Global Exchange in Medicine the opportunity accorded to me to participate in this Exchange program. Gratitude also to the Department of Nursing, University of Ibadan for this privilege.

The experiences and lessons learned so far on Community health nursing and a bonus experience on domiciliary midwifery has made this exchange program a very worthwhile experience and a step in the right direction for my career in nursing. The hospitality shown by the supervisors and students all through my stay here was a notable one and I am very grateful to them all. Even when the food did not taste like my local food in Nigeria and had to go in search of pepper, they never relented to support. Adapting to the cold weather at the community and also taking of local food like Matooke, and so many other food ‘confused’ together like we usually say are all experiences that cannot be forgotten. The support shown in teaching and helping to translate the local languages during our visits to the community, going through the theoretical aspect of the course and the oneness shown where we reside by the students was impressive.  The Community health service project was a success and this was aided by the unity, love and hard work shown by the students.

This has been a wonderful experience and I hope many more students will be able to participate in Exchange programs on this platform.

I want to say thank you to my home school, Department of Nursing, University of Ibadan under the headship of Prof.Prisca O, Adejumo for the recommendation and support, the GEMx coordinator of the my institution Mrs. Ifeoluwa Kolawole, to Madam Faith Nawagi the GEMx coordinator Africa and to Madam Lydia Kabiri, the GEMx coordinator, Makerere University Kampala.

Thank you!

 

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