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Elelective Experience in Managment of Paediatric Emergencies and Neonatal Resuscitation at Arthur Davison Childrens Hospital in Ndola, Zambia

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Blog by Suubi Mariam, medical student from Mildmay Institute of Health Sciences, who has completed her elective in management of pediatrics emergencies and neonatal at Arthur Davison Children’s Hospital in Ndola, Zambia through GEMx.

On 20th July 2019, I set off from Entebbe, Uganda for Ndola, Zambia. Upon my arrival, I found Mr. Alex who showed me around, first to Arthur Davison high cost hospital on Lopiri street, then to Arthur Davison school of paediatrics and child health nursing before I went to Arthur Davison Childrens Hospital where I was going to be accommodated. He handed me over to the senior nursing students who I found in my room and were all glad to receive me. They all introduced themselves like and we became friends from that instant. It was an exhilarating moment for me that made all the anxiety and tension loosen which made me feel more comfortable.

TRAINING

I was given a brief history of when the hospital started and introduced to the staff who oriented me about the different departments. I joined fellow students to Arthur Davison school of pediatrics and child health nursing for the workshop that lasted for 4 days.

The workshop was about Emergency Triage, Assessment and Treatment(ETAT) and Neonatal Resuscitation.The major objectives of the workshop were to; Equip us with the uptodate knowledge about how to triage children and categorise them into those with emergency signs, priority signs and non urgent signs so that we are able to meet their needs as quick as possible and according the available resources. The ABCDE concept and how to intervene appropriately and proficiently. Appreciate the principles related to facilitating physiological transition at birth as a basis for understanding when to intervene.

HOSPITAL EXPERIENCE:

My hospital experience at ADCH started on 6th August 2019. Ms. Mwango Berrice picked me up from the hostels and took me to the hospital where she handed me over to Dr. Kikonde a medical intern. There was always a hand over meeting chaired by a senior doctor. In this meeting, doctors post call gave a report of the number of patients managed overnight, discussed interesting case and the challenges faced for about 15 minutes, thereafter, one medical topic of choice was discussed by the doctor scheduled on the time table. This helped me to refresh and learn more from the Doctors.

I spent the second week in Muchinga where I practiced fluid calculation for dehydrated children and those with severe acute malnutrition. I got a chance to refresh on the feeding and general management of malnourished children under the kind guidance and supervision of Dr. Daka, Dr. Nyanta, Dr. Machona, Dr. Nonde and the Sisters.

For the third week, I was in Kafue ward which is majorly surgical and ICU. Here, I was with Dr. Ngose when he was reviewing post-operative patients with conditions such as fractures, hernias, severe burns, AVSD, frozen abdomen. I also saw patients with CKD and nephrotic syndrome in the ICU.

FOOD

Unlike Uganda where a single meal comprises a variety of foods, here they prepare one type of food which is normally Nshima (maize mill) which is served for lunch and dinner and they don’t seem to be bothered about it. Nshima is served with any other type of sauce like beef, minced meat, chicken, tomato sauce, lepu, silver fish and others. However, the amount of served on the plate was shockingly small that I had to take water so that I don’t choke on the Nshima.

PEOPLE AND LANGUAGE.                                                                              

Zambians are very warm, receptive, generous and jovial people and they are aware of it. I was always received by infectious smiles wherever I went, from the airport to the local people, the students, at the hospital, the kitchen attendants, the Senior Medical Superintendent and even some of the patient attendants.

There are about 72 languages spoken in Zambia, but Bemba is the most commonly spoken. However, I could Identify a bit with Bemba because most of the words are like Luganda, Swahili and Runyankore hence to me it sounded like a mix of languages in one. On this note, I could perhaps pick a word or two when the doctors were clerking the patients and they never hesitated to interpret for me if I asked.

WEATHER.

I was unaware that Zambia experiences “snowless” winter seasons. The winter season is usually between June and late July which is I usually very cold. I was greatly challenged by the weather because I packed light summer clothes only. All thanks to my friends Kafunya, Miriam and Sarah who helped me with some warm clothes until when I did some shopping and they always checked on me to ensure that I am okay.

SOCIAL LIFE

My friends and I used to stroll around town for ice cream and shopping especially over the weekends. However, one Saturday very early in the morning, we set off for Kitwe with Miriam, Sarah, Kafunya, Eunice and Sandra for Mary’s Chilanga Mulilo, a famous traditional ceremony mainly and strictly organized by women where the bride’s family prepares all types of food and takes to the groom’s home as a sign of being welcome to the bride’s home. It was fun to witness how Nshiima was mingled by the bride as the aunt whispered words I never heard into the bride’s ear.

I will always be humbled and grateful to be a part of this great learning experience. I have achieved all my objectives from the training and hospital practicum. I appreciate the Global Educational Medical Exchange for the opportunity Ms. Faith Nawagi the African GEMx representative and Ms .Phiona Kinwa for the kind guidance throughout the process as far as documentation is concerned , my facilitators at the host school, Ms. Sibeso Kamwi, Mrs. Chitimbwa, Ms.Berrice Mwango, Ms.Chisenga and Ms. Michelle.

Thank you is not word enough to express my sincere gratitude to my school, Mildmay Institute of Health Sciences, Ms.Mudoola Janet the GEMx coordinator at my school and the team, my tutors for the support and facilitation. Lastly but not least I would like to thank Mr. and Mrs. Magezi for the mentorship and support. May the Lord bless you abundantly! NATOTELA LESA AMIPALE.

PATHOLOGY IN THE +250 (RWANDA)

Filed under: GEMx Regional Exchanges GEMx Sponsored Events GEMx Student Reflections

Blog by Job Magare, medical student from University of Nairobi School of Medicine, who has completed his elective in general anatomic pathology at the university of Rwanda College of Medicine and Health Science through GEMx.

It was just after a busy examination period that I found out that my application for an elective term in Rwanda had been accepted. Having never travelled to Rwanda, I didn’t know what to expect but I maintained an optimistic demeanor. This paid off and even exceeded my expectations. I arrived at the Kigali airport at around 0930 CAT and took a taxi to CHUK (Centre Hospitalier Universitaire de Kigali), my working station for the next 4 weeks.

MY TIME AT CHUK

I was warmly welcomed from the first day, quickly sorted my accommodation and was taken on an elaborate tour of the entire hospital by Dr. Marie Claire Ndayisaba (Consultant Pathologist). The laboratory works round the clock but for residents we are required to be present during the week days from 7am to 5pm. I was mostly attached to the Histopathology department. On a normal day, residents are responsible for: grossing of surgical tissue specimens, performing FNAC, conducting slide review sessions under the guidance of a Consultant Pathologist for both cytology and histology cases, do weekly presentations on pre-selected topics in the department. Present cases at the hospital tumour board meetings every Friday of the week and attend to ward and accidents and emergency consults. All these duties we clearly elaborated in a monthly rota prepared by the Chief resident.

ACHIEVEMENTS

I learnt how to stain and interpret cytology slides using Diff Quik. Back at UON we routinely stain using H&E and PAP stains. I was also fortunate to go to the T.B unit and learn how to stain using Auramine stain. This even afforded me the opportunity to use fluorescent microscopy that I had not yet experienced before. During my elective term, we collectively came across two rare diagnoses (Sex cord tumor with annular tubules and Brain Hydatid cyst disease) that may end up as case reports in the foreseeable future. This, I feel will help me keep in contact with both my Rwandan and Tanzanian colleagues, laying ground for future collaborations in both scientific writing and case consultations. Other than CHUK, I got to visit the pathology laboratories in the University teaching Hospital of Butare (CHUB), King Faisal Hospital and Kanombe Military Hospital.

LEISURE

Every Friday afternoon, government employees are encouraged to engage in physical exercise. I got my weekly dose of physical exercise playing basketball at Cercle Spotify. I also visited the famous Kigali arena where there was an all-star basketball exhibition game to close the local basketball season. During the weekends, I spent most of my time touring the city under the guidance of my hosts. What I noticed is that Kigali is the true definition of a clean and safe city in Africa. I got the chance to try various foods Kigali had to offer but the Fish and skewered meat dishes were my favorite. My visit to the ethnographic museum in Butare also remains memorable.

SUMMARY

Rwanda is a very enjoyable place to be. The people are very welcoming and endearing. Getting to learn about their culture and customs was also very exciting and helped me gel with my new-found community. Overall, I feel the elective term was very beneficial from both a professional and academic growth standpoint and I will recommend these exchanges to learn how pathology is practiced in other countries. I would like to thank GEMx-COPECSA for the wonderful opportunity they afforded me by fully sponsoring this elective term at CHUK. Lastly, I would like to thank Dr. Annette Uwineza (my Host) who warmly welcomed me and ensured that I had a comfortable 4 weeks stay and the Chairperson, University of Nairobi, (Pathology department), Professor Angela Amayo, for approving of my elective term in Rwanda.

 

Gaining More knowledge in History Taking, Examination and Different Diagnostic Approaches Used in Obstetrics and Gynaecology: My Elective Experience at Kwame Nkrumah University in Ghana Kumasi

Filed under: GEMx Regional Exchanges GEMx Student Reflections

New blog by Ssekindi Faizo, a final year student of medicine and surgery from Makerere university Kampala-Uganda.

I was graced with the opportunity to do my electives from Kwame Nkurumah University (KNUST) on merit after interviews. I was the only student from Makerere university to this university, however, other students went to Kenya, Rwanda. Thanks to GEMx which sponsored the four weeks exchange program from 6th June-8th July.

TRAVELS

Dr. Isaac Ssinabulya booked for me a ticket to and from Ghana via Ethiopia airline, by then my passport and yellow fever card were ready, when I received my ticket, I was so excited because now I was sure I was to travel by plane for my first time. Traveling to Ghana is visa-free. Two cars filled with my friends escorted me to Entebbe international airport from Makerere University at mid-night. My flight was at 2:45 am from Entebbe, from Entebbe we went to Ethiopia and from Ethiopia, we got another plane to Accra-Ghana and from Accra, I got another plain to Kumasi then I got an uber to my hostel. I reached Kumasi at 6:20 pm mind you Ghana is 3 hours behind Ugandan time, meaning it was 9:20 pm in Uganda.

ARRIVAL AT HOSTEL

 When I arrived at the hostel, I called my Ugandan friend who studies from KNUST and he made life easy from me, he contacted the exchange officer at the facility. He led me to my room which was already organized. We had a lot of jazz with my Ugandan friend to brief me about the place. For accommodation, I paid at the end of my stay to the facility manager 25 cedis per day. Each room had a fan and refrigerator because the country is generally hot, my neighbours were also exchange program students from the USA and my roommate was from German also for the exchange program. 

FOOD

 
The available places of food were restaurants around the hostel which had a variety of food and snacks, I didn’t get chance to try most of their foods because am not a fan of chili, most of the source had a lot of pepper which was so hot, and this was a limitation to my exploration. I tried banku and okra soup once, but it was also hot I dint give it a second try, most of the days I would have rice and chicken which cost 8 cedis for lunch and I would also eat the same for supper with some watermelon.

THE PEOPLE AND LANGUAGE

I can possibly say, Ghana has the friendliest people I have ever met, not that I haven’t met all of them, but it gave me that ill-feeling that I don’t usually act in the same way when other visiting international students come to Makerere, I mean, who stops and asks if you are lost and then after directs you, where you desired to go. The only challenge though was the language, Ghanaians speak a variety of local languages, mostly Twi and also their English was a little fast, lecturers who crack jokes in the local language ad I would just look at others laughing while not knowing why they were doing so.

LEISURE

Most of the evenings I used to go for evening walks around Kumasi walking a distance of over 5 km in any random direction where I saw a variety of local natives and businesses, at times I would meet very many people during market days and I would do window shopping asking for price sand converting to Ugandan shillings, some items where so cheap compared to Uganda and I would buy them, like the ones below

Some nights we would go to club as international students for karaoke where we would ask for songs of our choices and we would sing, I can’t forget the night I asked for a Ugandan some called “neera neera” by moze radio and the entire club was so excited to listen to music from Uganda, they asked me the meaning of the song and I told it meant “we do it again and again”

I also used to go to KFC for chicken with my friends because I found it a bit cheap and the place was so cool, the package I always used to buy was 21 cedis with 2 pieces of chicken, chips and a small soft drink, other packages were also available but at affordable prices.

I used to visit Baba Yara sports stadium whenever the Kumasi team was playing because am fun of soccer and my weekends would be so cool with Kotoko football club winning all the time. However, I dint visit recreational places like other international students including cape cost and national game parks because it wasn’t catered for in my budget.

TRANSPORT

Well if you are from Kampala and you are used to bodaboda guys, in Kumasi I dint see any, the commonest means of transport by university students was uber which would always be available at all times, this was a bit expensive for someone who is used to using bodaboda guys who rarely go beyond a dollar yet in Ghana the cheapest uber would be like 2.5 dollars. Taxis also existed and they were a bit cheap but so challenging to use because of not knowing the local language and the places.

THE WEATHER AND CLIMATE

Ghana has two seasons just like in Uganda; the rainy season and the dry season, by the time I reached Ghana it was a dry season, but the temperatures were so high compared to Uganda, for this reason, all rooms and places had fans and refrigerators plus air conditioners. I was informed that even during the rainy season it’s also too cold and someone needs a sweater or jumper all day including a heavy blanket, unlike the period I was there whereby even fans would work all night and no need of a blanket to cover yourself.

LESSONS LEARNT

Gained more knowledge in history taking, examination and different diagnostic approaches used in obstetrics and gynaecology. Mothers may not present with obvious signs and symptoms of illnesses due to physiological changes occurring during pregnancy. This has helped me to know that no single symptom in a mother should be ignored because it may be the only symptom present for an undergoing illness however insignificant it may seem to be. Learnt about the different diseases affecting mothers in pregnancy in Ghana. Urinary tract infections and sexual transmitted being more prevalent, as opposed to Uganda where malaria in pregnancy being more common. Learnt the coordinated care of a mother from the time of conception. The mother is under the care of an obstetrician who sees her during ANC to child birth and follow-up during the PNC. This practice has improved the quality of life among mothers in kumasi as pregnancy related complications are diagnosed early and proper management is given. I improved on my communication skill with peers, doctors, nursing staff and consultants I improved on my clinical skills in assessing for the fitness of a mother for normal delivery. I got chance to experience medical practice in a better resourced setting.

In summary, it was such a great time and experience for me in Ghana, I again would like to thank MakCHS for having allowed me to go there and GEMx for the support, my supervisors, my tutors from the department of OBGYN for this wonderful moment and finally the people of Ghana for the hospitality, the love and support.

Understanding HIV in Harare: My Internal Medicine Elective at University of Zimbabwe

Filed under: GEMx Regional Exchanges GEMx Student Reflections

By Polibu Amos, a final year medical student of the Kwame Nkrumah University of Science and Technology (KNUST), Ghana. 

The period between 5th year and final year is always a time every medical student in my school looks forward to, as it the time for medical electives. So, I was excited when my school allowed me to apply for an elective through the GEMx program. With the help of my school coordinator Madam Charlotte, Ms. Faith (GEMx African representative), The applications for an elective in internal medicine at the University of Zimbabwe for me and my colleague went on smoothly. Once our applications were accepted Mrs. Gandara (electives coordinator, UZ) facilitated the rest of the process for us.

We left Ghana on Tuesday, 3rd of September 2019 at 9 pm, we had 2 stops at Nairobi and Lusaka and by 11 am the following day, we arrived at Harare. The weather was sunny but with a harmattan-like breeze. Thanks to Mrs. Gandara, a driver was already waiting for us at the airport. The driver Mr. Gift Tsikirayi, helped us a lot by taking us to our accommodation and all the places we needed to do our registration. It took us several days to get used to the cold weather in Harare, especially at night. We registered with the Medical and Dental Practitioners’ Council of Zimbabwe (MDPCZ) on Thursday and started the clinical work on Friday at the Parirenyatwa hospital.

CLINICAL EXPERIENCE

My colleague and I were assigned to different wards and joined the medical students there. I noticed a couple of differences in the hospital and medical school system in Zimbabwe and Ghana. In Zimbabwe, a team is assigned to a ward and they see all kinds of medical cases as opposed to Ghana where the doctors are in teams but not assigned to a ward. I was introduced to the doctors and medical students in the ward and they all warmly received me and made me feel included. We had wards rounds every day, where we get to present cases and we used to have a tutorial session with the residents (registrars as they are called in Zimbabwe) after rounds. I made a lot of friends who made my rotation interesting, they also helped in translating what patients said in Shona (the local dialect) for me.

As a student who is yet to do my senior clerkship rotation in medicine, this elective gave an overview of everything I will be doing and more. On the daily ward rounds, I saw cases I hadn’t seen before. This elective has also sparked my interest in internal medicine especially HIV and its associated opportunistic infections. As we saw patients with HIV only a daily basis, I read so much about HIV and also had several discussions on the topic.

Our clinical rotation came to a halt after our second as all the doctors declared a nationwide strike after the leader of junior doctors got abducted . Unfortunately, for us the strike wasn’t called off even after he was found, hence we did no clinical work for the rest of our stay in Zimbabwe. Some of the doctors, however, organized a few tutorial sessions for us. I learned about their health system, their culture and the country in general from the students.

 

SOCIAL

Socially, I made a lot of new friends from Zimbabwe, Uganda, Lesotho, and Sweden. We had a lot of fun together with other elective students from different countries. We visited the national art gallery where we saw a lot of great artwork. We were educated on who the artistes were and what inspired the paintings and artwork. We also attended monthly socializing event dubbed “hustlers’ market” where people display indigenous products for sale coupled with live performances. We visited the Mukuvisi woodlands where we had an amazing experience. We went on a horse safari and it was so exciting. I also ate the local dish sadza which is the staple food in Zimbabwe.

CHALLENGES

The major challenge we had in Harare is was getting cash from the banks and ATMs, other than that and the strike, we had a great experience in Harare. Don’t forget to get in touch with your embassy as Ms. Bernice from Ghana embassy made our stay wonderful, we left for Ghana on the 28th of September 2019.

In conclusion, I would like to thank GEMx for allowing me to have this experience. Special thanks to Ms. Faith (GEMx Africa), Mrs. Rachel Gandara, Madam Charlotte, doctors of ward C4 at the Parirenyatwa hospital and Ms. Bernice (Ghana embassy).

Journey To A Land Of A Thousands Hills And Unspeakable Beauty Rwanda!

Filed under: GEMx Regional Exchanges GEMx Student Reflections

New blog by Francis Zerd MD, resident in Anatomical Pathology, Muhimbili University of Health and Allied Sciences (Tanzania) who has complete his elective in Pathology at the University of Rwanda College of Medicine and Health Sciences (Rwanada) through GEMx Electives.

It was a busy morning at our department, when an announcement was made in the departmental meeting about an elective opportunity that we could apply for. I was excited and as soon as the meeting ended I approached my senior and asked for more information. She explained very well what needed to be done, and when I saw Rwanda as one of the options for the elective, instantaneously my brain recalled all the astonishing tales of its beauty from people who have visited, without hesitation right away I started the application process and completed successfully.

Life went back to our normal busy schedules, and a few weeks later an email notification popped up in my phone, it was an email from GEMx that I have been accepted to do my elective in Rwanda. Excitement began, all preparations went smoothly with great support from my home academic staffs. On the evening of September 8th, my journey started at Julius Nyerere International Airport, Terminal 3, Dar es Salaam, with great customer care! I took RwandAir and could see the smiles and kindness in the air hostess faces and started feeling home as soon as I boarded the plane ready to depart to start my elective at University teaching Hospital of Kigali.

I spent an amazing 8 weeks at University Teaching Hospital of Kigali, had a fantastic experience, both in terms of histopathology, the hospital community, the country and its people as a whole. Hopefully this post will give some insight into my elective, and why the experience was so beneficial.

The University teaching hospital of Kigali/CHUK is the largest hospital located in District of Nyarugenge at KN 4 Ave, Kigali City. It is also the biggest referral hospital of the country with a capacity of 519 beds. CHUK provides quality healthcare to the population, training, clinical research and technical support to district hospitals. 

The hospital was built in 1918 and in 1928, it worked as health center and upgraded to a hospital in 1965. From April 1994 to 1996, the CHK served as a health center, a district hospital and as a referral hospital as well. In 2000, with the enactment of law Nr. 41/2000 of 7/12/2000 on the establishment and organization of the University Teaching Hospital “CHUK”, the CHK became a public institution with legal personality known as “University Teaching Hospital of Kigali”

The pathology department at CHUK has been active since 2013, and it has 5 pathologists currently. The normal day at the department starts at 7.15am with a meeting mainly in Tuesdays and Thursdays followed by the day’s allocated duty. Each activity is pre planned in a monthly time table which includes pathologists, residents and laboratory scientists. The main activity for residents are grossing, fine needle aspiration clinics and reporting to pathologists slide findings, usually done using a multi headed microscope where most slide review sessions are done. 

As is customary, the residents at CHUK work on rotation in different hospitals with pathology services in Rwanda. They attend to each for a period of one to three months and there is other opportunity to attend different trainings. I was privileged to visit and work in some of the hospitals for at least a day and privileged to attend one of the trainings. University of Rwanda, Huye campus, Southern province with other GEMx resident from Kenya, Dr Job, Kacyiru hospital which forensic pathology is practiced, King Faisal Hospital, one of the largest referral and the first hospital in Rwanda, University of Rwanda, College of Sciences and Technology (CST) during Molecular Pathology (micro satellite instability and short tandem repeats analysis) training, a 3 days training provided by Promega, Rwanda Military Hospital and Rwanda Biomedical Center (RBC) department, where all molecular tests are done.

I had an excellent elective at CHUK and would thoroughly recommend it to anyone who would like to get involved in a friendly, welcoming hospital in a developing country, where they will work hard but be well supported during their stay. In terms of a country for your elective, Rwanda is a great place where you will meet wonderfully friendly people and can do some exciting activities, with several must-do attractions.

In summary, I had a fantastic experience professionally and yet I also enjoyed immersing myself in the life and culture of the local area, leading to a thoroughly rewarding time.

I would like to thank GEMx-COPECSA for the wonderful opportunity and funding support for my visit and entire stay at CHUK, Ms Phionah for always providing guidance whenever needed, Dr Annette for being there whenever needed and making my stay very comfortable. Special thank the hospital staff especially the laboratory staff and fellow residents for their unspeakable cooperation they have showed me during my stay.

I would also like to thank MUHAS pathology department for giving me permission to attend this life changing opportunity and lastly I give my special thanks to my supervisor and mentor, Dr Edda Vuhahula for introducing me to this program, her encouragement and endless support whenever needed, may you all be overwhelmingly blessed.

Pediatric Nursing in the Warm Heart of Africa, Malawi

Filed under: GEMx Regional Exchanges GEMx Student Reflections

New blog by Lubega Martin medical student form Makerere University College of Health Sciences (Uganda) who has completed his elective in Pediatric Emergency Medicine to Kamuzu College of Nursing (Malawi) through GEMx. 

In this modern digital world, it’s not rare that someone can abruptly begin smiling with their smartphone!!! That was the mood after I read an email notification from our international coordinator that my request to have a pediatric exchange experience at Kamuzu College of Nursing had been accepted. The next few weeks were filled with excitement and preparation to visit Malawi and get a feel of the pediatric nursing experience that side. Remember, Malawi is one of the African countries were most pediatric protocols like ETAT were developed, this too geared up the excitement. Surely my anticipation was high, wouldn’t wait to fly to and stay and have study experience in the warm heart of Africa. Unlike many who have their international exchange visits in the course of their training, partly triggered by the hunt for grades, our exchange visit was a month after we had finished our final university exams. All the learning was triggered by a passion for the field, not grades at all. This gave us a chance to learn and explore several things at our own pace.

The people of Malawi

Malawians call their country the warm heart of Africa and surely this one month was enough to testify this. The welcome from the airport and interaction all through the thirty days we spent on their land, just calls one to go back again and again. I come from one of the Bantu tribes in Uganda, Malawians are not different from the Bantu in Uganda. It was hard for many college students to realize that I was not a fellow Malawian, many who met me on compound or ward would rush to talk to me in their local language, we indeed resemble them!!! The historical Bantu migration is real!!! This also made it somehow easy for us to learn a few words in their Chichewa language since some words were like the words of some of our local languages in Uganda.

Learning experience

The one-month exchange period was to help us enhance clinical skills in the management of pediatric emergencies. As a prerequisite, we sought authorization from the Nurses and midwives council of Malawi. This required us to sit for interviews based on pediatric nursing only after which we were indexed and allowed to carry on our learning experience in the various pediatric wards at Kamuzu central hospital in Lilongwe.

Based on our objectives, we were attached to four wards: children’s’ OPD, children’s ward, Neonatal intensive care unit (NICU) and children’s high dependency unit. While at the hospital, we were taught and supervised by nursing instructors from KCN, ward in charges, fellow students, interns, and consultants. 

We successfully finished our four weeks of pediatric emergency experience in good health with multiple skills in pediatric emergency management, use of continuous positive airway pressure (CPAP) in management of a child with respiratory distress, application of ETAT protocols in the daily management of pediatric emergencies.

Accommodation and Meals 

We were accommodated within the college at the students’ hostels and we had most of our meals from a private supplier who comes at the college’s cafeteria. Although the meals are almost like those in Uganda, the way they are prepared and served is different and worth exploring.

 

Recreation 

We participated in the 40th anniversary of the college which took place on 12th August 2019 at the main campus in Lilongwe. The college was celebrating 40 years of service, caring and teaching the nursing profession in Malawi. It was such good timing!!!

 

It all got sweet when one of the Ugandan biomedical engineers and leaders of the Ugandan community in Malawi: Mrs. Lydia learned that a pair of Ugandan students were at the hospital for clinical experience. She invited us to her home where we met over twenty countrymen and women, had lunch and dinner, had a social warm-up, connected, shared contacts and many have inspired us to go back and practice from Malawi. 

How unfair it would be if we left Malawi without visiting the historical Lake Malawi, we spent one of our last Saturdays at Nkhotakota, one of the shores of Lake Malawi, about 200km west of Lilongwe. We participated in sports like football, volleyball, and netball with the college team as the versed a local team at the lakeshore.

Thank you, Makerere University, for this partnership with GEMx, thank you GEMx, thank you Kamuzu College of Nursing, thank you for the University of Malawi for this great opportunity. Malawi, I will soon come back.

Ndokuda, Zimbabwe. I Love You, Zimbabwe.

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Blog by Purity Wambui Nyaikamba medical student at Jomo Kenyatta University of Agriculture and Technology who has completed her elective at the University of Zimbabwe of Health Sciences through GEMx.

I set foot in Mashonaland on the 14th of August and the thought of being away from home for a little over a month was soon over ridden by the glistening sunset and the warm welcome I received. I settled in very fast and 19th August came by faster than a fleeting sunset and it was time to start my elective. I didn’t know how it would go or what to expect, but I dived into it with an open mind, ready to make it worth my while.

The School of Pharmacy received me with open arms and made me feel at home. I was given a brief induction on how everything would go for the next four weeks by Mr. Louis Gadaga, who would then be my supervisor. He also introduced me to the relevant individuals who would ensure a smooth run throughout the period.

Parirenyatwa Group of Hospitals (PGH)

I was at PGH for three weeks where I met incredible individuals at every corner who readily took me in and allowed me to be part of them over the next couple of weeks. I was attached at different areas of the Pharmacy and each department was a great learning opportunity, largely because the people were more than willing to take me through the process and satisfy the curios cat in me.

The different departments I visited included; Main Pharmacy, Casualty Pharmacy, Theatre Pharmacy, Manufacturing Pharmacy, Out-Patient Department, Maternity and Family Planning Pharmacy, Opportunistic Infection Pharmacy and Drug Stores. I was also lucky enough to attend a meeting with the Board of Directors of the PGH, an eye opening experience that clearly showcased the essence of Multidisciplinary teamwork within the healthcare system.

In addition to this, I also attended the inaugural Customer Service Week event that was initiated by the Ministry of Health and Child Care in a bid to promote proper customer service to patients and relatives. The Minister, who presided over this event, encouraged the inclusion of a customer care module in the curriculum designed to train healthcare professionals to ensure helpful and friendly cadres.

Ministry of Health

I joined the Supply Chain team comprising of individuals from the Ministry of Health, Directorate of Pharmaceutical Services among other key stakeholders in their bi-annual Quantification exercise that primarily involved forecasting and supply planning of medical products.

Pharmanova

This is a privately owned pharmaceutical Industry that focuses on the manufacture of generic products largely for domestic use with exportation to nearby countries such as Malawi and Zambia. I was taken through most of the Pharmaceutical procedures from the standard operating procedures of the various departments to quality assurance and control.

University of Zimbabwe Clinical Research Centre

This is where they conduct most of the major clinical trials in the hospital where the role of a Pharmacist in Research was clearly demonstrated and elaborated.

Medicines and Control Authority of Zimbabwe

I was taken through the various departments that ensure the regulation of Medicines in the entire country. They also regulate the practice by providing a premise licence and person’s licence to anyone intending to deal with medicines in the country. The departments visited include: Licensing and enforcement, Chemistry department, Pharmacovigilance and Clinical Trials, Medical products and devices, Microbiological department and evaluation and registration department.

Zimbabwe Pharmaceutical Students Association

I was humbled and honoured to be part of their White Coat Ceremony of the 1st year Pharmacy Students at University of Zimbabwe. I also had the opportunity to join them during their orientation.

Pharmacists Council of Zimbabwe

I was able to gather insight from the Registrar in regard to the regulation of Pharmacists and appreciated the current working structure that is being revised to include a student’s registrar where the universities report to the council in regard to their progress in school. The council contributes in maintaining discipline among the Pharmacists together with the Medicines and Control Authority of Zimbabwe seeing that they have the power to suspend licenses.

Pharmaceutical Society of Zimbabwe

I was honoured to meet the current President of the society. In addition to that I also attended a Continuous Education session organized by the society where I got to interact with some of the members.

Beyond the Elective

I planned a trip down to Victoria Falls and the Falls were a sight to behold, it was everything I expected and more. I seasoned this with an adrenaline filled Zip line activity and later a relaxed cruise on the Zambezi River. When it came to food, adapting wasn’t difficult seeing that Zimbabwean food is almost similar to East African food. “Sadza”, a bit softer than what we would otherwise call “Ugali” in Kenya, became an everyday affair and I totally loved it. As I went about my commitments, Zimbabweans impressed me day in, day out and what particularly stood out is their big hearts and warm personalities. I interacted with strangers who were quick to help and made lifelong friends from a simple hello.

This experience has enriched my life in every aspect and I am sincerely grateful to GEMx. Thank you for giving me the opportunity to see life and Pharmacy Practice through a different lens.

Poisons, Primary Care and Pediatric Pharmacy Rotation at Pari Hospital The “very informative learning voyage”of Karl Alex Mogacea

Filed under: GEMx Regional Exchanges GEMx Student Reflections

New blog by Karl Alex Mogaka medical student at Kenyatta University School of Health Science who has completed his elective at the Pari Hospital (Zimbabwe) 

A phone call from Dr. Kahiga, the GEMx coordinator changed a rather dull afternoon. I must have been excited to learn that my school had spotted me for an exchange program. Apart from having to travel to a different country, experience a new culture, just having to fly made it more exciting.

Zimbabwe was the destination at the University of Zimbabwe. The exchange was to incorporate clinical pharmacy skills and knowledge for a month-long period. I arrived in Harare well into the afternoon, allowing enough time for Mr. Pozi, our driver to pick us up at the Harare International airport. The city was beautiful in the sky. ‘I will love the stay here,’ I murmured to my colleague Beryl, with whom I would take the elective, as the Ethiopian flight touched down minutes past noon.

Mr. Pozi easily recognized soon us after we checked out and drove as straight to the host institution where Mrs. Rachael, the elective officer, was waiting for us to provide further directions for the elective. Beryl and I spent the rest of the afternoon settling down in the institution. The weeks ahead will be engaging, but we up for it. The dean school of pharmacy, Prof. Tagwireyi was instrumental in drawing a Rota for the four weeks we would spend at his school. We spent the first week at the Drug and Toxicology Information Services (DATIS). At DATIS we were able to gather knowledge on handling of poising cases. Poisoning can be chemical, biological or physical. Most of the cases handled at DATIS were referrals from the rest of the country. It was interesting to get hands-on skills in managing poisoning cases especially ones deemed hard to handle by primary and secondary care facilities.

Mr. Gadaga, the director DATIS was very instrumental in showing us what needs to be done at every step of a referred case. For him, response time and determination of the actual poison were key to helping the patient. He also engaged in running of key tests at the specialized lab that was relevant for the poisoning case at hand. The culmination of this knowledge and skills gathering was a case presentation to the panel of DATIS pre-registration pharmacists.

The weekend was here, and being sabbath keepers, we found a local church for spiritual nourishment. It was home away from home. Mr. Nkobu, a church elder at City Church made sure we came back for the rest of the sabbaths.

Week two was yet another learning voyage. This time we hit the road 345 km west of the capital Harare to a district hospital. Themed as ‘Rural attachment,’ the week-long attachment was aimed at imparting knowledge on health structuring at primary care establishments. We made a visit to a level 3 facility as well as several level 1 facilities. Here, we appreciated the role of a pharmacist at the primary care level. Again, this exposure was very informative since such does not exist in my home country. However, the dominance of alternative medicine at rural establishments did catch my attention. The hospitals admitted that they allowed patients to seek non- conventional interventions for some “difficult cases.”

Week 3 needed some conventional medicine. We regrouped with my colleague. It was evident, the one week apart had us both missing each other. After all, we were the only thing close to home for each other. Prof. Tagwireyi organized for us to join the ward rounds at the Pari Hospital. A rotation at the hematology unit was quite a piece. We got to learn much about blood cancers. It was very fulfilling to suggest some of the management protocols for blood cancers. This case of stage 3 Hodgkin’s lymphoma complicated with anemia had the clinician, Dr. Banaman, seek the input of a pharmacist oncologist.

We also joined pediatric rounds. Here prof. Natoo was quite a bill. Her mastery of the pediatric protocols was just admirable. I loved her involvement with the caregivers of the children in the management plan of the cases.

Gynecology was another stop. We also rotated for four days as the other two. Much of the cases we came across mirrored what we had already encountered at home. However, it was interesting to note the differential management protocols for some of those conditions. The consulting gynecologist was quite patient with us for not knowing the given concepts. But again, we were open to learning as well. We wrapped it up with a rotation at opportunistic infection (OI) clinic which also doubled up as a research center for HIV/AIDS regimens for the Zimbabwe populace. I agree it was much informative.

We would not have done justice to the stay in Zimbabwe had we not visited the iconic Victoria Falls. Three days before our travel back home, we made a maiden journey to Victoria Falls, 600km west of the capital. The site of the falls is just breathtaking. We were both in awe all the while as we let the site take our breaths away. The excursion was iced up with a zip-lining experience. The learning experience at the Pari Hospital might have been fatiguing, but this experience was a deserved nerve-calmer. Soon, a flight would touch down at Nairobi JKIA. “Home at last,” I sighed as I checked out of immigrations. The new friends including one Mr. Van would be ones to keep in touch all through.

 

Njera, castles, and compassion: just three of the wonderful things I experienced at Mekelle University

Filed under: GEMx Regional Exchanges GEMx Student Reflections

By: DAPHNE KIBANDA , 5TH YEAR STUDENT (MBChB) at MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY

Day out at Emperor Yohannes’ castle with Kidus(L) myself(C) and Henry(R)
The thought of an exchange study program away from my home university and country was as excitingas it was scary. With the GEMx website and with help from Ms. Faith Nawagi, the GEMx Africa representative, the application process went smoother than I expected. Within less than a month, my colleague and I were ready to travel to Mekelle University, College of Health Sciences, in Ethiopia. Ms. Sheila and Ms. Angela Nakato from the International Relations Office were also key in our travel preparations.

At about 5 a.m. on Saturday 13th July, we landed in Addis Ababa. Our flight to Mekelle was at 7.15a.m so we had some time to lounge. This was both our first time in Ethiopia and at Bole International Airport and so locating the different terminals took some bit of time. It can’t go without mention that every single person we interacted with at the airport, both passengers and employees, was very welcoming and helpful. Unfortunately, the flight was delayed for over 3 hours due to unfavourable weather at our destination and since we had no way of communicating with our hosts yet, we missed our transport from the airport. Nevertheless, we were very well received into Mekelle by the staff, students and even the locals.

With some of the C11 class members after a management session.

We joined the C11 group on the Internal medicine rotation as soon as we arrived and made very many friends. The students always readily helped with translation during clerkships as we were not conversant with the local language. I particularly remember an incident where I went to the ward to clerk a patient and all the members of my group were not around. I walked through the ward looking for a familiar face in vain. Later, I met a student from another group and when I explained myself to her, she was more than willing to help. They made the environment very comfortable and conducive for the one month we spent with them. Every day on the ward at Ayder Comprehensive Specialised Hospital was a new learning experience. Although the prevalent conditions didn’t differ much from those in Uganda, we were able to compare National treatment guidelines for common communicable conditions in both countries. We also participated in ward rounds, bedside teachings, and management sessions and were able to share and expand our knowledge further.

Outside of class, we appreciated the diverse culture of the people in Mekelle. We learned several words and phrases in Tigrinya, the native language, and by the end of one week, “Selam” which is a word for “hello” came much more easily to me. They have a unique taste in food, and I fell in love with “Njera”.

Njera and stew
I could not go an entire day without this traditional dish and to date, Ethiopian food is one of my favourites and Ethiopian restaurants in Uganda are a go-to. We also witnessed a traditional Ethiopian wedding and I must say the African culture is rich and full of diversity. We managed to visit Emperor Yohannes’ castle in Mekelle city, which serves as a museum currently and had some of our new friends show us around the rest of the city.

Our stay in Mekelle came to an end after exactly 4 weeks and on 9th August, we had to travel back home. We said a couple of emotional and even tearful goodbyes and promised to keep in touch with our friends. It was an educative, humbling, inspirational and fun experience for me, and I look forward to more of these opportunities with GEMx. Thank you so much for this amazing opportunity.

From Kampala to Rwinkwavu: Experiencing Rwanda and its Health Systems

Filed under: GEMx Regional Exchanges GEMx Student Reflections

By: Tinka George William, Makerere University School of Medicine to University of Rwanda College of Medicine and Health Sciences 

Tinka and other cohorts at the bus park

At Nyabugogo Bus Park

On the 27th day of July, at about 7:15 pm, I left my room and headed to the Trinity bus parking lot. By 8:45 pm Marvin, Martin, Emmanuel, and Edward had come. Our other friend Reagan was not able to get to the bus by its departure time and he joined us the following day.

This began the longest bus trip I have taken to date. I went listening to George Carlin’s “When will Jesus bring the pork chops?’’ I have listened to it before, so the jokes were a little less funny since I already expected what he was going to say. At some points, I slept off, then woke up to the bus hitting a hump or something of the sort. By about 4 or 5 am the following morning, we were at the Uganda-Rwanda border of Katuna. The process of crossing over was a little fast yet, somehow, a little slow. It was so cold and my hands were freezing!

After the immigration bureaucracies, we sped off into the land of a thousand hills. For a moment we were confused about the actual time. The weather outside looked like 8 am (Ugandan time). My phone, however, was showing 7 am! We later found out that Rwanda is in a different time zone from Uganda. It was 7 am (Rwandan time).

Students at Rwinkawavu

Kigali, Rwanda was quite different from Uganda. It appeared, without a doubt, cleaner (I deliberately went on looking out for plastic bag litter but I hardly saw any). Their water channels weren’t clogged (like a good number of ours back home), we were being driven on the right side of the road (unlike the left for Uganda), there were indeed many hills, and their city looked relatively less busy than ours. The rest were the same Ugandan stuff. Same house architecture (especially in the urban areas), same people lifestyles: clothing, general activities, and the same weather. By 9 am we were in Nyabugogo parking station.

We took our first major bunch of snaps in Rwanda there. Those of us that hadn’t exchanged our Uganda shillings to Rwanda Francs also did so from there. I was surprised (and a little embarrassed) that the Rwandan currency has more weight than the Ugandan currency. Our Rwandan contact, Mr. Nepo found us shortly thereafter and took us for our very first Rwandan meal- breakfast. It was enjoyable. Mr. Nepo was a nice host. He told us of many interesting stories about Rwanda. We received a pleasant welcome.

Students on motorcycles

 

Another apparent difference between Uganda and Rwanda that I noticed as we broke our fast was that the ‘’boda-bodas’’ (motorcycle taxis) there seemed to much more strictly follow the rule of carrying only one passenger. They all had helmets for the passengers. This is unlike what takes place back home, and it is good as it reduces road accident-related trauma cases and deaths.

Next was the drive to Rwinkwavu in the Eastern province of the country. We were driven through Kigali. I must say that I had always imagined Kigali to be a small city (since it is in a small country!). Oh boy, I have always been wrong. Kigali is a relatively large city.

The drive to Rwinkwavu was rather long. We had been told it would take about two hours. I can’t say I am sure how long it took because I slept off along the way. You see, one other difference between Uganda and Rwanda was that the roads in Rwanda never seemed to have humps or potholes. It is no wonder therefore that the journey to Rwinkwavu was so smooth that we almost all slept off at some point. Not to mention that we were also tired by then.

All journeys come to an end, and so did this one. By 1 pm, we had arrived and settled into the secluded home of Partners in Health (Inshuti Mu Buzima), our hosts in Rwinkwavu. The place was a nice, quiet, and peaceful countryside settlement on one side of a hill overlooking a far way valley. It had most of the amenities to make our two weeks stay enjoyable.

 

The following two weeks: 

Students after University of Rwanda walk and talk session grouped outside building

The following day, we were joined by twenty students from the University of Rwanda. We were to study the Social and Community Medicine (SOCOMED) course with them. By the end of it all, they were to become our very tight lifelong friends.

The following two weeks saw us having lectures, presentations, community visits, a screening session, a trip around Kigali, and a mine visit. The lecturers always made the sessions fun. Our sitting arrangement in a U-shape setup with students facing each other made the lectures more of interactive sessions and less of the traditional boring classes. The different topics we had over the two week period included; an introduction to the SOCOMED program, the Rwanda Health system, the SWOT analysis technique, communication skills, the community health program in Rwanda, leadership, social determinants of health, palliative care, research, health equity, disease prevention & health promotion, traditional medicine, quality improvement and team building, etc. We got to listen from the Executive Director of PIH in Rwanda- Dr. Joel Mubiligi, the Chief Human resource officer of PIH, the Head of informatics, the head of medical education and training and many others. This ensured that we got to learn knowledge and experiences from more than the medical perspective. We got career guidance, leadership skills, and strategies and many other attributes.For presentations, we were divided into different groups. We were sometimes then given group and individual assignments to present to the class. My assignment was to present about SDG 9 using Sao Tome and Principe as a case study.

 

Students huddled around community health worker

With the Community Health Worker, Mr. Emmanueri (2nd from the left)

 

 

We had several community visits. We visited community health workers first. We were surprised at how much the Rwanda Health Care system is relying on them. I realized they play a relatively bigger role in Rwanda than in my country (Uganda). They are provided with more resources also. For example, they must fill in the Health Information Management System (HMIS) Reports, they have clinical guidelines and treat malaria, pneumonia, diarrhea, cough & flu, and do health screening. They also seemed to have a relatively more advanced precision of clinical examination skills than their counterparts in my country.

students at screening sessions
  They could identify jaundice, anemia, cyanosis, edema, dehydration, the different signs of respiratory distress, etc. They also had the necessary tools like Mid-Upper arm circumference (MUAC) tapes,  thermometers, timers, drugs, etc. Another community visit we had was to a chronically ill patient. Here I learned that Rwanda, unlike my home country, has a working health insurance scheme called ‘Mutuelle de Santé,’ and people pay subscription fees according to their economic groupings (ubudehe) which ensures that the poor ones pay relatively less than the rich ones to ensure equity. During this community visit, we passed by Akagera national park. It was an amazing view.

We also appreciated that in rural Rwanda, people live together in distinct villages called umudugudu.’ This is unlike in Uganda where it is not uncommon to find people living in scattered homes away from everyone else. The umudugudus in Rwanda make it easier to get services closer to the people since they live in groups.

We had two non-communicable diseases screening sessions in Ndego. My role during the session was to measure random blood glucose levels using a glucometer.

Students in front of statue in kigali

 

Trip to Kigali. 

The first week ended earlier, on a public holiday called Umuganura (Friday).  It is a Thanksgiving Day. The day Rwandans celebrate their ever-bountiful harvest. We used the opportunity to have the following three days for ourselves in Kigali. In Kigali, we put up at the PIH house. We found Dr. Akiiki there with a good number of other people from different nationalities and career fields. We were nicely welcomed and had a good time there. By the time the three days of the long weekend were up, we had been to; the Kigali convention center, the genocide memorial center, Amahoro Stadium, Kigali airport, Kigali arena, Inema art gallery, downtown Kigali, etc.

The Rwinkwavu mines.

To appreciate different aspects of occupational health and safety, we on the second last day of our placement, went and visited the Rwinkwavu Wolfram mining site. We visited their offices where we were first told about the different health measures they have in place. We then proceeded to the mine itself and went a good number of meters down the mine tunnel. It was dark! I am kidding. There was light, but it was cold down there. Apart from appreciating the different health risks miners are exposed to, it was an exciting experience.

On the evening before the last day, PIH organized for us a farewell banquet. We had some good time with everyone and got our certificates. On the last day, the 9th day of August, we had the last presentations and sessions. We then prepared ourselves and were driven to Nyabugogo Bus Park where the whole story had started from. The bus we boarded departed at 5:45 pm and arrived in Kampala at 8 am. The story that had started with a long bus journey ended with an even longer bus journey.

 

 

 

 

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