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Eric and Aline’s Elective Exchange to Uganda

Filed under: GEMx Regional Exchanges GEMx Student Reflections

NIZEYIMANA Eric and AKAYEZU Aline, 5th Year Medical Student from University of Rwanda. We completed GEMx Exchange on Family Medicine at Makerere University 

INTRODUCTION

Eric and Aline on the way toward Makarere University for Elective

Our hearts were very full the first time we received an email confirming that we were chosen to be a part of this amazing elective. The Family Medicine is not yet initiated in Rwanda health system. This was a golden opportunity to learn more and bring back a package of knowledge to share with our colleagues.

It is the dream of every Medical student to do an exchange outside of their usual setting so that they work in another healthcare system to learn and have a different experience that’s why I can’t hesitate to say this was our turn to realize our own.

 WELCOME TO MAKERERE UNIVERSITY  

Eric, Ms. Phionah and Aline at Makerere University

 

 

 

 

 

 

 

 

Our journey took 718 km2 from Kigali-Rwanda to Tororo-Uganda training center in Uganda, where the training about family medicine took place.  Arriving at MAKERERE University, we met  Ms. Phionah, the international students’ coordinator at this university. With warm welcomes, she gave an explanation about the exchange and introduced us to the rest of the team.

It was a great experience to travel the long distance on a bus. It was the first time, we took the time to observe the Uganda country, environment, and appreciate how well it is.

ACCOMMODATION

During our elective, we stayed at the Crystal Hotel. The hotel was close to the hospital. It was safe, comfortable and calm when you were studying. They had all kind of foods and it was delicious.

 

Eric and Aline at Crystal Hotel

The hotel was close to the hospital. It was safe, comfortable and calm when you were studying. They had all kind of foods and it was delicious.

ORIENTATION AT TORORO DISTRICT HOSPITAL   

Our 2nd day in Uganda was for the introduction to family medicine and orientation at training center, Tororo district hospital. We met with Dr. George Welishe and Dr. Okuuny Vincent, the senior consultants in Family Medicine who greeted us with warm welcomes. We had a  tour of whole hospital, introducing us to all departments of the hospital. We visited patient hospitalization wards, general theater, labor and administration offices &staff, emergency ward, HIV patients department and antenatal and family planning services. Everyone was happy to host us and we were also happy to be among them and excited to be in different healthcare settings. It is a large district hospital, which has many departments.

Eric, Aline, Dr.Okuuny and Dr.Maria (intern from Italy)

The daily schedule was made by morning staff meeting which was followed by ward round, theater, or labor or other department visit in the hospital.

1.Morning staff meeting

Every morning we have presentations on the topics that we were given on schedule. The topics that was chosen by trainers according to two conditions: 1.The most common cases in medical career related to the family medicine in which they think that will be useful to us along our internship and medical career. The second condition is the cases that are mostly found in Uganda healthcare setting especially in Tororo district hospital.  . Under consultant supervision, we had discussions in which they taught us on both our presented topic and presentation skills.

 2. Hospitalization Patients, Internal Medicine wards round

Aline, Eric, with Family Medicine Post-graduates Dr.francais and Dr.Christine on right and word round team on right

We had a daily attendance of ward round with the rest of the team which was made by family medicine consultants, family medicine postgraduates, nurses, and other medical doctors. I gained more experience in patient clerking and presenting during this activity and from this I understood that medicine is the same all over the world because it was very exciting to be able to make a diagnosis for a patient from another setting and participate in patient management by the same knowledge.

This ward round also emphasized on bedside teaching according to the case as long as also that most of the attendants were students. This was occupying a big part of our exchange where we learned much as found more cases that we didn’t see in our healthcare setting. Here I can list sickle cell diseases associated with malaria which is more common in the pediatric setting here, sepsis secondary to septic abortion, HIV and TB were more frequent in general wards especially in young people. We have seen some special cases like Asthma attack, dog bite, and pregnancy on sickle cell disease.

We learned from all the cases and were involved in their management process. We can confirm without hesitation that we are confident in managing patients.

3. Gynecology and obstetrics department

Eric using fetoscope

This was another interesting and productive service that we rotated in. The main objective was to know what services they deliver and get experiences in them as a future clinician and the objective was achieved. The major services that we provided were TORCH screening (toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex/HIV)  and counseling on results, Prevention of Mother to child transmission of HIV, Family planning, Immunization, Examination of pregnant mothers to assess for any complications that might arise during pregnancy.

We experienced also on the procedures done included vaginal examination, head to toe examination focusing on the abdomen for the pregnant mothers to check for the fetal heart rate through the use of the fetoscope. The LEOPOLD Maneuver like palpation of the abdomen to check for the lie, presentation, and engagement of the fetus. Not only this but also in labor they taught us, conducting spontaneous vaginal delivery, neonatal examination, and resuscitation for the newborn with fetal distress and other complications.

We enjoyed the rotation since we could learn more from each other through discussion of patient’s condition and be sharing an idea with the rest of the team which was mostly made by midwives.

4. HIV patients clinic

Eric (left) and Aline *right in HIV clinic consultation

In all the time we work at Tororo district hospital, we rotated also in HIV clinic. The services provided were history taking and physical examination for HIV patients to access drugs adherence, new HIV diagnosed patients counseling, viral load monitoring and shifting of patients from drugs line to another.

Of course, as a referral hospital, the number of attendants was big, At the time we helped around 80 patients and surprisingly the 2/3 was women and reason was that of the polygamy culture in Tororo community which makes the prevalence of  the HIV infection to rise in women than in men

BENEFITS

We met friends and we made friendships, we learned much from each other and we made strong networks. Finally, we had fun.

SKILLS AND KNOWLEDGE GAINED

Together with family Medicine post-graduates having fun

Four weeks at the Tororo district hospital for family medicine was productive beyond our expectations. Along all time, rotating in different departments we gain many skills in Family Medicine, the way it works and the services it provides. As long this specialty is not yet initiated in Rwanda health system, I hope to share with my colleague medical students, and other health professionals this skills or others who will be interested in family medicine. In addition to this, we gained also more about presentation skills.

The knowledge gained includes patient history taking and physical exams to list differential diagnosis, appropriate patients management, conducting a normal lobar and c/section delivery. Antenatal care includes Leopard maneuver and use of fetoscope and management and follows up of HIV patients.

CHALLENGES

All the time we spent in this amazing elective, the main challenge we meet is the languages. After arriving in the Tororo town, we have found that they are more local different languages spoken in the community which account more than 5 which also is related to different tribes with a different culture. This has brought some limitation during patients caring especially in history taking and management, explanation on medication taking and patient diseases education.  So to handle this, we used to organize a team during ward round such that there is one health care provider who speaks both English and one of the local languages so that he/she will translate.

The other challenge we met was to work in low facilities hospital where some materials were not available especially medications and septic environment, which was a barrier in patients treated and also we thought it could be a source of spreading diseases among hospitalized patients. To handle this will need multidisciplinary involvement including Minister of Health in Uganda and other health institutes but we did some advocacy about the problems.

LESSON I LEARNT

Dr. Cecilia and Enrica (left)

Of course, learning is a continuous process, but in this elective, the first thing I learned is that every healthcare professional can deliver the health services to the community according to his or her level.

The 2nd lesson is that working in limited health facilities can be challenging in the medical career while you were delivering health services but it’s good and important to adapt and use the few we have effectively to help the patients

The 3rd lesson, learning from each other and sharing information and respecting each other is most important in terms of both helping patients and teaching during health care services delivered.

The 4th lesson is As a student I got a lot about professionalism at work during this elective at Tororo district Hospitals. The healthcare professionals were having a positive attitude of medics towards students and their work made me enjoy my stay and practice as a student there.

ACKNOWLEDGE

We want to express my sincere gratitude thanks to the executive committee of GEMx represented by Carol Noel Russo, GEMx Regional representative in Africa Faith Nawagi, the host coordinator at MAKERERE UNIVESITY Mrs. Phionah and my university of Rwanda GEMx coordinator, Dr. UWINEZA Annette and everyone who contributed to making this elective happen

It great pleasure to thank all confident you hard toward us and offer this opportunity in which we learned much skills and experience and all your commitment and effort you made to create a way so that the elective on Family Medicine at Makerere university lead to success.

Special are destined to our trainers, senior consultants in Family Medicine at TORORO District hospital, Dr. Welishe George and Dr. Okuuny Vicent with the rest of the team who showed strong commitment to teach us as much they can, we really highly appreciate their motivation and strategies they use during training  health professionals and I wish they could spread that attitude among the rest healthcare professional trainers around the world.

 

 

GEOFFREY MPHATSO KWABENA WIAFE

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post including excerpts of a report by Geoffrey Mphatso Kwabena Wiafe, who recently completed an Ophthalmology elective at the University of Nairobi, Nairobi, Kenya –a GEMx facilitated College of Ophthalmology of Eastern Central and Southern Africa  (COECSA) Regional Exchange. 

The University of Nairobi is located in Nairobi, the capital and largest city of Kenya. The University of Nairobi started postgraduate training in Ophthalmology in 1978 under the Department of Surgery. Ophthalmology became an independent department in 1990. The department has trained over 159 Ophthalmologists from 1978 to date. The teaching eye clinic is housed by Kenyatta National Hospital and there are various sub specialties including Glaucoma, Oculoplastics, Vitreo-retinal and Anterior Segment which I benefited from during my one month elective period.

Geoffrey examining a patient using an indirect ophthalmoscope

I am very fortunate to be one of the students from my University to be involved in the GEMx Elective program. Being a part of the exchange has further boosted my interest in sub specialties like Oculoplastics and Vitreo-retinal surgery.

The first half of my elective period was primarily spent at the sub specialty clinics, where I had the opportunity to see a wide variety of interesting cases including Aponeurotic Ptosis, Congenital Glaucoma, Choroidal Detachments and Central Serous Chorioretinopathy (CSC). I was also given the opportunity to take patient’s history, examination, and work up. Then, I presented some of the cases to the consultants and they gave me a better understanding of the diagnosis and how to manage those conditions.

I also had the privilege of learning and participating in the screening of Retinopathy of Prematurity, which made me more confident in not only the use of an indirect ophthalmoscope but examining neonates.

The last week of the elective took place in the clinic and operating theatre. Spending time in the operating theatre, I was able to observe for the first time the surgical repair of a retinal detachment. I also observed Laser surgery (photocoagulation) and vitrectomy surgery.

During my elective period I was also fortunate enough to have attended a few lectures on approach to management of Glaucoma and Glaucoma surgery and complications by Professor Damji. I also gained more insight on interpretation of visual fields and optic coherence tomography findings.

Dr Teddy, Dr Muchai (VR Surgeon) and Geoffrey

In general, the elective as a whole was a great experience. Both the consultants and residents were always ready to assist in whatever way possible to make our stay in Nairobi a memorable one. Towards the end of the elective I was certainly more confident and had a much better understanding of the management of several conditions.

Ophthalmology is an extremely rewarding and dynamic field of medicine. This elective gave me the opportunity to acquire more theoretical and practical examination skills. I look forward to using these skills during the rest of my training and career as an ophthalmologist.

 

 

 

ACKNOWLEDGEMENTS

Global Educational Exchange in Medicine and Health Professions for the elective opportunity.

College of Ophthalmology of Eastern, central and Southern Africa for funding and organizing.

Ophthalmology Department, University of Nairobi for providing multiple learning opportunities.

Kenyatta National Hospital for providing multiple learning opportunities.

Ophthalmology Department, Mbarara University of Science and Technology for allowing me to undertake this elective.

GEMx Exchange to UKZN

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Nancy Binsari and Tendwa George, 5th year medical students from Kenyatta University who’ve completed an exchange at University of KwaZulu Natal (UKZN).

Tendwa and Nancy smiling

Tendwa and Nancy ready to go on their exchange

Introduction:

This elective is an opportunity to find out more about yourself and what you want to do in the future. The elective allows you to explore a particular area of medicine or something different, such as research or teaching.

The two of us were selected to participate in the elective term through the GEMx program. Our home school, Kenyatta University was enrolled into this program through the regional platform in Africa for the first time in 2017. Being the pilot group, we were privileged to get a chance to participate in our elective at our host school UKZN (University of KwaZulu Natal) at Wentworth Hospital. Two of our other colleagues also participated in the GEMx program, and were sent to Makerere University in Kampala, Uganda to the cardiology centre.

We had 4 weeks of rotation in the department of Family Medicine in Wentworth hospital, one of the hospitals for UKZN clinical rotations. Family medicine, formerly “Family Practice” is a specialty devoted to providing comprehensive health care for patients. Family medicine is a three-dimensional specialty, incorporating knowledge, skill and process.

Dr. Mergan Naidoo, the head of department of family medicine at UKZN was our contact person and took us through the orientation at the hospital as well as our clinical rotations in our various sections. With the aid of a well-put logbook, Dr. Mergan Naidoo took us through our objectives for the clinical rotations and also guided us on a quality improvement project that we undertook during our stay at the hospital.

4 people standing and smiling at the Department of Family Medicine

Tendwa, Nancy, Dr. Naidoo and Kenneth at the Department of Family Medicine

Week 1: Out Patient Department (OPD)

Our first week was in the outpatient department (OPD) which is divided into the chronic and acute sections. In the acute section, we clerked patients and presented to the senior doctor in charge, Dr. Oyebola who guided us and corrected us accordingly. We had an opportunity to familiarize ourselves with the South African guidelines on management of common conditions of patients in the OPD. We were able to experience a variety of conditions and were tasked to identify or at least make out the differential diagnosis of the presenting complaints.

Of the patients seen, a majority suffered respiratory diseases with TB and community acquired pneumonia leading. We also noted that the country had a large burden of HIV and it was therefore not a surprise that it was in the background in most of the TB infections. We were provided with masks to prevent acquisition of TB in patients. Other conditions we encountered in the OPD were hemorrhoids, gastroenteritis just to mention a few.

Week 2: Accident and Emergency  

Nancy and Tendwa standing in front of Accident/Emergency Department

Nancy and Tendwa outside the accident and emergency department.

The second week of our elective term was at the Accident and Emergency department. This was under the supervision of many doctors. Our task here was again to see patients and clerks, suggest investigations and come up with a management plan. We would then present this to the doctor on call as well as the intern doctor for approval of our approach and advice on what we missed out on. This turned out as a very good way of learning as sometimes they pointed out that we have the theoretical knowledge but need to put more practice into applying it to the patient and seeing them as a whole. We were trained to act like investigators and see beyond what the patient is saying. It was quite interesting because no matter how busy the floor got, the doctor’s would never rush us both in clerkship and in presenting to them. We got really good insight on what it means to be part of a health team and experienced what role we had as doctors.

 

Week 3: Acute Admission Ward

During our third week we rotated in the acute admissions ward. This is where all acutely ill patients admitted from Accident and Emergency department are transferred for high care and monitoring till they are stable enough to be discharged or transferred to other medical facility or surgical wards. It is during this rotation that we familiarized ourselves with the protocols and guidelines of South Africa for the management of acutely ill patients during the acute phase.

Week 4: HIV Clinic

We spent our final week in Wentworth hospital was spent in the HIV clinic. Here, we learnt under the supervision of Dr. Ryan, we saw newly diagnosed patients as well as follow ups and got to experience first-hand the countries’ way of combating the high levels of HIV infection in the area.

A thorough examination of the patient was also well covered to examine symptoms the patient brought up as well as anything they would have missed e.g. skin rashes or mouth lesions. The consultation would end with the patient understanding all the information being presented and patients were asked to come back for another visit. We had to update them with a full summary of what was discussed in terms of patient health and progression or regression of HIV.

Tendwa and Nancy have masks on their faces

Tendwa and Nancy at the HIV clinic

Challenges:

One of the challenges was the language barrier. It was difficult to communicate with some patients who could only express themselves fully in Xhosa or Zulu. To combat this challenge, the doctors and nurses went out of their way to translate whenever possible and give us English speaking patients to clerk.

Acknowledgment:

1) We would like to thank Dr. Titus Kahiga for his exemplary role in making our exchange possible. He conducted regular meetings with us, guided us every step of the way, and took great measures to ensure we gain the most out of the experience. He acted as a link between us students, the university and the GEMx program. We are not sure that if we were under anyone else our exchange would have even been possible.

2) We would also like to extend our gratitude to Dr. Faith Nawagi. She was always present to respond to questions and concerns right from the first day we began the journey. She was always efficient in communication channels and would reply to emails within a very short time. This helped us with our planning and preparations. We are positive that the program will see greater heights with her commitment and passion for the students.

3) We extend our hearty gratitude to Professor Mergan Naidoo. The professor provided very good mentorship right from the planning phase to the end of our exchange. He also made time for regular interactions to address any concerns we may have had. We would also like to extend our gratitude to Mr.Ifukho, Mr. Vincent and the projects team in Kenyatta University as well as Ms. Anitha from UKZN. They were quite helpful in the processing of required documents both for visa applications and for exchange purposes.

4) We would like to thank the individuals who stood out in our elective term. These individuals managed to take time for us students and gave us an exceptional learning experience.  The staff’s enthusiasm and warmth remains entrenched in our memories as well as their motivation to providing us with a good amount of knowledge. These people include Dr. Ayubola, Dr. David, Dr. Daniels, Dr. Mbaiza, and Dr. Ryan.

5) Our sincere gratitude to the office of the Dean at Kenyatta University school of Medicine and our Dean Prof. Agina for ensuring we had all we required during our stay at KZN, as well as selecting the two of us to represent the school for the elective program at UKZN, South Africa.

6) Lastly, we thank the nursing staff as well as the interns who helped us settle in each department and allowed us the opportunity to help wherever we could.

An Ophthalmology Post-Graduate Exchange Experience in Kenya

Filed under: GEMx Post-Graduate Exchanges GEMx Regional Exchanges GEMx Student Reflections Uncategorized

Post by Dr. Vrunaben Patel, a 3rd year MMed Ophthalmology resident from University of Zambia, who recently completed a GEMx Regional Exchange at the COECSA Institution,  Lighthouse for Christ Eye Centre, Mombasa Island, Kenya

doctor in front of care center

In front of Lighthouse for Christ  Eye Centre, Mombasa Island, Kenya

After all the pre-trip emails and detail fixing I finally sat on my flight to Mombasa, the full moon shining bright right outside my seat window. I was received at the airport by a friendly Lighthouse member of staff (got to read my name off a placard). Clean, convenient and safe housing was provided within the eye centre grounds.

THE EYE CENTRE EXPERIENCE

Day one at Lighthouse I met both the consultant ophthalmologists based there. I was shown around the whole centre by the medical director and introduced to all the staff. First word I learnt in Swahili was ‘karibu’=’welcome’ as I was greeted warmly by everyone, including patients I was introduced to. During my elective, I spent most of my time seeing patients in the general clinic as well as the cornea and paediatric clinic. Interesting cases I got to discuss with the consultants included persistent diabetic clinically significant macular oedema, neovasular age related macular degeneration, high myopia in toddler, solar macular burns, branch/central retinal vein occlusions, ocular toxoplasmosis, amblyopia, recurrent corneal erosions, corneal graft complications and viral illness related uveitis.

 

Doctor performing and eye examination on an adult patient

Examining a patient in general clinic

Doctor in scrubs performing surgery

Performing eyelid graft surgery

Had a few clinical meetings as well, some cases discussed were central serous chorioretinopathy, retinitis pigmentosa, oculocardiac reflex, and driver examination. My elective period included two weeks of screening patients and surgeries with visiting paediatric and corneal specialists. I got a chance to observe some penetrating keratoplasty surgeries, Descemets Stripping Endothelial keratoplasty and phacoemulsification; a totally new experience for me. Surgeries I did included 7 small incision cataract surgeries, 2 conjunctival growth excision biopsies, 1 pterygium excision and auto graft, 1 intravitreal injection, eyelid full thickness skin graft, anterior vitrectomy, examination under anaesthesia, and suturing corneal laceration/graft. I also did some dry and cycloplegic refraction using a phoropter for the first time.

plate with local cuisine

Local meal- ugaali and leafy vegetable

THE MOMBASA EXPERIENCE

Within walking distance of the eye centre lays the town centre of Mombasa Island. Stalls, supermarkets, places of worship all accessed easily nearby. Mostly I would be accompanied by a colleague from the eye centre while sometimes I was able to take walks around the town by myself and went to some local attractions like Fort Jesus. I also got to visit the public beaches on the mainland Mombasa and shopping malls. I was able to appreciate some similarities with Zambian culture- the matatus (mini buses) used for longer distances; ugaali (Nshima) and muchicha (leafy vegetable) as the staple meal. Other foods commonly found were cassava chips, dates, cashew nuts, mabuyu, and fresh coconut water.

OVERALL EXPERIENCE

Practice at Lighthouse was just like an extension of the work environment from Zambia though I missed having fellow registrars to interact with most of the time. The staff had different levels and exposure to ophthalmology training and so I had a good learning and teaching exchange. It was a minimum-stress environment on most days. I am sincerely grateful to the staff at Lighthouse for an enlightening and happy experience during my elective. I am also thankful to the GEMx team and my school for making this trip possible. Experience, be it that of oneself or of another, is definitely the best teacher and that is what this elective was for me.

A Regional Exchange at the University of Malawi College of Medicine

Filed under: GEMx Regional Exchanges GEMx Student Reflections

a smiling student

Post by John Baptist Ssenyondwa
GEMx exchange student from Makerere University School of Medicine 

John standing outside of the Queen Elizabeth Hostipal

My first day at Queen Elizabeth
Hospital

Medical school without a clinical rotation outside the teaching hospital environment of one’s training is not comprehensive enough. Through elective rotations, medics are exposed to the different experiences that come with working in a different setting from one’s training facility. I was one of the students that got the opportunity to take part in the GEMx Electives program this year. It was last semester for me and not only was I looking forward to completing medical school but also engaging in a clinical rotation for the weary holiday prior to internship. I had tried to apply for several programs that I could enroll in before I started internship but in all in vain.

As I walked through the busy schedules of school, the call for applications by GEMx Electives came to my notice and so came the interest to apply to take part. I had always wanted to travel as a student to a different medical school for an exchange program that would contribute to building my future career as a doctor. I immediately logged into my new GEMx account to find out the available universities for elective applications. I also found out that I was under the GEMx- South to South program which included University of Witwatersrand in South Africa;  College Medicine in Malawi, Makerere University and University of Rwanda. The days passed by and three weeks later on, I received the good news that my application had been accepted for the elective rotation at Malawi University College of Medicine. Filled with joy, I shared my good news with friends who were happy for me.

Malawi is divided into the central, northern and southern regions with 28 districts. The college of medicine is located in Blantyre, which is found in the southern region of Malawi. Having been established in 1992, it is the only medical school in the country with four undergraduate courses offered which include the five-year-long Bachelor of Medicine and Surgery (MBBS), and the four-year-long programs of Bachelor of Medical Laboratory Sciences (BMLS), Bachelor of Physiotherapy (Hon) and Bachelor of Pharmacy (Hon). For a greater portion most of my rotation, the College was on holiday and therefore I had appropriate contact time with the senior lecturers however limited interaction with the other students.

surgery being performed

Assisting surgical theater at Mercy James Centre for Paediatric Surgery and Intensive Care

The first official day of my elective found me at Queen Elizabeth Central Hospital in the Surgical Annex for the handover meeting held daily. Queen Elizabeth Central Hospital is the largest government tertiary unit and main teaching hospital for the College of Medicine. The hospital handles the referrals from the districts surrounding Blantyre. I was oriented through the facility ends and corners so that I could get my bearings well thereafter. I was introduced to the head of department, Surgery and each individual on the team I was joining in paediatric surgery. I rotated through paediatric surgery for first three weeks and one week at Beit Cure International Hospital.

Cure Malawi is a 58 bed teaching specialized in treating orthopedic needs of children and adults opened in 2002. The hospital also has special expertise in total hip and knee replacement surgery, making it one of the few places where this surgery is available in Sub-Saharan Africa. The hospital treats a wide range of orthopedic conditions including clubfoot, burn contractures, osteomyelitis, and other acquired or congenital conditions. In addition, CURE Malawi also provides physiotherapy and chiropractic services.

Table of Metrics

Table I. The cases observed and assisted in Paediatric Surgery rotation at the MJC theatre

 

Table of Metrics

Table II. The different surgeries participated in at Beit Cure International Hospital

While at Queen Elizabeth Central Hospital, I attended the handover meeting first before heading out for the day’s work each day. At these sessions, a 24 hour recap of the cases handled by the department was held and these cases discussed by the resident doctors together with the respective surgical teams of General Surgery, paediatric and orthopedic surgery.

Ward rounds were conducted daily by a senior consultant and residents on the different wards. The wards included: Paediatric Surgical Ward at the Mercy James Center; Chatinkha Neonatal Unit; Paediatric Nursery Ward; Paediatric Oncology Ward.  At the ward rounds, I was able to see several of the common conditions in paediatric surgery most of which I hadn’t seen during my school rotation. Additionally, we were able to discuss the conditions with the consultants and learn the approach to managing the ailments.

While in paediatric surgery, I was able to attend 3 ward rounds in a week. At the ward rounds, I was able to see several of the common conditions in paediatric surgery most of which I hadn’t seen during my school rotation. Additionally, we were able to discuss the conditions with the consultants and learn the approach to managing the ailments.

The OPD [Out Patient Department] ran every Monday afternoon after the rounds. While at the clinic I participated in eliciting history from the patients, examining and discussing with the consultants the different cases. This was a special learning experience as we saw several patients with a variety of conditions and therefore I always had various conditions to study. I had assignments to do every clinic and this facilitated my learning throughout the rotation. It was exciting to be in theatre and take part in the management of patients. I worked in theatre on Tuesday till Thursday for about seven hours each day.

surgery being performed

Assisting through the operations at Beit Cure Hospital

The rotation at Cure hospital was one week during which I rotated through the OPD clinic, theater and the wards. The OPD clinic also ran on Monday the entire day. I attended one clinic day of which we saw 30 patients with various orthopedic conditions. I was well facilitated by Dr. Lubega Nicholas, an orthopedic surgeon at cure who always discussed and ensured I followed through the activities at the facility.

I also attended teaching seminars at Cure hospital with the resident orthopedic students. Much as the cases discussed at these seminars were beyond my scope, I was able to learn the basic concepts on how to diagnose and know who to refer to. I learned the basic surgical skills employed generally in the field of surgery. I also took part in the general surgical management of the patients admitted at Cure, assisting in the various operations at the facility.

natural waterfall and pools

At Dziwe Lankhalamba Waterfall

While in Blantyre, I toured several beautiful places around the town during the weekends which also rejuvenated me throughout the rotation. I hiked Mulanje Mountain the highest peak in Malawi and visited several other sites like Mandala historical site among others. I met so many people and made quite a number of friends both within the medical field and other fields.

During my stay in Blantyre, I was able to work in a different environment with warm people eager and committed to improving the health of their patients. Despite the fact that the setting was much similar to my training hospital, I was able to achieve the objectives of my rotation.

I was able to develop and build my confidence in proper approach to pediatric surgical cases. My diagnostic acumen depending on history taking from the patients without need to depend on newer imaging diagnostic modalities was greatly improved. I was trained by highly qualified surgeons in the basic surgical skills and technique employed in the operation theatre which is a lifelong skill obtained.

group of young people

With new friends

The rotation greatly supplemented my prior curricular clinical rotation in which some concepts and topics had been unsatisfactorily taught. I was able to deeply appreciate and understand some of the topics clearly through the ward round discussions with my supervisors and mentors. Throughout the rotation, I had ample time to read up the cases I saw on the ward and in theater. I was also able to identify the deficiencies associated with our African health systems and how these impact on the health of our patients. I met different individuals practicing in the medical field and made friends throughout my rotation and stay in Blantyre. It was great interacting and socializing with people from all over the world but with similar goals and interests. I was able to share several ideas and experiences with my new friends and establish career building relationships.

 

GEMx Elective Reflections: Exchange From Makerere University College Of Health Sciences To Kenyatta University School Of Health Sciences

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Wasukira Bugosera Sulaiman, Bachelor of Medicine and Bachelor of Surgery student at Makerere University CHS (Uganda), who went on a GEMx regional exchange to Kenyatta University School Of Health Sciences (Kenya)

GEMx student at medical camp

Medical camp at Huruma Children’s home

The first clinical year at Makerere University College of Health Sciences is always climaxed by doing a clinical placement in a field that a student is interested in and done from places of their own choice. Well, this was my opportune moment to hunt and grab a site and an opportunity to do my placement in a very resourceful fun and skill- impacting environment for one month (4th July – 4th August).

In just the same time, a rare and perhaps a first time opportunity presented itself in which a call for students interested in undertaking exchange electives through the GEMx exchange system was put up.

Application and Vetting

Another selfie of exchange students
Having been an ambitious highly motivated and open-minded medical student ever looking around for opportunities and trying out on each of them, I went ahead to initiate the application for the GEMx elective exchanges through the GEMx web based system. Application was through the international office and was consequently followed by an interview, which I presume to have just excelled in and followed by being successfully nominated to undertake an exchange elective at Kenyatta University School of Health Sciences, through the GEMx- MEPI partnership. This was with two other classmates: Namingira Simon Peter and Barigye Aston.

The rest of the process involved obtaining a couple of documents as required by the host University. I was amazed by the way the GEMx web system eased the whole process of document submission and with the fact that I could actually store these documents for another application in the future. At the end of the whole process, all documents were submitted through the web system! By this moment, I just had to hold on for the host institution to review and accept my application which came in through on the 9th June 2017.

Preparations before travel

GEMx exchange students in front of a monument
Just as the Luganda saying goes “Okutambula kulaba, Okudda kunyumya” literally meaning that “to travel is to experience and returning home is to tell stories”, the preparations were quite filled with a lot of expectations and excitement; new experience, a lot to learn, first time in Nairobi and so much more. As all preparations were under way, I am sincerely grateful the support given to us (me and the other two colleagues) both from the home institution (Ms. Phiona Ashaba and Dr. Isaac Ssinabulya) and Host institution (Dr. Kahiga Titus and Mr. Vincent) plus the GEMx staff (Ms. Faith Nawagi). As a team, they ensured that the funds to facilitate our electives were processed in time, bookings for accommodation made, bus station pickups arranged, plus guiding on what we need to carry for daily living in Nairobi. At this moment, the GEMx checklist was important since it acted as a measure of the progress in the preparation process. The GEMx web system also played a big role in the preparation process as it provided the emergency contacts from both the host and home institution. This greatly eased communication towards and during our travel.

Travel to Nairobi

Selfie of exchange students
Right after securing our fund facilitation for electives, we booked the bus to Nairobi on the eve of our travel with travel date of 3rd  July 2017, and opting for the 7am bus because we wanted to experience the epic scenery as we go sight-seeing the way to Nairobi as long as no one interrupted my peace in my window seat.

Our journey was a fine one with a lot scenery along the way and with most of the attention after crossing the border. The stops in Kisumu and Nakuru, made the journey was less tiresome and awesome.

I should say my eyes are wiseacres as they immediately identify and report to me the good and unique things they see. The same thing happened upon entry in Nairobi, it was the beaming street lights and the skyscrapers that welcomed me then I knew this is the capital of the famous Kenyatta land!!!  The great hospitality we received made me feel like actually we sometimes have 2 hearts- one that pumps blood and the other one for caring. Our arrival time in Nairobi was 9:30 pm and we were picked up by Mr. Vincent, one of the administrative staff members at Kenyatta University. Off we went to Kahawa-Wendani, where our accommodation had been booked in a Destiny Park Hostel, a student hostel approximately 500metres from Kenyatta University.

Stay in Nairobi, Kenyatta University and the elective site

Student with faculty supervisor

With our supervisor Dr. David Galgallo

HABARI!!!! Our Kenyan life begun with a visit to Kenyatta University where we were given a tour around the university by a medical Student (Kiema Lucky) and later on met the GEMx coordinator, Dr. Kahiga, Mr. Vincent and Dr. Francesca Ogencha. The three were to be in charge of our stay in Kenyatta University.

The lecturers strike and Nurses strike.

I thought we had left the habit of lecturers’, non-teaching staffs’ and other government workers’ strikes in Uganda. But little did we know that this would be our big welcome in Kenya. By the time period we arrived at Kenyatta University for our electives, the lecturers in all public universities had gone on strike and so was the case with the nurses in Kiambu hospital, which is the teaching hospital for Kenyatta university school of Health Sciences.

These happenings put our rotation on the clinics and wards on a halt for a full week as the staff at Kenyatta University tirelessly worked around to get us a nearby hospital to undertake our elective at. By the second week, Dr. Francesca had managed to secure us a place at the Mater Misericordiae Hospital, where I and Barigye Aston were to do Pediatrics and Child Health and our colleague Namingira Simon Peter was to do Obstetrics and gynecology. The group in pediatrics and child health were to be supervised by Dr. David Duro Galgallo and the colleague in Obstetrics and gynecology was to be supervised by Dr. Irungo.

The Mater Hospital: The clinical experience

With a colleague at Mater Miseracordiae Hospital
Mater Misericordiae hospital is a catholic founded missionary hospital, a multispecialty hospital with many branches worldwide, and the Nairobi branch being one of them. Located in Nairobi South B, having our clinical rotations in Mater Hospital meant that we had to travel an approximate distance of 20km to reach hospital from our residence in Kahawa, which is north of Nairobi city. A tiring but rather good opportunity for me and my colleagues to learn how to go around Nairobi by ourselves.

At the Mater Hospital, we were given a great hospitality with all the staff mindful to teach us whatever they could.

Outpatient clinics

Exchange student with hospital staff

At the OPD clinic

The outpatient clinics in The Mater hospital are conducted by consultant pediatricians and during the clinics, I was involved in clerking the patients to take history and also do clinical examination under the guidance of the attending consultant for the clinic. This was followed by forming a diagnosis and a management plan. Subsequently, we discussed the patient’s condition with the consultant and participated in patient education about their conditions including informing them about what the diagnosis is, helping them form decisions about treatment course of action and preventive measures for recurrence of certain conditions.

The outpatient clinics are mainly for follow up and review of review of patients who were discharged from the inpatient care.

At the outpatient clinic, patients who had symptoms that pointed to a diagnosis for which a patient needed inpatient care were admitted on the pediatric ward.

At the outpatient clinic, I also participated in the immunization of children and the consultant taught me about the recommended immunization schedule as per the ministry of health in Kenya.

Pediatric ward (Lourdel Ward) and Special Care Unit

Student poses with the admin staff at Kenyatta University

At the OPD clinic With administrative staff at Kenyatta University

On the pediatric ward and the special care unit, I was involved in clerking the patients to obtain history and also did clinical examination then later presented the patients to the consultants. After the patient presentations, we were engaged in the patient condition discussion and later patient education. I also participated in the request for the required patient investigations and follow up on the patients’ progress on the wards. The whole process was incorporated with bedside teachings about the common conditions experienced on the ward.

Obstetrics theatre

During the caesarean section theatre sessions, I would occasionally attend with the pediatrician and participated in receiving the babies.

In front of Mater Miseracordiae Hospital

Postnatal ward

In the postnatal ward, we participated in review of the wellbeing of the newborn babies who were always kept at the hospital for up to a maximum of 4 days. During this period, all those who developed any complications like hemolytic disease of the newborn and neonatal sepsis, were isolated and taken to general nursery or special care unit for the necessary care to be given.

Continuing Medical Education (CME) Sessions

The Mater hospital holds continuous medical education sessions for its clinical staff, aimed at updating the clinical staff members about the latest advances in management and care of patients with certain disease conditions.

During my electives period at Mater hospital, I attended CMEs about management of Asthma, Ateriovenous malformations and Cholera. During these sessions I learnt in detail about the etiology, epidemiology, pathophysiology and management options of the above conditions

Nairobi city and Culture

GEMx Student in traditional African attire

Trying out the Masai attire

Learning on job has never been among my hobbies but as it’s said “a drowning man even holds on a straw to survive”, I was made to reproduce the spoonful Kiswahili that I had learnt ages ago as I needed to get along with some “rafiki” and also navigate my way through the city. However, this in most times never worked and my thick accented English made in Uganda had to come and bail me out. But save for the fact that I did not know a lot of Kiswahili which is the national language in Kenya, the rest of the cultural experiences were just amazing and since most of the ward round and clinic activities ended by lunch time, we used to utilize most of our afternoons to explore the beauty of the city of Nairobi and trying out the local delicacies.  Tours to the Uhuru Park, Central park, Kenyatta International Convention Centre and many more other places enabled us view Nairobi from a variety of angles.

Most notable are the Matatus and the matatu culture. Matatus is the commonest public means of transport within Nairobi and the design plus the music in the matatus made using them to move around Nairobi a thrilling experience.

Kenyatta University: Involvement in student activities and Interaction with student community

While at Kenyatta University, even when we did not get chance to rotate on the wards with other clinical students due to the ongoing strikes, we were able to get time to meet with them in other activities. Important to mention is the Medical camp at Huruma Children’s home, which was organized by Kenyatta University Pharmacy Students Association (KUPhSA), where I was able to meet with many Kenyatta University medical students plus students from University of Science Philadelphia who were also visiting students to the Kenyatta University School of Health Sciences. During the camp, I was paired with a pharmacy student at the consulting desk, an experience which gave me a new touch of the importance of involving pharmacists in the day to day patient care. 

Group of students together after dinner

At Dr. Kahiga’s home with students from Kenyatta University and University of Science Philadelphia

As we were coming to the end of our electives, we were privileged to be hosted by Dr. Kahiga Titus for a luncheon at his home in Kitengela-Kajiado. Here I was able to meet a lot more students from Kenyatta University, meet the Students from Philadelphia again and still meet many officials from the Kenya Pharmacy and Poisons Board. This was a moment to grow social and professional circles.

Lessons learnt

As the medical discipline is known to be a monkey see monkey do business, for the knowledge we can read and acquire but skills have to be passed on through apprenticeship. With a very good mentor assigned to me as my supervisor, my rotation in Pediatrics and Child health at The Mater Hospital made the love for the discipline glow more and more. Being in Mater Hospital, a state of art hospital, I learnt a lot about comprehensive patient care and the practice of medicine in the concept of family care. I also got a deeper understanding of the importance of team practice in patient care. These two aspects of which I believe will enable me grow into a better healthcare provider. With the disease patterns slightly differing in Nairobi as compared to Kampala, I was able to experience child health in a new environment and learn of management of common childhood diseases in Kenya as compared to Uganda. This enabled widen my scope of thinking as a clinical student which is an important aspect in patient care. This coupled with the many differences in health policies made me better appreciate some of the concepts of global health.

Future commitments

The name may be called GEMx exchanges but personally I customized it as GAME CHANGER for the experience, knowledge and skills acquired. I can undoubtedly say it has been a cornerstone in my medical education and I believe it has already shaped my path as a future health worker. Talent may be everywhere but opportunity isn’t, thus I am committed to pass on information about GEMx exchanges to other students within and outside my university so as they may be able to gain the same experience or even better.

 

 

A Conversation Between Dr. Elsie Kiguli-Malwadde and Faith Nawagi

Filed under: GEMx Regional Exchanges

Faith Nawagi, GEMx Africa Regional Representative, recently spent time with Dr. Elsie Kiguli-Malwadde to discuss her work as a physician, faculty member, and medical educator, as well her work with the AFREHealth interdisciplinary health professional forum in Africa.  GEMx has been working in partnership with AFREHealth to pilot a network of regional exchanges among existing network partners in Africa. To read more about these Regional Exchanges in Africa please visit http://www.gemxelectives.org/regional-partners-africa/.

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Part 2:

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Part 4:

GEMx Elective Reflections – GEMx African Regional Exchange Experience

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Kennedy Omondi Ogutu, BScN Student at Jomo Kenyatta University of Agriculture and Technology (KENYA) in 2nd week of GEMx elective at University of Zimbabwe (ZIMBABWE)

PRE-DEPARTURE

GEMx student steps off plan for exchange

Indeed, I lack words to express my sincere gratitudes to the GEMx committee represented by Carol Noel Russo, the host coordinator at the University of Zimbabwe, Mrs. Hope Chuma Vunganayi and my school GEMx coordinator at Jomo Kenyatta University of Agriculture and Technology, Dr.Monicah Karara.

It is my pleasure to thank you all for your commitment and determination made to ensure my elective at University of Zimbabwe attached at Parirenyatwa Group of Hospitals become a success.

As a medical student, it was always my dream to participate in an exchange program outside my country in order for me to learn and gain skills on how healthcare systems workout in other countries.It was with much joy and happiness when I received an email congratulating me for being elected to participate in GEMx elective at the University of Zimbabwe (MEPI), to me the medical elective was a golden opportunity which only comes once in a lifetime. I was prepared both psychologically and physically to participate in the elective and make it a success.

ACCOMODATION AND ORIENTATION ACCOMODATION.

GEMx Student in housing accomodations

The day I arrived at Harare International Airport, I was received warmly, I felt at home. Later on, I was taken to the place of residence within the University. Indeed it is a well-furnished guest house meant for visitors who come for elective at the University of Zimbabwe. The house is conducive for learning activities and well secured. Indeed it is nice and comfortable.

CULTURE

The main languages spoken in Zimbabwe is Shona and English. I found it quite a challenge adapting the language because most of the places, the commonly used language is Shona. This led to some communication barriers at times but I was able to cope through the interpreters.

ORIENTATION TO PARIRENYATWA HOSPITAL.

In front of Parirenyatwa
My 2nd day in Zimbabwe, I was taken to Parirenyatwa Hospital located near University of Zimbabwe, College of Health Sciences.  It is the largest referral hospital in Zimbabwe, with well-equipped facilities and personnel. I was privileged to be oriented by one of the students at Parirenyatwa School of Nursing. It was a very nice learning exposure while at the hospital. I got the opportunity of visiting almost all the departments in Parirenyatwa Hospital despite the largeness of the hospital. Among the departments I visited were the paediatrics ward, surgical ward, medical ward, the oncology ward, the Intensive Care Unit, the labour and delivery ward, the accident and emergency department among the very many departments in it.

CLINICAL ROTATION AT THE LABOUR AND DELIVERY WARD.

Based on the elective that I chose, majorly dealing with obstetrics and gynaecology, I was attached to the labour and delivery ward for a two week experience

I report to the labour and delivery ward at 7am, where reports from the nightshift duty staff is given to the staff starting of the duty. The reports on the patient was given inform of case presentation.It was a very nice learning session to me during the ward rounds and giving off the patients report. Ward rounds were conducted with the presence of the Obstetrics consultants, the midwives, interns and the students. Different aspects on different patients were discussed based on their condition. The staff were able to teach us the very many obstetrics emergencies and complications and their management. Being a referral hospital, I was able to witness most of the complications related to labour and delivery and their management. Among the complications I came across was post-partum haemorrhage, breech presentation, retained placenta among many others emergencies and complications.

View of Parirenyatwa Hospital

View of Parirenyatwa Hospital

KNOWLEDGE AND SKILLS OBTAINED

For the duration less than 2 weeks that I was attached to the department, I have been able to meet my objectives in the labour and delivery ward.  Among the very many objectives set and which have been achieved include; the assessment of a pregnant woman, prevention of mother to child transmission of HIV/AIDS, management of women with post-partum haemorrhage, eclampsia etc, management of babies with special needs, performing and suturing of an episiotomy, administration of medication used during labour and delivery. Finally, was conducting labour and delivery.

IT IS AN AMAZING EXPERIENCE.

LESSONS LEARNT

GEMx exchange student in hospital
GEMx Exchange Student in front of university sign
I believe in improving and prolonging the lives of human beings through a holistic approach of healthcare services to humanity. It feels good when a patient who was critically ill, bed-ridden and was not be able to do activities of daily living, gets well as a result of good health care service offered to them. I learnt that medical practice is similar globally, and it needs teamwork, sharing of knowledge and empathy to patients in order to ensure holistic approach of care to patients.

From the deeper recess of my heart,/ express my sincere gratitude to GEMx for giving me this wonderful “golden opportunity”

 

GOD BLESS

 

 

A message from GEMx Regional Representative in Africa – Faith Nawagi

Filed under: From GEMx Staff GEMx Regional Exchanges

Post by Faith Nawagi, GEMx Regional Representative 


Faith Nawagi, GEMx Regional Representative

It all began in 2014 when I attended The Network TUFH conference in Fortaleza Brazil. I met Ms. Anna Iacone who was really passionate about global exposure for medical students. Having been volunteering at my school back then at the international office  I thought this would be a great opportunity for our school but also bearing in mind that i had strong interest in internationalization in health professional training. My roles at the international  office back home were really too basic These involved helping with orienting exchange students and faculty by taking them around the hospital and adapting to the life around Uganda by showing them places that would enable them get their basic needs. In 2015 I was lucky to be one of the winners of the student Projects for Health which was sponsored by GEMx in Gauteng South Africa under the Network TUFH. While there, I met the entire GEMx team and we discussed more on possible roles and ways to enhance visibility in Africa for GEMx.

Faith Nawagi, GEMx Africa representative
In 2016, GEMx launched the regional exchange program in Africa to enhance global exposure for students as they train to become future health practioners. In the same year I took up a role as the GEMx Africa representative where i played an imperative role to bring on board 24 African medical institutions to provide elective programs for medical and other health professional students. This was through working with the various networks that are existent in the region. These include, MEPI, COECSA, NEPI and EAHPHEA. With the various associations meetings were held with the board and GEMx representation for interested schools to sign up was through an Exhibition booth, abstract pre
sentation and modulation of conference sessions. Late in 2016 we worked on ensuring all schools submit the required documents.  The electives are to be up and running this year 2017. As the project is implemented various aspects of research and strengthening partnerships will also be looked at.  In addition I also serve as the Co-chair on the Student Ambassador Network for GEMx new brooding consortia of students for the various GEMx schools with great potential to enhance GEMx visibility yet at the same time promoting cross cultural linkages and global learning opportunities and interaction.

GEMx has offered the best platform for me to realize the kind of career path I always wanted through contributing to medical education in research, academia and building global partnerships. My greatest glimmer is the hope GEMx has provided to medical and other health professional students across the globe to gain global exposure through building global partnerships but also at the same time enhancing visibility of the outstanding community projects with significant impact implemented by students across the world.

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