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Cardiology Electives in Uganda

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Lindokuhle DIamini

Post by Lindokuhle Dlamini MBChB 5 student UKZN Nelson Mandela School of Medicine, South Africa

Preparations and Travelling to Uganda

During the time I was preparing for my trip to Uganda for my Cardiology electives for three weeks. I was not sure whether it was going to be possible for me to go to Uganda or not due to the fact that this was my first time traveling to a place that is outside of my own country. Immediately after my online application through GEMx, everything was easy for me because I received the help I needed on time and hence it was easy to get Immunizations, Visa, and other useful information about the place I was traveling to on time. Many people intervened and assisted a lot, Prof. Mergan Naidoo who is the GEMx Manager at UKZN, Professor Ncoza Dlova the dean of clinical medicine at UKZN medical school, Faith Nawagi from GEMx and Sunga Chumia helped me a lot with the whole process.

During the day of my trip to Uganda, I missed my flight from South Africa to Entebbe in Uganda, and this was due to the fact that there was a very long immigration cue at the airport and very few consultants, this was the only challenge I faced, but I did rebook the flight and the following morning I then traveled to Uganda, it was a good experience indeed.

Arrival and General Impression about Uganda

I arrived at Entebbe, and I checked in in the country after that I went to the Mugalo Hospital guest house where I was staying for my electives, I met many people in Uganda, but the common thing I noticed about every individual I met is that they were so welcoming and respecting as well, even though sometime I would not feel well because I did not fully understand their culture during the few days of my arrival in Uganda, and my fear was that maybe I will do or say something that means something bad or rude according to their culture, but their respect always kept me feeling at home. Uganda is a very good country but very expensive. I went to Shoprite just to get a few items at Acacia Mall and while comparing prices with the South African Shoprite, it was a lot more expensive. Staying at Mulago Hospital guest house was very good I met few Medical students from other countries and it was very nice to meet them, listen, and observe them as well I learned a lot from them both academically and socially.

Lindokuhle posing for the camera

My first day of Cardiology at Uganda Heart Institute, as I was still battling with the one hour difference between South Africa and Uganda, one of the Medical Students from the College of Health Sciences was sent to come and give us a tour around the Mulago Hospital, it was so useful because from then I did not struggle with directions around the entire hospital. On my first day, I met Dr. Isaac Ssinabuyla who is the manager of the GEMx at Makerere University, who is also a Cardiologist at Uganda Heart Institute, I also met Phionah Kinwa who is the Associate Coordinator for International Programs at Makerere College of Health Sciences. Dr. Isaac Ssinabulya took us and we went to the Heart Institute, we arrived the ward round had already started and he introduced us to the team. The Cardiologist who was in charge was Dr. Lugero Charles.  I learned a lot, most of the patients we saw were mixed valvular disease patients. The team I was with at the Uganda Heart Institute were so keen to teach, I learned a lot from them, not only academics but even the conduct of a Medical Doctor, being part of the team equipped me, to such an extent that I now consider Cardiology my first choice specialty. On Tuesdays, I attended major ward rounds where I met Dr. Batambuze an old Cardiologist who received his training in the United States. He taught me Cardiology, most patients presented with the mixed Valvular disease, coronary artery disease, Aortic dissection mostly caused by hypertension, and congestive Cardiac failure.

Lindokuhle and his colleagues

I clerked and presented patients to the doctors during ward rounds, and the most important thing Dr. Batambuze use to emphasize was the issue of being able to pick up clinical signs and being able to interpret them, as well as the importance of demonstrating how you elicited the clinical signs you mention. My Cardiology clinical attachment helped me a lot; it taught me to work with other people. Dr. Batambuze organized tutorials, and he uses to give both us medical students and MMed students tutorials, it is quite good to be involved in a clinical setting with many medical doctors, because you get different views and approaches as well which broadens your horizons. After the ward round, I used to study a lot, to try and cover as much work as possible. It was much discouraging to learn that Doctors are underpaid after so much hard work of their training, and the type of care they give to patients. It was also sad to see some of the patients in beds because nothing can be done but only palliation and some of them cannot afford to pay for the surgery procedures more especially the Type A Aortic dissection patients, because of limited resources at Uganda Heart Institute, and patients have to be transported to Kenya for such procedures only to find out that patients cannot afford, but I was glad because even though most patients could not afford, Doctors use to continue with medical treatment learned that there is a lot of communication in medicine, and to be a good doctor does not only require excellent academic record but it requires a lot of passion, patience, and commitment. I also learned to approach patients as a whole, not only to treat the disease but also to focus on other aspects of life, because they might be the precipitants and the cause of the disease. And now that I am at home I will make sure that I help other fellow students, and furnish them with all the information I received at Uganda Heart Institute. I really appreciate the experience I had at the Uganda Heart Institution.

Lindokuhle in his medical cap and stethoscope

Acknowledgments

I would like to thank GEMx for offering this exchange program, which made everything easy on my side as far as applications and other important information is concerned, thanking SAMA Scholarship for offering me funding. Prof Mergan Naidoo who is the manager of GEMx at the University of KwaZulu Natal(UKZN), Prof Ncoza Dlova who is the dean and head of the school of clinical medicine at UKZN who encouraged me to apply and further assisted me with finances where they were loopholes, Miss Sunga Chumia who assisted me with logistics. I would also like to thank Dr. Isaac Ssinabuyla who is the manager of GEMx at Makerere University in Uganda for the help and for hosting us as well as Phionah Kinwa.

Learning about the Healthcare System in Kenya

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Frank Mayindi, a GEMx Medical Student from Makerere University College of Health Sciences [MEPI] taking an elective program at Kenyatta University

Frank Mayindi is my name, from Uganda, a Muganda by tribe, 24-year-old male currently pursuing a bachelor’s degree in medicine and surgery at Makerere University Uganda-Kampala College of Health Sciences currently in my fourth year of study, with a very strong passion for surgery, aspiring to be a neurosurgeon in future.

FRANK MAYINDI(1) EBELE GIFT ISAAC(2) MRS DOROTHY .W(3) AND KIKOYO JOACHIM(4) from the left side at the safari park in Kenya.

I undertook an elective placement at Kenyatta University Nairobi, Kenya through the period of 2nd June to 1st July under the Global Education in Medicine Exchange (GEMx) and I take this opportunity to extend my heartfelt gratitude to everyone that made this possible. ( Makerere University international office, Kenyatta University, and the GEMx co-ordinators).

My stay in Kenya was full of many experiences. While at Kenyatta University I rotated in the Department Of Surgery at the Kiambu level 5 hospital.

For the time I was in the hospital, I participated in ward rounds (major and grand), clerkship, and examination of patients, follow up of care of patients and bedside teachings. These activities enhanced my clinical skills especially in surgery and also served as a stepping stone to pursue my career in surgery.

I also attended CME’S (Continuous Medical Education sessions) and Morbidity and Mortality reports in which I got updated about some of the current medical practices and different approaches to patient care. I also appreciated the key leading causes of mortality and morbidity in the hospital’s catchment area.

Photo with the rest of the GEMx members at the postmodern library in Kenyatta University

Through my interaction with fellow students, I learned a lot about the Kenyan culture in terms of language, culture, and entertainment. I cannot withstand the temptation to mention about the wedding I attended at one of my friend’s place and the fact that most of the weddings were held on Saturdays and all vehicles attending a burial had to bear a red cloth tied to side mirrors or any available place as a mark.

I managed to attend a community outreach held at Brydges Home Center in Kajiado County, it was a place away from Nairobi and I managed to have an experience of Kenya outside the main capital city. While at the outreach I stationed in the pharmacy department where I managed to dispense different medications to the different patients, it gave the opportunity to interact with the pharmacy students and also learn briefly about the common drugs used in Kenya.

Group Photo was taken at the community outreach

Through my stay in Kenya, I realized that it was a cold country compared to my home country, however, I managed to maneuver through the weather through the use of jumpers and very thick sweaters. However, there were no unexpected outcomes through my stay in Kenya.

I was warmly welcomed by the student community especially the students I was to rotate with, at a moment I didn’t feel I was in a different country, they played a major role in my stay in Kenya. They taught me a lot of Kiswahili and Kikuyu, allowed me to join them in their co-curricular activities like football matches plus tennis and also I participated in their discussions as early as the 4th day of my stay. Still, through the guidance of my fellow students I managed to visit the national hospital of Kenya-Kenyatta National Hospital-and this broadened my picture of the health care system in Kenya. All in all my interaction with the students was far-reaching and up to now I still maintain communication with them and there was no moment I felt unsafe and not welcomed by them. Through interaction with the lecturers, I managed to meet with surgeons practicing in Kenya and the chairman of the department of surgery at the hospital, these greatly natured me in the field and encouraged me to pursue my career further.

The picture was taken at one of the clinical teaching sessions in Kiambu

To any student out there planning to partake a GEMx elective in a country away from home, I strongly encourage you not to hesitate to pursue such an elective. Learn about the language of the host country especially the basic words for basic community survival and also while in the host country make as many contacts as possible to further grow your carriers and to enhance your international relations and let every day that you spend for your elective count.

 

Ntuthuko Mkhabela’s Cardiology Elective Exchange to Uganda

Filed under: GEMx Regional Exchanges

Ntuthuko Mkhabela

Post by Ntuthuko Mkhabela, a 5th- year medical student at the University of KwaZulu- Natal in South Africa taking an elective program to Makerere University in Uganda. (Student on the left)

Introduction

My name is Ntuthuko Mkhabela, I am a 5th-year medical student at the University of KwaZulu- Natal in South Africa.

I was afforded the opportunity to do a Cardiology elective program in Makerere Univerity in Uganda at the Mulago Hospital Heart Institute from the 4th until the 23rd of June 2018 by the GEMx.

I found this to be a great learning opportunity and also a very prodigious chance to explore new places and meet new people. From when I got to Uganda I found that everyone was very friendly, though it was difficult at first to settle in and comprehend how somethings are done but within a few days, it really felt like home.

Academics

Group photo at the hospital

I had to admit that I had the best bedside teaching at the Heart Institute and they have the best grand round on Tuesdays with the best and most enthusiastic teachers I have ever had any chance to meet.

I was a great honor to get teaching from Dr. Batambuze “The Lord of the Heroes” as he refers to himself when entering the ward, he isn’t only a great consultant but also offers the best form of teaching in a very passionate and motivating way; and he also has a great sense of humor.

He was very patient with us and even though he had not come to teach undergraduate students. He made us feel welcome and were willing to assist us wherever we got lost. He would take us all the way from basic science and anatomy up to the clinical and bedside medicine and the one thing he really enforced was the importance of proper and evidence-based bedside clinical medicine and how it would assist in saving a patient’s life and for that I would like to forward my special thanks to him.

Ntuthuko Mkhabela and Lindokuhle Dlamini

We also had the best team in the ward led by Dr. Majwala who also held our hands throughout the period together with his MMed students: Dr. Ssibuliba, Dr. Were, and Dr. Herbert. They were willing to not only share their much valuable knowledge with us but also even shared some of their resources with us.

It was really a great motivation to me and if given the opportunity I would definitely love to work with them again because I think there is a lot that I could learn from them and it wouldn’t be just for me to not appreciate these great individuals. It also wouldn’t be just for me not to appreciate Dr. Lugero for his great teaching, he was the first to welcome us and he rightfully told us that he cannot welcome us with a party or whatever but he can only welcome us with academic questions and indeed his teaching remains highly appreciated. I would also like to appreciate all the other doctors I have not mentioned above who also were willingly and undoubtedly making efforts to ensure that we are trained to become great clinicians.

I also had an opportunity to spend some time in the Cath Lab to see how coronary stents are inserted and again we were welcomed with warm hands and without any objections taught us as much as they could within the little time we had in there and it was again a memorable experience.

Briefly, I would just say I the academic side of my visit had the best teaching I have ever been exposed to in my life and I remain grateful, and one would then safely say the purpose of the trip was fulfilled.

Social

Ntuthuko Mkhabela selfie

During my stay in Uganda, I had a chance to explore a number of places in the area, starting with the tour around Makerere University which we had with Clement who was a great host and was always there when we needed him. He became more than just ‘a student who was supposed to show us around’, he became a friend and a colleague who we shared a lot of great moments with and also shared knowledge.

He is a great leader and has been in the student leadership myself, we actually shared a lot in common hence we got along very easily and I sure do wish him well in the future and hope we do meet again at some point.

I also had an opportunity of watching the multicultural tribes of Uganda performing their traditional dance TWICE because for some reason I just couldn’t have enough of their dance,  jokes,  music and of course the food courtesy of Dr. Isaac.

Ntuthuko Mkhabela enjoying traditional activities

This was a great experience and it made me wish to get a chance to go live in their rural areas for at least a day so I could be part of the traditional activities and have the first-hand experience of how it actually feels to be one of them because I was already feeling like one of them even at that time. I couldn’t really tell whether this gentleman was too tall or it’s just that I am very short but I honestly had the most fun at this cultural dance event I also had an opportunity to go and watch a local rugby tournament and also meet up with other medical students from different other countries from all around the world. I made a lot of friends who I learned a lot from; we also watched a number of world cup games together and shared a lot of fun moments. With some, we even share the same accommodation which allowed us to get to know each other even more.

Unfortunately, I didn’t get to go to the Safari and to Lake Victoria with them, which I really think it would have been really great adventure given the fact that it was in the home of the Nile Rivers its self.

Ntuthuko Mkhabela enjoying his stay in Uganda

Conclusion

Even though the trip started off on a very frustrating note from missing our flight and having to spend a night in Johannesburg to serious financial constraints but in the end, all the efforts were worth it and I definitely would relive every moment of it if given the chance again. I appreciate the opportunity that was afforded to me and would like to thank everyone who put their efforts into ensuring that this trip became a success.

Smiling with my new friends

I think this GEMx initiative is a great one and really I would like to see more people from our school taking part in it.

Thank You

 

 

 

 

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.

 

 

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