Health Education Project in Uganda

On August 9^th, I traveled across the Atlantic Ocean to another continent, to another world. Nearly 20 hours after leaving the United States, I landed on African soil in Uganda. My plan was to carry out a disease prevention educational program for the group of schools in western Uganda that the Kasiisi Project supports and that I had visited the previous summer. The basis of the program was intended to be disease prevention through basic health and hygiene education, which was to include hand washing and basic first aid. In order to maximize the success of this project, I planned to work with a local clinic, which is involved in health education outreach as well as first stage medical care. The second part of my project was going to involve spending time working in the clinic, observing health care in a developing country, developing my nursing skills, and expanding my medical knowledge.

In the weeks leading up to the trip, I spent many hours searching the internet for material to use for the disease prevention educational program. I found an endless amount of websites on germs, hand washing, and first aid. I compiled the most important information into a report and found activities that correlated to each subject. This included coloring sheets for the younger children and word searches and word scrambles for the older kids. I found songs addressing hand washing, which I used to write my own. Sung to the tune of Row, Row, Row Your Boat, the words to the song I wrote are: Wash, wash, wash your hands; Wash them everyday; Scrub, scrub, scrub them well; Wash those germs away. Once everything was together, I started creating posters and making copies of the activity and information sheets.

During this time, I was also collecting basic first aid and medical supplies. With the help of family and friends, I put together 75 small first aid kits that consisted of adhesive bandages, gauze for cleaning wounds, alcohol wipes, and non-latex gloves. In addition to these, I also created five large first aid kits, one for each headmaster or headmistress at the five primary schools supported by the Kasiisi Project. These first aid kits included all of the same supplies as the small ones, but in much larger quantities. They also had gauze rolls and pads for covering wounds, medical tape, scissors, ace bandages, and antibacterial cream. People also donated hand sanitizer and bars of soap, which were to be donated to each school. Many of the donations I received were from the community, who became aware of my project after an article was printed in the local newspaper. All together, the supplies filled three large duffle bags and weighed close to 175 pounds.

After weeks of preparation, I had finally arrived in Uganda. I had gone to Uganda for a reason. I had gone to make a difference in the lives of the Ugandans and in my own life. I had gone with expectations. I had gone expecting to find a clinic bustling with patients. I had gone expecting my help would be needed. Instead, I found a small three-roomed clinic. I found a clinic with only around ten patients per day. I found a level 2 clinic, the lowest level healthcare center. I found a clinic that does not admit patients, a clinic with no lab services, a clinic where babies are not delivered. I found a clinic underused and underfunded, lacking in resources.

Things change. Expectations change. I learned that in my first week there. I had gone to develop nursing skills. Instead, I developed a clear understanding of what a health care system looks like in a developing country. I saw what it means to have to walk to get medical treatment. I witnessed diagnoses being made strictly based on symptoms. I watched and I learned more than I could have ever learned by staying within the United States.

I had gone to provide heath education to five primary schools, to over 5000 schoolchildren. Instead, I found that with the language barrier and with the supplies I had, I could only educate one school, one school where over 100 students are packed into each classroom. I taught 1199 children about germs and the importance of washing one’s hands for disease prevention.

I had gone to donate supplies to be used for first aid and hand washing. I had gone with the intent to provide each teacher with a mini first aid kit and each headmaster or headmistress with a large first aid kit and many bars of soap. Instead, I found that schools have no water sources and teachers do not know how to treat even a basic cut. I handed the soap over to the headmistresses and headmasters of all five schools with information on how to create a hand washing facility. I learned that it would be best for the headmasters/mistresses to keep all the first aid supplies in their offices so that teachers do not use them for their own personal need. I realized that hand washing and first aid supplies can only be used if people know how to use them.

I had gone to teach teachers and administrators about first aid. Instead, I realized not everything could be done in a month and that sometimes it is best to pass along responsibilities to someone else. I gave the first aid supplies to each school with the agreement that Lucy, a Ugandan nurse, would come show them how to use them. I handed this part of the project over to Lucy, who will carry it out as part of her outreach. I also left her with the task of carrying out my health education program in the four schools I was unable to educate.

My time at the clinic was spent mainly talking with the nurses and observing health care. Because the clinic was the lowest level medical center, all diagnoses were made mainly based on symptom evaluation. There were times I would spend hours at the clinic and not a single patient would come by. When a patient did, I would go into the examination room with the nurse and patient. The nurse would translate the discussion for me, as most of the locals do not speak English. Once I got to take a woman's blood pressure. It was extremely high and she was diagnosed with hypertension. Another time I got to listen to the lungs of a child diagnosed with pneumonia. This for me was an eye-opening experience. Being a person who has had pneumonia on numerous occasions, I was shocked at how the diagnosis was made. Each time I have been diagnosed with pneumonia, I have received a chest x-ray, but without this resource, the nurse made the diagnosis strictly by listening to breathing sounds. I wondered how accurate this diagnosis was and whether the nurse could really distinguish between breathing sounds to know which ones were associated with pneumonia or whether the diagnosis was completely unsubstantiated.

Here in the United States, and especially on the East coast, we are so fast paced. Ugandans are the complete opposite. Everything is done on their own time and at a very slow pace. I wasn't able to get into the schools until my third week there, and because each school has over 1000 students, I realized that I was only going to be able to educate students in one school. Lucy, one of two nurses who work at the clinic, helped me with this portion of my project. She came with me as a translator and collaborator to educate the younger children, who had not learned English yet. I was on my own the second day because Lucy was on duty at the clinic, and while the older schoolchildren have learned English, it was difficult because English is not their first language. I walked away that second day uncertain about whether or not I had really gotten through to the children.

On one of my last days in Uganda, I returned to the school and visited the P1 (our equivalent to kindergarten) classroom. Upon entering, the teacher spoke one word in the native language, Ruturo, and in unison the entire class brought their arms up to their mouths and coughed into the crook of their elbows. It almost brought me to tears. Before my arrival, the children had been coughing into their hands, which is an easy way to spread germs. Realizing that the children had in fact been listening and taken in the information really made me feel as though my entire project had been worth it.

When not at the clinic or doing health education, I spent time working with two McGill University students, Lulu and Cristina, who were doing an internship under the Kibale Health & Conservation Project. They were working to create a health outreach program for the surrounding communities. Because the clinic did not see many patients each day, I had a lot of time to fill. I filled these gaps by helping create the outreach program. During the time I spent with them, the material I helped create addressed water sanitation and family planning. I was able to attend one presentation on water sanitation. This was a wonderful experience for me. Lulu, Cristina, the two nurses, and I walked to a village 45 minutes away. About 15 people showed up for the presentation. While I could not understand what was being said as the presentation was done in Ruturo, I could tell that the villagers were fully engaged and interested. A lively discussion followed in which the villagers mapped out the different sanitary water sources in the area.

The McGill students returned to Canada at the end of the first two weeks, leaving me to focus more on my health education project. In my third week, I created folders for each school and a folder for Lucy. In the school folders were the packets on how to create a proper hand washing facility, sets of posters to be hung around the school promoting hand washing and stopping the spread of germs, and first aid information on how to treat wounds and how to use the first aid supplies properly. Lucy’s folder contained everything the schools’ folders did, but it also had everything I used for my presentations and some extra information. That same week, I went and delivered the supplies and folders to the schools. I also met with Lucy at the clinic to discuss her outreach. I brought over a suitcase filled with supplies and the folder, which were intended to aid Lucy in carrying out her outreach and the rest of the health education project.

Because of how slow paced everything was and because there wasn't always much going on at the clinic, I added a third part to my project. This part consisted of visiting different levels of medical centers. The clinic I was in was a level 2 medical clinic, the lowest possible care center. I traveled to a nearby village, where I was shown around a level 3 medical clinic. The main difference between the two was the presence of a laboratory and maternity ward in the level 3 center. I also visited a hospital and nursing school in the town of Fort Portal. Having the opportunity to visit these different medical centers allowed for me to see what the full range of medical care looks like in a developing country.

I walked away from the clinic, from the schools, from Africa, knowing I had accomplished everything I could accomplish in the time I had. One of the things I learned while in Uganda was the importance of reducing dependency. A Vanderbilt student helped me see this. She is a huge believer in this. It had always been easy for me to provide support and resources to those who need it, but I never thought about what would happen if I weren’t there. While my work in Uganda and the supplies I brought over are going to help the people in the Kibale National Forest in the short term, the question is what is going to happen when the schoolchildren forget, when the supplies runs out. What I had failed to realize before is that the project I created was not a sustainable one. By leaving the health education portion of the project for Lucy to continue, I have made it so that the schoolchildren do not have to depend on an outsider to learn about germs and hand washing. Now, instead, a native Ugandan will continue to have a job and the schoolchildren can continue to learn about the importance of preventing the spread of disease and the proper methods of doing so. I also left Uganda with another project idea, one that will provide a source of income for the girls and one that will provide soap for the locals. Alice, the Vanderbilt student, and I thought up the idea of starting a soap making club for the girls. Once again, while outside help is important, it is even more important for the locals to learn to take care of themselves. The idea would be for the students to at first make soap to be used at their schools and at their homes, and then eventually they would learn to sell their soap as a way of supporting themselves and their families. As Alice says, it is important to create independence and equip a community with skills that are transferable and sustainable.

Four weeks in Uganda taught me more than I could have ever learned here. The whole experience was a growth experience. While my time in Uganda was meant to be a nursing experience, it became much more than that, and while I did get some health care experience, the life experience was much greater and will have more of an impact on my life in the long run. There were times I wasn't thrilled about being on my own in Africa, especially when I got sick, but I learned so much about the health care system, about the people, and about myself. This summer I stepped outside of my comfort zone, and in doing so, learned things about myself that I never knew. This experience has helped me to grow as a person.

In terms of health care, I learned many little things this summer that I can take with me into the nursing world. For one, being able to witness and observe a health care system in a developing country has given me a better understanding of the importance of the medical and scientific advancements we have here in the United States. My own bout of illness taught me that ginger tea settles an upset stomach and giardia is a parasitic disease that one acquires from accidentally swallowing Giardia picked up from surfaces or by ingesting contaminated food or water. I learned the importance of taking one’s medication first hand. Ten days on metronidazole, or Flagyl, an antibiotic effective against anaerobic bacteria and certain parasites, and I was feeling good as new. I learned the importance of natural medicine in the Ugandan culture. I was told that one of the reasons that so few patients came to the clinic was that many families still believe in using natural medicine. I learned what happens when the proper tests aren’t given and the wrong diagnosis is made. In a country where malaria rates are high, it is often assumed that any person complaining of chills and a fever has malaria. Tests are rarely done, even if they are available. In recent months, typhoid rates have risen and worse cases of the disease have been recorded. This is because people are often given an anti-malarial medication to take, when they in fact have typhoid. With the knowledge I have now, I am sure that I will be a better, more informed nurse. I have a broader understanding of medicine than I had before. I have a much better understanding of the importance of health education than I had before and certainly a better understanding of medical care in a developing country.