END OF PROJECT YEAR REPORT 2013.
Northern Uganda Village Health Outreach Project (NUV-HOP) is a village based health outreach project that focuses on operating medical clinic outreaches to the rural poor in Northern Uganda in partnership with other non-governmental organizations. It is fully approved by the Review and ethical committee of the faculty of medicine of Gulu University with reference number: GU/IRC/01/07/13.
Its main goal is to improve the living conditions in underprivileged rural communities of through increased self-reliance and responsibility as well as established of an affordable health care provision thereby enhancing community transformation.
NUV-HOP is implemented and hosted by Gulu University Medical Students Association (GUMSA), an MSA of FUMSA.
Goals and Objectives of the Project
The overall goal of this project is to improve the living conditions in underprivileged communities through increased self-reliance and responsibility, as well as establishment of an affordable healthcare provision thereby enhancing community transformation.
- To increase the awareness of the community and school children/students of the need for them to encourage positive attitudes and practice of good hygiene and sanitation in the prevention of diarrheal diseases.
- To reduce infection and death rates of mothers, children less than five years and other vulnerable group from HIV/AIDS, TB, diarrheal diseases, malaria, malnutrition through advocacy for good heath seeking and disease preventive behaviors.
- To challenge unhelpful practices that lead to the spread of infectious diseases and development of non-communicable diseases through extension of health education to homes and schools within the community.
- To offer free high quality health services to the rural poor in Northern Uganda in partnership with other Non-governmental organizations.
NUV-HOP has been implemented in two phases,
Phase I involved a training workshop to equip Medical Students with basic clinical skills and indigenous life styles including overt cultural norms and languages to allow the international students as well as the indigenous students to cope easily during interactions with patients and the members of the rural community. A total of 80 medical students were trained in the month of July.
The training contents included the following:
- Hygiene and Sanitation, healthy practices, the importance of keeping good sanitation and hygiene
- Primary health care practices in schools and in the community
- Reproductive health services and rights including safe sex strategies
- Project management, evaluation and monitoring
- Management of the medical camp including universal precautions
- Focused Communication skills and cultures of the members of the community.
Phase II involved medical outreaches to rural communities of Northern Uganda in the three purposively selected districts of Gulu, Amuru and Nwoya and Clinical placement for international students at Gulu Regional Referral Hospital.
A total of 15 health outreaches were conducted in the three months.
NUV-HOP used four approaches to improve community health in the short and long run, including:
Students for student (S4S) sub project
NUV-HOP conducted health education in primary and secondary schools in each of the districts of Gulu, Amuru, and Nwoya.
Health Education was provided to the students/pupils on common health problems, such as malaria prevention and control, HIV/ and STIs prevention, malnutrition (constituent and importance of a healthy diet), good hygiene and sanitation practices, control of respiratory tract infections and good health seeking behaviors.
Emphasis was put on the importance of proper hand-washing before and after meals, the need for rehydration when experiencing severe diarrhea and vomiting, regular brushing of teeth, basic first aid, and the importance of seeking help from an adult in a crisis.
In the three months, NUV-HOP conducted health education sessions in a total of 18 schools.
Free clinics for local communities (medical camp)
NUV-HOP conducted 15 free walk-in clinics in 15 selected villages in Northern Uganda for the first year of the project, 5 conveniently selected villages in each of the districts of Amuru, Gulu and Nwoya were reached.
The medical students worked in close supervision of the NUV-HOP doctors in triaging patients, history-taking and management of common disease conditions.
These clinics were conducted in partnership with other Non-governmental Organizations and lower government health centers.
The service provided in these clinics included clerkship and management of general outpatient conditions, family planning and use of modern contraceptives, cervical cancer screening, immunization, HIV counseling and testing, safe male medical circumcision and deworming.
A total of 4,788 patients were reached.
House-to-house visits and health education
Medical Students together with translators visited the community members in their homes and conducted brief health education sessions. The primary aim was to advise on lifestyle practices that could improve health and well-being, such as sexual promiscuity and its relation to AIDS as well as management and prevention of common ailments, namely Malaria, Diarrhea, and respiratory tract infections, short sharing session on safe sex strategies and sexual and reproductive health behaviors as well as advice on simple changes that could be made to improve hygiene and sanitation.
NUV-HOP reached a total of 38 homes in 15 villages of northern Uganda.
Clinical placement for international students at GRRH
In attempts to foster international relationship and collaboration in projects, NUV-HOP started an International medical students’ clinical placement at GRRH from the academic year 2012/2013 onwards. The initial clinical placement consisted of a team of 24 medical students from Belgium who are rotated in Antenatal Clinic, HIV/AIDS clinic, and the Immunization and young child clinic for a total of two weeks after community outreaches.
The international students made written reports of their experiences in the local teaching hospital of northern Uganda.
NUV-HOP attracted participating medical students from Gulu University, Mbarara University of
Science and Technology (MUST) and from 5 universities across Belgium including Ghent,
Leuven, Brussels, Antwerp and Hasselt.
A total of 24 medical students from Belgium, 80 medical students from Gulu University and 3 medical students from Mbarara University of Science and Technology participated in the project.
The medical students from Belgium were hosted by local host families around Gulu Municipalty. NUV-HOP also attracted five supervising medical doctors from Uganda.
Community participation and support from the district authorities and from Gulu University has been of great significance.
NUV-HOP registered a number of achievements in the three months of its implementation.
- NUV-HOP has conducted 15 outreaches reaching out to a total of 4,788 patients in three months, see summary table for details.
- Delivery of public health services, especially in villages. These include cervical cancer screening, family planning, VCT (voluntary HIV testing and counseling), immunization and safe male medical circumcision.
- Sensitization of the community, especially primary and secondary school children, focused on sanitation and reproductive health including HIV/AIDS.
- Good interaction and motivation for the Ugandan and Belgian students.
- Positive support from the community, district officials and Gulu University.
- Strong partnership with AMREF, Reproductive Health Uganda (RHU) and district authorities.
- Good relationship with the host families
- Commitment, persistence, accountability and transparency by the organizing taskforce.
- Filming some of the project activities by the team of the silent witness to make an ethically cleared documentary to aid in fundraising for the project and other local health initiatives.
SUMMARY OF ACTIVITIES CONDUCTED IN NUV-HOP 2013
|0UT PATIENT CONSULTATIONS||CERVICAL CANCER SCREENING||HIV COUNSELLING AND TESTING||FAMILY PLANNIN G & CONTRAC EPTION||IMMUNIZ ATION||SAFE MALE MEDICAL CIRCUMCISIOM||TOTAL|
- Shortage of finances to buy drugs (both in quantity and variety) and encouraging more financial allocation towards this.
- Concerning school outreaches, study aids (flip-charts/posters) would be very valuable to help overcome the language barrier, which can be very limiting at times.
- Poor or late communication to the communities about the medical and village outreaches, which could possibly, explain patients’ late arrival at the health centers.
- Finding reliable and adequate transport to the outreach sites.
- Taking care of the welfare of participants by scheduling in lunch and refreshments.
- Small numbers of students who participate in the outreaches yet the patient numbers are overwhelming. An increase in the number of students (40) participating in the outreaches, have been suggested to overcome this problem, this could also help to facilitate learning for a larger number of medical students.
- Need to design a referral and following up system, in order to be able to have timely referral of severely sick patients.
- Lack of proper transport for referrals.
Patients are referred but they do not have transport and are not able to meet their feeding costs while in higher health facilities.
- Keeping up the motivation of the students and all persons involved in the project.
- Augmenting the financing of essentials especially drug purchasing.
- Improve the involvement of the community, and need to first identify the problem of the community.
- Do more lobbying for financial support and attraction and maintenance of other health partners.
- Increasing the number of clinical participating students especially those who are familiar with the language.
- Acquiring posters and other teaching aid tools which may be effective especially when visiting the school and homes.
- Separation of students and pupils based on sexes especially during school health outreaches since some issues are sensitive to different sexes and need different attention?
- Establishment of a “model home” in each community where one can refer to. Even when the outreaches are over, it can still be used as reference. This instead of verbal communication to the communities only.
- Liaising with other organizations to provide ambulance/ transport means for referred patients.
Highlights from the participants
“I learned a lot during my one month participation in the NUV-HOP project, I came to realize that it is not easy to practice medicine with all the technical instruments that we have, but it was nice to practice good medicine without those technical instruments” – ANNIEK ERDEKENS.
“I can say that I really liked my experience, I learned and did more than I expected to do, I had to learn and accept the African time management and the way of working here but I believe my experience here will help me to become a better doctor.” – RUTH BOTTERMAN.
“I have learned a lot of things here, rather wisdom than knowledge. I am sure that the NUVHOP project is strong. The project gives us the perfect match between obligated things and time to develop our own interests, I will not forget the feeling that you can join the hospital where and when you wanted to and ‘you are most welcome’.
I had the impression that the house visits were useful, talking about family planning. I am already used to it…… one generation plants a tree and the other enjoys the shade. Every question they asked gave me a confirmation that they really listened to me” – LISA WELVAERT.
“The project offered us the opportunity to get to know and participate in the concept of health outreaches (which we don’t know in our country), and also to visit schools and interact with the people living in various communities in Uganda. I do believe that all of us will take new knowledge, cultural diversity and experiences back to Belgium, to be shared and caressed and to help us all become more culturally sensitive students of medicine, intent on improving the health of the population, in whatever country we are present in.” – NINA VAN MOORTER.
NUV-HOP is a relevant project to the communities of Northern Uganda and both to the Ugandan and Belgian Students.
It is a step that prepares both local and international students to work in a low resource and culturally challenging setting. This is in line with the objectives of the international Federation of Medical Students Association (IFMSA).
On the behalf of the entire taskforce, I extend my heartfelt appreciation to:
- AMREF for helping us with transport and mobilization to Awach, Bobi, taks center and Lalogi outreach sites.
- Reproductive Health Uganda for providing staff and equipment for cervical cancer screening, VCT and family planning.
- Host families for opening doors and showing love to the Belgian students.
- Gulu University for their continuous encouragement and support to allow us have health outreaches.
- District leaders for Gulu, Amuru and Nwoya for permitting us to conduct NUV-HOP In their health districts.
- NUV-HOP doctors for supervising the project
- Belgian Medical students’ association-BeMSA for financial support.
- The Federation of Uganda Medical Students’ association- FUMSA for technical advice and support.
- Gulu University Medical Students’ Association (GUMSA) for standing with us and keeping safe project funds on their account.
- NUV-HOP Taskforce for the hard work, focus and persistence through the hard times during busy schedules.
- All participating medical students for their great efforts, knowledge and clinical skills displayed during our outreaches.
- The community for their hospitality and co-operation with us.
Thank you and May God bless you all.
Report prepared by:
Mahulo Nelson, MB ChB V, GU
Head of NUV-HOP Taskforce 2012/2013.