Luganda Lessons

23 sleeps until we leave and I have finally found someone to teach me Luganda through the Uganda Cultural Association of BC.  Wikipedia says Lugandan is a "it is a highly agglutinating language with subject-verb-object word order and nominative-accusativemorphosyntactic alignment." I don't know what that means but I hope that it is far less complicated than it sounds.  I've also ordered my Luganda-English phrasebook by Margaret Nanfuka (available through Amazon). For those who are curious there is a free Uganda phrasebook on-line at http://www.buganda.com/phrasebk.htm. One step closer!


Posted by Alix Bacon

Drinking Water Treatment in Uganda

Wow- less than 4 weeks and there's so much to do! I need to pick up anti-malarials (I decided on Malarone), & some cipro- just in case. Some Canesten in case I need the Cipro...arrange banking, decide on water treatment options. I visited a friend who works in water treatment on the Sunshine Coast. We discussed several water treatment options including two really cool new inventions.


Water treatment chemicals: 
pros-inexpensive, do not require consumables, can be used to wash fruits and veggies, good for large or small amounts of water
cons- do not filter out debris or environmental toxins, reduced effectiveness in turbid (non-clear) water

• Pristine Water Drops: chlorine drops protection against protozoa (including cryptosporidium), bacteria, and viruses (you can buy at MEC $18 for 30ml- treats 60-120L). This is what I always take camping and what the previous UBC Midwifery Students have used. Mix solutions A&B, wait 5 min for them to activate, add to your water bottle and in 15 min enjoy!
• Aquatabs: Rapidly dissolving iodine-free tablets that can be used over the long term with no adverse effects. They are safe for adults (including pregnant women) and children. Effective against giardia, bacteria, and viruses, when directions are followed. They have not been proven effective against the cyst cryptosporidium when in the oocyst stage of its life cycle. 50 tablets for $9 (each tab treats 1 L)
• Micropur: A self-stable, easy-to-use water treatment option that purifies using chlorine dioxide. Effective against viruses, bacteria, giardia, and cryptosporidium. 30 tablets $16.50 (each tab treats 1L). 

Water Bottles with Built in Filter: 
pros-Chemical free, good for water with environmental toxins and debris
cons-expensive, filter on 1L at a time, slow, need replacement filters

• Lifesaver bottle: as seen on TED Talks. My friend Owen told me about this amazing apparatus. Rather than carrying a water bottle and a filter the filter is built into the water bottle. Good for day hikes/cycling, backpacking.  You can purchase the bottle through the lifesaver website. The bottle is pricey $140 and each filter is good for 700L. Replacement filters can be purchased for $30. Why such a high pricepoint- well this is the most badass of all filtered water bottles. The London School of Hygiene & Tropical Medicine: Under "worst case scenario" testing in the lab, results show that the ‘Lifesaver Bottle’ removed all bacteria and viruses from a contaminated water source in excess of legal requirements and as such, complies with all British, US and European Drinking Water Regulations for Microbiological Reduction.While this seems pricey and unnecessary for backpacking it sounds cool for trekking and where this company really shines is that they have programs where you buy yourself a lifesaver bottle at full price and you can buy and donate a 2nd bottle at half price. Worth reading about for curiosities sake.
• Pristine also makes a water bottle with filter built in $26 at MEC. Good for day hikes/cycling, backpacking. 

UV Water Treatment: 
pros-chemical free, compact, destroys water born organisms' DNA so they can't replicate (highly effective)
cons- costly, requires consumables (batteries) that may not be readily available where you are travelling, only works in clear (non-turbid) water, do not filter out debris or environmental toxins

• Steripen: UV light. Treatment of .5L takes approximately 45 seconds and 1.0L takes approximately 90 seconds. Lamp life is approximately 8,000 treatments. Requires four AA batteries (not included). The manufacturer recommends Lithium disposable, or NiMH rechargeable batteries with 2300 mAh capacity.Manufacturer’s tests indicate that Lithium batteries will treat approximately 100L, while NiMH will treat approximately 90-105L, and Alkaline batteries will treat 10-20L

In the end I went with the Pristine drops because they are affordable, require no batteries or replacement filters, because we won't be dealing with turbid water or major environmental toxins and because I can use it to wash fruits and veggies which are supposed to be so delicious in Uganda. 

I picked up bug repellant, hand sanitizer, canesten too. And a pair of shorts that hit just below the knee but can be rolled shorter and long short-sleeved tee...both organic, both respectful of conservative Uganda and Moroccan sensibilities. Still to find- onsale source of green sunscreen.

Posted by Alix

International Day of the Midwife May 5 2011

International Day of the Midwife is May 5 and the MABC has been working several initiatives which you can get involved with:

1) International Day of the Midwife Walk in Victoria
May 5 4-6pm from Clover Point to Legislature

2) Letter Writing Campaign to Support Midwives

A form letter is available for you to send to your MLA along with a presentation on how to start your own letter writing campaign. Gather some friends, a bottle of wine and print off a dozen letter and let your MLA know that access to midwifery is an important issue!

3) Fundraising for Students for Global Citizenship
The MABC will be matching funds raised through the International Day of the Midwife Campaign up to $2000. That means that your $ will go twice as far.

Posted by Alix

Uganda Women's Network

As I consider what I, a white western woman, feel are priorities for Ugandan women I find myself wondering what Uganda women consider are the priorities for themselves? I am grateful that all those undergraduate women's studies credits have had a lasting impact on my self awareness!  As a confident, resourceful and privileged westerner I am aware that it is all too easy to fall in love with a romanticized notion of an African county, to pick out challenges there and create solutions without ever leaving the fantasy version of Africa that resides somewhere between my ears.  So I did what I often do when I have a query- I ask the smart box. A quick google search and I found the Uganda Women's Network (UWONET). Once of their initiatives is Policy Advocacy, Research and Information including advocating for:

• gender and reproductive rights &
• sexual and gender based violence indexing

UWONET is implementing a five year 7th country Government of Uganda/United Nations Populations Fund country programme under the Gender Component: Advocating for Gender and Reproductive Rights in 8 districts (Mubende, Kanungu, Oyam, Yumbe, Kaabong, Kotido, Moroto and Katakwi).  The programme's goal is to empower individuals and communities, especially the most vulnerable, to demand comprehensive packages of social services.

The programme entails;
1.     UWONET establishing and or strengthening alliances at national and community level for GBV prevention and advocacy for gender and rights advocacy.
2.    Increasing understanding and application of national gender related policies at community level.

In a website post made yesterday, UWONET expressed concerns about the Ugandan government's proposed plant to spend 1.7 trillion on fighter jets when over 6,000 women die every year (16 die daily) from preventable pregnancy related causes and for every woman who dies six survive with chronic and debilitating ill health. UWONET is calling on the government to reconsider. 

In the interests of networking I have emailed UWONET to see about networking opportunities, to let them know about my research plans and to ask what they feel are priorities for midwifery care in Uganda. Know of other Ugandan led women's initiatives? Let me know in the comments section!

Posted by Alix

Post-abortion Care in Uganda & Millenium Development Goal 5

First of all- let me define abortion in midwifery speak. 


Abortion is the premature exit of the products of conception (the fetus or embryo) from the uterus.Abortions may be induced (i.e. therapeutic abortion) or spontaneous (i.e. miscarriage).


Any kind of abortion is a health concern. A 1992-1993 study in Kampala (the capital of Uganda) hospitals found that 21% of maternal deaths were due to abortion-related complications. Post-abortion care can help to prevent these deaths and is particularly relevant in countries like Uganda where induced abortion is illegal or restricted. 


Induced abortion is illegal in Uganda.  This can impair post-abortion care in several ways:
1) Surgical treatment of incomplete abortions involves the same techniques as therapeutic abortion. There is fear that if healthcare providers are trained in these techniques and have the supplies that they will provide therapeutic abortions illegally. Therefore training and supplies may be restricted.
2) Health care providers may assume women presenting at hospital with post-abortion complications have attempted a therapeutic abortion and may delay or deny treatment based on this assumption. This means that whether a woman has had an induced or spontaneous abortion she may have trouble accessing care.


Millennium Development Goal 5 aims to reduce the 1990 level of maternal mortality by 75% by 2015. The major direct causes of maternal mortality are well documented and include unsafe induced abortion.Post-abortion care is a key component to meeting Millennium Development Goal 5 as is discussed in commentary by RamaRao et al published in the most recent International Perspectives on Sexual and Reproductive Health. Comprehensive post-abortion care includes emergency treatment, family planning and STI/HIV services and community empowerment.


Midwives in Uganda and several other African countries have been trained to provide post-abortion care. While in Uganda I (Alix) will conducting interview on midwives and post-abortion care for my 4th year thesis paper.  


Posted by Alix

Ugandan Pharmacies Illegally Prescribe Depo-Provera

I have always admired those who push the envelope- particularly when it comes to forwarding women's reproductive rights. While illegal provision of reproductive health services can be a huge health concern (think unsafe abortion), when it is done in a safe manner by trained health care professionals employing best practice it can be a great force of change (think Dr. Morgentaler).  It sounds like this is the case with Ugandan pharmacists who are illegally selling and administering Depo-Provera. 


From the Guttenmacher Update March 2011...


In Uganda, informal drug shops are common providers of the injectable contraceptive, depot medroxyprogesterone acetate (DMPA), even though its sale and administration by such shops is illegal, according to a new study by John Stanback of Family Health International et al.Released in the March 2011 issue of International Perspectives on Sexual and Reproductive Health, the study reports on 124 drug shops that provide DMPA in three rural districts of the country. Given Uganda’s low modern contraceptive prevalence rate and shortage of health workers, the authors believe a strong case can be made for building the capacity of drug shop operators to safely provide DMPA, which is the most popular modern contraceptive method in the country.

Stanback et al. found that of the operators surveyed, just 35% reported that their facility was a licensed drug shop, while 9% were licensed private clinics. On average, facilities provided three DMPA injections per week and most operators (96%) administered the injections themselves. All operators surveyed claimed to have some medical qualification: Thirty-three percent identified themselves as nursing aides; 26% as nurses; and the rest as having other nursing, midwifery or medical training. Despite this presence of trained operators, the authors identified safety concerns involving injection methods, contraceptive knowledge and syringe disposal.

One-quarter of providers reported having had at least one needle-stick injury in the past year. And though almost all knew that disposable syringes cannot be sterilized and reused safely, 11% reported having reused a disposable syringe in the past because of lack of supplies. Moreover, although nearly all of the surveyed providers ultimately disposed of syringes in pit latrines or by burning, fewer than half properly disposed of syringes directly after use, and loose syringes were visible in many facilities. Given Uganda’s high rates of HIV and hepatitis B, these findings document practices that could pose a serious health threat.

The study also found that although nearly all providers knew at least one of the common side effects of DMPA, most could name only one or two of the four side effects that would require medical attention. In addition, more than a third could not name any of the health conditions that would make DMPA an inappropriate method for an individual woman.

Despite the problems they identified, the authors believe that drug shops play a valuable role as providers of family planning services, particularly in rural communities. They argue that all operators would benefit from training in safe injection skills and family planning counseling and from having better access to safe sharps disposal. The authors conclude that training operators as community-based providers of contraception (who can legally give injections), along with enforcement of licensing and safety regulations, could make drug shops strong partners in Uganda’s efforts to improve maternal health and achieve its Millennium Development Goals.

The study, “Injected with Controversy: Sales and Administration of Injectable Contraceptives in Uganda,” appears in the March 2011 issue of International Perspectives on Sexual and Reproductive Health.


Posted by Alix

MABC to Match Funds Raised for Students for Global Citizenship!

The Midwives Association of BC has committed to matching funds raised through International Day of the Midwife (ICM) Celebrations.  Donate before May 5 and your donations go twice as far!


Where are the donations going?

Spring 2011 brings a new fundraising initiative. Two Ugandan midwives, Anne Olaro and Prossy Musoke, will be sponsored by the Students for Global Citizenship Fund to travel to the International Confederation of Midwives (ICM) Conference in Durban, South Africa in June. There, alongside UBC Midwifery instructors, they will present papers on UBC-Makerere University Partnership activities over the past 5 years.

The goal of this new initiative is to raise a minimum of $7000 which will cover airfare, hotel, food and registration for the two Ugandan midwives. In support of this goal, the MABC has committed to matching the first $2000 raised! Together, we know we can surpass this goal.

Donating is easy:

Online donations can be made by following these steps:

1. Go to www.supporting.ubc.ca/onlinedonation.
2. On the secure web page that opens up, select “Other” under “Direct My Gift” and enter “S580:Midwifery Students Global Placement Fund”.
3. Follow the rest of the donation process, and you will end up with your choice of a printable tax receipt by email or a paper receipt by mail.

Please let us know how you plan to raise funds for the Students of Global Citizenship Fund by emailing mabc.registration@telus.net. We would love to cheer you on.


For more information see the  MABC's website!


You can also get information on International Day of the Midwife Walk to Legislature on May 5 on the MABC's Facebook page. See you there!


Posted by Alix

Uganda Travel Guide Books

Earlier this year I began to look for a Uganda guidebook. When I searched my 3 favourite guidebook companies I was very disappointed to find that Lonely Planet only has an East Africa guidebook with one chapter dedicated to Uganda (you can download this chapter on-line $4.95 US) and Fodor's & Frommer's has no guidebooks for Africa. Imagine my pleasure last night when I was given Bradt's Guide to Uganda as a birthday present! Michael Palin says "the Bradt Guides are expertly written and longer on local detail than any others." Recommended to my mom and brother at Travel Bug store on Broadway and by many of the guests at my party who suggested that Bradt guides are the go-to guide for the off-the-beaten path traveller. Thanks Mom & Kit!


Posted by Alix

Shanti Uganda Jewelry Fundraiser- Host a Homeparty

UBC Midwifery Students for Global Citizenship
The UBC Midwifery Program has a global placement to facilitate student's learning about health care in other countries, learning to work in settings with few resources, & working alongside midwives from other cultures. This summer four 3rd year students will spend 7 weeks in Uganda. Students fundraise to purchase medical supplies to donate to the hospitals where we work. Supplies include gloves, oxytocin (to prevent and treat postpartum hemorrhage), IV supplies etc. 


The Jewelry
Shanti Uganda jewelry is made with recycled paper beads created by HIV+ mothers in a women’s income generating group. Prices range from $5 for earrings, $10 for bracelets, $20 for necklaces.

Shanti Uganda Society
The Shanti Uganda Society is a Vancouver based registered Canadian Charity that runs a birth house and midwifery training centre in Northern Uganda. They also offer health workshops for teen girls, washable menstrual pad kits (so girls don’t have to miss school), a community garden, a women’s income generating group and a scholarship program.


Hosting a Home Party
Hosting a Home Part is a wonderful way to help contribute to improving birth experiences for the women in Uganda at no cost to you. Proceeds are split 60% to Shanti Uganda and 40% to UBC Students for Global Citizenship. Hosts are an integral part of our fundraising effort in improving infant and maternal health in Uganda. Students are available to attend parties in the lower mainland.


How to:

• Contact Alix at alixbacon@shaw.ca
• We will provide you with
• An email Invitation template
• Posters
• A variety of jewelry
• a student speaker for the event
• a powerpoint slideshow about Students for Global Citizenship 

• Send your invites and put up posters at your workplace, school, church etc, make it an event of Facebook, tweet! Remind friends to bring cash or cheques!
• There's really no right or wrong way to display your Shanti products, but we highly recommend you take them out of the box and get creative! It's important that you make it easy for guests to view the jewellery, so use tables and counters that are high enough for comfortable browsing. You can spice up an old table with a nice fabric, cover over-turned bowls with cloth to create depth, use wine glasses to display earrings– the possibilities are endless!
• get change for those who bring cash and decide where you are going to put payments when you receive them (fanny pack, ziplock). Have some pens on hand for cheque writers.
• Some other creative ideas you may wish to use for your party include
• compile an African playlist on your itunes
• serve an African recipe or have an African themed potluck

For More Information...

UBC Midwifery Students for Global Citizenship
http://www.midwifery.ubc.ca/midwifery/internationalmidwifery/globeCit.htm

Shanti Uganda Society
http://www.shantiuganda.org/

Posted by Alix

Anti Malarials...Decisions

After my consult with the Vancouver Coastal Health Travel Clinic I am still left pondering which anti-malarial option I should choose.

Uganda is a chloroquine resistant region. Therefore, the options are

1) Doxycycline: an antibiotic taken daily beginning 2 days before entering the malarious area, while there and for 4 weeks after leaving the area. That would be 12 weeks of antibiotics!!!

Possible side effects include photosensitivity (a bid deal when you are in Uganda in the summer), yeast infection (need I say more?), nausea and abdominal pain (isn't this what I'm trying to avoid?). 

Cost $5/week=$60

2) Malarone: Taken once daily beginning 1 day before entering the malarious area, while there and for 3 days after leaving the area (8 weeks).  Side effects: basically nill.

Cost $35/week=$280

3) No prophylaxis: If I get symptoms I would take 4 tabs of Malarone a day for 3 days. The doctor said this option is NOT RECOMMENDED.

What do you think? $280 or risk sunburn, yeast and GI upset?? 

Anyone have personal experience with anti-malarials? 

Please comment!


Posted by Alix

Where will we be working in Uganda?

Students will be working in hospitals in (from west to east): Masaka, Kampala, Jinga, Mbale


Posted by Alix

Why an international placement for Student Midwives?

History of the UBC Students for Global Citizenship Program (SGS)


The UBC SGS program began in 2005. Each summer, 3rd year midwifery students undertake optional 6-8 week placements abroad. In previous years students have gone to Uganda, Nepal, Holland, Zambia and Mexico. This year 4 students are going to Uganda and two students are going to Nepal. Placements are interdisciplinary: each year a family physician and registered midwife accompany students on placement. In the past medical and nursing students have also participated. This year a nutrition student will be joining us. 


The student goals of the program are

• Learn about health care systems and reproductive care in other countries
• Develop an understanding of Safe Motherhood Initiatives and current maternity issues in a global context
• Experience ways that other cultures experience and manage birth 
• Gain experience to apply to rural and remote settings in BC
• Participate in planning, implementing and evaluating part of an international maternity care project

Recent Achievements

• In 2008 Ugandan midwife Prossy Cossy Musoke was sponsored to come to BC for 4 weeks. She became a Neonatal Resuscitation Program certified instructor and was provided with resuscitation teaching equipment. She has since been teaching NRP in the Masaka region of Uganda.
• Emergency skills workshops and NRP certifications are held annually for Ugandan health care providers
• Other workshops offered for health care providers include Labour Management Without Episiotomy and Leadership in Maternity Care
• A system has been developed to re-enforce use of oxytocin to prevent a postpartum hemorrhage
• A strategy has been developed for improving working conditions for midwives by improving infrastructure, equipment, and availability of supplies and medications. Both hospital births and staff numbers have increased and team work has improved.

Immediate and Future Goals of SGS

• Sponsor 2 Ugandan Midwives to attend the International Confederation of Midwives Conference in Durban in June 2011. These midwives will present papers on partnership activities undertaken in the past 5 years
• We will be offering a workshop on post-miscarraige care for health care providers at Jinga Hospital
• in 2011/2012 SGS will become its own Global Maternal Health course open to other health disciplines at UBC

Donate to Students for Global Citizenship On-line

UBC Midwifery runs a Registered Canadian Charity- Students for Global Citizenship Fund

Funds raised by Students for Global Citizenship go to:

• Supplies for maternity wards in Uganda including oxytocin (to prevent and treat postpartum hemorrhage), speculums, gloves, IV supplies
• Registration, food and travel expenses for 2 Ugandan midwives to attend the International Confederation of Midwives Conference in Durban, South Africa in June 19-23, 2011. The midwives will be presenting papers on the UBC-Uganda partnership
• Continuing education courses for local maternity care providers. This year we will be offering workshops in post-miscarraige care for staff at Jinga Hospital 
• Airfare, visas, fees for professional licenses, lodging and in-country transport of UBC faculty for establishing placements and supervision of students of placement
• HIV prophylaxis medication in case of blood exposure incident
• Photocopying
• Local trainer honorarium

You can help!

1. Go to www.supporting.ubc.ca/onlinedonation. 

2. On the secure web page that eventually opens up, select “Other” under “Direct My Gift” and enter “S580:Midwifery Students Global Placement Fund”. 

3. Follow the rest of the donation process, and you will end up with your choice of a printable tax receipt by email or a paper receipt by mail.

For more information on Students for Global Citizenship see: http://www.midwifery.ubc.ca/midwifery/internationalmidwifery/globeCit.htm 

FIgure 1: Ugandan Midwife Prossy and UBC Faculty Cathy Ellis at a continuing education seminar. Prossy will be presenting at the ICM in Durban in June.

FYI Students provide their own funding for:

• visas, travel, lodging
• immunizations
• uniforms and gloves
• tuition, International Placement fee ($500) and minimum fundraising of $500/student

Posted by Alix

Trip Preparations- Travel Clinic

Many people ask me what vaccines are necessary for a trip to Uganda? I had my appointment at the Vancouver Coastal Health Travel Clinic.  This is a self referral clinic and a consultation costs $45 (ouch). If you know what vaccine you need you can skip the consultation..therefore I will share what I know in hopes of saving ya'll some travel bucks!

Most Recommended Vaccinations:

Yellow Fever (needed to enter the country) $90

Typhoid $40

Recommended:

Meningococcal $130

Optional:

Rabies

Cholera (Uganda is not a Cholera area)

Traveller's Diarrhea (only provides 60% protection against E coli)

FYI- my extended health insurance covered the cost of yellow fever & typhoid 100% and partial coverage for Meningococcal. 

Recommended over the counter medications:

oral rehydration salts

Gravol

Pepto Bismol

Bug repellant with DEET

Florastor  Probiotic

Probiotic Goodness:

Florastor is an oral probiotic with 5 billion live cells/capsule. It does not require refrigeration. It helps to prevent antibiotic associated diarrhea in adults (good to take with Doxycycline malaria prophylaxis). It also helps to treat the symptoms of acute diarrhea. 2-6 capsules daily for 1 week.


Posted by Alix

Welcome!

Hello, and welcome to our blog!

We're Alix, Carolyn, Lyanne, and Sarah, and we're in our third year in the UBC Midwifery Program.

This summer, we'll be heading to Uganda to catch babies, to experience maternity care in a low-resource setting, and to expand our understanding of global maternal health.

We'll be in Uganda from late May until mid-July. Check back here for updates on our adventures.