How was Uganda?

Out of Town ... in Africa.

One of my sisters was having a dinner at her house with a couple of friends recently. Someone asked why I wasn’t there (since I had been in town for the last few months I’ve been following her around just like I used to when we were children, pretending all of her friends are my friends too.) Anna shrugged her shoulders and said. “She’s out of town.” One of our mutual friends said, “She’s not just out of town!!! Anna! She's in Africa!!!” Anna shrugged her shoulders and said, “She’s out of town, in Africa.”

She went on to explain that she wasn’t entirely certain what I was doing, and that she was pretty sure I was in Uganda but she couldn’t say for sure.

So if you guys have been wondering why in the world I was in Uganda, not Malawi, only two months before I left for Malawi, join the club. My sisters were wondering too. Here’s the shortened version of why I was there, what I was doing and why it is important.

Three years ago, my boss/best friend/mentor Dr. Heather Brown and I first started the trauma training courses at MKMC in Uganda. This hospital, started by OneWorld Health continues to impress me with the affordable quality care that it provides to the patients that come through its gates and a partnership with this organization was one of the main attractions for me in agreeing to the global health fellowship. That same year we started a trauma registry to help us keep track of the details surrounding the injuries that were presenting to the hospital.

The retrospective study that we did on this registry with Dr. Josh Skaggs, another global health minded EM doc we work with, demonstrated that the most patients were transported by boda riders (motorcycle taxis), the average delay to care was > 11 hours, and that the most common reason for delay was lack of transportation. As a result, we started dreaming/planning what we could do about this. Unfortunately, there is no form of EMS or access to prehospital care in these areas so it required some ingenuity… and some research. Our research showed us that some places had effectively implemented rudimentary prehospital care training systems by training motorcycle taxi riders in basic prehospital care interventions. And so the preparation for the training of the boda riders in Masindi began. Since I was already scheduled to spend time at MKMC as a Global health fellow, it made sense for the training to happen during my time there in October of 2018. We arranged for two other EM docs interested in EMS to come along with Heather and myself, and began the process of acquiring materials and organizing 50 interested boda riders….

Then came the near drowning of my dad… the ICU stay which coincided with my final set of boards, the rescheduling of my boards for October 15th… and everything got a little confusing for a minute.

However, by delaying our final departure until January… we were able to get it all rearranged so I took my boards in the middle of October, went to Uganda for two weeks instead of one month, pushed the training back a week, and everything got done with a little extra family time built in and one last Christmas to spare!! Thank goodness for a flexible fellowship, hospital and husband.

So… how did the training go? Awesome!

We had full attendance and participation. (photo of all the motorcycles lined up outside of MKMC). The class was taught in Runyoro since this is the local language and with the assistance of our interpreters we had a full days training complete with a pre-test, lectures, five clinical skills stations, case studies and post-test. Both days demonstrated an improvement in the average scores of the pre and post test.

The content of the first round of clinical skills included airway rescue maneuvers such as head tilt, jaw thrust or recovery position, checking for central and peripheral pulses as well as capillary refill. The second round of skills included splint application and bleeding control techniques such as pressure dressings and tourniquet application.

Each rider was provided with a helmet, EMS patch and fully stocked kit including gloves, masks, tape, crepe gauze, trauma shears, tourniquet, chest wound dressing, gauze, pen and documentation cards. They will fill cards out on any patient transported to a hospital and will be able to turn in the cards to have their kits restocked.

These cards will allow us to monitor the materials most often utilized and we have even arranged for a local Ugandan to touch base with each rider while we are waiting for the formal follow up in March. In addition, since we have the trauma registry already in place, we can even monitor the long term outcome of the patients to determine if the care they receive seems to have affected them in the long term.

So while I was out of town I was hanging out with a bunch of boda riders teaching them when and when NOT to put on tourniquets. The story probably doesn’t make much more sense now that you’ve heard it… but just in case you were wondering, that’s what I was up to while I was “out of town in Africa.”