First of all, on behalf of all of us at VSO, I want to thank everyone who has given a gift for this appeal and who bought friends and family some VSO volunteer hours for Christmas. We are extremely grateful, and send you our very best wishes for the coming months.

The last update promised you news from Nurse Duncan Smith, volunteering as a trainer and tutor in Kampala. Duncan is on a 2-year placement from June 2007 to June 2009, providing care for desperately ill patients in Kampala, Uganda. He is working with students to develop their nursing skills in addition to running regular training workshops and courses. Many nurses in Uganda are extremely disempowered and consequently people in Uganda are dying because of poor nursing care. Duncan hopes the new school of nursing and the curriculum he is teaching will help increase nurse morale and lead to improved patient care. As you will see from this extract of his update below, there are difficult challenges. Duncan’s input is vital to establish and sustain a momentum to improve healthcare, starting with training the next generation of nurses and sharing good practice with them.

To see Duncan’s earlier update and to link with a VSO volunteer for just £10 a month, have a look at www.volunteerlinking.org.uk

Report from Duncan Smith, VSO Volunteer in Kampala, Uganda November 2008

“Hello everyone

Work has been eventful. The organisation where I am based has been working for the last 18 months to license, open and operate a University of Health Sciences. I am pleased that despite the University being named the International University of Health Sciences the majority of the staff are indeed African (if not Ugandan then Kenyan).

The organisation hopes to develop a more modern learning institution promoting student centred learning and trying to challenge the talk and chalk culture that exists in Uganda from primary schools right through to higher education institutions. This all sounds great of course, but this aim in itself is going to require a massive level of commitment, dedication and hard work from all parties. The power gap between lecturers and students in Uganda is massive and this fuels the image that academics are inaccessible to students and just to be obeyed rather than questioned or, heaven forbid, challenged. All of these deep seated expectations will need to be turned on their head.

I have been allocated to teach the whole of the Anatomy module to the BSc (nursing) students which equates to about 120 hours of teaching. I am hoping to use the anatomy CD ROMS I have collected to make this a little more interesting and 3D, rather than students staring at labelled diagrams in books for 3 hours a day.

Aside from all of the hustle and bustle, it has been business as usual. Our 3rd years sat their final examinations which was quite an ordeal for them. The papers (set by tutors from neighbouring nursing schools) had questions relating to everything they should have learnt over the past two years. True to form, the papers were full of spelling mistakes and grammatical errors, and the standard was tough.

Following their written papers the students were required to complete 10 OSCE or clinical examination stations. This ordeal (and it is literally that) involves the students moving around 10 different sets where they must carry out a nursing procedure within a short time period. A bell rings and then they move onto the next station. During this assessment they were required to complete everything from administering an intra-muscular injection to teaching a mother how to prepare oral rehydration solution for a child with diarrhoea. The process is made more terrifying by the presence of possibly the scariest, most miserable nurse tutors Uganda has to offer, who descend as the external examiners. They seem to take great pleasure in the students fear and spend long periods of time cultivating the terror by peering over the top of their specs!

Despite the adversities the students performed very well and all passed their clinical with either distinction or credit!

With the exams out of the way, all the diploma students (2nd and 3rd years) went out on clinical placements again. The 3rd years undertook a short stint at Hospice Uganda to gain practical insight into Palliative care nursing, following on from the teaching that I carried out with them the previous term. After this they attended Mulago (the big Government hospital) to do Obstetrics. In Uganda there is a requirement that all health professionals are able to carry out a delivery if necessary, even if you decide not to pursue Midwifery. The labour ward at Mulago is reputed to be one of the worst in Uganda, as complicated deliveries are often referred there from rural health centres. Of course in many cases by the time the mother arrives, the baby has died and complications have already occurred.

The 2nd year students meanwhile were also carrying out a long three month placement at Mulago but not in Obstetrics. They were rotating through the different specialist areas including Ophthalmic (eyes), ENT, Cardiac, Neuro, Cancer etc. and I visited on a weekly basis.

I thought I would tell you about my experience earlier on this year. After completing their exams the students (2nd and 3rd years) started their next clinical allocation in the specialised psychiatric referral hospital for the whole of Uganda. The stigma surrounding mental illness is massive here.

On the first day we were given a tour around the hospital. Not being a psychiatric nurse by speciality, on a personal level I think I was even more shocked than I have been in the general Government hospitals. Some parts including the drug and alcohol dependence unit seemed fairly well resourced and quite un-intimidating. Other parts were very distressing. To outline the general process of admission - the patient is first sedated almost to unconsciousness, stripped naked and placed in a green gown (all patients wear the same) and locked away in either the male or female acute ward, resembling more of a cell block with rows and rows of rusty metal beds and mattresses on the ground. Here the patient waits to see one of the psychiatrists.

As well as the acute wards the hospital has several convalescent areas and an occupational therapy department, which did seem quite impressive and well co-ordinated. The hospital also has a male and female sick ward for any patients who also develop physical illness. My impression from my visits so far is it most certainly is not the place to develop physical illness as the resources for diagnosing and treating such illness are sparse. Last week my students were telling me of a young man who had been transferred from the convalescent ward to the sick ward with acute abdominal pain. He had allegedly been left writhing in agony waiting to see a doctor. It transpires he was suffering acute appendicitis; by the time the doctor put in an appearance his appendix had burst and he died of peritonitis, he was only 22.

After our tour I left the students to receive their allocations. I always leave quite reluctantly when the students are starting a new placement, particularly one as challenging as this, but they are a truly amazing bunch and seem to approach even the most challenging placements with a remarkably positive attitude.

Just over a week later I returned, under my own steam, to follow the students up on the wards. On one of the wards I found a large gaggle of my 3rd year students observing a patient receiving ECT (electro convulsive therapy). This had not been performed in any private or concealed environment, simply in the middle of a very overcrowded ward area.

I left the hospital feeling quite overwhelmed. So many young people with extremely debilitating mental illnesses living in real squalor with obviously (and perhaps understandably) apathetic nursing staff and security staff very willing to dish out a beating often just to exert their authority.”

Duncan’s update shows just what challenges there are for a sick person to receive good medical care in Uganda, and how important his input is to training the new generation of nurses. Clearly attitudes are changing at the university and he is there at just the right time to be able to make the most of that. Clearly too, his “remarkably positive” students and colleagues are increasingly rising to the challenges before them.

If you are interested in following the work of volunteers like Duncan, Paul and Unni (the last two featured in the first update on this VSO Uganda health programme), VSO’s Volunteer Linking scheme will suit you down to the ground, and you can help us keep sending these amazing individuals to share their skills and practice in places where they are needed most. You can find out how to join by going to www.volunteerlinking.org.uk

Thank you again for your gift, your support and for your time.

Emma
VSO

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