PRODUCED QUARTERLY BY THE MESAU CONSORTIUM; A MEPI INITIATIVE Vol 3 No. 2 March 2014 MESAU Newsletter MESAUNewsletter Mesau Director’s Message

Dear Reader, ecently I The contribution of Ugandans in attended the World RFederation of the Diaspora to improved Health Medical Education (WFME) Executive Council meeting (14- Outcomes in Uganda 15 April 2014).The objective of WFME is to Moses Wasswa Mulimira and enhance the quality of medical education world- wide, and to promote the highest standards in Mariam Namulindwa Aligawesa medical education so as to improve health care for all mankind. This objective aligns with expertise in accountancy, law, IT well with one of MESAU’s aspirations. There significant barrier to is a need to improve communication between and business management. WFME and the Association of African Medical reducing health inequalities The Uganda Diaspora Health Schools as Africa seems to be the only region remains the shortage in the world lagging behind in this respect. Foundation works in collaborative Similarly neither MESAU nor MEPI have paid of health care workers enough attention to what WFME is doing. It inA low income countries and a to pg 2 is high time we turned our attention to WFME disproportionate concentration so that medical education in Africa can benefit from the Federation’s efforts. Let me focus on of skilled workers in high income three important projects that the Federation is countries. As a way of exploring Contents spearheading and which require our urgent alternative ways of continuing attention in MEPI:  The new World Directory of Medical to deliver high quality services „ The contribution of Schools has been launched and we across the globe, policy makers are Ugandans in the Diaspora need to ensure that our medical schools now focusing more towards their that are recognised by the Uganda National Council for Higher Education Diaspora communities. „ The Safri Fellowship; do appear in this directory. Please visit The definition of “Diaspora” being: a timely support for the directory on the WFME website. “members of ethnic and national  WFME has revised the global standards an important Need in for basic and postgraduate education communities, who have left, and for continuous professional but maintained links with their Medical Education development (CPD).The new version of basic standards is published on the homelands”. The Uganda Diaspora Federation’s web site and the other two Health Foundation was established „ Commitment: The missing will be in place later in 2014. We should in 2011 to integrate the expertise ingredient for Healthcare acquaint ourselves with these global standards and strive to achieve them as of Ugandan health professionals workers appropriate. in Britain. Whilst individuals had „ MESAU Gives me My  The accreditation of medical schools been previously involved in project around the world: WFME has started first Experience as a to accredit agencies which will be and hosting work in a global health responsible for accrediting medical partnership with East London NHS Researcher schools. Currently the accreditation agencies recognised include:The Trust- Butabika Hospital Link, a „ My time at Yale School of Caribbean Accreditation Authority formal Diaspora group was proposed Medicine, a life changing for Education in Medicine and other to provide greater opportunities Health Professions (CAAM-HP); experience The Association for Evaluation and for involvement and leadership in Accreditation of Medical Education future work. „ Preparing for Community Programs (TEPDAD) in Turkey; and The group has a diverse range of The Liaison Committee on Medical Based Education and Education, USA and Committee on health professionals including; Research Services at Accreditation of Canadian Medical nurses, midwives, psychologists, Busitema University Schools, Canada (LCME & CACMS). occupational therapists, medical MESAU needs to discuss development of engineers, medical/ nursing „ Davis Auditorium accreditation agencies that will accredit students, service users/ carers and African medical schools based on the Conferencing Center at global standards. Accreditation is one of the also members from the private sector MakCHS important mechanisms to ensure quality. to pg 2

MAKERERE UNIVERSITY 1 MESAU Newsletter The Safri Fellowship; a timely The contribution of Ugandans in support for an important Need in the Diaspora Cont’d Medical Education

Jane Frances Namatovu, Dept. of Family Medicine and Annet Kutesa, Dept. of Dentistry MakCHS Teaching others without any formal training in teaching is very challenging; particularly due to inadequate confidence one may have in the methods they may be using. The creation of the Southern Africa FAIMER Regional Institute (Safri) therefore is an attempt to address this anomaly. We both have interest and are practitioners in medical education. We applied to Safri for the training and we were seconded by the College (Left-Right - Maura Buchanan, Director of UK Uganda Health Alliance; Mr Moses Mulimira , Chair of Health Sciences which provided of Uganda Diaspora Health Foundation; Enid Mwebaza Chief Nurse, Assistant Commissioner of travel and upkeep support through Health Service Ministry of Health Uganda, Lord Nigel Crisp Member of the House of Lords UK and the MESAU-MEPI. SAFRI and MESAU- works mainly on international development and global health and Founder of Zambia UK Health MEPI project at Makerere University Workforce Alliance; Professor Ged Bryne, Director of the University Hospital of South Manchester College of Health Sciences have a Academy- Gulu Link and Dr. George Mukone Senior Medical Officer, Ministry of Health Uganda, common vision of promoting and at UK- Uganda Health Care Alliance Launch February 2013.) strengthening medical education. The MESAU-MEPI project in the and innovative ways in identifying • Non communicable College of Health Sciences at Makerere and delivering complex health disease awareness project University facilitated our travel and care related projects both in in partnership with C3 upkeep expenses for all the three United Kingdom and Uganda. In Collaboration for Health, 7-day trips to South-Africa for the on- partnership with The East London Uganda NCD Alliance, site sessions. During our stay there, we National Health Service Trust- Uganda – UK Health Alliance, had several rigorous sessions relevant Butabika Hospital Link ( www. Heart sound Uganda; to medical education in the areas of butabikaeastlondon.com), Diaspora Butabika/ Mulago Hospitals. teaching and assessment methods, Members have helped in delivering • Development of Older Adults leadership and management styles complex, multi-year projects around mental health services in and research methods. This is a one- Uganda to increase psychological Uganda skills of Psychiatric Clinical Officers, • E learning student project reduce violence in psychiatric wards, between Makerere deliver a new service utilising those University, Royal society who have recovered from illness, of medicine UK and Kings’ and develop Ugandan expertise in College London Student child and adolescent mental health. peer to peer partnership. The work of the Butabika Link is In conclusion, we should strengthen internationally recognised. links between Ugandan institutions and society and Ugandans in the Currently, the foundation is involved diaspora, so as to benefit Uganda. in the following projects; • Stress Management/ Contacts; resilience training for Moses Wasswa Mulimira health care workers Co-Chair – Ugandan Diaspora using Mindfulness (ACT) Health Foundation [email protected] Psychological Model (Diaspora nurses as Mariam Namulindwa facilitators – trained by Aligawesa Dr Paul Flaxman (City Co- Chair - Ugandan Diaspora University) and Mr Cerdic Health Foundation 2013 SAFRI fellows, (Jane F.Namatovu -3rd from left and Annet Kuteesa - 1st from right) Hall (East London NHS Trust). [email protected] at Southern Sun Cape Town South Africa.

2 MESAU Newsletter The Safri Fellowship; a timely Commitment: The missing ingredient support for an important Need in for Healthcare workers to stay and Medical Education efficiently work in Uganda year fellowship in medical education reach that critical level, where so the rest of the year when we were Henry Duke Tamale, Makerere commitment is a marriage. not attending site sessions, was spent University College of Health This is the level that health having weekly on-line interactions, Sciences workers need to attain to make submitting the monthly tutor marked meaning to their countries and assignments(TMAs) and working on populations. a medical education research project. Dear Medic, Each one of us was assigned a mentor he conversation we had last Healthcare workers like you from Safri and we also had to each time really got to my heart. and I, have a special calling, a choose a mentor from our institution. You complain, honestly vocation. And once we take of course, about the poor it up, we have got to make a workingT conditions, the small One of the life changing experiences commitment. We have to take for us was the poster day during yet delayed pay, failure of your nd more of a marriage mentality the 2 on-site session. On this day, superiors to promote you (as they towards this kind of calling. every fellow presents the preliminary promote their tribesmen), and Once someone goes through results of his/her educational research most importantly, even when you medical school, it’s definitely not project. This project must be done in want to do something great to time to keep drifting through life one’s institution as a way of promoting help your patients, the absence of without any thought as to who scholarship in medical education. essential equipment to use. So you or what is counting on you. To We had the opportunity of listening decided to leave for Melbourne, keep shirking responsibility and to every fellow’s presentation. This Australia where the grass is greener. causing those closest to you to gave us at least an idea of whatever This small note, is not to make you call into question your integrity. is happening in every medical school change your mind as much as it is No, friend. It’s time to commit to on the African continent. What an about to tickle your thinking. a path. Something! Anything! opportunity for networking and collaboration! Our conversation really got Imagine a wave of commitment me thinking how the world and change beginning with In addition to the above, we learnt (especially Uganda) needs more of you: we shall then have people a lot from the other 2013 fellows commitment and not new ideas and committed to ensure your and faculty who were from other daring dreams- a willingness to do salary comes in time and is Universities on the African continent. the hard work that matters. Sadly, commensurate with your job, This fellowship has added meaning to there aren’t many who have the others committed to ensure our career in medical education and perseverance to do so. And I think current school curricula we believe the knowledge and skills the problem is a misunderstanding and relevant research, good acquired are already transforming our of the word. There is, in fact, more governance, and still others day-to-day work at MakCHS. than one type of commitment. And committed to furnishing and knowing that can make a world of equipping the hospitals! difference. We don’t need your restlessness Commitment means something or your excitement. We have different at different stages of life enough Peter Pans, thank you and knowing these differences is very much. What we need is key in aiding our understanding a little more conviction in our of the term. For example, what difference-makers. We need commitment means to a toddler is your focus, your puck, your different from what it means to an courage. adolescent and different from what an adult understands by the same We need you to commit for a term. Through each season of life, better Uganda! we must relearn what it means to commit. The writer is a MEPI-MESAU fellow studying MSc. At certain levels, commitment is Physiology at the College of an adventure and seasonal, but it Health Sciences, Makerere is important for us to understand University, what these levels mean before we 2013 SAFRI fellows, (Jane F.Namatovu -3rd from left and Annet Kuteesa - 1st from right) at Southern Sun Cape Town South Africa.

3 MESAU Newsletter

MESAU Gives me My first Experience as a Researcher

Susan Nassaka-Byekwaso, Administrator at MakCHS International Office The pilot’s voice came booming over the planes PA system just before take off ’´this is to inform you that we have a multi-cultural team of flight attendants from 11 countries’. While I thought that was a good thing, my colleague asked , ”What does that mean to us; does it mean quality customer care services or faster services?” I explained that the pilot was trying to explain to us that the airline company has incorporated global dimensions in thier employment system and strategy. Whether that improves quality of customer care, was to be answered at the end of the trip. International students learning alongside Ugandan students in the community My MESAU-supported study is in Kumi district similar to the internationalisation of human resources the airline border collaborative research, attracts international students to is engaged in. I am studying in student/teacher exchange institutions like MESAU partner Internationalisation in health programes, joint publications universities is the fact that professionals education at the five and how they affect the quality of English is used as the language of MESAU consortium institutions. education, research and service to instruction. Students are also aware The study is assessing whether community. After the experience that accrediting an institution internatiolisation improves the with the responses from my will improve the profile of the quality of education, research and colleagues, I resolved to read a University and attract strategic service to the community. As a little more about the topic, before partners. They also appreciate that young researcher, my first thought inviting my co-investigators for a MESAU-MEPI consortium is one was to seek advice from my consultative meeting. of strategies that Medical schools colleagues who have been doing in the MESAU consortium have research; I was surprised by their The adage that Africans do not used to integrate international responses. Internationalization in read really applied to me before dimensions in health professionals health professional´s education!, October 2013 when I received education by facilitating Why did you choose to research on the letter informing me that was publication of research findings in such a complicated topic? Why not awarded a grant to facilitate the international journals, facilitating international students who you work research; now I read a lot thanks staff to attend international with directly,? You may never receive to MESAU. I have acquired very conferences, fostering networks approval from MakCHS IRB on time!”. useful information which guided between medical schools in the International students are only one us during the first meeting with my MESAU consortium in Uganda of the strategies employed at the five co-investigators, setting objectives with Universities in the U.S, (5) medical schools in the MESAU and research questions for the encouraging virtual mobility consortium in Uganda; Makerere study, designing of data collection of staff and students through University College of Health tools and writting the proposal for teleconferences and many others. Sciences (MakCHS), Gulu University IRB approval. The whole process has Students are well-informed. Medical School, Mbarara University been bumpy but with great lessons of Science and Technology (MUST), to learn. Collecting data from academic Kampala International University staff is a bit challenging as they (KIU) and Busitema University (BU). Right now I am colleccting seem busy, but a few that have My study will also review other data! During one of focus group time are not very sure what internationalisation strategies like discussions in Gulu University, internationalisation is all about. Joint PhD programmes, cross- I learnt that one feature that Some are not even aware that

4 MESAU Newsletter

MESAU Gives me My first Experience as a Researcher

The author (seated, left) with 4th year medical students of Gulu University

graduate degree programmes present; Swedish, Danish, Ugandans, Britons and an Ethiopian! The team undertaken under the was reviewing an article for a PhD student using English; the exchange of framework of partnerships with knowledge and ideas was great.. The meeting left me with an unaswered outside Universities are also a question ’Do MESAU institutions have a policy to recruit international staff? feature of internationalisation just like teleconferencing seminars between Universities across borders. One of my academic friends admitted to me , ” The International Officer from Karolinska has made a presentation to us; I didn’t know that outward mobility of teachers and students is an internationalisation strategy,’ I think your research is going to be very interesting” Iam glad to learn that the study is sensitising staff about the importance of internationalisation. From complicated study to interesting; that sounds good.!! Observation as a method of data collection has been the most interesting part of the study because I have now developed an inquistive eye which looks out for the global dimension of everything. Attending a research meeting recently at Lund The researcher (fourth from left) sharing cake after a research meeting at Lund University. University, Sweden, I observed First from left is Rose Nabirye (PhD) Chair Department of Nursing, Makerere University the multi-displinary composition College of Health Sciences of the group and diversity in nationalities of members

5 MESAU Newsletter MESAU Innovation in Surgical Training for Medical Students in Uganda and the US

Ryan Graddy, Mira Mehes, Khaled Al- leader in surgical training of medical tool. Dr. Ryan Graddy from Johns Omar, Fizan Abdullah, Jane McKenzie- students in Uganda. In collaboration Hopkins, in partnership with Dr. White, Bob Bollinger, David Kitara with colleagues at Johns Hopkins Kitara (photo above), and colleagues Johns Hopkins University and Gulu University, a novel, interactive at Gulu University have begun the University computer-based electronic learning baseline assessment for this program curriculum was developed to evaluation. In addition, Dr. Fizan Inguinal hernia repair represents one improve medical student knowledge Abdullah, Dr. Graddy, and colleagues of the most common elective surgical of the principals of hernia anatomy, at Hopkins are initiating the procedures performed worldwide. pathophysiology, physical exam and evaluation of the same tool among Up to 8% of all adult men will be surgical repair. medical students in Baltimore. diagnosed with an inguinal hernia in

their lifetime. Despite the prevalence of this condition, many adults with hernia, particularly in Africa, are In the past month, a study to evaluate Students will be assessed for their undiagnosed. When left untreated the effectiveness of this new training knowledge, but also their physical over the long-term, inguinal hernias tool has been initiated to compare examination skills (photo at left). can contribute todecreased quality knowledge of medical students of life and disability. Enhanced who have received the standard It is hoped that this tool will ultimately training of medical students has medical school hernia curriculum demonstrate improvements been identified as a key strategy with students who are also provided in both knowledge and skills foraddressing this very common access to this supplemental training among students in Uganda, the condition in Uganda. US and beyond. If the evaluation The Medical Education for Services demonstrates improvements in to All Ugandans (MESAU) initiative is knowledge and skills, this MESAU- committed to innovation in medical supported innovative, e-learning education. Development and use tool will be shared with students of distance learning tools are an throughout Uganda and perhaps important priority for MESAU. The world-wide. This would also provide strategic use of distance learning support for development of similar can also leverage the experience tools to support training in other and expertise of the top surgical surgical competencies. Stay tuned faculty to reach a greater number to future issues of the MESAU of students and improve their Newsletter for updates about the competency-based education. Dr. progress of this novel education David Kitara, Professor of Surgery strategy. at Gulu University is a well-known to pg8 6 MESAU Newsletter Accreditation of Kampala International University – Western Campus’ Institutional Research and Ethics Committee (IREC): A Priority for the Early Part of 2014

Claude Kirimuhuzya, Kampala Fundamental Research Ethics. The accredited fully-functional IREC. International University two-day training was conducted One of the of the key issues that by consultants from UNCST and emerged from the interactions By the beginning of 2013, Kampala Makerere University College of Health during the training was that KIU International University –Western Sciences who included Mr. Paul Western Campus, has to have in Campus had no research support Kutyabami, who had been tasked place a Research and Innovations structure to boast of. As per by MESAU with the responsibility of Policy with a clearly laid out research now, the institution has a fully overseeing the accreditation of KIU agenda, if the accredited IREC is to fledged Grants Office and is now IREC, and Ms Winnie Badanga, Dr. do a good job. Therefore, the other competing favorably in searching Fred Nelson Nakwagala, Dr. Julius priority that is to run alongside an for and disseminating research Ecuru and Dr. Joseph Ochieng. The accredited and operational IREC, funding opportunities, which training attracted 52 participants all is finalizing the formulation and are disseminated in a monthly of whom completed the training and operationalisation of the Institutional newsletter, to members of faculty and students. Added to this is the establishment of a Research Support Committee, as a component of the Institutional MEPI/MESAU Project Implementation committee. A good number of the research management team has undergone a full course of Research Administration and Management training, with two of them also acquiring Trainer of Trainer (TOT) skills. The fundamental blot in the process of research support for faculty and students, however, has been the lack of an accredited Institutional Review Board to handle the hundreds of research proposals that are produced A group photo of The Fundamental Research Ethics training. In the centre, (in a long by students (both undergraduate sleeved white shirt) is Dr. Julius Ecuru from UNCST, to his right (in a blue suit and and post graduate) and members wearing spectacles) is Professor Emmanuel Korooro, the DVC KIU Western Campus, of faculty. For quite a while, the and to his right (in a cream suit and wearing a hat) is Professor John Rwomushana, the researchers have had to go through Chairperson of the yet to be accredited KIU Institutional Research and Ethics Committee the rigours of preliminary review (IREC). by the provisional Institutional Research and Ethics Committee were awarded UNCST certificates. Research and Innovations Policy and (IREC) and then taking their At the moment, the provisional Research Agenda, the drafts of which proposals to Mbarara University of KIU IREC has developed almost all are already in place and for which Science and Technology Institutional the necessary Standard Operating approval by various institutional Review Committee (MUST IRC) for Procedures (SOPs) that are required bodies is already scheduled. approval, before proceeding to before accreditation. A second With these research support Uganda National Council for Science and final training, called IRBstructures in place, it is envisaged and Technology (UNCST) for final Operations Training (UNCST IRB that our young university, and the approval and registration. This has 101) was conducted 7th-10th April only privately owned member of been a time-consuming exercise 2014. The UNCST team has also the MESAU consortium, will have a but which was deemed necessary agreed to conduct the training on strong foundation on which to base since MUST IRC was charged with Responsible Conduct of Research and launch a campaign that will make the responsibility of mentoring the which will involve members of it take its rightful place as one of the KIU IREC, before it could qualify for IREC and faculty that are involved major health research institutions in accreditation by UNCST. in research and review of research the MESAU consortium. The good news is that from 19th - proposals. It is envisaged that after The Author is Chairperson Research 20th March 2014, the members of these trainings, the KIU IREC will be Support Committee, KIU MEPI/MESAU the provisional KIU IREC, and a large in position to submit its application Implementation Committee and an number of proposal reviewers from for accreditation and it is hoped awardee of MEPI/MESAU funding for among the members of faculty, that before 2014 comes to an end faculty-mentored research. underwent successful training in KIU Western Campus will have an

7 MESAU Newsletter

MyMy timetime atat YaleYale SchoolSchool ofof Medicine,Medicine, aa lifelife changingchanging experience:experience: AA lessonlesson forfor MESAUMESAU SchoolsSchools

practice of pulmonary medicine yet the number of medical students not well covered in my prior training. on each rotation to an average In addition to general pulmonology of 3 students. To give all students I had dedicated time in chest equal experiences students spend radiology, pulmonary function half of their rotation at the main testing, pulmonary rehabilitation, hospital and the other half at the interventional pulmonology and two other hospitals. A list of topics intensive care medicine. to be covered in each rotation is My day was typically spent between produced by the course directors clinical/procedure rounds, teaching and the course directors in each rounds, attending conferences and hospital ensure that the topics By Bruce J Kirenga workshops and personal study. For are covered before the end of the Makerere University College of Health personal study I concentrated on rotation. Inter program rotations Sciences patients with conditions likely to be consisting of medical, Advanced encountered in Uganda. practice nursing, Physician ast year I was selected to be assistants and pharmacy students are organized. This gives medical the next faculty member to go Most of my clinical rotations students the opportunity to interact to the Yale School of Medicine occurred at Yale New Haven with students from these other (YSM) for one year. My host Hospital, a tertiary health care Lwas the section of pulmonary, sleep professions early enough during facility of 1541 beds including a training. This inter-professional and critical care. I arrived at Yale on plane landing site where patients learning is the foundation of future 14th September 2013. This 300 year can be airlifted to and from the team based care old institution is located in the city hospital. Care is provided in teams of New Haven about one hour from that include attending specialists, New York and about two hours from trainees, allied health professionals, During clinical rotations students Boston. mid-level providers and nurses. are part of the clinical care team There is a heavy emphasis on that takes care of patients from admission to discharge. In fact the I was assigned a mentor (supervisor) technology and patient centered last year medical students are called who advised on all my training outcomes. sub-interns. Through close patient activities. My first rotation was care students develop ability to put general internal medicine purposely Clinical teaching at YSM is almost together all clinical, labs and imaging designed to give me a chance to get the same as at MakCHS but there data to arrive at a diagnosis. Limited an experience of general internal are some differences. For example patient teaching discussions occur medicine as is practiced in the at MakCHS an average medical on the rounds. Learning patients are US but also the medical students student’s rotation will have about identified for scheduled teaching training. The rest of my rotations 6 students. YSM has decentralized away from patients. were designed to focus on those clinical teaching to two other areas that critically necessary for the nearby hospitals bringing down

8 MESAU Newsletter My time at Yale School of Medicine, Cont’d I was also amazed by the no My exposure to the American Health be building capacity of Ugandan examinations system at YSM. care system has made me reflect specialists. As more students This is based on two historical to my own system in Uganda. The continue to be exchanged between philosophies: the need for medical MUYU collaboration really provides Yale, and Makerere, it will be critical students to be internally driven for great opportunities for a two-way to clearly define expectations, self-determination and the feeling exchange of medical trainees and responsibilities and limitations to that medical doctors should not be faculty between Makerere and both visiting students and their host. graded. To give examinations would Yale. For Ugandans, the greatest I cannot wait to return to Uganda have some students perform better and probably the most long lasting and implement some of the exciting and therefore feel superior to others. impact of this collaboration will new ideas I have acquired at Yale. The school has self-assessment tests that students can take on their own for assessing their levels My MercyCorps Pre-Internship Experience of knowledge but faculty members are not involved. These tests can in Karamoja, a Rural District be taken in the learning mode or Dr. Peter James Kitonsa self-evaluation mode. Progressive Most locals had non-tender assessment is however done by splenomegally cutting across all ‘’Karamoja, what? , God forbid, that immediate supervisors. To obtain ages and sexes. Could these people place is not habitable!’’ that was me a progressive assessment students have developed HMS? I should months before I stepped foot here. have to present patients’ portfolios surely tender in a MESAU-MEPI I spoke with so much confidence and supervisors assessment forms. research proposal. Malaria was the and ‘evidence’ that I could ‘prove’ A combination of these evaluations most prevalent illness and because there were no people but miserable allows classification of students’ of this, I left a pro at managing both animals and dry bones given that performance as an honors, high uncomplicated and severe forms. the ‘whole’ Karamoja population pass, pass or failure. To graduate Unfortunately, most of my patients is on Kampala streets; who by the students have to pass national would ‘self-discharge’ without way I was later told are the lazy ones examinations, the US medical completing the full dose especially who don’t want to work but prefer licensing examinations with artesunate. I got the two culprits hand- outs! I arrived in Kaabong responsible for this; ‘hunger’ and after travelling about 700 km from ‘over-whelming responsibility’. For There are also a number of notable Kampala, courtesy of MercyCorps, example, the mother of the triplets differences in care delivery from that but what I found shocked me; happy below was pregnant, had three in Uganda that I noticed. Patient are people with whom we spoke the older children and elderly parents put at the centre of their care, in fact same language save for a few phrases to take care of yet the drugs given in the intensive care unit, relatives are like ‘maata’ to mean greetings. I fell in demanded that the children be fed, welcome to join the rounds on their love with the language, and thus the thus the only simple thing to do was patients. But one observation stood people. The locals are such friendly to run away from the drugs and look out. Over the entire month I spent on people that they will always offer you for food! a hand shake even after sneezing in the general medicine ward, no single Diarrheal diseases ranked second their hands. patient was pronounced dead in the mainly due to poor hygiene and ward. Sick patients are cared for in sanitation; reason why I made a the different intensive care units and high dependency areas or step down Peter Kitonsa with the units. Another striking observation is triplets (Okello, Apio the amount of biomedical science and Odong) at the research that takes place at YSM Malnutrition Unit at at least judging from the number Kaabong hospital of research laboratories that are located everywhere on Campus. A number of physicians have labs where they conduct research on disease etiology, pathophysiological and therapeutics.

This one year at Yale has been a life changing experience; I have had the opportunity to work alongside the world’s leading clinicians and scientists. I have also had the opportunity to experience the state of the art technologies in medicine. 9 MESAU Newsletter My MercyCorps Pre-Internship Experience Connecting Research and academic institutions within and around the ‘decree’, but not the Idi Amin way, the patient post-operatively. My to have all children bathed on greatest fear, like most surgeons, was admission. Most parents complied anastomotic leak. Globe; the Role of Research networks and ‘oops’ other wards followed suit. However, by the 3rd post-operative day (P.O.D), the patient passed When I arrived in Kaabong hospital, flatus and by 7th P.O.D and 8th By Isaac Kasana, CEO Research and I was attached to the Pediatric ward P.O.D had passed stool and stitches Education Network for Uganda and we (finalists) agreed on a two- removed respectively. The patient weekly rotation so that we all could was discharged in good general At this point in time, it is clear that get the ‘feel’ of each ward (male, condition; at this point, I felt so ICT is a key enabler for education female, Maternity and Pediatrics). ‘complete’ and I thus realized that management and a major Here, I had and got the opportunity by the way, I also had ‘gifted hands’ to put into action what I had learnt in catalyst for the transformation thereafter started performing Safe of teaching/learning (especially medical school; I believe any medical Male Circumcisions, Caesarian student world-over aspiring to be a sections and Laporatomies with higher education) and an enabler good doctor needs this exposure. more confidence. for collaborative research which is the way research is now done. It was during my second week and This article seeks to explain the exactly two weeks after medical role and benefits of national school that I performed my first research and education networks caesarean section (C/S) under supervision with an indication of (NREN) and where the progress fetal distress, delivered a live baby made by Uganda in this regard. boy of 3.5 kg with an APGAR score It also emphasizes the impact on of 5 then 9 after 1 and 5 minutes research and the delivery of higher respectively. To my utter delight, the education as a basis for explaining baby’s mother named him after me; the role of research and education Okello PETER! network for Uganda (RENU), as Uganda’s NREN. It was a Sunday morning when we were called for an emergency on the male ward, where we found a RENU is a not for profit organisation Moses with an arrow lodged in his left that provides interconnection middle-aged man in excruciating upper abdomen for more than 8 hours pain with an arrow lodged in his between specific institutions and left upper abdomen for over eight This opportunity is one that does connects to a special international hours. We prepared him for theatre not readily present itself even during gateway that links its members’ and I hurriedly but shakily asked surgical or medical internship! networks to similar institutions’ that I perform the exploratory With this exposure I am ready to networks in the region and laporatomy! Thoughts started to market Karamoja to other health all over the world. RENU was wriggle in my mind that I was either professionals and eager to return established by universities and going to ‘kill’ or ‘save’ this young man. and work here. I have learnt that At this point, I requested to have research institutions in Uganda to: one can save and improve lives in the promote and facilitate research two assistants with the supervising world’s toughest places! doctor at least part of the two, just in and education networking case I cowered out. I opened the skin MercyCorps, Kaabong Hospital among Ugandan institutions, through a left paramedian incision and Makerere University College of create collective and stronger and the abdomen in layers, located Health Sciences (MakCHS), this is a negotiating positions to get the arrow which had perforated step in the right direction, especially better terms when dealing with the jejunum and mesentery with mixing junior and senior students. Government and Regulators on spikes piercing into the parietal I would therefore encourage other issues related to policy regarding peritoneum but no other organ health training institutions and accessing equipment, software, damage. At this point I developed students to embrace this once in a tremors; the truth was that the only on-line resources, and bandwidth, lifetime opportunity. Special thanks due to economies of scale ensuing gut I had ever repaired was that of to Mercycorps supervisors(Herbert, a goat in a surgical skills session but Gerald, Prossy, Sandra); Drs. Oneko out of cooperative action, engage was however encouraged by the fact Charity, Sharif Nalibe and Simon partners on issues of common that I had assisted twice in gut repair Akena; Mr. Tesfu, Mr. Hussein Oria, benefit such as inter-connecting operations as a medical student. I Prof. N. Sewankambo, Kaabong with other research and carefully removed the arrow without hospital medical and non-medical education networks worldwide further organ damage, resected and staff, my family, fellow finalists and and to explore ways of overcoming performed primary anastomosis, the almighty God for making my two the high cost of ICT resources lavaged and closed the incision months stay in Karamoja worthwhile. and entry wounds, and managed

10 MESAU Newsletter Connecting Research and academic institutions within and around the Globe; the Role of Research networks

through resource sharing where feasible. RENU also promotes collaboration in research, teaching, e-learning systems and access to digital library resources amongst research and academic institutions

RENU has made tremendous progress in regards to achieving its objectives and bellow we highlight some of the achievements;

- A UbuntuNetpoint of presence (PoP) has been established in Kampala to deliver global Research and Education (R&E) connectivity to member institutions.

- The Commencement of R&E network roll-out by linking University campuses (Makerere University, Uganda Christian University) to the RENUNetPoP.

- RENU has Acquired advanced network equipment for building the country-wide RENUNet backbone that will connect all research and academic institutions in Uganda. Figure 1. The Regional Research and Education Network (UbuntuNet) established through the AfricaConnect project - It has established the first R&E Point of Presence and becoming a locally- increased from 68mbps to 170mbps (PoP) in the Ministry of ICT based resource person. opening up numerous collaborative collation facility at Statistics opportunities through video House. At Makerere University that conferencing and other avenues. benefits of the RENU network Intensive support for Other institutions such as Gulu are starting to be realised. On University and Mbarara University of training of Ugandan R&E the 2ndof April 2014, Makerere networking staff in regional Science and Technology are yet to be University went live on the connected. training fora resulting in RENU network and since then the first Ugandan R&E staff the network is under test for any The Writer can be reached on Email completing the training of possible glitches to be fixed. [email protected] trainers’ (ToT) programme The University bandwidth has

11 MESAU Newsletter

Preparing for Community Based Education and Research Services at Busitema University Faculty of Health Sciences

Margaret Kigge, COBERS Coordinator The pioneer students of Busitema University Faculty of Health Sciences (BUFHS), Mbale campus are set to experience simulation sessions in readiness for their Community Based Education and Research Services (COBERS) programme due to start June this year. Basing on guidelines developed by Medical Education Partnership Initiative (MEPI)/ Medical Equitable Services for All Ugandans (MESAU), BUFHS has encouraged simulation sessions were first aid skills, which is an excellent addition to the required pre- COBERS medical skills that the Helping new-borns breathe students will continue to acquire and practice. The simulation saving new-borns etc. In addition (the before and after placement) exercises focus on a range of injuries to simulation sessions organised have been designed; a student’s and illnesses (epilepsy, diabetes, by faculty staff, students continue manual is in its final stages of etc.) and experience working in to undertake laboratory practicals development to guide students various environments including which are aimed at enriching in their COBERS expectations and health care provision settings. their knowledge in anatomy and what not to do in the community, physiology. while maintaining their medical After the 4th session, students were professional values. Students are also encouraged to identify a field asked to comment on the sessions In addition to simulation exercises in relation to upcoming COBERS. of research to undertake as they in preparation for COBERS, two advance in their studies. Seventy percent (70%) felt they lots of questionnaires to help had gained confidence on how to evaluate the relevancy of COBERS deal with first aid, clearing airways,

Simulating ways through which to keep a new-born warm as one of the basic first aid that can be offered

12 MESAU Newsletter The MUST MESAU journey towards Attitude and Attitude Change

By Edith Wakida, Mbarara University introduced to enhance Medical involved trying to understand the of Science and Technology Education in the Faculty of Medicine characteristics of our stakeholders, with the support of MEPI funding and what it is that we are trying to One of the things I have learnt along from the US Government. That the influence about them. Depending my journey with MESAU is attitude funding is there for a moment, but on the stakeholder attributes, we and attitude change; the power of the program is meant to stay so it is came up with different strategies attitude in building or killing any integrated into the faculty structures. for attitude change. We produce initiative. Once something is not well- That the aims of the MESAU program messages that present the position understood at the beginning, there are: we advocate and also convincingly is bound to be misconception of • Strengthening and sustaining deal with any objections to that what it actually is; MESAU at Mbarara innovations in medical education position. University of Science and Technology so as to produce an increased (MUST) has gone through this number of high quality health It has not been easy but the strategy phase and is successfully pulling professionals with competences has worked; slowly but steadily we out of it. Like many other initiatives, to address the priority health are realizing changes in attitude. MESAU for a long time was looked needs of Uganda; Fourth year into implementation, at as a project with a lot of money • Standardizing multiple health we are happy with the results and it should dish out for its activities facilities and community-based we shall get there! One of the key to be embraced; once this was not clinical platforms for education, lessons that we have learned from happening, then activity invitations service training and research to this experience is that to change were either pended or deleted. strengthen medical education an attitude, one needs to consider This was a mis-construement of the and the phases of the attitude change reality; we had not known what was • Establishing functional critical process which includes attention, in people’s minds but now we know. support systems to nurture and comprehension, yielding and Lessons have been learnt about sustain high quality locally- remembering followed by action. The the importance of building a firm driven trans-disciplinary other lesson learnt is the analysis foundation of anything right from research to promote health in of attitude change; this involves the word go. Uganda the source of the attitude change, It has taken MUST MESAU To ensure positive change in the message, the medium and the administration some effortattitude, our strategy has involved audience. to communicate to the MUST continuously talking about what I believe it is never too late, to change community what MESAU is all MESAU is doing, and involving a attitudes. Succeed we must! about. That it is a program that was wider range of stakeholders. This has

MUST staff during one of the consultative fora meant to create a positive attitude to MESAU

13 MESAU Newsletter Observation of the Practical Assessment of Clinical Examination Skills (PACES) for Membership of the Royal College of Physicians of the United Kingdom MRCP (UK)

Prof. Magid Kagimu, Director, Postgraduate Programmes, Department of Medicine, Makerere University College of Health Sciences

In May 2013 examinations, it was recommended by the external examiner, Prof Zaheer Lakhani, that in order to improve the clinical assessment of postgraduate doctors in the Department of Medicine at Makerere University College of Health Sciences, I should visit the Royal College of Physicians of London, to observe how the MRCP (UK) PACES exams are conducted. One of my observations when I visited UK in April 2014 was that the Long Case was excluded from the PACES. The reasons for this included: 1. performance of the candidate was not observed because he or she was left alone for 45 minutes Prof. Magid Kagimu with Desmond Bates at the without observing what was Royal College of Physicians being done; 2. candidates got different patients, some with rare themselves; 4. The long case was they are directly observed instead of conditions others with common not good at discriminating the being deduced from the candidate- conditions and it was not fair satisfactory and unsatisfactory examiner interaction. for examiners to judge such candidates because most candidates in the same way; 3. candidates would pass the long After this visit and my observations, the examiners did not calibrate case but subsequently fail the more I recommend that the PACES format the long case before it was done discriminating parts of the exam; of examination should be adopted and therefore it was not possible and 5. the clinical skills that were and adapted by the Department for them to make a fair judgment being assessed in the long case of Medicine at Makerere University of the candidate without having including history taking, physical College of Health Sciences, for experienced the difficulty of the examination and clinical judgment postgraduate clinical exams. There patient-physician interaction are tested better in PACES because is no need to reinvent the wheel.

Davis Auditorium Conferencing Center at MakCHS

Video conferencing involves two or locations simultaneously. Each conferencing feeds are run through more parties in different locations user must have some kind of a Internet or satellite connections. communicating through live audio monitor or television set to receive Compression software is vital, as and video feeds. Audiovisual (AV) the AV feeds. Microphones are the data streamed from audio hardware and software are required used to transmit the audio files. A and visual live feeds takes up a to run a videoconference. Each single microphone can be passed lot of space. Software to cancel location must have a video camera around between participants or out acoustic echoing is also vital or webcam to input the feed. Digital individuals can be miked. Speakers if live communication is to take projectors often are incorporated or headphones are required to place. Delays are wiped out so to show presentations at multiple receive the audio feed. Most video that parties can talk in real time.

14 MESAU Newsletter Davis Auditorium Conferencing Center at MakCHS any sound in the room. The room also has two wireless microphones as well as a microphone mounted on the podium for the presenter.

Video conferencing saves travel time and money. Participants can see and hear all other participants and communicate both verbally and visually, creating a face-to- face experience. PowerPoint and other on screen graphic, as well as other cameras are also available presentation options. People downtime is reduced and productivity gains are achieved by removing the logistics of flight preparations, airport delays, hotel stays, and all the other inconveniences of business travel.

Dr. Ian Crozier facilitating a Global Health Course to Students in In distance education, video the University of Washington from Davis Auditorium conferencing provides quality access to students who could not Video conferencing can either be presentation or any USB device. travel to or could afford to relocate point-to-point for participants in 2 People who prefer to bring their to a traditional campus. Video different locations or multi-point own computer can attach there conferences can also be recorded for 3 or more locations. laptop to the systems with the and made available in a variety connections on the podium. of ways for examples DVDs or through live stream videos. The Davis Auditorium is equipped with a multimedia presentation This system also gives the user system making the room an the ability to remotely connect to Video conferencing has benefited interactive teaching aide for different locations through high the MakCHS community in all forms of presentations and definition video conferencing. different ways: Seminars, lectures. The room has a large The room has a Polycom HDX Meetings, Guest lecturers from projection screen with the ability 9004 and two eagle eye high other institutions, Researcher to show computer presentations, definition cameras. The main collaborations with colleagues at power point presentation, movies, (rear) camera is for the presenter, other institutions, and video conferences. Room while the second (front) camera Thesis defense at another functions can be controlled is for the audience. The room institution and Grand Rounds through the Extron controller has two ceiling mounted mounted on the left side of the microphones which will pick up podium. Furthermore, the room can be controlled by any computer on the network by connecting to the controllers IP address.

The podium in the front of the room has a built in computer which can be displayed on the screen and using the Sympodium on the podium the presenter is able to make notes on the screen which the students can see. This computer has a USB connection on the podium for power point Makerere University College of Health Students Participating in a Grand Round with Mbarara University of Science and Technology

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The Mentorship Campaign in Makerere University College of Health Sciences shows Early Results

During this time, the committee commitment in mentorship was By Ismael Kawooya has embarked on a great made more obvious. mission to spread the gospel of mentorship to each individual By the time, Assoc. Prof. Pauline Byakika took to the platform On a number of counts we in the College, ensure all the to present the organization of have been advised “to take the students in Year 1 are matched mentorship and the results of the distance”. Whatever the distance with mentors and monitor these ‘Needs and Expectations Survey might be, it will be a product of mentoring relationships. amongst Mentors and Mentees’, speed and the time; the limit of With such foresight, the it was clear this initiative was which solely lies on the individual. committee organized a headed for success. Most Arithmetic shows that for one to mentorship workshop on April participants echoed the need achieve a greater distance one 9th 2014 held in the College for more of these workshops needs to tweak the variables to Boardroom, to share experiences, and reaching out to the distant a greater magnitude to reach the challenges and way forward. mentors (an initiative, the stars. Invitations were sent to pairs of committee has taken on by To provide the new students mentors and their mentees and visiting different departments, with the necessary propulsion, expectations were high of how the last being a very engaging Makerere University College of this could turn out to be. Mentees one at the Department of Family Health Sciences realized the need turned up in big numbers and Medicine). to support mentorship within the the mentors’ ‘no show’ was not At the penultimate activity of College at all levels. To achieve felt as it was over-shadowed by the workshop steered by Mrs. this, a mentorship committee was the vibrancy and expectations of Christine Muhumuza and Assoc. set up to guide this memento these students. But still, we would Prof. Damalie Nakanjako, there sojourn. have had a lot more fun, only if the mentors had come in equally was sharing of the pros and What a great time to be part big numbers. cons and the way forward for of the College? My face breaks mentorship. The participants into a grin as I think of more Prof. Sarah Kiguli steered were very frank and open fundamental changes to come the discussions through with their views which left to this great institution. With the excitement among the the committee nodding in such a monumental task, a participants. Students shared approval. As one of the mentees committee was set up to steer the their expectations of the roles encouraged fellow students College in an organized format and responsibilities of mentors to “stalk” their mentors with of mentorship that shall be a and mentees, with emphasis creativity, it was a sign of a good foundation of more great “stuff”. to mutual respect, listening, day. The committee was formerly led accountability and commitment Mentorship has been around by the industrious Assoc. Prof. from both parties standing for some time and with such Samuel Luboga (now retired.) and out more prominently. Using workshops keeping every one now the energetic Assoc. Prof. anecdotes, Prof. Kiguli steered abreast of the importance Pauline Byakiika, the committee the discussion of what a majority and need of mentorship, with Prof. Sarah Kiguli, Assoc. thought mentorship was not. more achievements are likely Prof. Damalie Nakanjako, Dr. While her method of work to be registered. With more Lynn Atuyambe, Dr. Rose Nabirye attracted rapturous laughter activities yet to come from the Chalo, and Yours Truly, and the from the predominantly young committee, the stars will only be more valuable coordinator audience, she managed to stress a stepping stone for each person Bakengesa Evelyn replacing the importance of mentorship in the college of health sciences. Gladys Khamili, and very recently for each individual at all levels of Although it is promising to be a Mrs. Christine Muhumuza who their profession. With memorable long walk, it is one I am willing to was co-opted on the committee. interjections of advice from the take, and enjoy every moment The guidance of Prof. Nelson only mentor present; Dr. Gerald of it. Sewankambo, Principal College of Tumusiime such as “Apply gentle Health sciences, is always banked persistent pressure” the grins on for the success of this venture. on the students’ faces got wider as the need for patience and

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