MESAU Newsletter MESAU

PRODUCED QUARTERLY BY THE MESAU CONSORTIUM; A MEPI INITIATIVE Vol 2 No. 4 • September 2013. TAKING THE MESAU EXPERIENCE BEYOND News“Rooting” Medical THE BORDERS AND BRINGING BACK THE Education for Equitable NEW LEARNED KNOWLEDGE AND SKILLS Services for AU By Joseph L. Mpagi, Roy Gonzaga Mubuuke (BMR, MSc, MHPE, for quality assurance of academic Faculty of Health programmes. In the course of carrying FAIMER), Radiology Department, School Sciences, out my responsibilities alongside my University of Medicine, College of Health Sciences, academics, I always called upon my MESAU experience, but I also gained ESAU, like the seedling above, other valuable skills and experiences needs to squeeze out of its s a junior faculty at Makerere that am ready to apply at MakCHS. confines and “root” deeper if University College of As a student leader in one of Britain`s it is to produce high quality Health Sciences (MakCHS), M leading research-led universities, I health professionals. In , I got interested in medical was involved in organizing research the media is awash with reports educationA which saw me attain a mentorship workshops for students of unprofessional conduct among FAIMER Fellowship immediately which often helped students to smoothly health workers. About two weeks ago, followed by the acquisition of a navigate through their research projects. Agataliko nfufu, a popolar TV news Masters Degree in Health Professions Key areas of focus were scientific writing, hour for ordinary folks in and around Education (MHPE). The coming drafting clear proposals, journal critique, , reported a woman who died into existence of MESAU-MEPI was database searches and writing research in labour―because of apparent neglect a blessing to me because I got an reports/manuscripts. MESAU has by a qualified health care professional. opportunity to operationalize my initiated research mentoring especially This case, now before court, re-ignited skills in medical education. When the for undergraduate students at MakCHS, a public outcry against uprofessional MESAU initiative commenced under but this needs to be strengthened and conduct among health workers in the the auspices of MEPI, I was lucky to we need to ensure that this continues country. get involved in almost all MESAU to pg 2 even after MESAU comes to an end. I activities addressing issues of medical believe I can apply the skills I gathered in . I got involved in this aspect to ensure continuity of such curricular reviews and development, Contents mentorship. assessment, teaching and learning, quality assurance, monitoring and Another key aspect of my experience u The Mentorship evaluation, educational research and was student supervision and support. relationship Between other student matters. Above all, I got As a leader monitoring how students Johns Hopkins into leadership positions on MESAU were progressing, I acquired key skills University School of committees. regarding the issue of student support. Students often have brilliant ideas on Nursing And MakCHS Later on, with travel support from how they would like to learn and it is MESAU, I embarked on my second u Using the Social Media essential to constantly seek audience Masters Degree in Medical Imaging to promote Networking with them. At Cardiff University, I was at Cardiff University, United Kingdom. among MESAU Partners involved in organizing staff-student My previous experience and skills in panels periodically in which student and Stakeholders medical education gained at MakCHS leaders would interact with staff to under MESAU enabled me to get u Health Professionals’ voice student concerns which would appointed as a Post-graduate student be forwarded to administrators. With a Education – the MHPE leader representing students of Cardiff competency-based curriculum now in Programme University Medical School on to the operation at MaKCHS, such staff-student Education Executive Committee, a sub- interactions are essential. This is an u MESAU – A journey committee of the University Senate aspect that I can also replicate here with of open doors, and that handles matters of teaching and support from other members. learning. I was also elected member opportunities of the Annual Programmes Review I also learnt that when students go for u Community and Enhancement Committee of the community placements; they often medical school that was responsible Placement Moments to pg 2 in Bwindi

MAKERERE UNIVERSITY 1 MESAU Newsletter

From 1 From 1 MESAU Director’s Message “Rooting” Medical Dear Readers, TAKING MESAU Education for Equitable ust over three years ago the BEYOND UGANDA Services for AU consortium, ‘Medical Education for Equitable Services for all conduct research projects that are Aware of the problem, MESAU training Ugandans’ (MESAU) was born. geared towards publications. I was institutions have embraced a number TheJ creation of MESAU was in itself a of corrective measures, and these involved in reviewing some of the disruptive innovation that led to the manuscripts written by students include (i) strengthening the teaching emergence of a new value-network and their supervisors. Whilst MESAU of medical ethics and professionalism that is gradually demonstrating its has strengthened the community- in medical training (ii) embracing value as it continues to cause changes based component of medical and promoting Community Based in our approach to health professions students by emphasizing the aspect Education (iii) revisiting selection education. In October 2013, MESAU of research, many of the Community criteria for admission into medical and the whole nation of Uganda had Based education, Research and schools (iv) introduction of a national reason to celebrate because Busitema Services, COBERS project reports exam that medical students must medical school finally opened its doors are not eventually turned into pass before they are allowed to to 53 students who registered to start publications. Thus, there is need for practice; this idea is still at a proposal on their first year medical education; all COBERS supervisors to work with stage, though. Unfortunately these the road to becoming a medical doctor. their students on and support them measures, like the protruding roots on MESAU institutions worked together as in manuscript writing. This is also a the seedling above, do not go deep family and supported efforts that led to key area I can actively participate in enough to produce high quality health approval by the Uganda government since I have also been very involved professionals in Uganda. organs to start this public medical school. in COBERS supervision. While addressing students of St. In so doing MESAU has contributed Mary’s College Kisubi in 2009, the Vice towards the realization of a MEPI goal In relation to research at Cardiff University, students were also Chancellor of Nkozi University said: of increasing number of health workers “The real formation of a child takes in the country. A new institution has a supported to write up proposals for funding. I was indeed part of a place at lower levels of education. clean slate on which to build its culture By the time they reach university, and therefore has lots of opportunity to team that often reviewed numerous student grant proposals. While some it is too late. Nothing much can be develop and implement new innovative done.” Literature shows that brain- approaches to education. There is an of these funding opportunities for students were from within the wiring (synapse formation/loss) opportunity at accelerates after birth and levels to develop a very innovative medical university, many were targeting other funding bodies from which off towards the end of adolescence school with a genuine desire and focus - ‘fixing’, among other things, a to implement transformative education many medical students won some grant awards. MESAU provides person’s natural orientation(s), i.e. of health workers who graduate when having/being competitive, analytical, they are fit-for-purpose and prepared funding opportunities for students. This can however be strengthened empathy, relational, seclusive, and so to be change agents. The new students on. It is extremely difficult to impart have the opportunity to pursue their by encouraging students to search for many other funding orientations such as empathy to lifetime dream of becoming medical medical trainees - however innovative practitioners and they speak with opportunities outside MESAU with the help of faculty. the teaching/mentoring will be in terms excitement and enthusiasm. The role of of attitude change. The easier way educational institution is to catalyze the Ultimately, an institution with a very would be to enhance entry of ‘talent’ process, provide the needed support vibrant faculty should also have an into medical training. MESAU can for and mentorship to the trainees to realize equally vibrant student community. example do this by strengthening their ambitions. Busitema University has MESAU has indeed nurtured this career guidance in schools - with the done well to partner with stakeholders vibrancy at MakCHS. aim of inspiring ‘talent’ into medical within and outside MESAU. My Post-graduate studies in the UK training institutions. In low resource environments were full of rich experiences It is primarily through young people partnerships are critically important in medical education and I believe with relevant natural orientation(s) that in developing an adequate workforce. I can use such experiences to Uganda shall get health professionals MESAU is built on a strong foundation strengthen what MESAU has started. who are committed to professionalism, of collaboration both between domestic The new experiences acquired from who exhibit a preference to practicing and international institutions. We need other parts of the world by myself, medicine, who are likely to stay after to harness all available opportunities to and other faculty members will training, who may easily work in less collaborate and utilize public and private contribute to the sustainability of advantaged areas and so on. In short, resources within the country, with other the enthusiasm, innovations and the starting ‘material’ has a profound African institutions and with institutions changes built under MESAU-MEPI impact on ‘product’ outcome in the in high income countries. There is a should be guaranteed as `We Build long run and hence, the need for growing pool of non-governmental for the Future`. MESAU to “root” deeper into lower institutions in Uganda that are showing levels of education, as the Vice interest in playing an increasingly Chancellor of Nkozi University hinted significant supportive role in both pre- on. service and in-service training.

2 MESAU Newsletter The resurrected THE MENTORSHIP RELATIONSHIP BETWEEN JOHNS HOPKINS UNIVERSITY SCHOOL OF NURSING AND Dream MakCHS DEPARTMENT OF NURSING CONTINUES Kiyai Caroline Otede, 1st Yr Medical AFTER THE TWINNING PROJECT Student Busitema University I am Kiyai Caroline Otede, 24 years old, By Nabirye Rose Chalo, Female, born in District. I have MakCHS a simple and humble background in quality and safety, evidence based and a rural part of in Eastern Thanks to her love for developing performance science, among others. Uganda. others in the nursing profession, Having learned that all faculty had My ambition of becoming a medical Dean Martha (as she is popularly completed their master’s level doctor developed way back in my early referred to in the Department of education, she observed that the childhood. . I was always sickly and often Nursing at MakCHS) has continued department was eager and ready under medical care. My mother had told to mentor faculty at MakCHS, to advance. Martha advised that we me that I was born by caesarian section long after the JHU-MakCHS should set goals (5-10 years), as a that was done by the late Dr. Otai, who Twinning Project (that initiated this department but also as individuals. For later on became our family doctor. The collaboration) ended. Recently, Dean example, as a department, we should sight of Dr. Otai was a breath of life in Martha Hill visited Uganda again on identify people for doctoral programs. my early years when I was frequently her mentoring task. She had come If we want to be promoted, we should hospitalized. I decided that I should to evaluate and give support to find out what it takes to achieve this become a doctor as well. the new Doctor of Nursing Practice goal. After my ordinary level, my health had (DNP) graduate from Johns Hopkins greatly improved and i concentrated on University (JHU) School of Nursing, my studies. I passed in division one to “Everybody should have a personal Dr. Godfrey Katende who has join High School and my ambition of development plan (PDP) and you initiated a Nurse-led Hypertension becoming a medical doctor grew School should help each other. Create social Clinic at the Assessment Center in of Nursing (SoN) Unfortunately, even groups, read each other’s manuscripts Mulago Hospital. with all the hard work I did not raise the and give constructive feedback”, she pass mark required to join any of the said. While in Uganda, Dean Martha medical schools. With no option left, I She emphasized the need to build took up a diploma in Comprehensive spent most of her time in the teams but at the same time getting nursing department, listening and Nursing under government scheme, to know the value of individual albeit with a lot of grief and pain. giving support to the faculty in independence. various areas ranging from teaching My mentors provided encouragement methods, writing applications Martha, we are so grateful for your love “Delay is not Denial,” nursing might be for consultancy work, research and support, hope we shall not let you a foundation stone to achieving your proposals, curriculum development, down – looking forward to becoming calling.” One of them said. On successful developing strategic plan, patient a School of Nursing (SoN) one day! completion of my course in 2011 at Masaka School of Comprehensive Nursing, I happily came back to Pallisa to serve in a rural health center. I knew my dream had vanished into thin air but I never gave up. Amidst that, in my strive to get the best out of life; I landed on the advertisement of Busitema University requesting for applications for students to join the new government Medical School in , Eastern Uganda. I immediately dashed to Mbale to submit my application. I waited for the admission list with a lot of anxiety. Tears, joy, laughter and anxiety all filled me at the sight of my name on the admission list. My dream of becoming a doctor had resurrected. I again say thanks to all stakeholders, the government, MEPI-MESAU and above all God for this miracle in my life. With the patient being my first priority, pursuing excellence and chosen by God Prof Martha Hill of JHU School of Nursing talking to Nursing Faculty at the MakCHS to love and serve, I am determined to become the best Gynecologist (for that is my ultimate dream) in Uganda. I will work to serve the mothers of this nation.

3 MESAU Newsletter Using the Social Media to promote Networking among MESAU Partners and Stakeholders Edward Kakooza, MESAU IT Officer

Social media refers to the means of MESAUMEPI and a Twitter account which was automatically integrated interactions among people in which was also created; https://twitter.com/ with a MESAU MEPI Twitter account they create, share, and exchange MESAUMEPI which means information shared information and ideas in virtual on Facebook is also in the same way MESAU MEPI Facebook Insights shared on Twitter and hence hitting Here below, you can find demographic two birds with one stone data about the MESAU audience and Now this being a consortium we see how people are discovering and don’t stop at that; content is also responding to our posts shared on all Facebook pages of partner Institutions targeting mainly https://www.facebook.com/ the students.

MESAUMEPI?sk=page_insights What we have achieved so far

communities and networks. Social media depends on mobile and web- based technologies to create highly interactive platforms through which individuals and communities share, co-create, discuss, and modify user- generated content. It introduces substantial and pervasive changes to communication between organizations, communities and individuals.

Social Networking The rise of the internet age has A social networking service is an Why Facebook enabled us to live in the fast lane; online service, platform, or site With over 200 million users worldwide this is because of the freedom the that focuses on facilitating the in 2009 (70% outside of the US) web provides, millions of people building of social networks or social and being one of the biggest social can communicate at the same time. relations among people who, for media success stories of recent years, Never before in human history has example, share interests, activities, Facebook is one of the most popular there been a time like this! What’s backgrounds, or real-life connections. social sites and cannot be ignored most intriguing about this revolution Social networking sites allow users by any modern institution. Facebook is that the young people are leading to share ideas, activities, events, is used on a day to day basis, so the the way; having information reach the and interests within their individual MESAU Consortium saw it worthwhile young people in a timely manner and networks. having its presence on Facebook and them sharing it with their colleagues. MESAU Joins Social Networking also make visible its work to the world. Expanding the MESAU community YES, MESAU is on social media too! Facebook has become an integral beyond borders, social networking MESAU Consortium joined social part of the lives of millions across the sites are a good way to make networking with the aim of facilitating globe. Pretty much everyone with connections with people with similar open communication, access to a computer or smartphone interests and goals. The MESAU community has a profile on the social network. community is continuing to grow by engagement, the day! collaborations and Content is the power of the web, so During the recently concluded MEPI exchange of ideas, we solicit content from faculty and site visit to MESAU (which was hosted enabling access students in the MESAU Institutions. by ), Facebook and to information and After receiving content and before Twitter platforms were used to update resources, providing publishing it on the web it’s reviewed the rest of the MESAU community opportunities among others and approved for publication. The plus the public on what was going On 29th February 2012 a MESAU MESAU Consortium has a portal on in real time. The interaction was Consortium Facebook page was http://mesau.mak.ac.ug/, where massive and people were engaged all created and it can be accessed content is first uploaded then shared the time. here; https://www.facebook.com/ on the MESAU MEPI Facebook page

4 MESAU Newsletter Health Professionals’ Education Educations Resources Unit (ERU) at Mbarara – the MHPE Programme University of Science

By Dr Robert O Opoka, MHPE and Technology

s a clinician/lecturer working a plethora of courses in medical By Samantha Mary, ERU Administrator in a Health institution one education of various lengths and The Education Resources Unit at is expected to have the complexity offered by various training institutions. of Science and skills and competency to Technology (MUST) is composed of Ateach. This expectation erroneously The Masters in Health Professional six major sub units which include the assumes that somewhere along the Education (MHPE) is one such Office of Research Administration, way teachers of health professionals course that focuses on medical Medical Curriculum Development and are taught how to teach. The reality education. This course covers Leadership, Faculty Development, is that most of the teachers/lecturers broad themes like Learning Community Practice and Family have no formal training in health and Education, Curriculum Medicine, Quality Assurance Unit and professionals’ education. Whatever design, Leadership and Change the Administration unit. teaching skills they have, are acquired management and Research in The major goal of the Education on a trial and error basis and from what Medical education. There are Resources Unit is to promote they see their seniors and colleagues many institutions in Africa, North professionalism and excellence in do. We can no longer continue in America and Europe that now offer medical education. this way given the progress that has this training. Maastricht University been made in our understanding of At MUST professionalism and in the Netherlands is one of the teaching and learning. excellence in medical education has leading institutions in learning been promoted through Objective The big change in medical education and offers the MHPE as a two-year Structured Clinical Examination (OSCE) has been the move from a teacher- online distance programme. I was trainings which took place in two centered to student-centered privileged to be one of a number phases from 16th-17th October 2013 and approach to learning. In the teacher- of teachers from the College of 21st-22nd 0ctober 2013. centered approach, the teacher is the Health Sciences that have done this It was an exciting opportunity master and the source of knowledge course. I completed in September to the student. This fundamentally for MUST faculty and staff; there this year (2013) courtesy of MESAU was representation from Surgery, limits the student’s learning to scholarship. Ophthalmology, Obstetrics and only the skills and knowledge that Gynecology, Pediatrics, Internal the teacher possesses. Current As a clinician who is involved in Medicine, Psychiatry, Anaethesia, trends tend towards more of a training health professionals I found Dermatology and ENT. Among the student-centered approach where the MHPE course to be a real eye participants’ expectations was to the student is in charge of his/her opener. It helped me to understand ascertain if OSCE was a true replicability learning. According to Al Khadir and appreciate my role as a of students’ knowledge and skills. and others in ‘Exploring assessment teacher and facilitator of learning. Some of the major achievements of factors contributing to students’ study It equipped me with knowledge strategies’, this approach is associated the OSCE Training were acquisition and skills to understand and of knowledge, skills and change of with better learning outcomes and design medical curriculum. Finally attitudes. In terms of knowledge allows the students to fully utilize it introduced me to the field of participants appreciated the fact that ever-expanding knowledge base and research in medical education and it was important to assess clinical skills resources that are available. in particular qualitative designs. using OSCE; they learnt the value of OSCE as an assessment strategy since it This shift in approach in medical In conclusion, in order to improve is objective. education goes with the change in the quality of medical training the roles of both the student and in our institutions our teachers/ The training could not get any the teacher. There is therefore a lecturers need to get formal better with the practical session need to re-orient our understanding training in Medical Education. In where participants were put into of the role of the teacher from this respect, I highly recommend different groups for OSCE assessment experimentation. It left both the being the source of knowledge to the MHPE programme. I can students and staff excited in that most a facilitator of learning. Similarly confidently say that the effort there is renewed interest in medical of the participants recommended that and sacrifice needed to complete all staff in clinical disciplines should be education and how best to train the programme will be worth it. trained in OSCE. today’s health professional. Several The College of Health Sciences medical institutions now therefore at Makerere University is in the Sincere appreciation goes to the OSCE include courses on teaching and process of designing the MHPE facilitator Assoc. Prof Samuel Maling, learning in the formal training programmes and hopefully it will Dean Medical School for a job well- curricula. In addition, there is now be available soon. done. We will soon be sharing the report on this training.

5 MESAU Newsletter FINALLY ON THE WAY TO BECOMING A DOCTOR! Keera Fuuna Ivan operating water pumps instead of the number of applicants was First year medical student Busitema blood pumps. I dreamt of working outrageous; about 1000 people had University, Faculty of Health Sciences on sewerage tanks instead of blood applied for the available 50 places. banks. I felt disgraced. At the moment, my family members It all began about a year back with To me, it was evident that my future and I kept our hands crossed in doing the National exams leading was dark and misty. At one time, prayer to save my childhood dream. to the award of Uganda Advanced Mum even suggested taking me to It was at 5.00 p.m.; after a long, Certificate of Education. I did the do medicine on private sponsorship boring, confusing and disgusting papers confidently and in a twinkling but dad was not willing to sponsor mechanics lecture when I received a of an eye, the results were out. We me and even threatened to disown life-saving call. rejoiced for the good results as a me. So I painfully accepted to do “Ivan, congratulations! You have family before we got befallen with a engineering. been admitted for Medicine. Pick cascade of misfortunes. While doing engineering, an advert your admission letter from the Within a fortnight, the admissions to came out, inviting applicants to the Busitema University offices at Mbale.” public universities on government Bachelor of Medicine and Bachelor said the caller. sponsorship were done. I was of Surgery program at the new This statement still remains the pivot awarded a government sponsorship Medical School in Mbale. I could not of my life. Since then, all my days were for the Bachelor of Water afford to miss this golden chance. punctuated with parties. My jealous Resources Engineering at Busitema When I got the application form, my friends all discouraged me from University instead of medicine; I had dad refused to sign it at first. It was doing this course in a new university always wanted to become a doctor. not until my relatives sat him down and emphasized the disadvantages This appeared to be the beginning of to allow me to do my dream course. of pioneering a medical school. misfortunes in my life; my family was He finally signed, though painfully. However, I agreed not to change all in low spirits except my dad. He my decision. Honors and respect to thought he had got a brilliant young After handing in the form; my MEPI-MESAU for contributing to my man as a successor since he was an patience was wearing thinner and dream and the dream of Uganda. engineer heading for his retirement. thinner because of the delay to Cardiology here I come (for this is my For about three weeks, I always release the admissions list. However, dream area of specialisation). sat down and imagined myself I later learnt that it was because

MESAU – A journey of open doors, and opportunities

Christopher K Opio This has been a period of learning, announces-1-million-commitment- innovating, and adapting price- to-action-with-the-clinton-global- t is now a year since I took on the effective solutions for health in initiative-to-solve-maternal- challenge of walking down the a resource-constrained research mortality--anemia-171139851. road of “doctor philosophiae”. environment. html Not that I desperately needed it. I Based on my subject of study and 3. Finally with support from KRELL However, what is Medicine without a family and MESAU I was able to challenge? What better way to do this supported by networking the obtain state-of-the-art endoscopic than through a Peer Handled Deed? following are opportunities in this road to “doctor philosophiae”. equipment worth USD50, 000. I say, the road is “scientific” –I am 4. My patients have also benefitted learning to appreciate my limitations 1. My colleagues have offered to from this project; I am able to as well as my successes with quiet donate a biochemical analyzer to offer therapeutic band ligation for dignity and grace. this project. those that need it. Currently, I am Planning for a clinical trial the 2. Masimo International has also the only specialist offering this life- foundation of my “doctor philosophiae” offered the opportunity for saving care package in Uganda. is challenging especially with a limited an equipment loan. The same This is a learning opportunity budget and the usual officious company also invited the and provides opportunity for potholes. Nevertheless, I must admit “OUT” team to collaborate on other specialists like me to offer when hard-pressed, drastic actions or implementing innovations for this service to patients with innovations are not uncommon. diagnoses of anemia in women esophageal varices. and children in resource-limited What are my successes or worthwhile settings. http://www.prnewswire. In conclusion, it is a new dawn, but the gains? com/news-releases/masimo- journey continues…………

6 MESAU Newsletter

MENTORSHIP IN THE ARENA OF RESEARCH ADMINISTRATION

By Edith Wakida- Grants Officer MUST

Webster’s Dictionary defines a mentor Research Administrators are very as “a person looked upon for wise important players in the support advice and guidance.” Have you ever of research. Some of the functional thought of a research administrator as support is through proposal a mentor? Other than the traditional development and submission, mentorship known to everybody- a award review & approval, contract senior mentoring a junior; mentorship negotiations, award and account can be unpacked into specific aspects establishment, compliance issues, to show that everybody is a potential project management, financial management and intellectual mentor providing wise advice and The author (second right) posing for a photo guidance. property management which with colleagues at the Equator sign post

can potentially be handled as WHAT SHOULD I EXPECT DURING independent mentorship areas to the INTERNSHIP?: EVERY FIFTH YEAR researchers. MEDICAL STUDENT’S ANXIETY Not all research administrators are ‘all- rounder’s’ however, but each one has By Ismael Kawooya a specific area(s) in which they have expertise and can offer mentorship to “Complete medical do internship all over again; may the researchers. school… go on to be in a different setting I would be a The mode of mentorship offered by complete internship, maniac to affirm to that. Life is as it is, research administrators is mainly then you shall be on one stage ends and another begins. ‘Interpretive Mentorship’-explaining a course to a great Basically, you move on and get going. path.” Such nice words to the researchers in understandable did stick and like There is so much to look back at and terms useful information that will those before us, we in equal measure a lot to forget. The contribute to good decision making. expected to see the beauty of it, is that this fast-paced one An interpretive mentor is well results immediately. Such, was the year has the good, the bad and the ugly connected to each mentee and has earnest comprehension of what the in proportionate quantities depending extensive and current knowledge medical field offered six years ago. Six on whatever your priority is or will be. about each researcher’s background, years, life was simple. It was a routine It is the heart-beat of anyone’s medical abilities, experiences, understanding and I did not have to worry about what career or may be not but it serves a lot of the field, goals and aspirations. would follow. I just had to read for the to lay a foundation on how someone Without understanding of these, the exams when the time came. During might follow up their career progress. advice given may not be appropriate; those innocent years, even what you it is therefore important that with the read was literally that and may be a The good, the bad and ugly of this interpretive role, there is a kind of little bit more. I dreamt of graduation period is that it is one year; one year gut-level understanding between the like it was the world to be. No idea of a lot of activity to last you a life mentor and the mentee. that graduation would come and all time. You might see certain conditions I would think of is when does all this once (one example in my case twice- The interpretive mentor translates end. Being a medical student meant Varicella pneumonia or chicken pox) the vast and confusing information your friends called you “musawo” in your lifetime and others so frequent, about academic and professional and you turned your head in that di there is no time for dust to settle on opportunities, requirements, norms, -doctor) rection with a bit of gait. the knowledge gathered. regulations and so on into terms that have meaning for the student in the It is now almost a year since internship At the final bend, one asks oneself the context of his or her own specific begun and so the end is nay. Even if I same question asked to graduands; goals. have been weathered, battered and “what next?” At almost all corners, drained of all energy, I am actually not rumor mills are aplenty with the The administrative role in interpretive bothered by being told how much latest on the job market and study mentorship is to provide active, weight I have lost (I wonder how opportunities. Whatever your interest programmatic support in the form of much I actually weighed before). Yet and options might be, the GPS of your attention, resources, and coordination again, I am confused by the dimorphic internship could actually be fulcrum to and to maintain some degree of feelings of this period. May be it was that decision. For those joining, keep administrative involvement in that period when I felt hopeless with your wish lists short and expectations addressing issues that may arise. a client or that one euphoric time, without reservations. For those who when by doing something a life was are this end with me, the ship is about saved. But if you asked me if I would to set sail. 7 MESAU Newsletter

COMMUNITY EMERGENCY MEDICAL SERVICES IN UGANDA

Eva Kisakye, MESAU beneficiary and Intern Nurse- Mulago National Referral Hospital high maternal and infant mortality emergency care, the ministry of health rates (438 mothers and 64.2 deaths could take up the responsibility to per 100,000 live births respectively) licensure eligible members after still recorded. The solution could be successful completion of a nationally developing exceptional emergency accredited program at a certificate medical transportation in all our level in emergency and trauma communities, be it urban or rural. The care. Partnerships between different aim would be to improve lower level government bodies for example the patient care, ensure patient safety and police and fire department would set standards for community service be helpful. The services should be with a shared commitment involving freely provided to all Ugandans and the citizens served. The delivery of funded by the government. However these services should involve health the challenge of maintenance in Emergency medical services should professionals with a primary focus of terms of funds rises. One could ask: ideally be delivered at two levels. providing quality emergency medical What if the responsibility of providing That’s to say at the community and care at the community level. These the emergency medical services is health facility levels. The referral could be paramedics functioning as pushed to the private sector such system between these two levels part of a comprehensive emergency that it becomes business? This would should be perfect in order for patients service response in case of critical make the services available only to the to receive the best care as fast as situations like motor accidents, fires, “haves” (affluent people) and not to the possible for the safety of their lives. injuries due to domestic violence and “don’t haves” (poor and unfortunate). Uganda has not invested much in natural disasters, Obstetric cases and It comes back to the government to community emergency and critical severe child hood illnesses. There seek for funding opportunities for care services therefore poor referral could be links from the community these services. Improving community systems from communities and scenes into the health care system. emergency medical services should poor first hand patient care could Because of the amount of complex be one of our strategies as a country to probably be contributing to the decision making required while giving decrease mortality rates resulting from a delay in receiving medical care. Community-Based Research Teaches Key Lessons

By Jane Frances Namatovu, Family Medicine Department Makerere University College of Health Sciences

It was refreshing when our group was awarded MESAU - MEPI faculty- mentored research support. After receiving the award letter, we went through all the steps to get the requirements to carry out the study. This was a qualitative study, exploring how communities get involved in the development and running of their health services. We were interested in knowing whether communities are involved or not and also to identify the available support mechanisms to promote their involvement. We had selected to carry out our study in the catchment areas of Namayumba Health Centre IV Wakiso district and Bobi Health Centre III Gulu district. Community mobiliser talking to participants at Kyampisi Village before the focus group discussion. It was very interesting to talk to

8 MESAU Newsletter

Community-Based Research Teaches Key Lessons people in their communities. the people. In order to achieve this, running of the health centers. They One gets a strong feeling that the community should be involved clearly mention their lack of control communities are yearning to be as an active partner at all levels i.e. over the health workers at these listened to. Everyone wants to planning, implementing, monitoring health centers. Therefore, there is need talk! In one particular community, and evaluation. It was evident for more research on communities’ Kyampisi village in Wakiso district, from our study that community understanding of community after conducting a focus group involvement is understood involvement in their health services discussion, the participants differently by health workers and by in order to appropriately direct efforts requested to sing for us. We had to the communities. Communities feel that promote their involvement. sit, watch and listen to them (men that they should take charge of the and women) sing. They sung songs praising their community on the development efforts within the community and also reminding the community members against the dangers and risks of HIV/AIDS.

I personally learnt that people need and want to be listened to. Whether we perform statistical tests on data Asaph Byamugisha, Fifth Year as our resources and many other sets, we must always remember Medicine -MUST better resources to build on. We that these people are behind them. are better equipped than them; we We must think of the people first. should use the chance.

During the process of carrying I enjoy listening to music and since out the study, I realized that some time immemorial great talented of the efforts by the different singers have impacted the field. stakeholders to improve the The great ones are yet to come and health of communities are not the world shall not run out of such talents. oriented to the community in question. A significant finding of Through research, a lot of our study was how the community discoveries have been made but a members perceive the use/role lot more are on the way. The islets of the suggestion box to get the of Langerhans in the pancreas were views of the community on the discovered 144 years back and the health services provided by their “Islets of Byamugisha” are yet to be health center. It is true and we discovered. know that suggestion boxes are installed in most if not all places As a medical student and an Just like many other “naïve” where services are offered to the undergraduate researcher, in the undergraduate students, research public. The question is: how is research titled “Assessing the comes with mixed feelings; knowledge, attitude and practices the information received in the many think about molecular suggestion box handled and by of abortion among university level researches with Nobel prize students in Uganda”, I have come whom? The community members winning and being in books of great feel that they should be in-charge to learn that we must critically achievers like our fore fathers (Paul think about our health challenges if of the suggestion boxes at least for Langerhan-who was a medical we are to make a difference in our the health services. The community student when he discovered the medical profession. members feel that suggestion islets in the pancreas). Others boxes are for now not useful as a think of the time invested, financial I thank the MESAU-MEPI way of involving them in health implications and many other consortium for the great services. Their main concern is challenges. mentorship extended to us young that when the health center staff academicians. It is strengthening get issues which directly implicate Reflecting upon the great our foundation. them, they are likely to throw them discoveries and innovations by away since they do not want to be our fore fathers , I’m inclined to implicated. think that these geniuses were a lot smarter than us today, but no The writer can be reached on It is very important to make health way!, we have their discoveries [email protected] services people-centered; that is health services should be tailored to the needs and health priorities of

9 MESAU Newsletter MEPI-MESAU-CVD Linked award making dreams a reality

By Yvonne Brenda Nabunnya because all along I had been and wrote up my thesis which I building an EMF registry and defended by the end of May 2013 “Yvonne, do you have Kampala Pharmaceutical Industry and now writing a manuscript for clinical equipoise and what was able to manufacture and publication. is the standard of care for deliver to me the study drugs. As you realise, this research took Endomyocardial fibrosis (EMF)?” So, I met my research assistants a lot of time to complete. Partly These were the first questions who had been trained for this because of the many approvals the epidemiologist asked me particular purpose and started for the study design, as well on telling him that I wanted to screening and recruiting patients as the slow patient turn up; since the disease entity is rare. carry out a clinical trial. This was into the study. On calling the The answer is very clear to the way back in January 2011 as patients from the registry, to question of whether a clinical trial a graduate student in internal my utter surprise, I found out is possible for a master’s thesis. medicine at Makerere University that most of the patients had Only that I recommend that the College of Health Sciences. I was passed on and that I now had process is embarked upon early excited about my research topic to screen and recruit new ones so that the student has enough and particularly that it was going prospectively. The challenge of time to complete the research to be a clinical trial. Little did I slow patient turn up then started. within the stipulated time know that this journey would Initially I was able to recruit about knowing the challenges Involved. lead me to more than just writing 6 patients per day but after about Finally I must say that I have a thesis and passing exams but two weeks, they reduced to 6 per been greatly transformed in the that it would lead me to self- week, by the end of the second way I think, reason and carry out discovery, learning how to learn, month, they had tremendously research; thanks to the MEPI- analyse and make timely decisions reduced. In September 2012, I MESAU-CVD Linked Program. in whatever I do. Thinking that called a DSMB to address this Out of the 9 students who proposal development would challenge and was advised to have completed their masters be the hardest part, I embarked contact doctors in other hospitals degrees under the MEPI-CVD on it with zeal and vigour after outside Mulago to send me Linked program, Dr. Kebba obtaining supervisor consent suspected EMF patients. I did as Naomi and I carried out clinical that the science therein merited suggested but still receiving very trials and they are registered as PACTR201207000395469 and: investigation. Presenting the few referrals. This went on until ISRCTN 63999319 respectively. proposal to the department March 2012 when with DSMB Having been the first clinical generated new questions about acceptance, recruitment was trial for a master’s thesis in the my outcome variable and when stopped having achieved 90% of Department of Medicine, the the end point would be. Still the desired sample size. This was start was very educative and more questions than answers. the most challenging time of the worthwhile and I encourage This warranted a comprehensive research project for I learned to more enthusiasts to carrying out search on research methodology have a lot of patience, persistence research with this design in the for clinical trials from the resource and focus without which the data years to come. As for me “gakyali persons in the College outside collected wouldn’t have been mabaga”; looking towards the Department of Medicine. enough or even complete. With growth and achievement in cardiology. Even though it took some time, this data, I started the analysis I was able to get the necessary input and present the proposal to the School of Medicine Research and Ethics Committee later that year, then to the National Drug Authority. Ethical approval and obtaining an international clinical trials registration number took time and when it was finally complete in April 2012, I was good to go. I thought that within a maximum of 6months I would have completed data collection

10 MESAU Newsletter Use of data analysis software for research by undergraduate health professional students: the case of three Universities Mwaka Erisa, Munabi Ian, Buwembo William, John Quinn, Bajunirwe Francis, Kitara David, Obua Celestino

Despite the increasing focus on research however the students This study showed that though most teaching biostatistics there is evidence do not know how to handle the students have access to a computer, of continuing misunderstanding data accrued from their research they are not utilizing this access for of basic statistical concepts among activities. Though all students had had research. There is need for curricula practicing clinicians and medical courses in biostatistics and research enhancements in the form of selecting researchers. Students are yet to methods they were naïve about data one institutional preferred statistical appreciate the depths, applications management therefore, this study analysis software, encouraging and true meaning of various was timely. Students benefitted a lot computer ownerships and emphasis statistical approaches for every day and requested courses for those who on routine and regular use of various health professional practice. The had missed, but for economic reasons statistical approaches. objective of the study was to describe we were not in position to grant their undergraduate health professional request. student’s reported research analysis software experiences, preferences, and perceived levels of expertise. This was a cross-sectional study that used a self reported questionnaire A Closer look at SRA: What makes it so tick? survey tool on undergraduate health professional students at Makerere By Joan Larok University College of Health Sciences, Manager Grants and Contracts Mbarara University of Science and Makerere University College of Health Technology and Gulu University. A Sciences hands-on data management course using Epidata was also conducted at Makerere College of Health Sciences. In this course students were requested to come carry along their own data sets on which they were taught data entry and basic statistical analysis. The 46 students who participated in the course were awarded certificates of his year marked my 2nd anniversary excellence in research management participation. as a member of the Society and administration. of Research Administrators There were 602 health professional TInternational (SRA). I have been I will focus on 5 aspects to attempt undergraduate students in their third intrigued by the growing numbers at to answer the question why SRA is so SRA annual conferences. This year over to fifth years of study. The majority tick and what lessons we can learn 1,500 members attended the annual of whom were pursuing a bachelor from it. of Medicine program and owned conference in New Orleans, Louisiana, USA. Not even the highly anticipated computers. The most commonly used United States Federal Government 1. The Name. Society of software for computer analysis was shutdown deterred members from Research Administrators Microsoft excel (75.34%). About 62.5% attending the annual conference. International provides an of respondents had ever participated The question is ‘What makes people elevating identity that all in research activities before and attend these conferences, year in, year members are attracted to and 51.8% had ever done some form of out?’ want to be associated with. data analysis. The majority of the A little about the association; SRA 2. Leadership and respondents reported benefitting a lot was founded in 1967 as a nonprofit Management. The board of from the data management course. organisation and is headquartered directors and management in Falls Church, Virginia, USA. It has share the vision of the MESAU has been awarding small a membership of over 4000 with a association and can be grants for student mentored vision of being a premier resource for seen to walk the talk. The to pg12 11 MESAU Newsletter From 11 A Closer look at SRA: What makes it so tick? Community Placement Moments in Bwindi

By Najjuma Josephine, Mbarara University of Science and Technology

Curiosity intensified in me on my first day at Mbarara University of Science and Technology (MUST), when I saw on the Mbarara University Medical Journal pictures of students riding bicycles, during their community placement.

During the orientation week, my hopes were increased, when the head of Community Health Department made it clear that during our stay in Medical school all students would be given an opportunity to go to the community. To me it sounded like going for a fully paid holiday in a foreign land! Group photo with Colleagues from Nairobi University, , MUST and KCMC - In 2012, the long-awaited opportunity came my way knowing that I was placed in Bwindi filled me with joy leadership is such that there people will listen to what although this came with scary tales is succession with a well you have to say and from fellow students of how we were structured way to groom new appreciate. going to stay deep in the forest; in the leadership. 5. Benefits. SRA offers a wide middle of nowhere... 3. Staff. The association has range of benefits to her After one week of intense leadership a committed staff body members. The association training at MUST we were then taken to that is passionate about provides a platform for Bwindi Community Hospital through their work. The staff go out knowledge and skills Kabale then to Kanungu via Bwindi of their way to make the acquisition, a place to get impenetrable forest. By virtue of the members satisfied through contacts of helpful people, fact that we didn’t pass any vehicle timely communication and exposure, a place that on the highway to Bwindi Community feedback. The staff work challenges one out of their Hospital (BCH) which is about 5hours, is further augmented by comfort zone as well as a drive on a very rough bumpy road, it enthusiastic volunteers who place where people share was clear we were going to a hard-to- reach place. come to support the activities their successes, failures, of the association in peak fears, challenges and most seasons. importantly solution freely. 4. The Product. The association has studied their market The name, leadership and well in that every member’s management, staff, product and need is met at their own benefits are some of the aspects terms. For instance at the that make SRA so tick. SRA is annual conference a lot of therefore a worthwhile investment information is provided, for research administrators willing there is opportunity to speak to learn, relearn and unlearn in a to varied service providers; conducive environment. network , get new contacts and renew old ones, make friends, have break from Eye source: http://brokenredeemed. routine office arrangement wordpress.com/2012/09/18/watchful- and have a place where eyes/

12 MESAU Newsletter Community Placement Moments in Bwindi

Amidst the forest in a valley was Bwindi Community Hospital (BCH)! We spent the first night dancing to the tunes of the mosquitoes, and we were assured they were part of the deal as they are the natives of the forest. We kicked off work with helping out at the hospital and doing community work. It was amazing how the hospital was organized.

clerkships, presentations, different procedures and many more. This involved a two way learning process from the people we found on ground and we as well shared with them what we knew. Community Work

In the Hospital We were welcomed by the administrators, who introduced us to the hospital staff, and lastly to the well-organized community department that made our community work enjoyable. We participated in the hospital activities from Walking through the paths of Bukoma village, during community diagnosis

Meeting the chair of the Batwa community to request for permission to With the HOD CMH doing a door to door survey allow us meet his people. to pg14 13 MESAU Newsletter From 13

Some of the pit latrines we found in Bukoma village.

Some of the challenges met included the unfavorable weather and rough, hilly terrain that we hadn’t prepared for.

Later, we came up with the challenge model that helped us to identify the challenge, obstacles and prioritize our activities. Presentation/Dissemination

Meeting the people of Bwindi community was a very easy activity as the Head of Department almost knew every community member by name; he briefed us and was always ready to work with us.

From the information gained in the training we worked as a team and everyone played their part actively. We were able to achieve our goals; though the time we spent there Doing assessments and health education in schools wasn’t enough to finish all interventions and evaluations. Working closely with a multi-desplinary team for one month was at first a challenge, but later showed us that we had gained the experience and attitude to work with different people despite their back ground. Team members wished they would stay in the community longer, or be able to work in such a setting again. We presented our findings, to the Faculty of Medicine for assessment and also in the 8th MUST Annual Research Dissemination Conference 2012.

14 MESAU Newsletter

MEPI/CapacityPlus Collaboration to Enhance Community-based Education, eLearning and Physician Tracking

Rebecca J. Bailey, Team Lead, Health In early 2013, CapacityPlus Throughout the year the MEPI/ Workforce Development, USAID received expressions of interest CapacityPlus collaboration has CapacityPlus Project for collaboration from nearly all strengthened and progressed. MEPI PIs. We then worked with the In October, a physician tracking During the first meeting of the WHO MEPI-CC and relevant TWG chairs workshop held in Lusaka, , Technical Working Group on Health to identify specific needs through brought together representatives Workforce Education Assessment structured surveys and interviews of MEPI institutions from nine Tools held this December, a group of the MEPI institutions with respect countries with eight representatives of technical experts from around to the three technical areas. Based of medical councils and ministries the world, including myself and on the information collected, of health and education to define MEPI Principle Investigator Dr. CapacityPlus, the MEPI-CC and the business processes required to Nelson Sewankambo, agreed TWG chairs developed a workplan meet the graduate tracking goals of that collaboration is critical for with clearly-defined objectives, MEPI institutions. A detailed report transforming education to support milestones and budgets. Key activities of requirements will be released in the production of relevant, in the workplan include: applying a January 2014 in order to inform the competent, and sustainable health collaborative development process development of physician tracking workforces. The working group, with MEPI representatives and other systems. The physician tracking which is guiding the development key stakeholders to define the basic systems will advance a variety of of a protocol and tools for assessing requirements for graduate tracking goals, such as fundraising and CPD, progress towards the 2013 World systems; supporting the drafting but most importantly, will enable Health Assembly Resolution on or updating of eLearning strategic schools to measure how successful Transforming Health Workforce plans; and identifying and sharing they are in training health workers Education in Support of Universal proven approaches and tools for to serve underserved communities. Health Coverage (http://apps.who.int/ the evaluation of CBE programs. Upcoming milestones for the gb/ebwha/pdf_files/WHA66-REC1/2. One objective that spans across all collaboration include an eLearning A66_R1_Res23-en.pdf#page=49 ), three technical areas is to build or strategic planning workshop discussed the importance of different strengthen a network for school-to- scheduled for late February 2014, and types and levels of collaboration, school support and problem solving a CBE evaluation workshop tentatively including but not limited to in each of the technical areas. scheduled for March or early April collaboration between students, 2014. educators, academic departments, institutions, sectors, and employers.

The growing MEPI network offers an excellent example and opportunity to both practice and promote collaboration for the transformation of health workforce education. Drawing upon our expertise in informatics, education, and continuing professional development, the USAID-funded CapacityPlus Project has had the privilege of collaborating with the MEPI- Coordinating Center (CC), Principle Investigators (PIs), and Technical Working Group (TWG) chairs to advance the areas of community- based education (CBE), eLearning and physician tracking. CapacityPlus, led by IntraHealth International, is uniquely focused on developing the health workforces needed to deliver accessible, acceptable, affordable and quality health care that improves health and saves lives, with particular attention to countries with critical health workforce shortages. Participants at the graduate tracking requirements development workshop 15 MESAU Newsletter

Table 1: MEPI Network Institutions Country Primary MEPI School Partnering Schools/Institutions Managed by

Botswana University of Harvard School of Public Health and the University of HRSA Pennsylvania. PI: Oathokwa Nkomazana Consortium of Ethiopian Medical Schools: , HRSA Haremaya Universities, and the Defense Forces Medical Colleges, PI: Milliard Derbew In the US: Emory University, Johns Hopkins University, University of California, San Diego, University of Wisconsin and University of Alabama-Birmigham Kwame Nkrumah Ministry of Health, Komfo Anokye Teaching Hospital, NIH Science and Technology Ghana College of Physicians and Surgeons, and Ghana Ambulance Service. PI: Peter Donkor In the US: University of Michigan In the US: University of Washington and the University of NIH Maryland. PI: James Kiarie Universidade de Eduardo Universidade Lurio, Universidade Zambeze, the World Health NIH Mondlane Organization, the Canadian Network for International Surgery

PI: Emilia Noormahomed In the US: University of California, San Diego (UCSD), the American College of Surgeons. College of University of Cape Town NIH Medicine In the US: University of North Carolina, Johns Hopkins University PI: Dr. S Kazima Bloomberg School of Public Health

Nigeria Consortium of Nigerian medical schools: University of Jos, NIH University of , University of Maiduguri, Ahmadu Bello PI: David Olaleye University,

In the US: Northwestern University and the Harvard School of Public Health. Tanzania Kilimanjaro Christian Medical In the US: Duke University School of Medicine. HRSA University College ( KCMUC)

PI: Moshi Ntabaye South of KwaZulu-Natal In the US: Columbia University NIH

PI: Umesh Lalloo South Africa Stellenbosch University The University of Cape Town Lung Institute, Makerere University HRSA

PI: Jean Nachega

PI: Marietjie de Villiers Uganda Makerere University Consortium of Ugandan Medical Schools: Mbarara University, NIH Kampala International University, Busitema University and Gulu PI: Nelson Sewankambo University. Medical Research Council at Uganda Virus Research Institute

In the US: Johns Hopkins University, Case Western Reserve University, Yale University Zambia Consortium of Zambian Medical schools: , NIH Cavendish University, Lusaka Apex Medical School. PI: Yakub Mulla In the US: Vanderbilt University and University of Alabama- Birmingham. University of Cape Town, University College London and King’s NIH College London, Institute of Psychiatry. PI: James Hakim In the US: University of Colorado-Denver and Stanford University United States The George Washington In Uganda: The African Center for Global Health and Social HRSA University Transformation

PI: Fitzhugh Mullan PI:

PI: Seble Frehywot 16