Maternity Wards at Mulago Hospital

We finished off our day at Mulago Hospital in Kampala, Uganda in the maternity ward. This was perhaps the most moving part of the trip for me, and certainly the most moving part of the day. We went with Dr. Katamba to meet the head of the Department of Obstetrics and Gynecology who had been at the Grand Challenges Canada talk earlier in the day.

The department head spoke to us first about the work of the OBS/GYNAE department. Some of the numbers shocked me. He told us that the hospital has about 32,000 deliveries each year, with a peak rate of 115 births in 24 hours. Those are huge numbers, for a hospital in any country.

The doctors then walked with us around 3 wards. I had never been to a maternity ward at a hospital at home, so it was a very eye-opening experience for me.

My initial reaction was surprise at just how many women there were. We walked through room after room of women in various stages of labour; the women filled each ward to capacity. In the first room, I was some compelling sights: a woman moaning on the ground in obstructed labour waiting for a cesarean section and a young girl, about my age (16 years old), who was 9 months pregnant.

Talking to doctors and nurses caring for a young girl in labour

One of the wards was specifically dedicated to the care of women with pre-eclampsia (a high blood pressure disease of pregnancy), and it was also completely filled. Finally we saw the 'high-dependency' room for women with complicated pregnancies. There were two patients who were having severe complications including something else I'd definitely seen before -- a woman getting a blood transfusion.

Listening to a nurse in the high dependency room discuss her work

To be honest, I was disturbed by some of what I saw. I think it was because I had not spent much time in hospitals. So problems like obstructed labour had never been visible to me. That changed here. Though I was unsettled, I realized that at least these women are in the right place to receive care, and I was able to hope that almost all of them would survive.

Mental Health Unit at Mulago Hospital

After seeing the Nutrition Unit, we headed over to the Mental Health Unit where Dr. Musisi was able to show us his work environment. This was the first time either my dad or I had seen a ward of this kind anywhere in the developing world.

Dad and Grand Challenges Canada Program Officer Karlee Silver with Dr. Musisi

As we walked along the path to the psychiatric wards, we met a woman who looked as though she had a mental health condition. She shook each of our hands and asked my name, and walked quietly along with us. I think a bit of kindness goes a long way with someone like her, who faces so much stigma as a mentally ill patient in the developing world.

We were first shown the outpatient facility, where there were residential rooms, a treatment room, areas for group therapy, and rooms for one-on-one therapy. There weren’t any patients in the facility at the time, since the patients all come to clinics in the morning, so we got the full tour from a nurse who showed us around.

A group therapy area in the outpatient facility

Next we went to the inpatient facility, where there are separate wards for men and women. We went and saw both. Each patient had an attendant and some had friends by their bedsides. We didn’t interact much with the patients, but a few were glad to return a smile and a wave.

We passed by the nurses’ station where two young nurses sat at a table beside a medicine cart. We asked what medicines were used and the nurses listed a number of older psychiatric medicines like amytriptilline and haldol. There didn’t seem to be any access to newer, more effective, and more expensive drugs.

Medicine cart in the nurses' station

We were fortunate to be able to see an occupational therapy session, where patients sat around a table and got to choose an activity they enjoyed. Most were doing crafts like knitting or painting. I looked at one of the patient’s paintings and saw she had depicted a face. Perhaps her own?

As I watched her paint, the woman who had been walking with us earlier came up to me and untied the bright orange sash I was wearing around my waist on my dress. She carefully tied another bow and I thanked her for it as the nurse gave her a supportive pat on the shoulder.

Inside the facility is an office where we met a young man involved in a community project. He told us that the project works with communities to encourage community-based care and understanding of mental illness. It was very impressive and made me hopeful that he and those like him could fight the battle against stigma surrounding mental illness.

A poster in the office of the community project

I had the impression that although the staff provide good care, the ward only reached a tiny proportion of the population suffering mental illness in Uganda. I left feeling glad, though, that in however small a way, here were doctors, nurses, and members of the community making a difference in the lives of people with mental illness.

Mwanamugimu Nutrition Unit

Dr. Musisi and Dr. Katamba were kind enough to take us on a tour of Mulago Hospital. We started in the Mwanamugimu (Healthy Child) Nutrition Unit!

As we walked up to the ward, a woman was being wheeled on a stretcher from one room to another. She was pumping her fist in the air and cheering with a loud, “WHOO, WHOO, WHOO!” The doctors were laughing and I was confused until they told me she had just given birth! She was cheering and thanking God for keeping her and her baby safe.

Right away upon arriving at the Nutrition Unit, I could tell it was a happy place. The doctors introduced us to Sister Christine, who was a nurse very willing to show us around and tell us about the Unit.

She first showed us the intensive care ward, where the most severely malnourished patients are admitted when they arrive at Mulago. They are tube-fed until they are strong enough to take formula orally. They are moved to the Giraffe Ward, then to the Zebra Ward, as they get better and stronger. Once a child is taking formula well for a period of time, they are moved to the outpatient facility just up the hill.

Giraffe Ward

This is an essential part of the program. The children are weaned onto solid food while the nurses work with the mothers to establish a sustainable feeding regime. In the meantime, the children can play on the playground or in the playroom in the facility! The patient is only discharged once the nurses feel confident that the mother knows how to keep their child healthy.

Dad and Grand Challenges Canada Program Officer Karlee Silver with Sister Christine

It was a beautiful place full of children receiving the care they needed. But most inspiring was the commitment and passion I could see and hear in Sister Christine’s eyes and voice.

Makerere University

Yesterday we had a very eye-opening day at Makerere University and Mulago Hospital in Kampala. Since we spent so much time there and saw so many different things, I will post several entries.

Our day began by meeting Dr. Achilles Katamba, a health economics researcher at Makerere. He took us to meet Professor Nelson Sewankambo. I’d met Dr. Sewankambo before, a few weeks earlier in Toronto, and was excited to learn about his work at the University as the Principal of the College of Health Sciences. We spoke about the research at Makerere before walking over to a University lecture theatre where the learning really began!

The first surprise was the number of researchers, professors and academics who were waiting to hear the presentation on funding opportunities. It was the largest group I’d seen yet! That cemented for me the fact that Makerere is a university very committed to its research capabilities.

Researchers at Makerere University

We were welcomed and then we were very fortunate to be able to hear a psychiatrist from Mulago Hospital, Dr. Seggane Musisi, speak about a project investigating “Nodding Disease” in Northern Uganda. It was so interesting!

Nodding Disease is a condition that affects mainly children in areas of intense conflict or trauma. Many of these children are separated from their parents and have to endure emotional and psychological trauma without them. Many develop Nodding Disease, which is characterized by a physical tick, nodding, and by Complex Post Traumatic Stress Disorder and Severe Depression.

I thought that the most effective part of the presentation was a video of children with Nodding Disease. I knew that Global Mental Health was a very neglected area, so it was fantastic to see a bright and committed psychiatrist like Dr. Musisi working to improve it.

Next my dad gave his presentation on funding opportunities from Grand Challenges Canada and the Bill & Melinda Gates Foundation Grand Challenge Exploration Program. Because there was such a wide range of people listening, I really paid attention to the discussion period and wasn’t disappointed.

Grand Challenges Canada presentation

In previous discussions I’d heard a lot about the specifics of currently open opportunities. During this period, however, a Makerere researcher asked a question that really intrigued me: “How can we convince Ugandan governments to adopt the same model as you have in Canada?”

Now that’s the kind of thinking that’s going to further the ability of local innovators to solve local problems!

Nelson Mandela African Institute of Science and Technology

Yesterday we spent a great day the Nelson Mandela African Institute of Science and Technology (NM-AIST) just outside of Arusha, Tanzania. There are four AIST institutes throughout Africa; one in Burkina Faso, one in Nigeria, one in South Africa and one in Tanzania. Each has a different focus; water in Burkina Faso, oil in Nigeria, mathematics in South Africa and life sciences at NM-AIST.

AIST is named for Nelson Mandela because the institutions were originally his “brainchild”, as the literature on the history of NM-AIST says. It is a school for masters, PhD and post-doc studies and will be welcoming its first 100 or so students this September. It's a very young institution and its facilities were pretty well just completed!

Professor Burton Mwamila, Vice Chancellor of NM-AIST, welcomed us graciously and took us to the conference room where we spent most of the morning. First Prof Mwamila gave a presentation on NM-AIST including its focus, vision and mission, plan for infrastructure and philosophy. I was very impressed by the focus on two main goals: to become a world-class institution in life sciences and to bridge the gap between academia and society.

Next the Dean of the School of Life Sciences and Bioengineering gave a presentation on the academic structure of the school and the programs they plan to offer. In addition to programs in life sciences and bioengineering, the Institute will also offer courses in mathematics, business and humanities.

Another professor spoke about the research he is currently conducting on inoculation of legumes with rhizobium. Though technical, the project was understandable and fascinating! By improving the productivity of legume crops, the professor highlighted how child nutrition and livelihoods could be improved. This was a true demonstration of the focus on bridging science and society.

Finally another professor spoke about future plans in the area of health and biomedical sciences. I was impressed to see that his presentation was very aligned with the one my dad was about to give in terms of identifying grand challenges in health! I was especially interested in a project he is working on in the genetics of hypertension in Masai populations.

Prof Mwamila showing the view from the main building

We were toured around the campus and then continued with a discussion on the funding opportunities that had been spoken about. Another very receptive group of researchers made for an interesting discussion of how some of the projects the professors are currently working on could be supported.

This is exactly what Africa needs. I really hope that NM-AIST can achieve the success that its faculty and administration are striving for. This is where technical innovations are born; and this is where they can be best suited to address on-the-ground problems. As Nelson Mandela said, “Education is the most powerful weapon you can use to change the world”. 

National Institute of Health Research

Today we spent the morning at the National Institute for Medical Research (NIMR) in Dar es Salaam! We first met with the Director General of NIMR, Mwele Malecela, who is also a scientific advisory board member of Grand Challenges Canada. Having known our family for some years, Mwele gave us a very warm welcome.

For the earlier part of the morning we were shown around the research facilities and training labs. Some of the labs that were originally created for HIV/AIDS research are now being used in research with influenza. It was great to see that the equipment could be incorporated into more than one program. We were also able to see PhD students and training lab technicians conducting their work!

A lab technician at work

There was also a group of researchers eager to demonstrate their new herbal drug products. Among these were drugs for erectile dysfunction and a drug for opportunistic infections in HIV+ patients. They predict, however, that their bestseller will be a baobab juice that is drunk for improved health and vitality!

Enjoying the demonstration of herbal products

A group of researchers from different research groups and institutions such as Ifakara Health Institute, NIMR and the Tanzanian Research Forum were assembled to learn about funding opportunities. They were especially interested in the Global Mental Health Request for Proposals put out by Grand Challenges Canada.

(ATTN Researchers! Learn more about the Global Mental Health RFP here: http://www.grandchallenges.ca/grand-challenges/gc4-non-communicable-diseases/mentalhealth/)

This group, in my opinion, was particularly receptive to the presentation and had a lot of interesting things to say in the discussion period about Global Mental Health and health innovation in low- and middle-income countries. They agreed that in Tanzania, relatives or friends with mental health problems go untreated. In some cases, the condition is so stigmatized and unwanted that they are put aside and even locked away. It made me hopeful that Grand Challenges Canada is bringing attention and financial support to this neglected problem. 

Ifakara Health Institute

Yesterday we spent the day learning about the Ifakara Health Institute (IHI). It was a day of inspiration for me! We met Fredros Okumu, an IHI researcher and Grand Challenges Canada grantee, and headed over to the IHI headquarters in Dar es Salaam. I’d been very excited to meet Fred, who is the principal investigator on the “smelly socks against malaria” project I’d heard so much about! Several others met us there, including Dickson Wilson and Robert Sumaye, the co-investigators on the smelly socks project.

Dickson demonstrated and explained a prototype of one the smelly socks devices he, Fred and Robert are developing. It’s a device that’s complementary to the use of insecticide-treated bed nets and insecticide spraying inside the house, because it attracts mosquitoes outside the house. 

Dickson demonstrating the smelly socks device

The device attracts mosquitoes with the odour of worn socks or a synthetic chemical odour made to simulate the same. The mosquitoes are then contaminated with insecticide. Some die in the box-shaped device, and the mosquitoes that escape die soonafter because of the insecticide!

A prototype of the smelly socks vs. malaria device

Learn more about the Low- and Middle- Income Stars in Global Health Program through which Fredros received his grant: http://www.grandchallenges.ca/grand-challenges/gc1-explorations/grand-challenges-in-global-health/. Fred's biography is also available here!

After the demonstration, we briefly met with the director of IHI, Salim Abdullah, who welcomed us warmly and highlighted that he hoped to produce more successful researchers like Fred who could get grants to do transformative research in global health.

When my dad again spoke to researchers about funding opportunities, I realized that these are truly people that understand the problem. They live the problem; and they have a better chance than any developed world research scientist of figuring out implementable solutions if given the opportunity.

Engaged in discussion on funding opportunities

Next we headed off to Bagomoyo, a town about an hour outside of Dar es Salaam where another branch of IHI is located. We first travelled to a government health station or “dispensary”, the first step in the Tanzanian health care system. We were toured around the location by two IHI researchers who also showed us what would soon become a new labour and delivery ward.

     Dispensary in Bagomoyo            New labour and delivery ward

Then we drove a bit further to an IHI clinical research facility under construction. This is also the site of the insectory where the colony of mosquitoes for a malaria vaccine trial is being grown. Marta, or as she is called by the others “Mother Mosquito”, showed us her insectory and explained how she is growing her colony. Very cool!

Finally we travelled to the office of the Bagomoyo branch of IHI to meet some of the researchers there and again highlight the funding opportunities for low- and middle-income innovators. This particular branch of IHI manages the pediatric ward of the district hospital, so they showed us around the ward as well. There were 2 children with measles. I thought nothing of it until I registered my dad’s reaction; he’d never seen a case of measles in many years of medical practice in Canada.

Dad with the nurses in the pediatric ward

After a long day and a lot of new learning, we returned to Dar es Salaam with a stop on the way at a historic slave port in Bagomoyo. I was very grateful to Fred and all of the IHI researchers for showing us so much of what the Institute is working on and teaching me so much! I was inspired by the commitment of young local innovators to tackle local problems.

      Dad and I at the slave port         Dad and the smelly socks team