IPSF Public Health Edition Humanitarian Campaign November 28, 2010

The Mobile Pharmacy in Northern Uganda Project (MPNUP) Volunteer Reports

The Mobile Pharmacy in Northern Uganda Project: The objectives of this project were to Increase access to health services, public health, medical care and home-based services, improve awareness on infectious diseases, allow students to experience life in a developing country and to use and develop the knowledge gained from studies to contribute to the healthcare of those in need. In just over 5 months the MPNUP team made a difference to over 6000 Ugandan citizens living in refugee camps in the Gulu District. Data was collected from this work and is currently undergoing analysis but from the analysis that has been done so far it was identified that the most commonly suffered diseases were Malaria, Respiratory tract infections, Helminth infections and diarrheal diseases. This provides information about possible interventions and campaigns that can be conducted with this population. For example education on Malaria prevention and recognition and the use of mosquito nets etc.

A Public health campaign that was conducted in Uganda was a Hygiene and Sanitation Campaign with Concerned Action for Health Uganda (CAFH). As part of the campaign the team visited homes with questionnaires and obtained data. They found that 57% of the population were using unclean latrines but only 23% had good knowledge of communicable diseases. They educated patients on the importance of clean water and boiling water before use to reduce diseases. Unfortunately due to a number of unforeseen circumstances the Project had to be suspended prematurely. However IPSF still has contacts in Uganda and has important epidemiological information. Furthermore the Ugandans are still in a situation where they will benefit from external assistance and the Humanitarian coordinator and subcommittee will present its’ findings to the Annual Congress 2011 regarding the future of humanitarian work in Uganda. In this newsletter you will read stories from the MPNUP volunteers about their experiences. Without them MPNUP would not have touched as many people as it did and IPSF is grateful to them for their hard work and contribution.

Taisa Trischuk from Canada. In Uganda from 8th May to 18th June 2010

Any type of volunteering builds character and helps to shape who you are as an individual. It is essential for any type of health care professional to develop this type of compassion towards people in order to give them proper care. When I first heard about the Mobile Pharmacy in Northern Uganda Project, it immediately caught my interest. Not because it would give me a chance to travel, but to be witness to the struggles and hardships that these people are able to survive and try to contribute to a solution. I desired to be a part of this project because it was a way to reach out to people who are living in a society with little or no proper health care. It is unbelievable how they are able to survive with the few tools that were given to them.

When I left Canada alone I didn’t know what to expect in Uganda. I knew it would be a test of my character and I would have to expect the unexpected. It turned out to be one of the best experiences of my life. I had no idea I would fall in love with the country and its people. The Ugandan people I worked with, lived with, and saw in our daily routine became part of our family. The survival stories the people shared from the war opened my eyes to the physical and spiritual strength that these people possess as a result of what they have endured. They have gone through so many hardships but still manage to have a sense of family, love and finally peace in their villages. I enjoyed the simple life learning about the Ugandan culture and the peoples’ way of life.

Working in the camps went beyond any experience I was expecting to get while in Uganda. We were able to diagnose and treat over one hundred patients a day with our collaborative team. We treated cases of malaria, infection and injuries that if left untreated would lead to amputation or death. We were also able to do health campaigns to increase knowledge and awareness of proper hygiene to stay healthy in the people’s given living situation.

The severity of the lack of health care really opened my eyes to the problems that these families have to face just to survive. Mothers would walk with their children through the night for hours just to come and get medicine to treat their sick child. The people were very appreciative of the work we were doing. As we were closing the project, one of the doctors expressed his gratitude to the project. He said we were sent from heaven to help these people and told us we couldn’t leave because there were so many more people who needed us. This touched my heart and made me realize the impact the project had on the people of Uganda.

The other volunteers I worked with from around the world showed humility and strength, both physical and mental. We became a family, becoming close and working together for the same cause. Jim Bernhardt, the project coordinator, taught me so much through his leadership, compassion and knowledge. He encouraged me to take advantage of my time in Uganda and this experience inspired me to be part of another project in the future.

After returning from the project, I noticed a definite change in my overall outlook on life. I appreciated the small things and dealt with problems with more patience and reason. The project opened my eyes to the desperate help that people need around the world. I learned so much from my time in Africa, I would not take it back for anything. It is hard to express in words the impact this project had on me and would tell anyone considering this type of volunteer work to take advantage of

this amazing opportunity. You can not understand how it feels until you experience it for yourself. I travelled to Uganda in order to make a difference in other peoples’ lives and ended up changing my life in the process.

Youseff Shehata, from Egypt. In Uganda from 8th march to 18th April 2010

Making the decision to go and volunteer in Uganda wasn't an easy thing and the idea wasn't a common thing for anyone here in Egypt. Almost everyone I knew, family and friends tried to stop me from doing this claiming that it was not safe and that I was not going to gain any benefit from this experience so there was no need for me to take a risk and go work in Uganda. For me, taking part in volunteer work in an African country like Uganda has always been on the top of my list of things to do and when I heard about MPNUP I knew that there was no way I was going to miss such an opportunity. Helping people and expecting nothing in return, sharing with them my knowledge, helping little children who were victims of a war they had nothing to do with was what made me insist on joining the project and try to actually make a difference in their lives no matter how small that difference is.

Our work in Uganda was mainly giving out medical treatment for 100 patients a day or three camps a week besides doing some health education campaigns on how to prevent the cause of disease. In my opinion, the health education campaigns we did were the most useful for those people in the camps. They were totally counting on us and other aid programs to deliver medications and health treatments to them and did not realise that one day our project will come to an end like other aid programs. They had to learn how to start fighting disease on their own and how to prevent it in the first place through simple and easy procedures such as boiling water before drinking it or using mosquito nets to prevent mosquito bites, or not to cook inside their huts, keeping their huts and children clean to prevent skin diseases, all of which are so easy to do and would have a big impact on decreasing the number of diseased cases. If only someone would teach them and inform them of how to carry out these procedures and tell them about the outcomes of applying them.

There were a lot of fungal/bacterial skin infections in little children, which made our sanitation and hygiene campaign really useful for these patients. We worked in the Pajule health centre once a week and our work mainly focused on organizing the storeroom where they kept all their drugs. We noticed that the store room had a lot of different kinds of medication, but were kept in a completely random unorganised manner that made it really difficult for them to know what exactly they had in stock and how to reach those drugs. It was just a room full of boxes, some of them were even expired and the people in charge of the pharmacy hadn’t noticed. The health centre pharmacy mainly needed

proper shelves and cupboards to store the drugs and most importantly needed a proper recording system to keep a record of the drugs they have, their expiry date, drugs out of stock etc. A computerized system to keep track of the medication would be really useful but only if someone would show them and teach them how to use it because they didn’t have any idea about how to run a pharmacy. Working with other volunteers from different countries and different backgrounds made us exchange some useful information on how pharmacies are run in different parts of the world.

On the weekends, we used to go to Gulu, which is about two hours away from Pajule or go on some kind of trip. We went to Murchison falls, which was really great and we also made a two day safari trip. Seeing different animals living in their natural habitat in harmony was such an amazing experience. Rafting on the Nile was definitely the highlight of my trip in Uganda. I was so lucky that I had such an amazing group of volunteers with me during my six months rotation, each one of them had a different character, we all came from different countries, different cultures and different religions but was never a problem and we got along so well and each of us was so interested in knowing more about the others backgrounds. Getting along with local Ugandans was a totally different experience and so exciting to hear all about their history, their beliefs and their stories about the war.

Finally, I can’t say anything except that the six weeks that I spent in Uganda were no doubt the best six weeks of my life and I would totally do it again if I got such a chance. For those who told me at first that doing this was of no benefit for me, and that I would gain nothing, I want to tell them that I think I gained more and benefited more than those people we went to help in Uganda. I learnt more about life, I learned to appreciate everything I have, how to respect others and how to adapt well in a different place, with different people in all kinds of situations.

Angela Nachtigall, from Germany. In Uganda from 12th February to 26th March 2010

I reached Entebbe on the 12th February met Alenka and James at the airport. After having spent the weekend in Kampala, we went to Pajule on Sunday afternoon.

On the way to Pajule I got to know Joseph, the Clinical Officer and he gave me my first Luo lessons. The tribe living in Pader District is called Acholi. They are a part of the Luo tribe, and their language is Luo.

The welcome in Pajule was very friendly, nevertheless I felt uneasy because everything around me was quite different and unknown to me.

The next morning we went to Awal, where I visited the first resettlement village.

I had to experience that living conditions were really challenging there, but we had a lot of work to do, so fortunately there was not much time to think.

James explained the programme of work to me:

Patrick, the translator, registered the patients before they went to Joseph, the Clinical Officer. He made a diagnosis, prescribed a treatment and noted it down. In another hut, James and I handed out the medication.

We had brought the medicines in boxes, and then we set up the pharmacy in the hut, using a small table we had been given by the residents of the village.

We kept patient booklets for each family in which we noted the date, name, sex, age, diagnosis, advice, treatment and follow-up date. It was our task to put together the various drugs for each patient and then hand them out in individually wrapped plastic bags. Most patients were prescribed one to three different drugs.

In addition to the “normal” pharmacy work we also applied anti-fungal creams and James attended to the wounds. I did only one dressing on my last day.

As we treated approximately 100 people per day we only had a few minutes for each patient. So I had to learn very fast how things worked.

In addition to this, Joseph's and Patrick's handwriting was very weird. Fortunately James already knew it and could “translate” it until I also understood their letters.

We finished work at around 5 pm. After work we took lunch with the VHT-members (Village Health Team) and went back home to Pajule.

Work in the resettlement villages was exhausting, but it was also satisfying to see how many people we could help in one day. And once we were back in Pajule, had taken a bath and changed our clothes, satisfaction outweighed exhaustion.

In time, I got used to the amount of work and soon became more efficient.

I also got used to our usual working day routine: getting up early, breakfast at home or on the 30- to 60-minute drive from Pajule to the villages, setting up the pharmacy (sometimes that took a while because nobody felt responsible for bringing us chairs and tables), treating the patients, packing the drugs back into the car and then eating lunch before going back to Pajule.

The setting was of course different in each village: one day we worked in huts (Awal, Bolo Agweng), the next day we were in a school (Ogwil) or a church (Amoko Lagwai, Ongany). However the schools and church buildings were still some kind of hut, they were just bigger, with more air and better lighting conditions. In Oweka we even had our own temporary building. Apart from such differences, work in general was the same.

During my second week we also worked with Irene, another Clinical Officer. It was interesting to see how different doctors interpreted the patients’ troubles.

In the following weeks we also worked with two other Clinical Officers because Joseph fell sick. In my mind, they were a valuable addition to our project and it was useful to work with various doctors as each had a slightly different approach to certain symptoms and illnesses.

Apart from the engagement in the camps I also helped James to do the paper work. We used Fridays and sometimes the weekend to print booklets and staple them, to write counter books for every village and James also had to do some other tasks.

In my first week at PHC I worked together with Rosalyn. She is responsible for the drug storage in Pajule Health Centre. At first we cleaned up a room in the back of dispensing station which serves as the pharmacy. Alenka had already done a good job tidying up but there were still boxes everywhere and some expired drugs had to be sorted out. When the room in the dispensing station was reasonably tidy we went to the storage next to the laboratory and started the same procedure there: We discarded the expired and unusable drugs and burnt them outside and tried to organise the useful medicines properly. Again I noticed that the problem was not that they didn’t have enough medication, but that they lacked shelves or any system to organise their stock properly!

The second week Rosalyn was sick, so I worked with another woman called Sabina in the pharmacy and did almost the same job I had to do every day in the villages.

When Youssef, the second volunteer, arrived after my fourth week, Rosalyn still needed treatment in the hospital. Therefore we worked with Agnes, the secretary of Pajule Health Centre, who did Rosalyn's job temporarily. Agnes did not know what task to give us, so we went on organising the small room next to the laboratory. We built shelves out of boxes and cleaned the room. The window we did not range free as the glass was broken. So it would have been possible to steal drugs through this hole. During my last week, they received several boxes full of drugs from the government. We helped to store and file the newly arrived medicines.

Once again, I would like to say that it came as a surprise to me to see how many different drugs they had at the Health Centre, but I was shocked by the state the storeroom was in! It was so untidy that I cannot imagine that anybody knows where to find a particular drug in there. They desperately need shelves etc. to set up a proper storage system.

To sum things up, coping with all the new, foreign impressions, conditions and customs in the beginning was not easy. Also some cases in the villages were horrible to see: a broken arm that could perhaps not get fixed, the many fungal infections, anaemia, HIV and how people have to deal and live with this diagnosis, unbelievably weak people, the burned bottom of a baby, the hand of a boy burned to the point of being unrecognizable, cruel relatives, frightening deep wounds, people having to walk such a long distance to receive medical care, parents doing everything to help their children, poor general living conditions, hungry eyes and so on...

Nevertheless I am glad that I

had the courage to take part in the project and to go to Africa. I already knew before I went that it was a small project that had just started. I hope that the MPNUP will develop and improve further, so that future volunteers are going to have an easier start. After the first week I got used to life in Pajule and in the end I really liked it. It was an absolutely great experience to see this part of the world that is so different from what we are used to. I enjoyed getting to know the people’s culture and customs, the African landscape and all the surroundings!

Su Jin Yim, from Canada. In Uganda from 8th May to 18th June 2010

My name is Su Jin Yim, and I am entering my third year of the pharmacy program at the University of Alberta in Canada. Before this project, I have volunteered in health care settings such as the hospital and the Canadian Blood Services as well as at festivals in the community. However, I never had an opportunity to volunteer abroad, and I have always wanted to do so. When I received information from our student body about MPNUP, it caught my attention right away. I felt that the timing was right for me to go. I was especially attracted by the fact that I would get to volunteer in Africa, as I have never been there.

My time spent in Uganda was definitely an eye-opening experience, and it helped me to grow as a person overall. I faced hardships in different aspects of life that I would not otherwise have experienced back at home. These challenges really pushed me to my limits sometimes, but I feel that by overcoming these challenges, I was able to learn a lot from them. This experience challenged me emotionally, mentally, and physically but now that I look back, the lessons learned were invaluable and I would love to do it again. If I had to describe my entire Uganda experience in one phrase, I would say that it was an awesome roller coaster ride. It was quite an adventure filled with highs and lows.

I was not quite sure of what to expect of the project before I went, but once I arrived in Uganda and started the project, everything was coming together. Our group worked three to six days a week at different refugee camps. Then we would follow up with each camp after two weeks. A typical working day included packing up medications and driving about an hour to each camp, setting up and providing medication to around 100 to 150 people. Some types of diagnoses and drugs that we dispensed were common there but quite rare in Canada such as malaria and fungal infections. Visiting the Pajule Health Centre was a good experience too as I got to see firsthand how health care is provided in a rural setting in Uganda.

Living in Pajule was so different from what I was used to back at home, but it was definitely an unforgettable experience. Everything from Ugandan food and toilet to pumping water at the borehole and walking in the dark with no street lights were new and different. It took some time to get used to living in a totally different environment but as the days passed by, I got used to it. I felt so fortunate that I was able to experience these different aspects of life in Uganda.

Our group got to travel for several days after the project was finished. The trip was great, and just like the time in Pajule, it was another adventure. I got to do things that I would not otherwise have tried back at home such as white water rafting and bungee jumping. I miss the Nile River and the fun we had at Jinja.

It was unfortunate that the project had to end early due to financial reasons but I felt so lucky in a way that I was still able to come and help the people in need. I am so thankful for the wonderful people that I got to work with, and I miss my group. I also miss the people in Pajule and the people that we met on the trip. The life lessons that I learned during the six weeks in Uganda are priceless. This experience is just so different from anything that I have ever done in my life, and it has indeed changed my outlook on life. I would recommend to all pharmacy students and any student in a health care program to seize this type of opportunity.

Humanitarian Campaign Progress to Date

This year the humanitarian subcommittee will be assessing the impact MPNUP had on the Ugandan community and will be investigating IPSF’s future humanitarian projects.

A couple of projects that are currently underway are the Vampire Cup campaign and the Books for Africa project. For further information on how to get involved please contact Roohil at humanitarian@ipsf.org

Brought to you by IPSF Public Health Humanitarian Campaign Subcommittee