10 January 2019
I volunteered in Uganda as a RCOG Marcus Filshie fellow working with the Resilience in Obstetric skills project (ROS). ROS is a three-way partnership between the RCOG and two maternity units in Masaka, Uganda. This project builds on the success of a previous project ‘ Emergency Obstetric skills” and focuses on ensuring sustainable obstetric emergency training through supportive supervision and mentorship. The ultimate goal of this project, which ends in January 2019, is to improve reproductive outcomes of women and girls in Masaka. Some of the training is being led by a group of healthcare workers called Master Trainers (MTs). MTs are Ugandan midwives, doctors, nurses and clinical officers who are championing safe and respectful obstetric care by training and empowering their fellow health workers. I worked together with Ugandan MTs conducting assessments, training, as well as providing mentorship.
I was most struck by the strong sense of local ownership driven by a desire for change. During my stay I met MTs like Andrew Muhumuza, a 27-year-old medical officer who is extremely passionate about quality improvement and empowering midwives to recognise acutely unwell mothers and obstructed labour. I swapped stories with Caroline Labatu, a formidable and kind paediatrics charge nurse, who inspired by the impact of EWS charts in maternity, is now interested in developing a paediatrics EWS chart for her unit in Kitovu. Over tea, I bonded with Milly Mukasa, a 65-year-old boisterous midwife who is hoping to retire in June 2019. She intends on spending her retirement training midwives about safe neonatal resuscitation and respectful care in health centres II and III. I was impressed by innovative ideas and practices such as: the savvy recycling of clinical waste in Kitovu hospital, task shifting in Masaka referral hospital, where midwives are being trained and supported in performing ventouse vaginal deliveries and the active involvement of relatives in administering patient care and facilitating rehabilitation on the ward. I wonder whether we could learn from these practices and apply strategies such as task shifting to support the increasing demands on NHS perinatal mental health services for example. Reflecting back, I can draw some parallels with the NHS where everyday I am also inspired by the resilience of individuals working hard and creatively in a system with limited resources.
Volunteering was a very inspirational experience that provided a valuable insight into global health partnerships and specifically into project implementation, monitoring & evaluation in development work. On my return, I noticed a renewed enthusiasm for work, a significant change in my attitude towards problem solving and initiating difficult conversations. My experience has given me more empathy for hospital management teams and inspired me to learn more about managing health systems within the NHS. The experience challenged and advanced my mentoring, leadership and teaching skills. I appreciate that mentorship is as much about listening and encouraging individuals to reflect on possible solutions to their problems, as well as providing them with a solution. As medics we are trained to ‘fix things’. As such I have a tendency to want to offer solutions. Whilst in Uganda, I learned to give people the space to reflect on and solve their problems whilst providing a supportive framework. I believe this can generate creative problem solving and bring about more long-term behavioural changes. I learnt to always be mindful of the context within which I am operating with regards to interpersonal power dynamics. Reflecting on the impact I’m having on others and others’ impact on me provides a more objective opportunity for behavioural change and personal growth. This is particular importance when developing cross-cultural global partnerships.