This week begins a new chapter in my time in Uganda: my foray into teaching health workers. The past two weeks, my efforts on this front mainly involved scouring the internet for a curriculum on neonatal resuscitation, and adapting it for use in rural Ugandan health centers. Although I have participated in community education such as the safe birth workshops many times, this is my first time trying to teach other health professionals across language and cultural barriers. So I put on my best Ugandan accent, brought a borrowed baby mannekin and a bag valve mask, and started in a typically African way: stymied by a lack of electricity. I had been up late into the night putting the finishing touches on the curriculum, planning to print in the morning prior to departure. The electricity came on during breakfast, and I headed for the print shops, but large volume copying and printing, unfortunately, is much more difficult without the amenities of the USA. Dad performed admirably under pressure, getting multiple copy stands working simultaneously, and then launching on a bike trip to deliver the goods since I had to take off, being late for the workshop. Unfortunately, I was unsure of the distance of the health center from town, and it turned out to be about 15 goat-dodging, African miles away. The heat was sweltering, and town names in Uganda are frustratingly similar, thus he ended up crisscrossing Nakalama to no avail as I began my workshop in Namalemba.
The workshops seemed quite popular, with fairly good audience participation and many thanks given by the midwives and nursing assistants who joined us. As one of our mentors and friends here pointed out, the problem in Uganda is that the language that healthcare workers learn about health in is a different language than the one they practice healthcare in. This observation was particularly striking when I studied the pre and post test results from the initial workshops. Though particularly the midwives surprised me with their breadth of knowledge (though they seemed to struggle with the Apgar score while I was teaching it, actually both of them had answered my Apgar score question correctly on the pre-test), there were also various challenges presented by teaching in my students’ second language. First, the vagaries of British-Ugandan-English, phrases that seem to be common parlance here but make little sense through an American lens. Phrases like “the baby is flabby,” which I believe means that it is floppy. Then answers that I doubted to be true reflections of practice, i.e.
Q: “After your initial interventions, the baby is still not breathing. What do you do next?” A: “Refer to the hospital.”
Of course, there were also nonsensical items such as:
Q: “When should the baby first be given to the mother?” A: “Vitamin A”.
Some responses really gave me pause.
Q: “After your initial interventions, the baby is still not breathing. What do you do next?”
A: “Give bag ventilation, give chest compressions, then wait 30 minutes.”
(The curriculum specifies that each piece of the resuscitation lasts 30 seconds). Does this mean that my teaching failed? Was it simply a slip because the respondent is not answering in her primary language? Would she really wait 30 minutes in practice, staring at a blue, dead baby? I did change the pre/post test to multiple choice and specific numbered answers to try to clarify where the issues are. In case you are wondering, I did have a translator with me, but because the participants know so much English, they find the use of the translator frustrating because they are understanding most of what I’m saying already. It’s the other 10% of what I’m saying that I worry about.
I chose to take an optimistic perspective based on the fact that the midwives and medical officers really do have a surprisingly good knowledge base, given that they do not get reliable continuing medical education. They are not used to participatory learning, and thus they have a difficult time with giving me the sorts of answers I am looking for. Although I could see from our assessments and pre tests that the midwives knew the details of how to basically care for a sick neonate, I would pose a question to my audience like “So, what do you do then if the baby is not breathing?” After some silence, one midwife would whisper “Resuscitate,” and the rest would nod as if that said it all. The Basoga are a very soft spoken people and I have to walk up to the participants at times and lean towards them to make out what they are saying. Overall, it was a very interesting departure from my usual work in Uganda, and I am looking forward to pursuing this further and seeing what progress we can make. It’s exciting!
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