Field Visit to Adjumani

Sunset at the Fishing Lodge in Adjumani.

Following the weekend at the Fishing Lodge, we packed up our things and headed back into town to begin a week full of site visits in Adjumani. While we moved from hotel to hotel every couple of days in search of a place that would adequately accommodate all three of us, each day nonetheless began in a similar way. We stayed at rather humble places, so each morning started with a meager breakfast of instant coffee and toast, and maybe an egg if I was lucky enough to find one. We first stopped by the Adjumani District Hospital to pick up the district EPI (Immunization) Focal Person, Sunday, and then headed to our first site visit destination. We visited various health centers (HC), which are designated by levels I, II, III, or IV. A level I HC is the most basic and is run by the government-sponsored Village Health Teams (VHT), which are made up of lay community health workers. A level IV HC is typically larger and provides more services. Regardless of the level, however, each facility that we visited was run primarily by nurses and clinical support staff. The only bona fide doctors that I observed were at a HC III that was run by an outside NGO with support from the Ministry of Health (MOH) and provided foreign doctors on short-term contracts. In later discussions, I came to find out that doctors are a rare commodity at these public HCs, as the health workers are severely underpaid, and trained doctors typically opt to open their own private practices for a more lucrative business.

Conducting active case finding by reviewing patient registers
at a Health Center for potential missed AFP and measles cases.

AFP surveillance poster at a Health Center in Adjumani.

During the first part of the week, I observed my more experienced colleague, Joseph, as he went about the tasks of sensitizing (educating) the health center staff, reviewing patient registers, conducting active case finding for acute flaccid paralysis (AFP) and measles, and assessing the vaccine cold chain (i.e. vaccine storage and maintenance practices). Though my colleague is a Field Consultant and I am a Communications Consultant, my goal was to learn what is done in the field and begin to assess the current situation on the ground pertaining to routine immunization (RI) and vaccine-preventable disease (VPD) surveillance. Per my supervisor’s advice, I also conducted some brief surveys to assess at various levels (district, health facility, community, etc.) whether communications and social mobilization activities around RI and VPD surveillance are occurring.

A father and his children at the Nyumanzi refugee camp. 

The HCs were normally open outdoor structures constructed of cement. The walls were often painted half blue on the bottom and white on the top. I spied groups of women with their young children waiting outside, seated on the floor by the entrance or under trees with a blanket on the ground. A few men also lingered around. When I entered the HCs, I would normally see patients sitting quietly with children swaddled in their arms or sitting on their laps. Some children were fussy and crying, and others just stared as the strange muzungu (white people) walked by. I was surprised by the uniforms of the staff, often feeling as if I had been transported back into the 1960s, as the women wore white knee-length dresses with white nurses hats pinned to their heads. I imagined that’s what my grandma looked like when she was a nurse many decades ago.

Discussing AFP and VPD surveillance with Adjumani Hospital
staff at their weekly CME meeting.

By the end of the week, I felt more confident in my knowledge of the material, and my colleague Joseph handed over the task of conducting the AFP surveillance education session to the HC staff. I attempted to speak slowly and enunciated every letter I spoke so that the staff would understand my American English, and also to avoid the blank I-have-no-idea-what-you’re-saying stares. As a side note, I am still working on my “African English,” which consists of speaking a lot (I mean, a LOT) slower, and pronouncing every single letter of every word. Words with the letter “t” really get me. I also chuckle to myself when I hear Ugandans say “cloth-es” and “Wed-nes-day”. Nonetheless, the HC sessions went very well, and the staff were very appreciative of our efforts to provide them with some additional support.

Me leading the discussion on polio and AFP surveillance at
a Health Center in Adjumani.

Me discussing the correct method for collecting stool samples
for suspected AFP cases.

I was glad to have had the chance to go into the field with Joseph. I learned a lot not only about making field visits, but also about how to move about the small towns, negotiate hotel accommodations, and find places to purchase water and cell phone air time. And little did I know that these small lessons would come in handy on future field visits without my experienced colleague.