Wednesday, Oct 16, 2024

Good afternoon (for me)! I hope everyone is doing well as I approach the end of my 2^nd week here.

Let’s play catch-up…Late Sunday morning, a box arrived at the birth center from a boda currier. The 2^nd half of my bound lecture notes arrived from the printer! I went through each of the 10 copies, one page at a time, to find everything done correctly. Imagine that. I had already given a lecture on Friday that was in the 2^nd notebook, and I was worried that I would have to continue lectures on Monday without the rest. WHEW!

Usually, I wake sometime between 5 and 6am, with the sun rising around 6:30. The lovely kitchen staff usually have the hot water and tea set-up ready by 7am, breakfast is usually served by 9am. I make myself oatmeal for breakfast, along with a large mug of tea, and am settled in the classroom by 7:30am. Class typically starts at 9:30am, giving the trainees time for breakfast, before joining me. As much as I prepare my curriculum and lectures in advance, I often find that additional lectures are helpful, depending on the academic and practical experience of the class. I spend the 2 free hours creating lectures, reviews, quizzes, etc…

Monday began without power, so no overhead projector for lectures, and it did not return until 1pm. Pregnant mothers from nearby villages have become aware of our ultrasound class, so more and more of them have been arriving in the mornings. We decided to start with scanning practice, hoping for power by the afternoon to complete the lectures. The ultrasound machines have batteries, so we scanned until the batteries ran out, took a lunch break, and when we returned to class were able to finish the scheduled lectures.

Tuesday went without a hitch, spending half the day scanning and half the day with lectures. The lectures are getting shorter, and the reviews are getting longer and more detailed. I am at the point in the curriculum where I attempt to make a connection between the lecture information and how to use that information while scanning. This transition is easier for some of the midwives and harder for others. I am glad that two of the potential trainees were not able to attend at the last minute, so I can spend more individual time with the four in this group. We also were not able to get the third machine we were hoping to have, so I have 2 people sharing each machine, which is a good combo. Even in the environment of the 2-year Ultrasound Programs in the states, scanning does not come naturally to most people. It is even harder for people who have no academic experience with human anatomy, and especially no concept of cross-sectional anatomy. I have had to create a lecture on basic human anatomy and have now added it to my curriculum.

Those of you around for my last trip may remember my birthday experience here at the birth center, seeing my first baby delivered on my birthday. It’s common for Christian Ugandans to give their babies a Christian name and a village name, and the mother who delivered (Amam) named her son Joe in my honor. We have kept in touch since baby Joe’s delivery, and they came for a visit! Joe is the happiest, chubby baby, joyfully being passed around to all of us in the classroom. One of the knitted hats fit him well and I was able to give Amam a solar lamp to take home with her. 

We did have a surprise visit from 3 clinical directors from Gulu District. This was unexpected and they arrived as we were breaking for lunch. The trainees stayed behind with me as I described the training program and answered questions. One of the questions was if the trainees would be receiving a certificate. Certificates are a very big deal here in Uganda. I had to explain that this is a new training program, in the early phases, with an unsure future. Rachel is arriving tomorrow, so I explained that this is something I will be sure to discuss with her when I see her. I am happy to say that they were very pleased with what they had seen so far. They met with Christine, who later told me that they wanted to make some sort of ceremony about the training program. Thank goodness Rachel is returning, because I have no idea how to navigate that! I’ll keep you updated.

This morning, we were blessed with power! YEAY! I gave a detailed review of yesterday's lectures, and then we began scanning, having almost 15 mothers waiting outside the classroom for an ultrasound. This week, I began writing the “Scanning Plan” on the white board in the classroom, giving them specific things to focus on. The objective is to start with the structures and measurements that are most important for midwives, such as evaluating the cervix, determining the location of the placenta and measuring the fetal heart rate. If they can progress with these (find them easier, optimize the image, etc…) then I add something else the next day. This allows for some flexibility at the end of the training, my goal focusing on quality instead of quantity. This also gives them a chance to improve their speed and skillset, before adding a new expectation. There is no point teaching them 10 things they learn badly, when I could teach them 5 things they can ultimately do well. I have explained this many times to the class, but people are people everywhere, and sometimes individuals have their own goals. The classroom is set up with 2 beds and machines, 2 midwives working at each station, and I bounce back and forth between the stations giving instruction and input. Approaching a station, I asked what the midwife was working on and was given an answer that was not on the scanning plan. When I questioned why, her response was to tell me that she wanted to look at something else. I told her that there was a reason I made a scanning plan and that I expected her to follow it, and she began to argue with me and talk over me. Unfortunately, she chose to argue with me in front of everyone, so I responded in kind. UGH. This is what some refer to as a “come to Jesus” moment, letting her know that if she does not appreciate my instruction, the class, or my method of teaching, she is free to go. If she chooses to continue in the class, she will follow my instruction. Uncomfortable, but necessary. I can only best describe her behavior for the rest of the morning as churlish, refusing to answer my questions or look at me.

When the group returned from lunch, her surly behavior still present, I pulled her aside and told her “Enough. We are fine, you are smart and talented, and I am trying to help you be the best midwife you can be. Shake it off and move forward. I’m over it, you should be also.” I’m happy to say it worked, and the rest of the afternoon went well, with all of them improving quickly.

I do not claim to be the best instructor, but I do spend an exorbitant amount of energy trying to be as successful as possible in an unusual environment. I do not expect everyone to like me, having been reminded throughout most of my life that I am “too much”, but my effort to be a flexible and supportive instructor is constant. I also have tangible proof that my method of teaching in this environment has been quite fruitful, so it is sometimes necessary to stand up for myself and my teaching methods. It still makes me uncomfortable as hell and I’m relieved that the squabble was resolved.

So, class is over for the day. Tomorrow will be spent reviewing lecture material, preparing for the written exam on Friday, and continuing with hands on training. I have remained in the classroom to write, soon heading back to the hut for a shower and dinner. We have been having warm, but lovely days, and last night a heavy layer dark of clouds moved in by 5pm. Loud, continuous thunder went on for an hour before the rain finally arrived, continuing throughout the night. Even with temperatures in the high 80’s, I much prefer it, compared to the 106-degree weather from my March visit!

The local cat and mighty hunter, chasing lizards.

Frankie came to visit! I'm happy to report that he remembered
me from my last visit. 😍🐶

Frankie lives with the nuns at the orphanage and school next door.

The sun is dipping below the horizon, so it’s time to gather my things and head up to the hut. Wishing you all a good rest of the week!

Much love, Jo/MB