Back in Durham

Back in Durham...sorely missing Kampala, but feeling invigorated by the experiences of the past week. We were fortunate to have met 3rd and 5th year medical students from Makerere School of Medicine last Thursday. We had a great time comparing our curriculum's (they have been practicing with "problem based learning" for a few years now) and talking about medical outreach projects they conduct in rural Uganda. In their own way, they are addressing the HRH issue by committing to long-term projects in these respective communities. The students are responsible for identifying a medical/public health issue and coming up with solutions which they implement over the course of 2-3 years (the projects start in the 3rd year; students complete 5 years of medical school).



On another note, I was quite pleased with the various public health messages displayed across billboards in Kampala! Among the more common ads were ones that alerted viewers against cross-generational sex in order to fight the spread of HIV among girls and women. New Vision, a Ugandan daily newspaper reported in August 2007 that several studies have found HIV prevalence among girls ages 15 to 24 to be four times higher than boys in the same age group in Uganda.

On our way out...

A hectic schedule and lack of convenient internet access have kept me from posting since arriving. Although the official conference ended Wednesday night, there have been additional sessions over the past two days. Some highlights included developing an International NGO Code of Conduct for Health Systems Strengthening (paying tribute to the sometimes detrimental impact international NGOs can have on the health care worker shortage or situation in many developing countries) and hearing the experiences of the Strathmore Business School in Nairobi, Kenya in developing health management training programs. With 1000+ participants here in one place our research and learning has really been at maximum capacity and efficiency!! It was without a doubt a great decision to spend the week here and connect with so many interesting individuals.

This morning I also had the chance to leave the conference "bubble" and experience some realities of downtown Kampala... markets, rolexes, bora-boras, and more. I'm racing against a low battery so next report later (perhaps from Durham!)

Wednesday in Kampala

Wednesday was a busy day. We continued networking and the Session on how the private sector can help the manpower shortage in health care workers was wonderfully led by Kathy Cahill from the Gates Foundation. Certainly the whole Duke team is to be congratulated for organizing such an interesting and informative panel and session. There were 60 minutes of prepared comments by the panel followed by an hour of discussion - a real interaction between the audience and the panel. We were left with the reminder that "the big trees need to nurture the little trees". The afternoon was spent in conversation - the students continuing their interviews and Dr. Merson rekindling old relationships and making new ones. There is a great sense of optimism that new collaborations and programs will originate from this meeting. Geelea Seaford is also to be thanked for her seemingly effortless manner in keeping us all in line and on track.

Being a student in this part of the world...

...is not so different, I find, from being a student at Duke.  Okay, so I should've prefaced the title statement by saying, "Other than the massive differences in tuition, the excruciatingly small chance of being accepted into a grad program in healthcare (or even making it past secondary school),  the small amount of job mobility, and the striking difference in salary and working conditions, being a student in this part of the world is not so different..."

I was extremely lucky to be contacted by a woman at the WHO last week, and she asked me to be on a panel during the conference related to strengthening the pipeline of healthcare professionals (mainly by easing the entrance of students into academic settings & supporting them during the educational process).  Today, I met the other students on tomorrow's panel, and the five of us sat talking for nearly 3 hours about the similarities, differences, challenges, and motivating factors of being a healthcare student. What was so striking to me was how all 5 of us - a 5th year medical student from Rwanda, a 4th year nursing student from Ghana, a 4th year pharmacy student from Swaziland, a NP/MPH student from Hopkins (my alma matter for nursing school as well...which was a fun small-world connection), and me, a registered nurse & first-year MBA student in Health Sector Management - are motivated predominantly by the same factors in terms of our career. Upward mobility, ongoing education, keeping all career doors open, and making a difference in the world (and especially in healthcare) were the themes that were continually repeated in the conversation. Salary, certainly, is a motivating factor as well, but there's a real feeling that having possibilities to effect change in this world and to effect it in different capacities throughout our lives, is extremely important.

The three African colleagues in the discussion talked of migration (a theme that the conference is examining in detail), and all of them plan to work or pursue advanced degrees abroad. We heard last night from the Minister of Finance in Ghana that there are more Ghanaian doctors working in the state of New York today than are working in the Ghanaian public health system.  In Ethiopia, we've been told, 70% of clinicians leave the public sector (some to private sector and most to other countries). The "brain drain" is severe in almost every African nation, but I cannot blame a single student or practitioner for taking advantage of the activities.  It was really interesting though, to leave the high-level, officially sanctioned panel discussions about migration and the health worker shortage and speak openly, honestly, and student-to-student about the challenges and opportunities that lie ahead for us.

So, perhaps it is a generational trend (young 20- & 30-somethings wanting to have a variety of career options and choices), or maybe it's just a human need (to better oneself and feel challenged).  In either case, I felt really inspired by the discussion and interaction today between colleagues from around the world - a great afternoon.

Discussions in the corridor

I have heard it said a few times already: It’s not what is being said at panel discussions that necessarily make an impact; rather, it is the discussions taking place in the hallways that make a difference. Attending my first WHO-sponsored conference has been eye-opening, to say the least. I have been an avid observer of the dynamics dictating a conference of this nature. The panel discussions have had their engaging moments—especially with distinguished speakers such as Anarfi-Asamoa Baah, Deputy-Director General WHO, whose humor has drawn many a laugh during serious matters; Rajat Gupta, Chair of the Global Fund to fight AIDS, Tuberculosis, and Malaria, and Bience Gawanas, the Commissioner for Social Affairs for the African Union and Task Force. However, the more fruitful conversations take place during our breaks and after planned sessions when we have a chance to approach such individuals and speak to them more about their projects. I’ve been amazed by the number of innovative projects and collaborations. Yesterday, I listened to a representative from Touch speak of collaboration with McKinsey and Co. and the Tanzanian government to scale up HRH training and capacity in schools across the country.
Being in this environment has been both tempering and invigorating. It has been tempering in the sense that in witnessing the dampening effects of bureaucracy and politics on effective policy change, I have started questioning my desire to be directly involved with organizations such as the WHO in my future career. Invigorating, given the innovation, research, and advocacy that is occurring globally among individuals and organizations
Just a few thoughts on the matter…this post hardly does justice to the past few days in Kampala. More to come soon.

Tuesday in the Pearl of East Africa

I continue to be amazed at the steady progress that Uganda has made in the last 35 years in spite of incredible adversity - particularly in the HIV/AIDS area. There has been steady progress in disease treatment, expansion of public health and an increasing percentage of students who gradtuate from high school and who subsequently complete technical and professional education. The people are friendly and hospitable and we are welcomed everywhere we go. The taxi drivers are full of information and conversation as are the wait staff. We hope that our endeavors here will pay off with collaborations in the future. We feel we have a lot to learn from each other.
The conference began in earnest today with morning plenary sessions that were very well attended and Kevin Schulman represented us very well. His comments were very well received. There was a parallel Human Resources for Health Research in Africa meeting in the morning and those attending were impressed with the initiation of the new Coordinated Research Group (ISHReCA) being formed across Africa that is chaired by Professor Nelson Sewankambo - the dean of the medical school at Makerere. The group was founded on the idea that it should be African led and based on problems that that are African - whether or not they cross borders. The Wellcome Trust gave a great overview of its philanthropy in Africa (they give 1 billion dollars a year in grants). The lunch and afternoon were spent in breakout sessions and networking interviews. It was a full day.
Many spent the evening at a small Turkish restaurant in town - see photo. We are certainly eating well on this trip. But we need the calories to be able to attend all the meetings - of course.