Day five - Desk
Desk review - this was something new! It's
similar to preparing a review paper. You assemble information
related to health in Uganda at all levels
and then prepare a report based on this.
This was beyond tedious! I wondered whether
this would be helpful or not.
From discussions, I do now realise that this
is an important part of the process which fleshes out the
background for the task ahead and feeds into a formal report. It
helped me understand Uganda's health needs. It also helped me
participate in a workshop.
This is hard, dry work but useful.
Days six and
seven - Entebbe
Desk review continues each day as it is an
ever expanding task. I'm sent papers from all sides to incorporate
into the desk review. At the end I feel like I have something
that is reflective of the information I have...although some of the
data seemed out of date in 2012.
Wondering around Kampala: Mark from WHO Geneva
is a welcome addition to our group. Over the last few
years, I have been in contact with Mark about mhGAP and
different projects. It was nice to spend time with him in
person rather than email. I learned a lot from Mark about
international work and WHO. He's a master of technical knowledge as
well as very nice company.
On Sunday we travel to Entebbe. Entebbe is
either a very tiny place or I missed most of it. There are a few
roads and little traffic. Bizarrely the hotel seemed populated
by lots of Russians as well as the expected NGOs.
I expected mosquitoes and got none
- instead I had lake flies.On arrival at the hotel
I had so many lake flies in my hotel room -1000s if not millions
that I slept in the bathroom. It was literally a carpet of insects
by the morning. I have never seen anything like it.
We had a buffet at the hotel - this was a
place we began to hate!
Days eight to twelve -
This was the meat of the trip and a new type
of process for me. Designing the mhGAP project in Uganda may
have been long and sometimes exquisitely tedious, but by
the end I realised how this would ensure that the project would
This is a Ugandan project that World
Vision sponsors - WHO provides technical advice and the owners
are the Ugandan health services and ministry. So there was a
variety of stakeholders at the meeting including psychiatrists,
psychologists, ministry people, NGOs representing epilepsy and
psychosocial work. My role was a bit less clear in my mind. I was
there to share my modest experiences of mental health in
international primary care work.
There were new terms for me to learn and
understand: log frame, detailed implementation plan, monitoring and
evaluation as well as budgeting. The workshop day begins with
prayers and end with prayers.
Ugandans like to talk and there's lots of
participation. Chairing was a challenge and I did my share. There
was lots of enthusiasm and ideas. Log frame means the logical
framework. This was the core of the workshop which is
about the skeleton of the design. It consists of a table
featuring goal, outcome, output, indicators, and assumptions. This
took the bulk of the whole workshop and is the base for the
implementation. We ended up with a goal and several outcomes. The
workshop fleshed these out with input from all stakeholders.
Detailed implementation plan is a plan to role
out the outputs and outcomes with a time line. The budgeting
discussions were predictably difficult. As normally happens
the initial budget goes well over budget and then needs to be
painfully trimmed down.The end result was a design which was scaled
down, realistic, achievable but still valuable for patients with
mental, neurological and substance use problems in Uganda.
What was very interesting was the input on
user groups. This became an important part of the
discussions and became a structural part of the design. User
groups would be able to combat stigma, publicise and market
clinics. They would drive the momentum for the service to
continue. My own feeling was that epilepsy would be a key condition
that could generate its own market. The community will see the
benefit of treatment and insist on treatment continuing long into
the future. Something I had seen previously in Chad.
By day five I was so shattered that I
realised that doing direct clinical work or training –the
“exciting” stuff - is actually less exhausting.
Day thirteen - Day off
This was a great day. Dr. Mugaga was our
wonderful host who took us sightseeing. We saw waterfalls
and were taken to schools with unbelievably well-behaved school
children. We also went to the source of the Nile in Jinga
District and had a boat trip. Dinner was with Word Vision in
Kampala then back to Entebbe.