Five years after the start of the USHAPE ‘Whole institution approach’ initiative to promoting family planning, it has been great to go back and reflect on the achievements and the challenges.
The most inspiring thing has been to see the personal and professional growth of many of the USHAPE trainers, both at Bwindi Community Hospital and Kisiizi Hospital. Sarah Uwimbabazi, former USHAPE nurse at Bwindi Community Hospital, for example, is now in her second year of her nursing BSc at the Uganda Christian University, and it has been wonderful to see her grow in confidence in her teaching and leadership.
There are now approximately 140 student nurses and midwives studying for their nursing certificates at Bwindi Nursing School, and the USHAPE training that is available to them, gives them all the opportunity to additionally qualify as family planning providers. This is achieved by developing previous USHAPE graduates as trainers. Bwindi Community Hospital needs the ability to replenish their pool of trainers regularly because inevitably in such a remote area, staff often need to move on to develop their careers. At least having the opportunity to participate in the USHAPE ‘Train the Trainers’ programme, they will do so with greatly enhanced teaching and contraception skills.
The larger and slightly less remote Kisiizi Hospital has less of a staff turnover, and it was great to reunite with all four of the USHAPE trainers who completed their training last year. Following the success of a similar practical training camp at Rugarama Hospital last year, a week-long camp at Kisiizi was organised by USHAPE Lead Trainer Damari and her team. Free cervical screening and contraception was offered and the opportunity was taken to train many more staff in the technique of VIA (Visual Inspection with Acetic Acid) cervical screening. The camp was a success with more than 300 women screened, of whom 20 were referred for further gynae assessment and 10 were recommended to proceed to hysterectomy because of a strong suspicion of cervical cancer. 30 nurses and midwives also received their Letter of Competence in VIA screening, and eight more nurses learnt to fit contraceptive implants. Since USHAPE training started at Kisiizi, uptake of implants has increased to over 600 per year compared to 40 fitted in 2013.
My other exciting role during the five week visit was to help co-ordinate filming for a project called ‘FACT or FICTION’. I was involved in a successful bid for a joint Medical Research Council and Arts & Humanities Research Council grant to create films to promote family planning. A key aim is to specifically test whether target audiences in rural and urban Uganda respond best to messages delivered from drama (fiction), or through testimony from real patients and nurses (fact). Dr Merlin Willcox (academic GP) and Professor Jane Plastow (Professor of African theatre) are working with other Ugandan and UK co-investigators to create these films in two culturally and linguistically different areas of Uganda. Four short films will be created and refined using feedback from focus groups. It is fascinating to bring together so many different ways of thinking, and we are all learning a great deal from the qualitative research, which we hope will inform the development of films in the future. Opinion about which will be the more successful format is genuinely divided.