By P. Clare Kelley
P. Clare Kelley, Administrative Coordinator in the ASH Executive Office, recently spent two weeks in Uganda.
"Have you ever had malaria?" Dr. Melody Cunningham, of St. Jude Children's Research Hospital in Memphis, posed the question recently to Godfrey, her amicable Ugandan cab driver as they drove the mountains dotted with banana trees and zebras. "Of course," he responded, his tone indicating that his malaria experience had been nothing out of the ordinary, "it hurt. " Dr. Cunningham looked puzzled. "What hurt?" she asked. "The needle for the IV," Godfrey answered, "it hurt." "But doesn't malaria hurt?" countered Dr. Cunningham. Godfrey shrugged. "No," he replied nonplussed, "But that needle hurt!" The two shared a chuckle over their differing worries.
Dr. Cunningham found herself in Kampala as part of an assessment team to evaluate the teaching and training needs at sites in Uganda for ASH's new partnership with Health Volunteers Overseas (HVO). The site assessment team, which included Dr. Thérèsa Coetzer, of Wits Medical School in Johannesburg, South Africa, as well as ASH and HVO staff, met with health professionals and toured facilities in hospitals in the capital city of Kampala and Mbarara, a large metropolitan area outside the capital.
Hematology is not well developed as a discipline in Uganda. In the entire country, there are two certified hematologists, one of whom recently retired. Hematologists and pathologists are often seen as a "last resort," meaning that by the time many patients reach one, they have been treated by a process of trial and error in many other departments and/or outside clinics. Communication between labs and clinicians, as well as between departments, can be fragmented and inconsistent, much to the frustration of the committed doctors and scientists trying to provide a high level of quality care for their patients.
Thus, the need to train health-care professionals in Africa is critical. The World Health Organization (WHO) recently reported that while Africa has 11 percent of the world's population and 24 percent of the global burden of disease, it only hosts three percent of the world's health workers. In order to be sustained and passed on to the next generation of hematologists, training must be based on the needs and equipment at the site. This problem was identified by Dr. Susan Ndidde Nabada, a Ugandan histopathologist who recently returned from a fellowship at McMaster University in Toronto. Although passionate about studying and treating hematologic conditions, she found much of her Canadian training irrelevant to her work in Uganda, since the techniques she learned were too sophisticated for the equipment available to her through her hospital.
The most prevalent hematologic issues in adults in Uganda tended to be malaria, anemia, HbSS, and HIV/AIDS. One doctor estimated that one out of every two patients admitted to the hospital in Mbarara was HIV positive. Pediatric patients presented with HbSS, malaria, iron deficiency, and other anemias with unclear etiology. Testing for most of these conditions was generally based on smears and/or morphology. However, the facilities lacked equipment, and even when equipment was available, sufficient reagents were unavailable, either due to a shortfall of funds or unreliable suppliers. In addition, only about 10 percent of patients would be able to afford more comprehensive testing, treatment, and medicines through private clinics.
The hematologist volunteering in Uganda will find him or herself not only providing teaching and training, but in the midst of a life-changing learning experience.
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