I have moved my blog to http://www.evelyncastle.com
Adam and I are heading back to Nigeria in less then 1 month! Please keep updated on my new blog location.
I decided to change my blog around a bit so that it becomes more useful now that I am back home. Hopefully, this arrangement will let you see the implementations we have already done and what we are working on now. Also, be sure to check out our projects site at eHealthNigeria.org for more details on the project.
We are still working very hard on improving OpenMRS and working on another, larger, implementation. Adam might be able to go back in Dec to do the set-up for the summer project. We are just waiting to see if we can get the money in time so please cross your fingers for us.
We are also working on a “work group” for the winter in order to get more students involved and get a lot more work done on the OpenMRS system. There is way too much for just Adam and I to do.
We have also started applying to a lot of grants so I will post those as I go.
That’s it for now. Sorry for not keeping you all up to date but I think with the new design, it will be easier for me to do so in the future.
A lot has happened since the last time I wrote. I will focus only on work, mostly because that is all I have been doing lately.
I gave a presentation to PathFinder Org on Monday and it went really well. I talked about OpenMRS, how we implemented it into the clinic, and how we could work with them to start implementing it into their clinics as well. They were very interested in working with OpenMRS and I have been going to their offices for the past few days. I am trying to set them up with a system that they can implement right away at a government hospital in Kaduna. Then, over the next two months, they are going to help us to finish the OpenMRS Nigeria program so that we can give them the finallized version in December (and hopefully come back for a few weeks to help them set it up in clinics!) We are still planning on coming back next summer to do this more but then we will be coming back to something that is already under way which we can just work on instead of start from scratch.
Everything is wraping up at the clinic. Ibrahim and Yakubu, the two men in the record room, know the program and are pretty good at it. They are putting a new steal door onto the room this weekend and have built a new table and book shevles for the room (after I asked very politely about a hundred times).
I had a meeting with the man in charge of Medical Health Information Program at the Shehu Idris school and he is very excited about the system. We are having a meeting with him and the Deputy Provost on Monday to discuss creating a cirriculum for them to teach to their students. The meeting is also to discuss what needs to be done/not done in order to keep the clinic running once I have left. I am very nervous about the whole project falling apart as soon as I leave so I want as many people as possible determined to make sure it keeps working.
Lastly, I have a meeting with a woman from ICAP on Monday and then am giving a presentation to the whole group on Tuesday. One reason for this is I owuld like to show them OpenMRS Express (they record HIV/AIDS and give free medication to clinics). The other reason is to try and convince them that we should come back in December and give trainings and that they should pay for it.
Now for “fun” info.
I am in Abuja at Dr. Mairo’s house for the weekend. It is my last weekend here and I haven’t been able to spend much time with her over these past 3 months so I would like to get to know her a little better before I leave. Also, they have good light, internet, and running water so that is always a plus. Her son is going to take me “sight-seeing” tomorrow as well which should be interesting. She also said that she will try to get me in contact with the head of ICAP and if I can squeeze in a meeting with the head of PathFinder while I am here, that would be great too.
I made some really cool friends the other day. It is a bit of a shame that I met them a few days before I leave but I had a really good time just hainging out with some normal girls talking about boys and sex and work. Granted these conversations were very different then conversations I have had in the states, but they were really interesting and hysterical.
Other than that, I return to CA in 10 days. I am very excited to come home although I know I will have to get right to work as soon as I do.But don’t worry, Ill be able to fit in some fun as well.
Thats it for now. This might be my final blog until I return to the US but I am going to continue writing to keep everyone updated on the project. I will also be able to give more information about the project, upload pictures, upload data files, and all sorts of fun things once I get back.
So I have been a really horrible blogger and I am sorry. But, I am going to offer a few excuses to make myself feel better and explain why I have been so bad.
1. There was a power serge at my house which knocked out the lights, water, and internet (lights are back but still no running water or internet which REALLY sucks)
2. It is the rainy season here and when I say rainny, I mean it. So it has been difficult to walk to the internet cafe because I don’t have an umbrella and for some odd reason refuse to buy one
3. I have been really fricken busy! The OpenMRS system is finished! Now all I am working on is getting the people at the clinic to use it. And that is exhausting! Working in Africa is really hard.
But since I am on a “numbering” role, I will continue it to give some highlights/lowlights of things that have been happening here. Sorry for being brief but so much has happened it would be impossible to write it all down.
1. Two more babies died. One was breach and the other one was just big. But this time they both had episiotomies performed(with no pain meds) which was probably one of the most horrible things i have ever experienced (I am sorry to say, but i was very very close to passing out the first time i watched it)
2. I got my Nigeria clothing which is absolutely fantastic. Also, today the matron gave me two new outfits, one is the uniform at the clinic, and i am really excited to try them on. We are all going to take a group picture wearing our matching outfits
3. I have had to deal with some really gross 40 year old men hitting on me. I want to tell these stories in person because they are even too horrible to write. And I feel like they will be much more entertaining in person.
4. “my” baby at the clinic is absolutely adorable and she loves me now. I have some pretty cute pictures and videos to show you all when i get back
5. I am giving a presentation to this organization called Pathfinder on Monday about working with them next summer implementing OpenMRS in their clinics so wish me luck
6. I am currently hating the internet because it is so darn slow!!!!!
7. I have discovered my inner girl and have blown all my money shopping here… opps
8. I REALLY REALLY hate the internet right now!
9. I come home in 2 1/2 weeks and am very excited about it. I love Nigeria but I think I am ready to come home. I am very excited to see all my friends and family and to start school. Also, we are going to start working on the final OpenMRS Nigeria program and start planning for next year which will be very exciting
10. I am going to be the TA for GIIP next year.
Ok, thats all i can think about right now. I am going to leave the Internet Cafe and literally run home cause I think its about to start raining… AGAIN.
Thanks for still reading. I will try to write more about the project before I leave and then I will write lots and lots more when I get home about the project this summer and what our plans are for next summer.
So today I finally got a chance to actually deliver a baby! It was probably the fastest delivery I have ever seen. I could barely get my gloves on in time. But it was pretty darn cool. And then I got to clean the baby off and dress him in his clothing. The custom in Nigeria is to dress the baby, wrap him in his blanket, show him to the mother, and then bring him outside to the family that is waiting there. All the family was really stoked that a baturea was bringing out their new baby. I am getting better at Hausa and “Barka” means Congratulations so I just kept telling them all that and they all said “nagode”, thank you, back to me. It was pretty fun.
I also did real work today. The computer trainings are going really well. I started teaching another of the records keepers, Yakubu, and he picked up on the system right away. The power went out around 11 but I had my laptop so I asked Yakubu if he wanted to play a typing tutor game that I had downloaded. The game is called Tux Typing. It has a penguin as the player and the words are in fish which you have to type in order to feed the penguin. It was probably one of the funniest things watching a 40 year old man get a total kick out of playing a children’s typing game.
That all for now. Hope everyone is doing well and I enjoy all your comments!
So I have been working very hard on my project this past week and I realized that I haven’t really explained to you all what I am actually doing here, work wise. I am in the process of writing up an abstract/full project report which will be in the “about project” section when I am done. But until then, here is a brief description of the project.
Open Medical Record System (OpenMRS®) formed in 2004 as a open source medical record system framework for developing countries. OpenMRS is a multi-institution, nonprofit collaborative led by Regenstrief Institute, Inc. (http://regenstrief.org), a world-renowned leader in medical informatics research, and Partners In Health (http://pih.org), a Boston-based philanthropic organization with a focus on improving the lives of underprivileged people worldwide through health care service and advocacy. These teams nurture a growing worldwide network of individuals and organizations all focused on creating medical record systems and a corresponding implementation network to allow system development self reliance within resource constrained environments. To date, OpenMRS has been implemented in several African countries, including South Africa, Kenya, Rwanda, Lesotho, Zimbabwe, Mozambique, Uganda, and Tanzania. This work is supported in part by organizations such as the World Health Organization (WHO), the Centers for Disease Control (CDC), The Rockefeller Foundation, and the President’s Emergency Plan for AIDS Relief (PEPFAR).
OpenMRS and HIV/AIDS
OpenMRS Express is a pre-packaged program built specifically to follow HIV/AIDS and has been implemented throughout Kenya. It has pre-defined regimens for patients to enforce that patients are getting the correct medical advice and medicines. It also is capable to doing analysis of the HIV situation in different parts of the country for different groups of people and age groups. This system has been incredibly effective at providing communities with the correct amount of HIV medication and at making sure patients are receiving the right care.
OpenMRS and Us
We have decided to take OpenMRS to Nigeria. We are working on creating a pre-packaged program specific for Nigeria. The aspect that I am focusing on is maternal and child health. This process involves creating “concepts” for each aspect of maternal and child health, re-creating the clinics forms into an html version, and linking all the concepts and forms together so that they can be easily analyzed through reports. At first, this was incredibly difficult but Adam and I have finally gotten the hang of everything and have made some real progress!
We have finished the Immunization Form and last Thursday, I began to teach the Records Keeper, Ibrahim, how to use the system. Adam got an Inveneo computer (really low powered and portable) donated for the clinic so that is the computer that I have been teaching on. As we finish creating the other forms, I will start to teach them as well.
Teaching has been a bit more difficult than I had imagined. I forget that these people have no/very limited trainings with computers and I need to teach EVERYTHING. One of the hardest things I have come across is the “Delete” button. I can’t tell you how many times I have had to explain that in order to delete a word, you have to press the “backspace” button, not the “delete button. It’s the little things like that, that make teaching go very slowly.
So the goal of the project in the clinic is to have, by the end of the summer, the main forms made and have the clinic running the system by itself. We are getting at least one other computer for the clinic and will link them together so that they can share information. Power is not as big of a problem as I initially thought. The clinic does use its generator and the low powered computers help a lot!
The goal of the project over all is to create a pre-packaged program for Nigerian Maternal and Child Health that can be implemented at any clinic and needs little customization. We have been working with many organizations here that are very interested in also working with Medical Records Systems. We would like to partner with them on implementing OpenMRS throughout Nigeria to create a better understanding of the health situation here. Over the next year, we want to partner with clinics and schools in Northern Nigeria and then next summer, go and teach/implement the system.
Sorry for the kinda vague outline of the project. It all makes sense in my head but it is always more difficult to write it down. I think you can get the general idea though. I’ll let you all know when the final report is up so that you can read more about it.
Wish me luck on my teachings! I know I am going to need it!
A baby died today who should have lived.
When I arrived at the clinic this morning, two woman were in delivery and 1 woman had just delivered. The first woman delivered a premature baby girl but she was healthy and beautiful. The second woman began to push only about 30 min after the first had given birth. She already had gravida 9 with 8 children still alive. She was a skinny woman and her stomach was huge. She was having twins. Everyone in the clinic was excited to give birth to two beautiful twin girls. All the woman insisted that I deliver the first one and then Helen would deliver the second. I was petrified but since Helen was next to me, I figured it would be fine. With my gloves on, I stood by the bed and waited for the placenta to break and the baby to come. Helen reached inside the woman, felt around and then told me to do the same. As I put my fingers in, Helen asked me if I could feel the foot, which I could, and told me the baby was going to be delivered breach. I stepped aside, knowing that in Nigeria, this could lead to complications. Helen took over and told the woman to push. Half the baby came out easily but that was it. Helen tried to pull the baby the rest of the way out but the woman had stopped contracting and the head and shoulders were stuck inside. You could see the babies legs and body move a bit and it looked like it was trying to breath. Immediately, Helen called for the head nurse who rushed in and told one of the students to giver her an IV drip that should make the woman contract. The head nurse tried to wiggle the baby out and after about 10 minutes of the nurses yelling at the mother, the baby had not moved any further out. At this point, there were about 15 students in the delivery room, all leaning in to watch, and making it difficult to move around the room. I couldn’t understand why the head nurse didn’t yell at all of them to get out so that she could actually work. It was really frustrating and I felt so claustrophobic.
This whole time, all the woman were yelling in Hausa so I am not sure exactly the reason, but they had the mother get up, with the baby hanging half out of her, and move to the bed next to hers. At this point, the IV was beginning to work and after a few more pushes, the baby came out. This all happened in a span of about 20 minutes. The baby came out, still, eyes closed, and not breathing. The head nurse took her the side bed and tried to revive her. In order to do this, they have a device that you stick one end into the babies throat and the other into the nurses mouth and suck the mucus out of the lungs. Then repeat with the tube down the babies nose. The baby was still lifeless and the students were all crowded around the table watching. Some of them were crying a little and the others had their hands on their face. I couldn’t watch any more so I turned my attention back to the mother and the second baby. The second girl came out easily but she had been in distress during this whole time. I helped to deliver her and then another student, Suzy, and I began to clean her off. The head nurse came over to us and did the same procedure of removing mucus from the babies lungs. You could tell the baby had been in distress because it had diarrhea immediately. After the baby was cleaned, we dressed it and wrapped her in a blanket. She was a very healthy and beautiful baby girl.
The other baby had died and she was laying on the table with a blanket over her. I pulled up the blanket just to get a look at her and she looked like a healthy baby. She was actually bigger then the premature baby that had been delivered before her. The mother was laying on the table and she was visibly exhausted. Through this whole experience, she had managed to cry only a little bit. She was a strong woman but she looked very upset about losing one of her twins.
When I was talking to the head nurse later, she explained that breached babies don’t always die here. The reason this one died was because the mother was not pushing hard enough. I don’t know how true that was or who’s fault it was that the baby was dead, but I know that if that same situation had occurred in the states, that mother would be at home right now with her two beautiful babies.
One of the more interesting and slightly upsetting parts of all of this was the reaction of the students and nurses. As this situation was unfolding, everyone was very upset and worked very hard to save the baby. But, after there was nothing left to do and the baby was dead, that was it. They went back to work and started joking and laughing as normal. I guess that is what happens in a country where it is so common to lose a child during birth. It was hard for me to joke and laugh with the girls because I was still very upset (although had somehow managed not to cry) and because the woman who had just lost her child, could hear the girls laughing. Once again, this is not my culture. I do not know how things are done here, how people feel about some situations, or how people coup with loss. I can’t judge the actions of any of the nurses at the clinic. I know they did their best to save that babies life. It is just upsetting that I know that baby should not have died and that they are so used to babies dying that they are able to laugh right after.