Summary of UMB Faculty/Student Meetings in The Gambia
June 4-16, 2014
Wednesday, June 4
Visit to Kachikaly and Barboucarr Art Studio
Tour of museum and section of Alligator Park
Meeting with Dr. Azadeh (Physician at private GYN facility; Senior Lecturer at the Medical School at UTG and; Physician at Bafrow Women’s Clinic)
· Private facility provides gynecological services including rooms for delivery
· has addressed female genital mutilation primarily by providing alternatives and educating patients
· Private clinic serves nearly 30 people per day
· C-section patients can remain at facility for up to 3 days.
· Regular vaginal delivery patients often remain at facility for 1-2 days.
Thursday, June 5
Visit to Banjul Public Hospital – Edward Francis Small Hospital (Dr. Amad Jaffe/ Chief Medial Director) (Hospital overview, hospital resources and challenges)
· Hospital Overview- This is the major hospital in the Gambia; currently has 8 ICU beds
· Hospital Resources: Dr. Jaffe outlined the challenges of medical practice.
· Major challenges faced by hospital include need for medication and equipment
4pm -Talk with Abubukarr Sillah – traditional medicine in Gambia
Mr. Sillah provided an overview of traditional medication and explanation of benefits and deficits of traditional medicine.
· Deficits – Traditional medicine is unregulated in the Gambia. It is sustained because it depends on customs.
· Benefits of traditional medicine: It is deemed affordable (although some healers claim to cure all diseases with no consequence for failure to fulfill this) and it is accessible
· There are four types of healers in the Gambia:
1) Circumcisers
2) Bone Setters
3) Traditional Birth Attendants
4) Eye Healers
Impotence and infertility is attributed to Satan according to traditional medicine practices.
Friday, June 6
MRC Visit- Overview of services and clinical trials
Interview with Marie Tu Salla (Staff Development Mgr./training and development)
Matron Pamela Colliera (Nursing Department)
Vivian Thomas (Registered Nurse and Clinical Trials Unit Lead)
MRC areas of focus:
· Vaccinations
· Disease Control and elimination
· Small unit childhood and adult day clinic (serving 150 people on avg per week) Does not provide surgical, gynecological or dental services)
Works in partnership with UTG and has 20 PhD students on-site and offers three scholarships per year to Gambians.
According to Matron Pamela, the three health areas of concern in the Gambia:
- Infection disease particularly TB
- Diabetes
- Malnutrition. Citing the “granny syndrome” – mothers leave their newborn with their mother who is unable to breast feed and thus child is left under or malnourished.
MRC does clinical trials.
They have seen a trend of increasing number of liver cancer patients due to Hep B.
Saturday, June 7 and Sunday, June 8
Trip to Tumani Tenda, Western Division
· Naming ceremony
· Gender role discussions with villagers
Monday, June 9
Visit to BAFROW Clinic /Women’s Health Center
Mrs. Ceesay (Vice Director) provided an overview of the clinic and a description of the patients commonly served at the clinic.
The clinic has a one location in Banjul; the other site is in remote Matinab.
· Clinic’s focus is on improving the quality of life of women and young people. The clinic was opened to address the basic needs of women who were traveling long distances to obtain basic services. The clinic defines their treatment model as “holistic” and involves community members in nursing education/treatment particularly in rural communities. Bafrow employs 76-80 clinical and administrative staff; 2 Pediatricians and 4 surgeons part-time.
· Community Engagement- The approach to community engagement includes having a core group of men in the community they have sensitized on certain issues. The community-based volunteers/counselors must meet certain criteria including having a status in the community and having the chief (sr. leader in the community) appointing them as the designated contact for Bafrow. These community based counselor’s work with a mobile unit particularly for HIV testing. The community education employs various tactics while recognizing the significant number of illiterate women (approximately 45% of the women in the Gambia). The clinic provides training to rural communities. They attempt to complement the government’s efforts and not duplicate. Bafrow encourages pap smears and has the capacity to reach grassroots community.
· Female circumcism- Bafrow has attempted to address female circumcision by providing microforms of credit to serve as an alternative form of income to circumcisers. One emerging issue is the rising number of circumcisers unregulated that have come from Mali and do not comply with the micro credit.
5:30 pm Meeting with Rex A. Kuye (School of Public Health, Allied Health Services. Works with the GEO Health Hub- (Fogarty funded NIH program with U.S. NIEHS) main focus is on rural health needs specifically around water, agricultural health and pesticides. There is also a great emphasis on disaster preparedness including floods, drought, fires and locust invasion.
6:30 pm Meeting with Mr. Gassamo of the World Health Organization- local office.
In his role, he serves as a broker for health. Was the former of minister of health. WHO has seed money in the past few years. He is headed to Sierra Leon to address Ebola which has already claimed the lives of four under-protected nurses. He had high interest in our healthcare worker/health system strengthening project.
Tuesday, June 10
11 am- Meeting with Dr. Csar (Dean of Nursing at UTG)
Provided an overview of nursing services in the Gambia
3 levels of nursing services (Primary, intermediate and tertiary)
· Primary level includes traditional members of the community trained by nurses to serve as a community health nurses. Offers mobile clinic to rural communities.
· Intermediate level included RN’s and BSE’s. Immunizations are also provided at this level.
· Tertiary level includes care delivered in hospitals. The hospitals have the majority of the resources.
Wednesday, June 11
10:30 am - Edward Francis Small Hospital- Meeting with Dr. Nyan (Provost of Medical School) and Mr. Gomez (Infection Control Unit)
Dr. Nyan provided an overview of health care gaps within The Gambia including:
Capacity building;Funding to expand on medical education and lack of policy and regulation of medical services (policies not always updated).
Mr. Gomez reviewed the six-page toolkit and provided answers about written policy, staff training, prevention, TB exposure and PPE.. (See excel spreadsheet)
6pm – A.Ellis Meeting with Somia Nje (Female Lawyers Association of The Gambia)
Attorney provided an overview of key legal challenges in the Gambia; FLAGS focus (economic empowerment and education/advocacy regarding women’s rights including community education about Women’s rights law enacted in 2010)
Thursday, June 12
11 am meeting at Ministry of Health with Ms. Gomez (moved to 1 pm)
1pm- meeting with students from Miami University of Ohio, Mel, Debbie and A.Ellis
Ms. Gomez emphasized the need for the Gambia to focus on capacity building
Provided an overview of Dr. McDiarmid’s work and emphasized health system strengthening; health system workforce.
3 pm meeting with Matron Pamela and Occupational Health Physician
· Infection Control – working on implementing Hep B vaccination of workers
· All people born after 1990, received vaccinations.
· Posters on the ward promoting safety
· There is one staff person who handles occupational health- person earned a master’s degree in occupational health.
· Reviewed the six-page toolkit and addressed prevention, training PPE’s and TB surveillance. (See toolkit excel spreadsheet.)
Friday, June 13
Meeting at Barfrow with Ms. Ceesay and Katherine Dalliah (nurse)
6-page toolkit was reviewed and compared to Bafrow policies and procedures. Staff offered feedback about the toolkit including highlighting the need for gender specific language “on a whole it [the toolkit] the gender perspective is not very visible. The staff highlighted given the high percentage of illiteracy in the Gambia, there is a need to include a glossary in the back of the toolkit and better explain medical terminology. The staff also explained people are inclined to accept jobs and not report if there is a safety issue because they simply want to gain and sustain employment. The staff mentioned there is little emphasis placed on occupational safety in The Gambia despite their need to address workforce needs.
· Two critical points made regarding the toolkit and those who might review the toolkit at Bafrow:
Someone could be in a leadership role but not a medical role, thus the language cannot be specific to medical staff only.
Even if a person is in a medical role, their nursing preparation/training may not have included certain terminology.
· Great emphasis was placed on Bafrow’s attention to workforce development. New employees are pre-tested on various topics and then provided training. Supervisors are tasked with checking in daily and confirming comprehension of issues. Each person gets a personal orientation and review after three-month probation period.
· Bafrow emphasized their focus on training including two day training focused on infection control
· The staff provided a draft of their policies and procedures, which attempted to address occupational safety. They admit to needing help with their policy and want direction regarding content.
(See also excel spreadsheet.)
Monday, June 16
Meeting with Ms. Gomez (Chief Nursing Officer, Ministry of Health)
The meeting was cut short due to an emergency meeting with the Minister of Health
Ms. Gomez expressed interest in utilizing the toolkit at various health care facilities throughout Banjul.
Meeting at UTG School of Law (Bobo Baldeh (Assistant Registrar/Faculty) and Hanatu Kabbah (Lecturer & Director of Law Clinic)
Provided an overview of law school curriculum.
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