Across disciplines, across the world: Multidisciplinary team engages in Uganda

A group of eight students from the U-M Nursing, Medical, Social Work and Pharmacy schools traveled this summer to Uganda as part of a project that combines interdisciplinary education and research with global health.

The student teams were led by Professor of Internal Medicine Brent Williams (back row, left) and School of Nursing Clinical Instructor Leslie Nestro (front, second from left), and Adjunct Clincial Assistant Professor of Social Work Joshua Brewster (not pictured).

Funded by a Health Sciences Council IPX-Research seed grant for interdisciplinary research collaboration, the month-long experience found students working in multi-disciplinary teams at three rural sites in southwestern Uganda. Bringing interdisciplinary work to the global setting is both complex and rewarding, said PI Megan Eagle, a Clinical Instructor in the School of Nursing.

“The insights that come from global health – around working in low-resource settings, around cultural differences being way deeper than you realize – are not discipline-specific, and there is no reason you have to learn those things in a disciplinary silo,” said Eagle, MSN, MPH, FNP-BC. “And there are good reasons to engage interdisciplinary teams in the international setting, because the fact is other places have been doing interdisciplinary care, often out of necessity, for a much longer time than we have.”

One of those places is in Uganda at partner institution Mbarara University of Science and Technology (MUST), where students from all health sciences schools are required to participate in multi-disciplinary community-based health projects prior to graduation. This August, eight U-M students traveled to the MUST campus before splitting into three groups in three different communities – two small-town hospitals as well as a community-based program offering in-home hospice care. The goals: to build community-level partnerships and explore potential future research projects.

Related: The Dec. 12 Global Health Initiatives Forum will feature a discussion of the IP-X project and other Uganda activities

Some found on-the-spot projects to tackle while at their respective sites. Second-year medical student Yalda Toofan spent most of her time in a rural hospital in Rwibaale run by sisters in the region’s catholic diocese. She rounded with the two clinical officers who staffed the hospital, taught science in the nearby grade school, and brainstormed a short-term project to complete in the few short weeks she was there.

“I noticed in the maternity ward they would spend a lot of time charting information about the patients by hand. They had books of valuable information, but not in a computerized form,” she said. “I pitched to them to let me gather the books from the prior six months and put the important data into an spreadsheet – patient age, antenatal visit records, HIV status – for about 500 patients.”

Social Work student Richard Robles (seated) interviews a Ugandan healthcare worker as part of his project.

The idea was to digitize the records to enable simple analysis for metrics like average gestational age at initial antenatal visit; it turned out to be around 6 months, much later than the typical age in the U.S. Documenting such information could help drive future interventions at the community level.

“I was afraid of gathering information that they already knew, but the head midwife was so dedicated to this project happening,” said Toofan. “They know the women are coming late, but the clinic is so busy that no one has the time to sit down, crunch the numbers and document. I’m not at a point in my training where I can help in the clinic, but I could do data entry. They were really appreciative.”

Social Work student Richard Robles was at a similar clinic in Bugoye, another small community about 50 miles away. In addition to observing on the wards with the local providers, he conducted interviews of everyone he encountered, asking a set of consistent questions about their work, lives, and more.

“For me, it offered a different perspective to learn about about social work means in Africa versus what it means in the United States,"Robles said. "I wanted to see what types of health services are available there. It was very eye opening.”

At all three sites, the visiting teams included at least one student each from the Medical, Nursing and Social Work schools. They would gather at the close of each day to reflect as a group.

“The nursing student would ask questions that didn’t even come to mind when I was shadowing the same person. Or the social work student would ask questions about home life and whether programs were available in different areas, so their perspectives were valuable,” Toofan said.

It was also insightful for the U-M students to see how different members of the local care teams worked together in the host institutions, said Leslie Nestro, a School of Nursing Clinical Instructor who accompanied the students to Uganda and split her time between the three sites.

“For our students in these settings, it is really big to see how people from all of the disciplines pitch in in terms of trying not to keep people siloed in their own profession. There’s never this attitude of, ‘Well that’s not my job,’” said Nestro, DNP, RN, FNP-C. “That’s an important perspective for students to learn early in their careers.”

While this summer’s initial experience laid the groundwork and helped establish relationships, future plans call for additional student groups to return to Uganda in the spring of 2019 to embed with MUST students in their own ongoing community projects.

“For a first time out, we learned a lot, but we’ve just scraped the surface of what’s possible,” said Eagle. “At MUST, the relationship between primary, secondary, tertiary care, and what we think of separately here as public health, is much closer. They have years of experience putting interdisciplinary student teams together to teach them about community interventions. There is a lot we can learn from them, and we are all interested in learning how to improve community based interventions through a team-based approach"

Med student Yalda Toofan gives a science lesson in a Ugandan primary school in the village of Rwibaale. The instruction wasn't an official part of her project, but Toofan volunteered to help teach there during off hours.