To Africa With Love

Stacy Hanson

University of Kansas School of Nursing

Gulu, Uganda

Immerse yourself in the Ugandan

Culture…• Location: Northern Uganda

• Population of Gulu: 418,650 with more than half being children below the age of 15

• Language: Acholi& English

• Religion: Catholic

• Tribe: Acholi

• Life Expectancy:• M: 51.66 years• F: 53.81 years

Major Health Issues In Gulu

• Malaria

• Upper respiratory tract infections

• Diarrhea

•Nodding Syndrome

• HIV/AIDS

Description & Statistics of Nodding Syndrome in

Uganda• Occurs in Acholi and Lango tribes

• Became prevalent in 2002

• Most common in ages 5-15 years old

• More than 3,o00 kids have this syndrome in Northern Uganda

• Most common symptoms• Nodding of the head• Seizures• Mental retardation

Symptoms & Progression of

Nodding Syndrome• The most common characteristics of this disease have to deal with head nodding that is triggered by feeding, a cold breeze, or cold weather (Idro et. all, 2013b) .

• As the disease progresses children become severely malnourished, have slurred speech and often become physically and mentally stunted and will drop out of school within 2-4 years of onset(Idro et. all, 2013b) .

• Peripheral muscle wasting is present and most patients that are affected have another type of seizure disorder (Idro et. all, 2013b)

Nodding Syndrome contributing factors from personal interviews with

the people of Uganda…

• 1) They believe that it is caused from an autoimmune dysfunction related to specific protein in brain. A previous infection starts an autoimmune response (Dr. Beatrice, personal communication, June 18, 2013).

Nodding Syndrome contributing factors

continued…• 2) They theorize that Vitamin B6

deficiency is a contributing factor: which causes:• Motor function problems• Convulsions• Anemia• Cognitive problems

(Dr. Beatrice, personal communication, June 18, 2013)

• Side note: Vitamin B6’s main involvement is in the formation of myelin

Nodding Syndrome

contributing factors

continued…• 3) Lack of sexual

development related to adrenal gland or growth hormone (Dr. Beatrice, personal communication, June 18, 2013)

• 4) Toxin – mining gold and mercury upstream and then people drink downstream (Dr. Beatrice, personal communication, June 18, 2013)

This picture was taken when visiting the botanical gardens.

Barriers discovered in Gulu

• Lack of income

• Lack of resources/education

• Lack of ability to get all nutrient requirements

• Lack of transportation

• Belief that nodding syndrome is transmitted via airborne

Negative stereotypes present in Gulu regarding Nodding

Syndrome..• Nodding syndrome is a result of evil spirits

and curses – believe that it is happening due to the war and people who died during this time were not given a proper burial (Mutamba et. all, 2013).

• Nodding syndrome is incurable and fatal (Mutamba et. all, 2013).

• Nodding Syndrome makes the patient a burden to society because it disables them (Mutamba et. all, 2013).

Community, Individual & System Strategies present…

• Tie the children up so that the parent can go to work and not have to worry about the child running off and getting hurt (Benedict, personal communication, June 24, 2013).

• Drop them off at “wards” so they are no longer a burden to the family.

• Quarantine the patients who show symptoms due to belief that it spreads via airborne transmission (Benedict, personal communication, June 24, 2013) .

• CDC has been involved to investigate the process, etiology, and treatments of this disease.

Conclusion

• No known cure but CDC continues to research the disease to make healthcare strides (Indro et. all, 2013a)

• Anti-epileptic drugs such as: Sodium valproate, and phenobarbitone help reduce some, but not all, symptoms. Health outcomes in response to medications cannot be proven (Indro et. all, 2013a)

• Prevalence in Northern Uganda was not as high as Southern Uganda

• Rehab strategies:• Gross motor skills are often affected but a way to improve

and strengthen these aspects would be to have the patient participate in activities like jumping, playing in sand, or skipping (Indro et. all, 2013a).

My personal growth…

There truly are no words to describe the abundance of love I felt over in Gulu, Uganda. The nurses and students of Lacor School of Nursing and Saint Mary’s Lacor Hospital showed me what it is like to be utterly passionate about your career. I have gained cultural competency that will allow me to transform the way I care for my future patients. Traveling to Uganda allowed me to find the beauty in the Acholi culture.

Qualities I have gained from the Ugandans:-Selflessness-Ability to be present-Ability to suspend judgment-Ability to be a better listener-I have learned how to be a friend; how to compromise.& more.

My mentor Martha & I earning our helping babies breathe certificate

together

The love, generosity, vulnerability and humility in Uganda is admirable and really does not compare to anything like what we are used to here in the states. I initially thought I would have something great to teach them and I think they expected the same. Truthfully I feel like they have taught me an incredible amount about life, love, and happiness.

“As you move through this life… you leave marks behind, however small. And in return life – and travel – leaves marks on you.” — Anthony Bourdain

Creating ever-lasting memories learning traditional dances

References

• Idro, R., Musubire, KA., Bayamah Mutamba B., Namusoke H., Muron, J., Abbo, C., Oriyabuza, R., . . . Mbonye, AK. (2013a). Proposed guidelines for the management of nodding syndrome. African Health Sciences, 13(2): 213-232. Doi: 10.4314/ahs.v.12i2.4

• Idro, R., Opoka, R.O., Aanyu, H. T., Kakooza-Mwesige, H., Piolya-Were, T., Namusoke, H., Busoke, S. B., Nalugya, J., . . . Tumwine, J. K. (2013b). Nodding syndrome in Ugandan children - clinical features, brain imaging and complications: a case series. BMJ Open, 3, 1-11.

• Lacor Hospital. (2002). St. Mary's Hospital Lacor. Lacor Hospital > Home. Retrieved July 12, 2014, from http://www.lacorhospital.org

• Mutamba, B., Abbo, C., Muron, J., Idro, R., & Mwaka, A. (2013). National Center for Biotechnology Information. Stereotypes on Nodding syndrome: responses of health workers in the affected region of northern Uganda. Retrieved July 12, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056485/