The long-range goal of the program is to establish a means for simulation training across continents. The goal of this trip was to train local champions who could sustain the program. Over the course of a week, Ugandan learners (including midwives, anesthesia providers, nurses, and physicians) participated in the inter-professional simulation focusing on teamwork and communication in the context of postpartum hemorrhage.
The success of the program was highly dependent on the diversity and passion of the team, both in Uganda and in the U.S. The project required support from simulation experts, anesthesia providers, computer scientists, nurses, and obstetricians both in the U.S. and in Africa.
One recurrent question was whether the learners would accept and the hospital infrastructure would support our software. The Ugandan trainees embraced every aspect of the training, including the technology. Some learners were tech-savvy while others sheepishly admitted they had never used a computer. Despite the learning curve being different for each trainee, everyone remained intently focused on the learning objectives. Even those with no computer background learned new skills that would be useful to them in practice.
Prior to our trip, we identified many potential barriers to our success: inadequate computer infrastructure, potential interruption of power or Internet connection, potential damage to computer equipment in austere environment, poor acceptance of technology by Ugandan learners, and work responsibilities that would usurp the time of the training sessions. It was critical to consider each of these situations in advance and come up with contingency plans prior to our departure from the U.S. The planning time was well spent, as we had to institute many of our contingency plans while in Africa. These on-the-fly changes included: moving to different computer lab, moving from the wired to the cellular network, purchasing additional network airtime, and borrowing compatible equipment. Although we planned for many contingencies, the project still required team members on the ground to think quickly and creatively on their feet.
Perhaps the most important lesson learned was the amount of time needed to navigate an international IRB. We budgeted approximately three months of time to obtain IRB approval in Uganda. Three months was not enough. With future projects, we would reserve at least six months of time to obtain international IRB approval (and thus were only able to obtain part of the data we hoped to obtain while abroad). Despite this challenge, we were rewarded with lots of positive feedback from Ugandan trainees and a crew of local champions that are interested in continuing the project long-distance.
We are thankful to our counterparts at Mulago Hospital in Uganda, without whom none of this work would have been possible or worthwhile, and to SEAD (and USAID) for their belief in our vision.