From Cambridge to Kampala — MMM17 across continents

8th June 2017Eugenie Verney

From Cambridge to Kampala — MMM17 across continents

Karen Miles is a research nurse at the Experimental Medicine and Immunotherapeutics department at the University of Cambridge/Cambridge University Hospitals, Addenbrooke’s, in the UK. With her colleague Jean Woodcock-Smith, she ran May Measurement Month screening sessions at Addenbrooke’s between 4 and 24 May 2017 before heading for Uganda and doing the same there on 26 May. Here’s her report…

Surprisingly, I noted quite a number of similarities between Cambridge and Kampala: even the ambient temperature was not so different — a stuffy 24C in Cambridge, around 26C in Kampala, but with a lovely through breeze most of the time.

A key difference was the sea of waiting faces in the antenatal clinic waiting area at Kawempe Hospital, on the outskirts of Kampala, where we ran the screening alongside local nurse Dorcas Ayo. All were attending the hospital for a variety of out-patient appointments, all were invited to take part. Many wanted to immediately take up this opportunity and others perhaps felt obliged, although some also opted to not take part.  

In the UK, the busy hospital foyer at Addenbrooke’s provided a more ad hoc approach, and we had to sell our wares more forcefully:  ‘Can we take your blood pressure today?’ we called to passers-by. Many waved a hand, indicating ‘no thanks’, many others paused and said ‘why not?’ before coming over to sit down. A few said: ‘Not today, thanks — it will be high!’, while quite a few told us they already knew their numbers.

British nurse Karen Miles at work in the May Measurement Month screening centre she and Jean Woodcock-Smith set up in the antenatal clinic waiting area at Kawempe Hospital, Kampala.

Clearly language barriers played a part, but the Kampala folk were waiting around, not busy passers-by, so perhaps we should think next year about where we set up our Cambridge MMM station!

In Kampala, the men and women provided a steady flow of bums on the bench. They gradually pushed us along as they squeezed in at either end, keen to be measured next. Little was said, but I was very grateful to Mary, a clinic midwife, for making herself available to translate as needed. I did have a go at a bit of French for a Congolese woman, and I grew more confident with my Bugandan ‘How are you’ — phonetically ‘olly-awe-te-a’ — and ‘thank you’ —‘wi-baa-lay’. (My sincere apologies here for spelling and any misrepresentation!).

Sleeves were rolled up both in Cambridge and Kampala. People do know what blood pressure measurement involves and they are interested to know theirs. In both the UK and Uganda we found that people often don’t know what a normal reading is, so across both stations we were able to inform and advise.

Among those we screened in both countries who already knew they had hypertension, some had stopped taking their medication — in part due to side-effects and, in Uganda, also in part due to cost and accessibility.

Jean Woodcock-Smith with a patient in the May Measurement Month screening centre she and fellow British nurse Karen Miles set up in the antenatal clinic waiting area at Kawempe Hospital, Kampala.

Most people had had their blood pressure taken within the previous six months to a year, with only a few in either country saying they had never had it taken. Many Ugandans did not know their weight and height, while most in Cambridge had some idea. And while those in Cambridge could answer a clear ‘yes’ or ‘no’ to having diabetes, a common response in Kampala was ‘I don’t know — I have never been tested’. All Cambridge people knew their date of birth; in Kampala all knew their age (roughly), some knew their date of birth.  

Many people both in Kampala and Cambridge had spent several hours or more travelling to the healthcare facility for specific services. I was left with the impression that the MMM opportunity was more greatly valued in Kampala — in UK, if people did not stop today they could get a check some other time. In less than three hours in Kampala, three of us recorded more than 70 blood pressure measurements. In three hours in Cambridge, two of us took between 20-40 blood measurements. We ran five MMM stations in Cambridge across May,  just two in Kampala.

At both we were able to advise about accurate measurement, informing participants whether they should have a large or small cuff, that they should sit quietly before and during the measurement, and that three readings are better than just one. Most importantly, we were able to inform those with high blood pressure that they should seek further advice and follow up.

Ugandan nurse Dorcas Ayo worked alongside Karen and Jean at the antenatal clinic waiting area at Kawempe Hospital, on the outskirts of Kampala.

Running a blood pressure measurement station requires few resources: a table, some chairs or a bench, a few validated blood pressure machines, some posters, t-shirts, two or more volunteers passionate about informing people about their numbers, and of course a busy venue providing willing participants. It was fun — it is more fun when you are visiting a foreign country as this offers a whole new perspective, but wherever it is, it certainly feels worthwhile.

We were in Kampala for a collaborative research meeting and were able to join forces with local midwives and nurses to run the Kampala MMM station. Sister Dorcas Ayo, deputy chief nurse at Kawempe Hospital, and Dr Annette Nakimuli were particularly helpful in rallying support for the Kampala event. Professor Ian Wilkinson and Dr Carmel McEniery supported the Cambridge event and the Uganda travel opportunity; our sincere thanks to all.