The African Family Medicine Education and Development Initiative (AFMED)

Progress and Future Directions - April 2008

The African Family Medicine Education and Development Initiative (AFMED) is an effort by Maternal Life International (MLI) to improve maternal and family health care in Nigeria by increasing the level of in-country health care training for family medicine physicians, nurses, midwives and allied health care personnel. This report examines MLI’s AFMED pilot-program training February-March in Jos, Nigeria.

BACKGROUND

AFMED is a collaboration of MLI and the National Center for Health Care Informatics (NCHCI), both of Montana; Our Lady of Apostles Hospital (OLA), Jos, Nigeria; and the Catholic Secretariat of Nigeria (CSN), the administrative arm of the Nigerian Catholic Conference of Bishops. The CSN’s Health Unit oversees more than 300 medical facilities in Nigeria and provides some 40 percent of the health care in the country.

AFMED is an extension of an ongoing program of MLI and CSN, called Safe Passages, to reduce maternal and infant mortality and to improve delivery of services to prevent mother to child transmission of HIV/AIDS (PMTCT). In 2003, CSN's Health Unit approached Maternal Life, asking for assistance in developing a Safe Passages strategy, which resulted in the program and ongoing five-year collaboration. The AFMED/Safe Passages program is centered in Nigeria, a country that experiences 10 percent of the world's maternal deaths.

By 2007, through a series of eight intensive workshops over four years, MLI had trained and equipped some 600 Nigerian health care providers in basic and emergency obstetrical procedures. During this time, Maternal Life realized that a complex social, educational, economical and developmental paradigm surrounding maternal and family health exacerbated maternal and infant mortality. In addition to a lack of adequate medical training, supplies and facilities, discrimination, poverty, illiteracy, and a lack of adequate housing, safety, and community services (water, sewer, transportation), also contributed to the dire situation in-country.

For example, preventable maternal deaths happened because women couldn’t afford a doctor’s care, couldn’t get transportation to a clinic in emergency situations, or underestimated the seriousness of the situation. If a woman reached a medical facility and was treated rudely or if the facility didn’t have trained personnel, medicines and equipment to help, the hospital or clinic lost the trust of that woman, who often returned to the care of a traditional birth attendant.

Over the years, Maternal Life has learned that to reduced maternal and infant deaths requires more than training and equipping medical providers. You also need to support and build trust in the health care system, increasing the availability of its services. This understanding fits well with MLI’s mission of providing excellence in holistic health care based on the value and dignity of the human person. MLI also realized that maternal health went beyond childbirth and PMTCT services to include family care for treatment of infectious diseases such as malaria and tuberculosis.

Thus, MLI examined different ways to enhance family medicine and increase trust in the system. After working at OLA Hospital in Jos, Nigeria, MLI realized a need for Nigerian family physicians to have more advanced family medical training. MLI also realized that poor women needed access to hospital care.

Maternal Life shifted its focus from large training conferences to training smaller groups of doctors, nurses and mid-wives who would deal with a whole range of family health issues and who could become community care leaders. Additionally, MLI’s New York affiliate, Aiding Infants and Mothers (AIM), would pay for all medical services for 500 women in Jos and surrounding areas from pregnancy through six months post partum. This would help solve the access issue.

Thus the AFMED program was developed with CSN and the staff of OLA Hospital. The goal was to provide a certified, advanced residency program for family physicians along with additional training for nurses and mid-wives. The doctor’s program would include ongoing medical educational opportunities through distance learning in which Nigerian family physicians would have access to medical specialists in the United States. By emphasizing on-site residency training in Nigeria, the AFMED model would help prevent the exodus of African physicians that takes place when post-graduate training is done in non-African countries. Also, using technology is not only cost effective but, when perfected, will allow for timely uptakes in new medical practices and applications. AIM’s assistance program would help provide a way to determine the effectiveness of treatment and to ascertain levels of community acceptance.

THE PILOT PROGRAM

With the pieces conceptually in place, a MLI team traveled to OLA Hospital in February to conduct the AFMED pilot program. OLA is a regional medical facility that is becoming a center of excellence with a family medicine residency program and a nurse-midwifery school. OLA also has established relationships with several rural clinics, making AFMED/AIM multi-dimensional in application.

The training team consisted of Dr. Bob Scanlon, MLI's maternal health coordinator and director of AIM of Huntington, New York; Ray Rogers, Chief Executive of the NCHCI located on the campus of Montana Tech of the University of Montana, and Dr. George Mulcaire-Jones, MLI's medical director, Butte, Montana. The program included a maternal health training workshop and hospital and satellite clinic site assessment.

During the course of the visit the following objectives were realized:

1. A SUCCESSFUL TELECOMMUNICATIONS/DISTANCE-LEARNING LINK: Working with Dr. Sam Inyang, a Nigerian physician and owner of a Nigerian-based internet service provider (ISP), a video communication satellite link was established between Jos and the NCHCI’s telecommunications laboratory at Montana Tech/University of Montana-Butte. Using an off-the-shelf, mobile PolyCom unit (owned by NCHCI and hand carried to Nigeria) and running at a relatively low bandwidth of 512K at a sustained 30 frames per second, we were able to establish a near television-quality interactive learning interface. This allowed for real time communication between the two sites for several, sustained, two-hour live sessions. This was no small accomplishment as we had to understand and overcome numerous infrastructure barriers. However, we now know the problems and how to solve them.

Some 35 healthcare providers and administrators from throughout Nigeria attended the first live video demonstration. These participants included hospital administrators, midwifery school principals and the family medicine residents and staff of OLA Hospital. In Montana, some 20 people -- representing the NCHCI, IT professionals, and college faculty and administrators -- attended the video demonstration. When the actual connection between Nigeria and Montana was made, cheers erupted on both sides. Several Nigerian healthcare leaders took the occasion to tell their new colleagues in Montana about the importance of what we had accomplished and the remarkable hope that IT brings to improving healthcare in Nigeria. The opportunity now exists to provide certified, regularly scheduled, and on-going video conferencing training sessions to physicians, resident physicians, nurses, and midwifery students at OLA Hospital and elsewhere.

2. ROOT CAUSE ANALYSIS: As a part of the AFMED pilot workshop, a modified "root cause analysis" process was used to explore the proximate and root causes of maternal and newborn deaths in Nigeria. While much of this information is available from published studies, the input of physicians, midwives and community educators working in rural Nigerian settings contributed a great deal to our understanding of maternal and infant mortality. We understood first hand the need for improvements in institutions, education, community awareness and life-skills training in rural communities. Through this process, we are now in a position to complement our institutional-based learning programs with a strong community education and outreach effort as part of our holistic approach to healthcare.

3. PRIOR SAFE PASSAGES FEEDBACK: A number of workshop participants had attended one of our previous Safe Passages workshops. They reported on actual experiences using basic and comprehensive emergency obstetrical interventions that had been previously introduced. For example, the OLA midwifery school now trains its midwives emphasizing evidence-based approaches to obstetrical care first introduced by Safe Passages. Other examples include improving the management of severe preeclampsia and ecclampsia through the use of magnesium sulfate and a standardized approach to neonatal resuscitation. One hospital has built upon their success with neonatal resuscitation through the development of a special care nursery for premature infants.

4. AIM AND OLA HOSPITAL: During the trip, MLI found that OLA not only had the institutional capacity to provide high level obstetrical and newborn care but also possessed a rural health network. This network allows OLA to reach out into the "bush" and touch people at the village level. We know that many problems in health care occur due to a delay in accessing the system. Understanding OLA’s capacity allows AFMED to limit this delay through an integrated health delivery and education network. One of AIM’s objectives is to encourage the use of the health network by subsidizing the cost of care to the poor.

5. PARTNER COMMITMENT: The relationship between MLI and CSN continues to strengthen. CSN has a new office in Abuja and has expanded its capacity to provide coordination of obstetrical and HIV care among 300 Catholic health care institutions in Nigeria. MLI has a full-time coordinator working directly with the CSN’s Health Unit, which twins with the Christian Health Association of Nigeria (CHAN) and with other family medicine and midwifery schools so that eventually they will be able to access AFMED training.
The Safe Passages Program is included in the Nigerian Catholic Procreative and Family Health Policy, which is published by the CSN’s Family and Human Life Unit in collaboration with ENHANSE/USAID. ENHANSE – Enabling HIV & AIDS, TB and Social Sector Environment -- is a Nigeria-USG bilateral project that creates an enabling policy and legislative environment for high quality, highly accessible health and education programs in Nigeria. It is a five-year (2004-2009) project funded by the United States Agency for International Development (USAID).

6. LINKAGE WITH COMMUNITY HEALTH: During a second training in March, MLI partnered with Catholic Relief Services of Nigeria (CRS-Nigeria) to present "The Faithful House," an HIV risk avoidance program based upon strengthening marriage and family health. MLI developed this program for CRS-Baltimore under another USAID grant. Previously, the program had been successfully introduced and positively evaluated in Uganda, Ethiopia and Rwanda. The Faithful House serves as an entry point for improving family health - including education about "safe birth," breast feeding and basic disease prevention. Portions of the Faithful House can be incorporated into AFMED.


7. WEST AFRICAN POST-GRADUATE EDUCATION: Detailed discussions were held between MLI, OLA and several family medicine physicians in Nigeria active in the West African College of Post-graduate Medicine. It was agreed that through distance learning the content and quality of education for Nigerian physicians could be greatly enhanced. We discussed ways in which the learning content could be directed towards the specifications of the West African College and, thus, could be used in other countries as well.

8. OLA REGIONAL CENTER OF TRAINING AND EXCELLENCE: Over the past three years, OLA hospital has demonstrated its capacity and commitment to become a regional center for training and excellence. It has developed an accredited family medicine program, has improved the quality of its midwifery school, and recently has become a leading site for antiretroviral treatment through PEPFAR. Additionally, OLA has working relationships with several outlying medical clinics and facilities, providing multiple levels of care. We believe, with further support, that OLA can become a center for training all levels of health care providers in Northern and Central Nigeria, leading to improvements in the delivery of maternal, newborn and HIV, malaria and TB care.

AFMED is now well positioned to take the next step forward in addressing the needs for improved training and health care delivery in Nigeria. We have demonstrated the technological feasibility for ongoing, real-time, distance learning and program development. Over the course of our five-year partnership with the Catholic Secretariat of Nigeria and other key stakeholders, we have a clear understanding of both problems and potential solutions for maternal, newborn and related infectious disease treatment and care. And we have a greater understanding of the need for quality post-graduate training in family medicine in order to improve the quality and continuity of medical care and the acceptance of professional care within a community. We are confident that program development and lessons learned through the implementation of AFMED can be applied throughout Nigeria and other African countries.

POST SCRIPT

Every time we travel to Africa we are struck by the story told in the eyes of those we meet and with whom we work -- from the pride of a first time mother holding her newborn daughter to the haunted gaze of a young boy dying of AIDS. As our distance-learning technology surmounted one barrier after another and came together, we could see the unmistakable gleam of hope emerging in the eyes of the physicians, midwives and nurses gathered around the computer screen. Here was an opportunity, a promise, and a dream -- to learn new skills in new ways, to be connected with others committed to health care development, to believe that notions of human progress and solidarity can find their way even to the most remote corners of the world.

We know it is possible to conduct live, interactive healthcare education and development between the United States and Northern Nigeria, an area with one of the highest maternal and infant death rates in Africa. With an ongoing interface, the "live air" of continuing dialogue and ongoing, accelerated maternal health and family medicine training replaces the "dead air" of waiting for the next in-country training and wondering how past instruction has been implemented.

This technology, combined with our experience in partnering with African healthcare leaders, will enable us to chart a new course in maternal, newborn and family related medical care. It is a vision we have seen; it is a vision we share with our African colleagues; it is a vision that embraces the life, health and well-being of thousands of African women and babies and those afflicted with malaria, tuberculosis and HIV/AIDS. We know it is a vision that can be realized.

For More Information, contact:

Dr. George Mulcaire-Jones
Medical Director
Maternal Life International
326A S. Jackson Street
Butte, Montana, USA 59701
406-782-1719
www.mlionline.org
mlicares@yahoo.com

Raymond F. Rogers
CEO
National Center for Health Care Informatics
1300 W. Park Street
Butte, Montana, USA 59701
406-496-4821
www.nchci.org
rrogers@mtech.edu

Thoughts on Visit to Nigeria & AFMED

Thoughts on visit to Nigeria and AFMED
Ray Rogers

People keep asking me about my experience in Nigeria, and, at times, I find it difficult to describe everything I saw, everything I experienced, and everything I sensed while I was there. “Life changing” is certainly a fitting description in that I see our world in a new light. The uncertain imagery that I had in my mind prior to seeing Nigeria was forever replaced with real images of people living in a country where many of the very basic necessities of life are beyond reach.

Clean water, uninterrupted electricity, public sanitation, and quality healthcare – essential provisions that Americans take for granted – seem both possible and impossible at the same time for Nigerians. And yet, the people of Nigeria, at least those we met, are filled with an astounding hope that tomorrow will be a better day, that their standard of living will advance, and that the wealth they possess as a nation could one day find its way to them. In a region with extreme poverty and some of the highest infant and maternal mortality rates in the world, hope may be all that some people have.

With so many unmet needs, it is difficult to imagine where to start: where one’s efforts can impact the lives of a hopeful nation. But the essence of service-to-others lies in knowing that the collective product of many small efforts can be transformational. While disappointment exists in a world fraught with uncertainty, never have I met people with greater hope for what can be done or what might be possible.

I was inspired by the work of team members Dr. George Mulcaire-Jones, a family physician from Butte, Montana, and Dr. Robert Scanlon, an OBGYN from Huntington, New York. Both have dedicated their lives to improving the care of so many people in places that seem so out-of-sight, so out-of-mind. Making sure that a mother is given a better probability of safely delivering a child, of a child surviving those first few critical months, and supporting HIV/AIDS prevention, treatment, and care were all part of the training provided by George and Bob to healthcare providers from throughout Nigeria.

Characteristically, these healthcare workers thirst for better skills, more timely and relevant information, and the dissemination of “best practices” in medical treatment and care. Their desire for knowledge is palpable.

The effort to improve healthcare in Nigeria may at times seem inconsequential in such a vast region with such a large population, but the results can be measured … one healthy mother, one healthy baby at a time. And as these healthcare providers take their new found skills and knowledge to other care providers throughout Nigeria and Africa, the cumulative effect is soon measured in much greater numbers. However, this task must be accomplished correctly; bad training doesn’t help anyone.

Maternal Life and the National Center for Health Care Informatics want to create a multiplier effect – where certified medical training can be propagated to care providers throughout a community, region or nation. From this recent trip, we now know that information technology can play an important role in achieving that desired result. While infrastructure challenges remain an important consideration when attempting to implement any information technology project, we successfully demonstrated that adequate infrastructure indeed is in place.

Using the same video conferencing equipment we use at the National Center for Health Care Informatics, we were able to connect 35 energized healthcare workers in Jos, Nigeria -- many from Our Lady of Apostles (OLA) Hospital where we were conducting medical training -- and 20 IT, healthcare, and faculty representatives at Montana Tech in Butte, Montana. These two groups were in a sustained, high quality, two-way video conference half way around the world with streaming quality nearly equal to that of TV.

When the actual connection between Nigeria and Montana was made, cheers erupted and no one on either side held back their excitement. Spontaneously, several of the health care leaders present in Jos took the occasion to rise and articulate to their new colleagues in Butte the importance of what we had accomplished and the remarkable hope that IT brings to improving healthcare in Nigeria. The opportunity now exists to provide certified, regularly scheduled, on-going video conferencing training sessions to physicians, resident physicians, nurses, and midwifery students at OLA Hospital and elsewhere.

With a better understanding of the myriad healthcare issues and needs of the people in this region of Africa, we collectively believe that we have taken a major step forward in establishing the framework for our African Family Medicine Education and Development Initiative (AFMED). We have envisioned educational training modules that target specific healthcare needs while emphasizing cultural sensitivity and appropriateness to existing healthcare capacity and infrastructure. We also now understand the technological challenges and opportunities of delivering high quality video conferencing/training from locations in the US to locations in Nigeria – connecting healthcare providers.

We recognize that conventional methods of medical training in developing nations are inadequate. Our AFMED initiative fills the gaps and provides a systematic approach to providing continual training that can be easily replicated and highly scalable.

Our next step is to encourage a partnership with funding agencies that align with the goals and expectations of AFMED. Our goal is simple … to improve healthcare by improving the quality of training to healthcare providers. So too are our expectations … to help one mother, one baby, or one malaria, TB, or HIV/AIDS patient at a time. The results will be measurable … in great numbers.

Note From Dr. George

We are on our way home to the USA. We are in the Amsterdam Airport and I have a few minutes to send this quick message. As we left Nigeria, we discovered our video communications equipment weighed too much to be put on the plane. This surprised us because it didn't make sense that we could take the equipment to Nigeria but not bring it back with us. However, after some negotiations we were able to get it through.

The day after we left Our Lady of the Apostles (OLA) Hospital in Jos for Abuja and our training there, Sr. Mary, administrator of the hospital, told us they had a case of a woman who had come to the hospital with an IUFD - there acronym for a intrauterine fetal death. In either the village or at a primitive health center, those providing maternal care had cut two large medio-lateral episiotimies trying to get the baby out. These lacerations bled into her perineum until it was the size of a soccer ball. Doctors at OLA, where we had just conducted speciality family medical training, were able to help the woman and save her life, but it is so tragic what women suffer for want of basic health care.

There will certainly be mountains beyond mountains to climb regarding maternal health care in developing countries, but very good things happened this trip and we continue to make progress.

Finishing up in Abuja

From Ray Rogers

We are just finishing up here in Abuja and getting ready to leave. The training has been excellent and George, Gonzaga, and Paskazia and the participants have been very happy with the training. The Faithful House team is looking forward to the training being implemented around Africa.

The heat has been a bit overwhelming. It was 108 degrees F in Abuja yesterday and seems as warm today. We will be returning to much cooler weather in Butte. George is still looking forward to some more cross country skiing.

Update on Our Trip

Note from Ray

As George mentioned, we have been challenged at the Catholic retreat center where we are staying to get good internet access. But now that we are connected, I thought I'd give a quick update on our activities of the past few days.

We wrapped up the Safe Passages training at Our Lady of Apostles (OLA) Hospital in Jos on Saturday around mid afternoon. The training and interaction with the participants was incredible. George and Bob were able to reconnect with a number of people and we all made many new friends. It was a pleasure working with everyone at OLA. The thirst for medical and IT knowledge is tremendous, and the staff at OLA are looking forward to working with us to connect more often using video conferencing.

We traveled on Sunday to Abuja to a Catholic retreat center on the edge of the city. George has been conducting the Faithful House training with two facilitators from Uganda this week. I assisted the Safe Passages Coordinator with some IT support and have visited some nearby villages. On Tuesday morning, Bob returned home to New York. George and I return on Thursday.

Our trip to Nigeria has been very worthwhile and successful. I look forward to getting back to see how we can advance the education of Nigerian healthcare providers through the application of information technology. During this trip, we successfully demonstrated the potential and quality of training through IT.

From Dr. George Mulcaire-Jones
March 4, 2008

We finally got Internet connectivity outside of Abuja. Our Internet connections where we have been working in Nigeria have been shaky, and, sadly, we are not able to blog or post pictures as much as we would like. So here's a quick update. Training is going great. We had a good visit with the Deputy Secretary General, Catholic Secretariat of the Nigerian Catholic Conference of Bishops (NCCB). The Catholic Secretariat is the administrative arm of the (NCCB) that oversees more than 320 health facilities in Nigeria and provides some 40 percent of the health care here. Thus, the meeting with the Deputy Secretary was important. He is really impressed with AFMED/Safe Passages and its possibilities. They have elevated AFMED/Safe Passages to a major program within the Secretariat's Health Committee.

There is a paradox here of great poverty, challenges and yet great hope. I am impressed again an again how the people we interact with, especially the Christian community, are reaching out to those in need. I think we can all be pleased with the efforts that have been made and at the same time realize there is so much more to do. Peace and thanks to everyone.

Pics

Some Pics

Here are a few pictures from our work in Jos.

Greetings from George

From George:
It is now Saturday morning and we will finish our OLA training today. There is such a collage of faces and events – the cheers and smiles when the satellite transmission worked, the stories of those who work with the poor and face the challenges of providing health care with limited resources and the enthusiasm for the physicians and midwives to learn as much as they can. In the back of your mind is the cases you have seen on the ward – how is the six year old girl with meningitis, does the five month old boy pneumonia and such bad thrush have AIDS, the woman who just came to the hospital with a dead baby after a prolapsed cord.

I am most grateful to everyone who makes our work possible. The challenge of improving maternal, newborn and HIV care in Africa is daunting. Yet I am struck that there are so many African physicians, midwives and nurses who are absolutely committed to the challenge. They give of themselves completely in very difficult circumstances and from them I take much inspiration.

Successful test of Video Conferencing

Note from Ray:

On three occasions this week, we have successfully linked with a video conference between Jos and the Montana Tech campus in Butte. Thanks to the great efforts of the technical team in Butte (Mike, Gary & Eric) and Dr. Sam here in Jos, not only were the tests successful, but they exceeded our expectations. The quality of the video conferencing was outstanding. We accomplished this through a satellite link running at a bandwidth of 512k, but we believe that we can conference at a bandwidth of 384k and still have very acceptable video quality. For our last and final test, everyone from the Safe Passages training was there for the test. When the link with Montana occurred, there was a roar of cheers from everyone in the room. The hope that this technology brings to improving healthcare in Nigeria and other parts of the developing world is beyond words that I can express. Now that we have proven that we can connect and deliver high quality video conferencing on a regular basis, we can begin to deliver real-time training to the physician residents and midwifery students here in Jos. Instead of waiting years for best practices to filter down to these areas, we can now begin to teach these best practices on an on-going, regular basis. This is, after all, not about the technology. This is about saving mothers and babies. The technology just makes it become a reality.

On another note, I was fortunate yesterday to visit some small villages outside of Jos. At one of the villages, named Bomo, we met with the staff of a small clinic and then visited with the teachers and students at the village school. The kids loved the soccer ball we left with them. Seeing this village gave me a real sense of the challenges of providing health care in Nigeria.

Greetings from Jos

From Bob Scanlon:

Greetings from Jos, Nigeria.

It has been quite a week. The array of tasks we have accomplished is a cause of joy.

The educational component with the family Medicine Residents and nurse midwives has been successful. The feedback we are receiving when we review indicates that the material is being received and processed. It will be up to them to apply it in the care of their patients.

I was privileged to perform a cesarean section on a mother who was scheduled for one and consented to allow me to operate for the purpose of resident physician education. We delivered a healthy baby boy and both mother and child are doing well. Interesting, the boy’s middle name is Bob, unusual name here in Nigeria!

Finally, our AIM program that is designed to pay for the care of the poor is fantastic. I was able to meet many of the infants and mothers who have benefited from the program. They were all so grateful. The program will certainly continue to grow as the hospital draws the poor; you see they trust that the Catholic sisters will not send them away. AIM will allow Our Lady of the Apostles Hospital to continue this mission without going bankrupt.

As much as I love this work, I miss my family terribly and look forward to coming home. However, with the contacts that have been nurtured and the aid of technology we can continue to aid infants and mothers by supporting our Nigerian colleagues even when we are not physically present with them.

More to come… Bob

Arrived in Jos

Blog entry … Tuesday, Feb 26

By Ray Rogers, CEO National Center for Health Care Informatics, Montana Tech, University of Montana.

We arrived in Abuja, Nigeria (the Capital city) on an 8:00 pm flight from Amsterdam. Flying over the immense Sahara Desert gives one a true sense of the size and uniqueness of the African Continent. Upon arriving in Abjua, our first sensations were of the heat, the ever-present dust in the air from the Sahara winds (Harmattan), and the smell of smoke from thousands of fires used for cooking and as a source of light.

Our hosts from the Catholic Secretariat of Nigeria provided us with very nice accommodations for the evening, and we headed off to Jos (Plateau State) the four hour drive. Along the way, I witnessed great disparity in wealth, including extreme poverty. The roads were packed with cars laden down with people and possessions, many people walking and thousands of people along the roadsides selling their wares. I was struck by the immense amount of plastics (bags) littering the roadsides and fields, trash that cannot degrade and continues to remain in the environment.

Upon leaving the busy city of Abuja, we entered the rural villages on the northeast drive to Jos. Along the drive, villagers had set up public markets to sell bread, fruits, yams, tomatoes, onions, peppers and other items. Occasionally we would see small schools with children dressed in colorful uniforms. The slow-paced villages with thatched-roof mud huts or tin roofs are in stark contrast to the busyness of the large cities of Abuja and Jos.

We arrived at 12:30 pm to a wonderful welcoming reception at the Our Lady Of Apostles (OLA) Hospital in Jos. Everyone we have met has been extremely welcoming and has made us feel right at home. We immediately launched into our Safe Passages training which George and Bob will describe. I provided an overview of information technology and what we were attempting to accomplish by connecting OLA hospital to Montana Tech and other parts of the world to support their clinical and medical teaching needs.

The interest and response was overwhelming. They can not wait to have access to better IT tools, and welcome the opportunity to work with our team. I also worked closely with Dr. Sam Inyang to access the OLA network. By the end of the day we had completed a successful video session, using their wireless Internet, between OLA and Mike Kukay of the National Center for Health Care Informatics at Montana Tech. Over the next few days, we will begin to conduct more advanced tests. We have made arrangements for increased bandwidth for tests on Thursday and Friday morning (Montana time).

Our evening ended with a wonderful cocktail hour and dinner in the courtyard of OLA complete with entertainment. We ended the day quite late and look forward to busy and productive Wednesday.

Wednesday am …. I started my day by getting to sit in on a cesarean section and witnessed the delivery of a healthy baby boy. Dr. Bob Scanlon conducted the procedure before a group of medical residents. We are now teaching and getting ready to conduct another IT test. More later…..

Comments from Dr. George Mulcaire-Jones:

Ray did a super job describing things. I would add a couple of notes - it really is great to have Ray and Bob, who really are first class persons and great teachers.

Second, one always wonders "do our efforts make any difference?" It was gratifying to hear the reports of some of those who have participated in past trainings. A number of them said how much the training has improved their maternal and newborn outcomes. They are now using a bag and mask for newborn resucitation, and instead of having asphyxiated babies with neurologic compromise, they are having babies who are nicely resucitated. They have good outcomes with the soft cup vacuum extractors. They are passing down the training to other midwives and physicians and elevating the standard of care.

We see "Safe Passages" posters in the labor and delivery wards - and the awareness that all women should have a safe birth has defintely taken root. Hey ... thanks for your support ... more later!

MLI Projects In Africa

Team Biographies

Dr. George Mulcaire-Jones
President and Medical Director -- Maternal Life International

Dr. Mulcaire-Jones is a native of and attended high school in East Helena, Montana, where he was a member of the varsity football team, American Legion baseball team and a volunteer for Big Brothers and Sisters. He worked summers at the ASARCO Smelter as a yard and zinc furnace laborer.

He attended Carroll College, Helena, Montana, on an Elsie Corrette Memorial Scholarship, majoring in premed biology. After three years of college, he entered the University of Washington Medical School, graduating with an MD degree in 1981. While attending the university, he was a volunteer at Seattle’s Catholic Worker Kitchen, a downtown Seattle Free Clinic.

His medical internship and residency was at Deaconess Hospital, Spokane; a Family Practice Residency at the University of Minnesota; a surgery internship at St. Peter’s Hospital, Helena; and an obstetric fellowship at Sacred Heart and Deaconess hospitals, Spokane. He is Board Certified by the American Board of Family Practice.

Mulcaire-Jones began his family medical practice in 1984 in Long Beach and Anaheim, California with the Mission Doctors Association, transferring to Cameroon, West Africa later that year. He returned to America in 1987 and continued his practice in the Seattle area before moving to Butte, Montana, in 1992. He is active in the medical and civic community of Butte, having served on the board of the YMCA, as co-chair of the St. James Hospital Ethics Committee, and as co-coordinator for the Butte-Silver Bow Suicide Prevention Task Force

In 1997, he formed what eventually became Maternal Life International, a nonprofit organization providing training and resource support for AIDS prevention and care, and maternal health services to developing countries, mainly in Africa. Dr. Jones is an
acknowledged expert and has spoken at numerous national conferences on these issues, including a US-sponsored United Nations panel on the causes of maternal mortality; the Authentic Women’s Health Care Conference at Marquette University, Milwaukee, Wisconsin; and the United States National Aids Conference.

Dr. Jones was awarded the Charles Borromeo Humanitarian Award from his Alma Mater in 2001, the highest award Carroll College bestows.

While living in Butte, Dr. Mulcaire-Jones has been a little league baseball coach and a youth soccer league coach. George and his wife, Mary, have six children.

Dr. Robert F Scanlon Jr.
Director of Maternal Health Services and Board Member
Maternal Life International

Dr. Robert Scanlon Jr. is a native of Huntington, New York, where he presently is in private practice at the North Shore Medical Group, attending physician at Huntington Hospital. He is a Clinical Instructor at the Mount Sinai School of Medicine, New York City, and Director of Maternal Health Services and Board Member of Maternal Life International, Butte, Montana.

Dr. Scanlon earned a BS in Civil Engineering from Bucknell University in 1978, an MBA from Duke University in 1981 and an MD from the Bowman Gray School of Medicine at Wake Forest University. His post-graduate studies include a Family Medicine Rotating Internship and an Obstetrics/Gynecology Specialty residency, both at the University Hospital, Stony Brook, New York. He is board certified by the American Board of Obstetrics and Gynecology, with the most recent recertification in 2006.

Dr. Scanlon’s international work includes fistula surgical repair at the Baptist Medical Center in Ghana and emergency obstetrical care instruction and training in Nigeria with a Maternal Life International team of specialists.

He coaches basketball, baseball and softball in his spare time. He and his wife, Cathleen, live in Huntington, New York with their three children; Robert, Timmy and Elizabeth.

Raymond F. (Ray) Rogers
CEO National Center for Health Care Informatics

Raymond F. (Ray) Rogers is the Chief Executive Officer for the National Center for Health Care Informatics (NCHCI) in Butte, Montana, and a faculty member at Montana Tech of the University of Montana. Rogers has more than 20 years experience in higher education, administration, management, fundraising, marketing, and business development. He holds an undergraduate degree in Engineering and a MS in Technical Communications.

In 2001, he led the effort on behalf of the Montana University System to create the nation’s first undergraduate degree in Health Care Informatics. He now serves as CEO of the NCHCI, a non-profit corporation dedicated to improving the management of health care data, information and knowledge. Through the NCHCI, he has built awareness and encouraged the board adoption of electronic health records, personal health records, and health information exchange. He was instrumental in developing a $250,000 multi-way, interactive, Internet II communication laboratory operated by the NCHCI.

Rogers is leading a number of significant educational, business development, and research and development efforts through the NCHCI. He is the national co-chair of the educational committee for the Healthcare IT Access Network for Rural & Underserved Populations and is a founding steering committee member for the Montana HIT Taskforce. Rogers is actively involved in several efforts to define and develop the national’s Health IT workforce. He is also working with Hewlett Packard Company and Crossflo Systems to develop a Health Information Exchange Pilot Project in Montana. He is a member of Maternal Life International’s Board of Directors.

Rogers also is active in his community, is a youth soccer coach and an outdoor enthusiast. He has three children.

Press Release - AFMED

BUTTE MEDICAL TEAM TO ADVANCE AFRICAN FAMILY HEALTH CARE IN NIGERIA

Butte, MT – Two Butte organizations, Maternal Life International (MLI) and the National Center for Health Care Informatics (NCHCI) at Montana Tech, have joined to advance family medicine in Nigeria, promoting safe births and combating malaria, tuberculosis, and mother-to-child transmission of AIDS. Nigeria with 135 million people has one of the highest maternal death rates in the world, as well as increasing levels of infectious diseases.

Dr. George Mulcaire-Jones, Butte physician and MLI’s medical director, and Ray Rogers, NCHCI’s chief executive, leave Sunday, February 24, for two weeks of specialty medical training and information technology evaluation and development. They will be joined by Dr. Robert Scanlon of Huntington, New York, an obstetrician and gynecologist, who heads MLI’s New York affiliate, Aiding Infants and Mothers (AIM) that funds women and infant health care in Nigeria.

“Since 2003, we’ve taught essential safe-birthing techniques to more than 800 Nigerian health care workers,” Dr. Mulcaire-Jones said. “This latest phase, known as The African Family Medicine Education and Development Initiative, or AFMED, will focus on specialty medical training for smaller groups of family physicians, which is necessary to sustain improvements in community care.”

This year’s program will take place at Our Lady of the Apostles Hospital (OLA) in Jos, Nigeria. It will be augmented by additional course work through interactive web-based distance learning and other technological information tools to be developed by the NCHCI.

“This model combines the best in health care training with the best in technology,” Rogers said. “We will identify the appropriate technology solutions for OLA in order to deliver distance learning among locations in the US and Nigeria.”

NCHCI will assist the hospital in building a computer laboratory and will train OLA staff on the use of video conferencing equipment. “We want to begin the process whereby our technology at the NCHCI can leverage the video conferencing capabilities in Nigeria to link multiple locations simultaneously. Then medical experts in the US not only can instruct Nigerian family doctors where they work in rural Africa but also offer them a way to implement medical solutions and applicable technologies in a timely manner.”

According to the World Health Organization, approximately 542,000 women die from pregnancy related complications each year, with 99 percent of those deaths occurring in the developing world. Dr. Scanlon said this shows life-saving interactions that have been available in the developed world for nearly 100 years fail to take hold in many places in the developing world.

“Our approach to this breakdown is two-fold,” Dr. Scanlon said. “AIM will pay for the health care of some 500 women and their children at OLA from pregnancy through six months post-birth. The AFMED model will give family docs additional specialty medical training to increase their abilities. The care the women receive for their pregnancy and births, including the treatment of opportunistic infectious diseases, will be affordable, fair, competent and consistent. This should help us to better understand and resolve some of the technology transfer questions regarding safe-births.”

AFMED is being sponsored by the Nigerian Catholic Council of Bishops that operates some 320 health facilities and delivers approximately 40 percent of the health care in the country.
For those wanting more information or to see the progress of the Butte team in Nigeria, visit the team blog -- http://healthcareinnigeria.blogspot.com/

Maternal Life International is a Butte-based nonprofit dedicated to providing safe, practical, life-affirming, and innovative programs in AIDS prevention and care and in maternal health services. The National Center for Health Care Informatics at Montana Tech is a Montana non-profit corporation whose mission is to improve the management of data, information, and knowledge throughout healthcare.

What is AFMED?

The African Family Medicine Education and Development Initiative (AFMED) is a program to improve healthcare in rural and underserved areas of Sub-Saharan Africa by improving the quality and availability of African-based family medicine training. Through improved training and mentoring, family physicians can take a leading role in health care delivery in Africa. In this context, family medicine is uniquely positioned to provide, (1) Primary care and preventive services, (2) Curative inpatient and outpatient care, and, where necessary, (3) Surgical and advanced obstetrical care.

AFMED builds upon the fundamentals of family medicine, which emphasize evidence-based practice, cultural sensitivity, community outreach and care of the whole person. From this foundation, AMFED seeks to address the challenges of providing high-quality, on-site, post-graduate family medicine education in Africa through a collaborative effort emphasizing modern learning and communication technologies, pilot community hospital training, and sustainable partnerships between US- and Africa-based institutions and organizations.

As proposed, AFMED consists of three integrated phases to be implemented over three years, each building on the other and each strategically placed to insure program sustainability.

Phase 1.
A. Identification, review and adaptation of existing international family medicine training curricula now in existence to the health care needs and conditions in Africa.
B. Development of an Africa-specific model family medicine residency training curriculum integrated with a learning resource center in North Central Nigeria.
C. Development of an educational e-mail list serve and Web-site emphasizing maternal health, obstetrical care, and prevention of mother-to-child HIV transmission (PMTC).
D. Design, production, and distribution of Web-based learning tools specific for family medicine training in Africa.
E. Design, production, and distribution of CD/DVD-based learning tools, herein after refered to as multimedia tools, specific for family medicine training in Africa.
F. Network development between existing family medicine organizations and institutions in the United States with those in Africa.
G. Collaboration and network development with WONCA (World Organization of Family Doctors).
H. Dissemination and adaptation of existing family medicine journal and print materials.

Phase 2.
A. Design of a pilot family medicine curriculum delivered through state-of-the-art distance learning technologies.
B. Develop feasibility study and operational plan for faculty development and exchange between African- and US-based residency programs.
C. Development of AFMED Program Monitoring and Evaluation (M&E), Certification, and Accreditation.

Phase 3.
A. Plan for the dissemination of AFMED curriculum and technology to 10 additional English-speaking, Sub-Saharian African countries in need of upscaling post-graduate family medicine training.
B. Conduct an AFMED International Summit engaging key government and faith-based health care leaders to integrate family medicine specialty training into national health care development strategies.

Map of Nigeria

Here is a map of Nigeria. We will be flying into the Capital city of Abuja and driving to Jos.