Villagers collect drinking water from a local water source. / Heidi Kassenborg

Global Health Starts at the Village

A training course for future One Health workers motivates students to implement public health innovations in local communities.

Today’s global health challenges are increasing as our health workforce continues to try and prevent, detect, and respond to infectious diseases. The best way for our world to respond to an epidemic is to have a workforce that is prepared for its many challenges.

This spring, a group of Ugandan students participated in a training that focused on a big picture view of health care — the One Health approach. The approach promotes collaboration across multiple disciplines to manage infectious diseases on a local, national, and global scale.

If you think about a large-scale outbreak, you may start to realize that doctors and scientists are not the only professions needed in an epidemic response team.

Who manages the outbreak response? Who coordinates the medical supply chains? Who decides what type of technology is needed? Who understands the community culture and belief system?

The One Health Institute, organized by the One Health Central and Eastern Africa (OHCEA) network’s Uganda Country Office with support from the USAID One Health Workforce project, aims to prepare university students for the vast number of careers that involve the detection, prevention, and response to emerging pandemic threats.

With the One Health approach, the participating students came from multiple colleges and schools at Makerere University, each contributing a unique aspect to One Health — Human Medicine and Health Sciences, Public Health, Veterinary Medicine, Agriculture, Animal Production, Environmental Science, Humanities & Social Science, Technology, Engineering, Art & Design, Computing & Information Science, Business & Management Sciences, and Law.

Of the 89 students who registered for the course, the first round of students (29 undergraduate and 14 graduate students) attended the institute from May to July. Before students can venture out into the field, faculty and experts from Makerere University, the University of Minnesota, and Tufts University, shared information in theoretical courses. The principles of infectious disease prevention and mitigation were laid out through modules on outbreak investigation, biorisk management, antimicrobial resistance, health policy analysis, gender risk management, and leadership.

In preparation for the field attachments, the students learned how to engage with communities during courses on community engagement and interaction. Students participated in case studies and role-playing. Experts on Uganda’s national epidemic response team demonstrated their skills during a simulation of an outbreak situation.

Real World Experience

An important part of this program is the real world experience the students receive from training in the field where they work in multidisciplinary teams that include different professions, which may not be a common occurrence at the district level. After the students completed the theoretical courses, teams of 8–10 students traveled to field attachments in districts across western Uganda.

A slaughter pad at a local market showcases the challenges in an animal-human-environment interface. / Heidi Kassenborg

The districts of Lyantonde, Kihura (where Sanga Town is located), and Rubirizi have unique One Health challenges due to their wildlife-domestic animal-human-environment interfaces.

Each team was assigned to identify One Health challenges in the districts. The challenges encouraged the students to get their hands dirty while exploring local sites, including hospitals, markets, slaughter slabs, residences, and water sources.

While identifying the challenges, the students interviewed residents, community leaders, and local health workers to gather ideas for potential solutions. Each team was supervised and guided by multidisciplinary teams of university faculty members and local government field-based supervisors.

The students implemented a number of health interventions around the districts in an attempt to solve the challenges.

Basic Health Needs: Clean Water

The student team based at the town of Lyantonde met with several local health officials when they heard that a fairly large number of diarrheal illness cases were affecting the community.

Students collect water from local sources. / Heidi Kassenborg

The team investigated potential causes of the outbreak when they discovered a local watering hole frequently used by the villagers as a collection point for drinking water. This mud-laden valley dam is also used as a water source for cattle.

One Health has a strong focus on zoonotic diseases — those that can be transmitted between animals and humans. Pathogens from livestock manure in a drinking watershed can potentially cause an outbreak in humans. Some of the most common waterborne outbreaks are Salmonella, Giardia, Cryptosporidium, and E. coli.

The team knew that even though the water source may not have been the direct cause of the diarrheal illness cases, they had to address the drinking water issue. A brainstorming session produced an idea for a low-cost water filtration system that could easily be replicated and implemented in the local area.

The students created a small-scale prototype of their idea to see how effectively it could filter the dirty water.

Levels of particles were layered in a container to form the basic water filtration system. Multiple layers of sand, gravel, and charcoal capture undesirables, like mud, feces, and bacteria, while allowing the clean water to fall through to the waiting drinking container. It is similar to how our own in-home filters use activated carbon to filter our drinking water.

The gravel catches large debris like bugs, while the sand stops dirt and smaller particles. The activated charcoal captures bacteria and viruses. / Heidi Kassenborg

The next step was creating a full-scale version of the filtration system. The team traveled to the village of Katagyengera with the materials and built the system on site. The students showed villagers how the filter works and discussed the benefits of the system: cleaner water, less illness, and easy to maintain. And the downsides of the system: the filtration process takes time, it does not completely guarantee safe drinking water, and the filter particles need to be washed occasionally to clear out contaminants and speed up filtration.

Not only were villagers receptive to the filtration system, they also wanted to learn how to make their own filters. The students demonstrated how they can make their own system and estimated each one cost about 100,000 Ugandan shillings ($30 USD) to create.

Waste Management at a Village Hospital

Sometimes the solution to a challenge is not an innovative new way of taking on the problem, but good old-fashioned hard work. The students on the Rubirizi team visited a local hospital and discovered unsanitary conditions around the buildings.

The run-down garbage dump utilized the hospital within its vicinity spanned a large area and was freely accessible to chickens, dogs, and children. Inadequate waste management can cause a number of public health issues, particularly hospital waste with potentially bio hazardous materials.

The team of students decided to take on this One Health challenge with a no-cost solution. It just required a little elbow grease.

The Rubirizi team dug out bricks for the new garbage floor. / Heidi Kassenborg

The students began by cleaning up the area and clearing out the garbage dump. They dug out the site to make way for their new implementation — a contained hospital garbage site. The team also dug up old, unused bricks from another area that they could use for the new floor. They brought new soil to the site and packed down the bricks with a homemade tamping device. The reformed floor was then lined with a fencing structure made up of fallen tree branches. The implementation resulted in a hospital garbage site that now accommodated the separation of hazardous waste and kitchen waste.

The students labeled each contained waste site with instructions and allowable waste materials. / Heidi Kassenborg

Community Health Awareness

A major health challenge of rural villages cannot be solved with tools or innovations. The shrinking number of health workers in villages means longer hours dedicated to medical treatment and less time dedicated to preventative health awareness.

Each field team shared health presentations with the local communities. The Rubirizi team taught local school children about malaria, HIV-AIDs, and personal hygiene. They were able to answer questions on common misconceptions about the transmission pathways of certain diseases. The Sanga team also shared information about sanitation and hygiene with students at a local school. Other activities included vaccination and deworming campaigns for goats and dogs and demonstrations of a hands free way to wash with an easy-to-make tippy tap.

Future One Health Workers

The One Health Institute trains the next generation of One Health workers by providing an opportunity for them to learn outside of the classroom and to strengthen not only their health-related skills, but also competency needs like communication, leadership, systems thinking, and management.

As the undergraduate students wrapped up their visits, the teams presented their findings and implementations to the district councilors or community leaders.

As for the fourteen graduate fellows at the One Health Institute, following the theoretical training, they were placed in attachments to global health organizations, including the Mountain Gorilla Veterinary Project implementing PREDICT-2 (a collaborating EPT-2 partner), Amref Health Africa, ResilientAfrica Network (RAN), Africa Center for Strategic Services and Development (AFRISA), the Uganda Ministry of Health, Uganda Central Public Health Laboratories, and other academic and federal departments.

The graduate fellows will also get a chance to actively participate in disease outbreak investigations with the local district task forces that handle interventions. Currently, several of the OHI graduate fellows are participating in the investigation of an unusual illness in Bukomansimbi, a district located in Central Uganda, with the district task force team. During the investigation, they will be mentored by Dr. Immaculate Nabukenya, an epidemiologist with the Uganda Ministry of Health.

OHI graduate fellow, Ms Angella Musewa (BS in Biomedical Lab Tech and MSc in Infectious Disease Management), collects information from vulnerable community members at their homesteads as part of her work in the investigation of the unknown disease in Bukomansimbi. / OHCEA Uganda

Another group of graduate fellows are working with Amref Health Africa on the Scale-up Comprehensive HIV and AIDS Prevention (SCHAP) project, which is running in the districts of Wakiso, Luwero, Nakaseke, Nakasongola, Mityana and Mubende. The project deals with a number of sensitive health issues relating to sexually transmitted diseases. Dr. Peninah Nsamba, the OHCEA Focal Person at the University of Makerere College of Veterinary and Biology, notes that the organizers “hope the fellows will utilize the skills acquired in [OHI’s] gender risk management [lessons] and use gender sensitive and friendly methods to approach and gain access to the affected population.”

Other outbreak investigation skills gained in the OHI will be put into practice during these attachments, including computing epidemiological curves, data entry into epidemiological software, requisitioning for supplies, packing and dispatching supplies, sample collection dispatch, etc. They also need to use the soft skills they were trained on — leadership skills to gather a team, working together, and the ability to moderate discussions.

As part of the attachments, they will gain new practical skills during the experiences, including data analysis, case situation analysis, draw logical conclusions, and write reports at the end of each day. These 3-month attachments will give the students hands-on work experience while adding to their resumes.

One Health Workforce

The One Health Central and Eastern Africa university network works to strengthen the current and future health workforce in 8 countries across the continent. The countries — Uganda, Democratic Republic of Congo, Cameroon, Ethiopia, Tanzania, Kenya, Rwanda, and Senegal — work towards improving the health workforce by conducting field-based trainings, strengthening faculty development, creating curricula and textbooks, and other collaborative activities.

The network is supported by the United States Agency for International Development’s One Health Workforce project. The project is lead by the University of Minnesota and co-lead by Tufts University to collaborate on activities and provide international experts in health and sustainable strategies. The project also works with One Health networks in Southeast Asia — another tropical disease hotspot.

About the Author

Kendra McCormack is a communications specialist at the USAID One Health Workforce project based at the University of Minnesota.

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