A report on our visit to Uganda
In January 2013, I was given the unique opportunity to travel to Uganda as part of my role as a post doctoral fellow at the Monash Institute of Pharmaceutical Sciences. This trip was made possible by financial support of donors to the 2012 Victorian College of Pharmacy Annual Appeal and was vital in furthering our research into the environmental, cultural and social factors that affect the development of an oxytocin dry powder inhaler.
Over six days we visited seventeen different locations and met in excess of 170 clinicians, midwives and people from the local communities. These interactions offered a valuable insight into the current use of oxytocin during the third stage of labour but more importantly helped us understand the thoughts and input of end users in developing our product for resource poor settings.
Our visit began at Mulago National Hospital in Kampala which oversees 32,000 births a year out of which postpartum hemorrhage is encountered in up to 5% of cases. While oxytocin was widely available it was not always stored under refrigeration, thus reducing the efficacy of the drug. We also found that a chronic shortage in trained medical staff and every day medical supplies like syringes, needles and alcohol swabs, meant that even when oxytocin was available, administration of the life saving injection was often compromised. At Mbale regional hospital, 220 km from Kampala, it was surprising to hear that one midwife was responsible for the delivery of 20 laboring women. This meant that oxytocin injections were often not given in time during the third stage of labour.
The staff at these hospitals were very enthusiastic about the benefits of a ready-to-use oxytocin inhaler in dealing with the chronic shortages in trained staff and medical supplies that are required for injections. In particular, many midwives suggested that a pre-measured oxytocin inhaler could easily be given to mothers for self-administration after birth, freeing them to tend to other laboring women.
While in Mbale we also took the opportunity to demonstrate the use of a proposed inhaled delivery device to gauge people's perceptions, thoughts and preferences on this method of drug delivery. We visited lower level health facilities and antenatal centres and spoke with local women and village healthcare teams. Unlike cultural beliefs previously observed in India, women in Uganda were mindful of the need to prevent excessive bleeding after birth and the support for an easy to use inhaled oxytocin over injections was overwhelming.
As Ugandan society is based on a patriarchal social structure, we also sought the opinion of men. They too believed that an oxytocin dry powder inhaler would allow them to assist women in preventing postpartum hemorrhage after birth whether at home or while in transit to a health facility.
Overall, my visit to Uganda enabled our team to gather invaluable information in developing a stable oxytocin dry powder inhaler. It was both humbling and motivating to know that my contribution in developing a simple oxytocin inhaler can make a real difference to the lives of mothers in countries like Uganda.
Dr Tri-Hung Nguyen
Read about Tri and the Oxytocin team
See pictures from Tri's trip on Flickr
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