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Day three and four in Uganda–training the teachers

By Penny Cook

Team work

The Teams4U motto is ‘real people making a real difference’, and one of the aims of the programme is to give the volunteers a life-changing experience. Some of the volunteers already knew each other and have done this trip before; others, like me, are new. It is amazing how quickly everyone has bonded and started to work as a real team. See my previous post for more information about the interventions. The games that we play with the children during the morning continue to be enormous fun, both for the volunteers and the children. The ‘Develop with dignity’ element has been refined and developed as we go along. The team members that deliver this element include a doctor, a nurse, a teacher as well as me. The final team member is a social worker from the local area. Fortuitously between us we have a combination of relevant skills, knowledge and experience.

Training the teachers
On day three, our usual format of our day was to be extended–after the main school programme, we went to a different school where we delivered a training session to all the senior female Primary 6 teachers in the district. The Head of Education in the district is a big supporter of the programme, and has strongly encouraged the teachers to come and facilitated their journey to the school where the training is to take place. P6 children are the target of the intervention–they can range in age from 12 up to 17 (because those who do not pass their exams do not move up to the next class). Whilst this was going on, other Team4U members did games, stories and face painting with the school children.

For the train the trainer session we decided to give an overview of our aims and then present the same material as we present to the children to the teachers, so that they could see exactly how we delivered the intervention. It seemed to go well and was enjoyable from my perspective. At the end we asked the teachers for their views and feedback. We had a long discussion about the other contexts of the child’s life, and how for some children there is a lack of encouragement to go to school. Some are given no money to buy the necessary equipment, many have no food for the middle of the day. Teachers commented that some children were spending the time away from school, with neither the school nor the parents knowing where they are. This potentially puts girls in situations where they are at risk of rape. Teachers often saw their school girls alone after dark–again this is risky. The teachers felt that we needed an intervention for parents, a suggestion that we agreed to take back for consideration. We had a long discussion about whether the intervention was aimed at the right age, and while there was a feeling that some children at that age were innocent (and it was tempting to ask why they needed to know about sex and condoms), there was general acceptance that children of this age can and do get pregnant. We heard a shocking story of a 9 year old girl who had given birth recently.

Mud huts
On the way home we stopped and visited one of the little mud hut settlements in a very rural area. A father showed us around. He allowed us to see into each hut: the smallest was where there was a simple fireplace made of stones on the floor. The cook pot rests upon stones, and the smoke is chokingly thick. Three children were in one of the other huts and the father had his own hut. His wife and baby slept in a different hut.

Children wearing gifts of school dresses brought by one of the volunteers © Penny Cook

Day four and a Ministerial visit

The Games in the morning were great–the smile and excitement on the girls’ faces when they had a ball in their hands was just a picture, and it is so hard to put into words the satisfaction that we get from doing this. It seems to be reciprocated! The headmaster of today’s school made a special effort to tell us how important this visit was for him and the school, and a senior teacher told us that they will be adopting the games to play with the children every Monday from now on. I loved the pink uniforms in this school!

In this school many children received a school lunch, for which the parents have to make a modest payment. We learned that in some schools parents do not pay for lunches, and nor do they send food from home. School days are from 8am until 5pm in Uganda, which is a long time to go without food.

Other Team activities proceded as usual including the HIV counselling and testing. We have tested hundreds of people this week, both school children and their parents, and it is really good to be able to report that we have found very few people with HIV. About 7% of adults are estimated to be living with HIV in Uganda. Substantial progress has been made with testing and treating HIV, so that between the years of 2005 and 2013 the number of Aids-related deaths dropped by 19%.

Taking a small drop of blood for HIV testing

In the afternoon were were honoured with a visit from Vaughan Gethin (Cabinet Secretary for Health, Wellbeing and Sport, Welsh Government) and Jon Townley (from Wales for Africa). They were able to see Teams4U at their best, with an action-packed afternoon of HIV/AIDS & TB testing, Reproductive & Sexual Health Education, our Develop with Dignity programme; and of course, the smiles of hundreds of children having enormous fun with our enthusiastic volunteers!

L to R: Ben Omoding (T4U), Vaughan Gething (Welsh Gov), Penny Cook, Jon Townley (Wales for Africa), Ciara O'Donnell (volunteer), Father Deogratias Tembo, Sarah Sankey (volunteer), Dave Cooke (T4U founder) — L to R: Ben Omoding (T4U), Vaughan Gething (Welsh Gov), Penny Cook, Jon Townley (Wales for Africa), Ciara O’Donnell (volunteer), Father Deogratias Tembo, Sarah Sankey (volunteer), Dave Cooke (T4U founder)

Public health interventions in Uganda

By Penny Cook

I have been given the amazing opportunity to take part in some practical public health interventions in rural Uganda, with Teams4U, an organisation with many years’ experience of work with poverty. My aim is to get some insight so that I can plan trips in the future for University of Salford’s public health students.

Day one

Our journey here from Kampala had taken us 5 hours, during which we had glimpsed some of the poverty that is a reality of everyday life in rural Uganda: the roads were dirt tracks; people were pumping and carrying their water; children were dressed in rags; homes were shacks with little in the way of a decent roof.

Day one of the field-work happens to be Sunday. On Saturday night, the leader of our team of volunteers discovered that we were expected to be at a local Church for the 7am service. Thus, at 5.45am we were up, ready to set off at 6.30am. We learned that no practical intervention in the community can happen around here without the involvement of the church–it is the hub of the community, and it serves as a means to spread practical messages to the local people. The priest will be working with us all week in the various schools that we will be visiting. The church service lasted 2 hours, during which we had to get up at the front and introduce ourselves to a few hundred people. It was through the church that the community had been told about our visit, and invited to one of the local schools for a day of fun and activities.

Games

By 10am we were at the school. Being a Sunday, we were uncertain of how many people would turn up. In a very well organised operation we started to play team games with the children. There were hundreds. We did the games with batches of 8 children (for each of the 14 team members). We did this 3 times–first with some smaller boys (aged 5 to 12), then with girls (9-14) and then with some older boys (10-16). The games all involved running up and down, sometimes with a ball. They varied in each set, depending on age and gender; for example, games were more complicated for the older ones, and we had been warned that girls often did not own underwear, so we did not do any games involving somersaults. We were on the field without a break for nearly two hours, in the heat: absolutely exhausting but really good fun.

The games served as a draw to the local community, and while the fun was going on, adults were being tested for HIV, and if needed, able to obtain antiviral drugs straight away. We now also had the opportunity to do some basic health interventions with the children, after the games were over.

‘Develop with dignity’ intervention

Sanitation is very poor at this school. There is no water and open pit latrines. Once the girls have started their monthly menstrual periods, the lack of facilities, and lack of any means to manage their periods causes them to leave school for a few days each month. Girls typically manage their period using rags to absorb the blood. Fear of soiling clothing and embarrassment keep them away from school, causing them to miss up to quarter of their education. The aim of our intervention was to explain some basic facts about puberty, sex and management of menstruation. The highlight of the intervention is when we supply the girls with their own pack of re-usable, washable ‘Afripads’, and knickers to hold the pads in place. We also had a sack of donated bras, which the girls were absolutely delighted with!

The girls were very pleased with their washable pads and new knickers

As we left the school, children squabbled over our empty water bottles, which appeared to be a much sought after prize, reminding us how much we have and how much we take for granted. When we saw small groups of children we were able hand out little toys and gifts.

See the next blog post on my Uganda trip here.‎

Vice Chancellor’s Research Excellence Awards 2015-2016 – The ‘Fabulous Five’

Five early career researchers from the Directorate of Psychology and Public Health won the runners up prize in this year’s Vice-Chancellor’s Research Excellence Awards, including two Public Health lecturers, Dr Anna Cooper and Alex Clarke-Cornwell.

Dr Clare Allely, Robert Bendall, Alex Clarke-Cornwell, Dr Anna Cooper and Dr Jo Meredith, contribute to three of the research programmes within the School of Health Sciences: Applied Psychology: Social, Physical and Technology Enabled Environments; Equity, Health and Wellbeing; and, Measurement and Quantification of Physical Behaviour.

The ‘Fabulous Five’ would like to thank Dr Sarah Norgate for the nomination; as part of the nomination Sarah wrote “People make a research environment, and our early career researchers (ECRs) are our lifeblood”. We are grateful for her continued support, the support we receive within the Directorate and also from the School as we continue to develop as researchers.

Four of the ‘Fabulous Five’ picked up their award from Dr Jo Cresswell as part of the University Day celebrations on 8^th June 2016. Dr Clare Allely, one of the Fabulous Five, could not attend because she was in Sweden on a research visit at the Gillberg Neuropsychiatry Centre at the University of Gothenburg.

Left to right: Dr Jo Meredith, Dr Anna Cooper, Dr Sarah Norgate, Alex Clarke-Cornwell, Robert Bendall

As part of their research, the ‘Fabulous Five’ all work with external stakeholders/users in psychology, health and health-related areas. The aim of many of their projects is to be interdisciplinary, both within and outside the University. The short sections below aim to provide brief details about each of the five early career researchers:

Dr Clare Allely is an affiliate member of the Gillberg Neuropsychiatry Centre (GNC) at Gothenburg University in Sweden. She is currently collaborating with colleagues at the GNC on a number of papers and projects including one looking at cholesterol metabolism and steroid abnormalities of various kinds (cortisol, testosterone, oestrogen, vitamin D) in autism spectrum disorder (ASD) and another looking at immunology and ASD. She is also working on projects with colleagues in the UK looking at ASD in the criminal justice system. Specifically, one looking at the experience of individuals with ASD in the prison environment and another looking at the experience of defendants with ASD as well as how they are perceived by judges and juries (e.g., whether a diagnosis of ASD is considered to be a mitigating and aggravating factor in sentencing and to what extent an ASD diagnosis impacts on criminal responsibility, criminal intent, etc.).

Robert Bendall’s research initially focused on the interactions between the arousal system and the circadian system. This work investigated the impact of circadian and photic influences on the neuropeptide orexin and included research positions at the Department of Pharmacology, University of Cambridge and the Faculty of Life Sciences, University of Manchester. Recently Robert’s research has focussed on the cognitive sciences – both cognitive psychology and cognitive neuroscience. His main interests are how emotion influences aspects of cognition (e.g. visual attention) as well as the role of the prefrontal cortex during emotion-cognition interactions. Robert uses both neuroscientific and behavioural techniques in his research including the novel neuroimaging technique functional near-infrared spectroscopy. His recent research has been presented at the Annual International Conference on Cognitive and Behavioural Psychology and published in the journal Frontiers in Psychology. http://dx.doi.org/10.3389/fpsyg.2015.01592

Alex Clarke-Cornwell’s research interests include the measurement and quantification of sedentary behaviour, physical activity and workplace health using the activPAL™ and ActiGraph activity monitors; she is currently writing up her PhD. Alex’s research on the measurement of sedentary behaviour from accelerometers has recently been presented at international conferences in Limerick and Brisbane. She is also currently working with European colleagues as part of the consortium or the Determinants of Diet and Physical Activity Knowledge Hub, on sedentary time and physical activity surveillance in four European countries. Alex and Dr Anna Cooper (editor) have worked together on a book chapter around the impact of office design and activity in a book of blogs entitled Dialogues of Sustainable Urbanisation: Social science research and transitions to urban contexts (researchdirect.uws.edu.au/islandora/object/uws:30908). Alex has recently been awarded £17,607 from the University of Salford’s Research Capital Investment Fund, in order to purchase physical activity behaviour monitors for future research projects.

Dr Anna Cooper’s current research focuses on behaviour change in primary school children; the role of digital technology in research with primary school children; and NHS Health Checks in regards to the health check journey. The outputs from Anna’s PhD contributed to the outputs of the World Health Organisation (WHO) Collaborating Centre for Oral Health Research in Deprived Communities. In 2015 Anna helped to co-edit a Book of Blogs with Dr Jenna Condie (Dialogues of sustainable urbanisation: Social science research and transitions to urban contexts), which is now freely available as an e-book. Since joining the University Anna has been successful in a number of internal and external funding projects both as PI and CoA, presenting at conferences, and also the production of reports for external bodies and peer-reviewed journal articles. Anna was also returned in the 2013 REF as an Early Career member of staff. One of Anna’s current projects is around the development and testing of an Application (Digitising Children’s Data Collection (DCDC) for Health Project) designed to support the collection of data with children in a variety of settings and a collaborative research project with Liverpool John Moores University.

Dr Jo Meredith researches online communication and interaction, and is particularly interested in developing innovative methods for collecting and analysing online data. She uses methods such as conversation analysis and discursive psychology to analyse a range of online data. Since joining the University of Salford in April 2015, Jo has had a paper published in a peer-reviewed journal on the development of a transcription system for screen-capture data. She has also contributed chapters on the collection and analysis of online data to two prestigious qualitative methods textbooks. She is currently working with colleagues from radiography on the WoMMeN project. She is also collaborating with colleagues from the University of Manchester and Keele University on a number of projects and papers, including the analysis of psychotherapy using conversation analysis, the analysis of tweets around #dyingmatters and the analysis of police 999 calls. Jo is currently organising an international conference, with the media psychology team, on the micro-analysis of online data.

Follow their research on Twitter @SalfordPH @SalfordPsych @ClareAllely @Robert_Bendall @barmyalex @AMC_83 @JoMeredith82

How foetal alcohol spectrum disorders could be a hidden epidemic

There is no safe limit of alcohol consumption during pregnancy. www.shutterstock.com

The new Department of Health guideline on alcohol says that there is no safe alcohol limit for pregnant women. Alcohol should simply be avoided.

Alcohol exposure during pregnancy can cause damage to the body and brain of the baby, causing a range of lifelong problems. These problems are grouped under the umbrella term “foetal alcohol spectrum disorders” (FASD). The most recognised form of FASD is foetal alcohol syndrome (FAS). People with FAS have distinctive facial features, are small for their age and have problems with learning.

The exact number of drinks a woman can have before harming her baby is unknown (and is likely to vary from woman to woman), so most countries, including Canada, Australia and the USA, have taken a conservative approach and recommended that no alcohol is the safest option. This new guideline now brings the UK in line with those and many other countries.

Signs of FAS Teresa Kellerman/Wikimedia Commons, CC BY-SA

Recent research has revealed a large number of problems experienced by people with FASD. Around half of all people with FASD have attention-deficit hyperactivity disorders (ADHD), 62% have vision impairment (a rate more than 30 times higher than the general population), 58% have hearing problems (more than 100 times higher than the general population), 83% have speech and language delays and 91% suffer from impulsivity and inappropriate behaviour.

Each person with FASD may have some or all of these problems, and each person may have these problems from a mild to severe degree.

May be as prevalent as autism

We don’t know how many people have FASD in the UK, but based on a large review of data from other countries, it’s estimated that it may affect as much as 2% of the population. This would put FASD on a par with well-recognised developmental disorders such as autism spectrum disorder. In fact, a significant proportion of children currently diagnosed with ADHD or autism may have undiagnosed FASD as an underlying cause of their learning problem.

One problem with recognising the extent of the hidden epidemic is that FASD is significantly under reported. For example, out of a search of five years’ worth of outpatient hospital data in England, no cases of FASD were recorded. The researchers also looked at hospital admission data, expecting to find that areas with higher levels of alcohol-related illness in young women (such as in the north-west and north-east of England) would also have higher levels of FASD. This was not the case, suggesting that either FASD is not diagnosed, or it is diagnosed but not routinely recorded in hospital data.

A difficult diagnosis

Diagnosis is dogged by difficulties, including the fact that many healthcare professionals don’t know much about FASD and specialist training is needed to make a diagnosis. A diagnosis has to be made by a team of different professionals following a thorough assessment of the child that involves a physical examination, intelligence tests, occupational and physical therapy, and psychological, speech and neurological evaluations, as well as genetic tests to rule out genetic causes of problems.

Another difficulty with getting a diagnosis is that the behavioural and developmental problems that are signs of FASD may not emerge until a child is at primary school, by which time vital evidence about whether the birth mother drank during pregnancy may be missing. This information is crucial to make a diagnosis if the distinctive facial features seen in full-blown FAS are not present. Another difficulty is that people with FASD usually have other disorders (such as ADHD or autism spectrum disorder), making it difficult to isolate FASD.

To get the true number of people with FASD, it would be necessary to screen a whole group of the general population. This has been done in other countries, such as Italy, the USA and Canada, but there has been no such study in the UK.

Action at last

Last summer, a cross-party group of MPs took an interest in FASD, forming the All Party Parliamentary Group (APPG) for FASD. In its first report, released in December 2015, it made a number of recommendations including the call for a public health campaign to raise awareness of FASD. The APPG also called for “urgent consideration to be given by the government into commissioning a UK-wide study to ascertain the prevalence of FASD”. This would be a vital first step in uncovering the true extent of FASD.

Why is such recognition important? The consequences of unrecognised and unsupported FASD are wide, including addiction, mental health problems and disengagement with education. Children can appear bright and talkative and can appear to learn, but often forget what they have learned by the following day. They can also behave inappropriately. Because the cause of their difficult behaviour is not understood, they frustrate teachers and are often labelled as “naughty”. Sadly, another tragic consequence of unrecognised FASD, is that many go on to find themselves in trouble with the law.

Early detection and intervention are important because with the right support, there is growing evidence that people with FASD can live and work independently. But, until the UK catches up with the USA, Canada and Italy, many people with FASD will continue to suffer in silence.

Authors:Penny A. Cook

Professor, University of Salford
Raja Mukherjee
St George’s, University of London

Taken from The Conversation

https://theconversation.com/how-foetal-alcohol-spectrum-disorders-could-be-a-hidden-epidemic-52835

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