ALCI Bursary – Volunteering Report: Maternal and Child Health at Kisiizi Hospital, Uganda

Report By Úna DeeHogan, IBCLC, May 2025.

Introduction 

This report details my experience as an IBCLC at Kisiizi Hospital, located in rural  southwestern Uganda. The placement was arranged through CHEEERS: Developing  Healthcare Together. My clinical focus was on maternal and child health, especially exclusive breastfeeding (EBF), outreach services, and neonatal care. A significant highlight  of the trip was our two-day educational workshop delivered in partnership with the hospital’s staff. 

CHEEERS: Developing Healthcare Together (DHT) is an Irish non-profit,  multidisciplinary volunteer-sending organization. Its name reflects its mission: 

• Community 

• Healthcare 

• Empowering 

• Education 

• Experiences 

• Relationships 

• Support 

CHEEERS partners with healthcare institutions in developing regions to improve services through collaboration, professional exchange, and capacity building. All volunteers cover their own costs, ensuring funds directly benefit project sites. Our team of 14 professionals brought expertise from nursing, midwifery, paediatrics, surgery, public health, and lactation consultancy. 

Collaborative Two-Day Workshop: The Role of the  Multidisciplinary Team 

A core component of the CHEEERS visit was the co-hosting of a two-day workshop for hospital staff. This year’s theme was: 

“The Role of the Multidisciplinary Team in Post-Operative Care.” 

The workshop was designed in collaboration with Kisiizi staff and involved shared teaching and learning across a range of specialties. Sessions covered infection prevention, surgical care, maternal and neonatal care, emergency management, and post-operative recovery.

My Presentation: Supporting Early Breastfeeding 

As part of this workshop, I delivered a session titled “Supporting Early Breastfeeding”,  with a particular emphasis on post-operative mothers. My presentation focused on practical  strategies and clinical reasoning around: 

• Skin-to-skin contact: its role in regulating newborn temperature, heart rate, and initiating instinctive breastfeeding behaviours immediately post-birth or post-surgery.

• Exclusive Breastfeeding (EBF): as a life-saving intervention, especially in low resource settings, reinforcing its importance even in post-operative recovery.

• Positioning and attachment: particularly for mothers recovering from caesarean sections or other surgical procedures, with tailored techniques to minimise discomfort. 

• Frequent and effective milk removal: to establish and maintain supply, reduce engorgement and mastitis risk, and promote newborn growth. 

This was an excellent opportunity to apply lactation consultancy principles within a  multidisciplinary clinical context, and to contribute to ongoing education and quality  improvement at Kisiizi Hospital. Feedback from staff indicated that the emphasis on  practical, low-cost techniques was both welcome and relevant. 

Maternal and Child Health Context 

Mortality Rates: Uganda vs Ireland 

Uganda continues to face elevated maternal and child mortality, compared to Ireland: 

• Maternal mortality (2022): Uganda – 189 per 100,000 | Ireland – ~0 per 100,000

• Infant mortality: Uganda – 22 per 1,000 | Ireland – 3.2 per 1,000 

• Under-five mortality: Uganda – 52 per 1,000 | Ireland – 3.8 per 1,000 

These figures illustrate the critical need for improved maternal care, neonatal support, and early feeding interventions. 

Challenges to Exclusive Breastfeeding 

Exclusive breastfeeding for six months is a proven intervention that could reduce child mortality by up to 11.6%. Despite widespread breastfeeding initiation, EBF rates remain low, in sub-Saharan Africa, only 33% of infants are exclusively breastfed. 

In Kisiizi: 

• Cultural practices include early supplementation with cow/goat milk, porridge, and biscuits soaked in milk. 

• Mothers’ heavy workloads (farming, cooking, fetching water) often hinder consistent breastfeeding. 

• Social stigma influences feeding choices—non-breastfeeding may signal HIV positive status, causing mothers to avoid formula use despite medical advice.

Outreach Clinics 

The hospital operates outreach clinics, offering essential services to remote rural communities. These include: 

• Antenatal care: HIV/syphilis testing, abdominal exams, BP monitoring, folic acid  distribution. 

• Child health services: nurses weigh children and measure mid-upper arm  circumference (MUAC) to assess nutritional status. Growth is plotted on standardized charts to identify malnutrition. These clinics also administer all childhood  vaccinations (BCG, polio, DPT, measles, etc.)Nurses treat common paediatric illnesses on-site: they dispense antimalarials, rehydration salts, anthelmintics for worms, and medicines for respiratory or skin infections. 

• HIV screening for breastfeeding mothers every three months. 

• Breastfeeding and nutrition counselling delivered during every visit. 

These mobile clinics are a lifeline for many families, bringing high-impact preventive care to otherwise underserved areas. 

Neonatal Care 

Safe Cup Feeding 

In resource-limited settings where bottles are not recommended due to infection risk and limited sterilization facilities, cup feeding offers a safe and effective alternative. I worked  with nursing staff to discuss and demonstrate key aspects of safe cup feeding, including: 

• Proper infant positioning to minimize the risk of aspiration 

• Techniques for pacing and observing infant readiness cues 

• Hygiene practices to reduce the risk of infection 

• Supporting mothers to remain actively involved in the feeding process when direct  breastfeeding is not yet possible 

The staff showed strong commitment to these practices, and discussions often linked safe feeding to overall neonatal outcomes, especially in fragile infants. 

Safe Skin-to-Skin Contact and Kangaroo Mother Care 

Another key area of focus was the practice of skin-to-skin contact and Kangaroo Mother  Care (KMC)—an approach particularly relevant in Kisiizi, where incubator availability is  limited. 

Drawing on the work of Professor Nils Bergman, whose research underscores the  neurodevelopmental and physiological benefits of immediate and continuous skin-to-skin  care, I emphasized: 

• Skin-to-skin as a biological necessity, not a luxury, especially for preterm infants

• The role of maternal warmth and sensory connection in stabilizing breathing,  temperature, and heart rate 

• The impact of early KMC on improved bonding, breastfeeding success, and long-term  developmental outcomes 

Prof. Bergman’s work supports the principle that “the mother is the baby’s natural habitat”—a concept that resonated deeply with both the staff and mothers in Kisiizi, where close maternal involvement is already central to care practices. 

The team and I reviewed safe positioning techniques for both mothers and babies during  KMC, including wrap styles, monitoring signs of distress, and facilitating comfortable  breastfeeding during KMC. 

These interactions reinforced the importance of evidence-based, low-tech solutions like  KMC and cup feeding in reducing neonatal mortality and promoting maternal confidence in settings where clinical resources may be constrained. 

During my time in the neonatal unit at Kisiizi Hospital, I observed both the challenges and the commitment involved in caring for vulnerable newborns. The unit is equipped with 10  incubators and has recently received two CPAP (Continuous Positive Airway Pressure)  machines, a significant step forward in supporting babies with respiratory distress. 

Despite these improvements, mechanical ventilation is not available. When I inquired  about whether the unit had a ventilator, one staff member quietly replied, “We are the ventilator.” 

This level of commitment, combined with practices such as safe cup feeding, skin-to-skin care, and Kangaroo Mother Care (KMC), demonstrates the powerful impact of low-tech,  high-touch interventions in improving neonatal outcomes.  

The Mother's Waiting House 

During my time at the Mother’s Waiting House—a facility at Kisiizi Hospital that offers accommodation and antenatal care for expectant mothers nearing their due dates—I had the opportunity to engage with staff about local beliefs and practices around breastfeeding,  particularly those concerning colostrum. 

A recurring theme was the deep-rooted myth among some community members that colostrum is “dirty”. This leads to some mothers discarding colostrum and delaying the initiation of breastfeeding. In some cases, other fluids or foods—like cow’s milk, glucose water, or porridge—are given instead of breastmilk in the crucial first hours and days of life. 

This belief presents a significant barrier to Exclusive Breastfeeding (EBF), setting a precedent for early supplementation. 

Together with staff, we explored strategies for sensitively addressing these beliefs,  including: 

• Integrating breastfeeding education into antenatal sessions at the Waiting House

• Empowering midwives and health educators to talk openly about the importance  of colostrum 

• Using storytelling and peer role models to gently challenge myths with lived  experience 

• Reinforcing the message that colostrum is the baby’s “first vaccine”, rich in antibodies and vital for early immunity. 

Empower Project 

Beyond clinical care, Kisiizi Hospital is committed to supporting young girls in the  community through the Empower Project—a vital initiative addressing menstrual health,  personal hygiene, and sexual education. 

The hospital provides schoolgirls with a practical hygiene pack containing: 

• Four reusable sanitary pads 

• Knickers  

• A discreet wet bag for storage and transport 

This intervention helps ensure that girls do not miss school during their menstrual cycle,  tackling one of the most common reasons for school absenteeism among adolescent girls in rural Uganda. 

• Improved school retention and academic participation 

• Reduction in stigma and misinformation about menstruation 

• Empowerment of young women to make informed decisions about their health. 

Acknowledgements 

I would like to extend my deepest thanks to: 

• ALCI – for the bursary support. 

• CHEEERS – for coordinating this meaningful experience and promoting respectful,  skill-sharing global partnerships. 

• Kisiizi Hospital staff and patients – for their warmth, collaboration, and commitment to care. 

Conclusion 

My time at Kisiizi Hospital was profoundly educational and fulfilling. The collaborative workshop highlighted the importance of multidisciplinary approaches in improving care quality. In particular, promoting early and exclusive breastfeeding in the post-operative period can have a substantial impact on maternal and infant outcomes in low-resource settings. Working alongside local staff reaffirmed the power of peer learning, respect, and teamwork in building stronger, more equitable healthcare systems. One of the most striking observations was the exceptional clinical skill and intuition demonstrated by the midwives at Kisiizi Hospital. In the absence of routine access to ultrasound scanning,  midwives rely heavily on hands-on assessment, clinical judgement, and experience to monitor maternal and fetal wellbeing. The experience at Kisiizi Hospital highlighted both the challenges and the potential in improving maternal and child health in rural Uganda. The stark differences in mortality rates between Uganda and Ireland underscore the gravity of the situation. Promoting exclusive breastfeeding emerged as a high-impact, low-cost strategy: it is already widely practiced, but can be better supported. Cultural norms (such as prelacteal feeding and HIV-related stigma) and economic pressures (labor-intensive farming) pose barriers that must be addressed sensitively. Kisizi Hospital’s outreach clinics are a critical asset, delivering antenatal care, immunizations, nutrition screening, and HIV services directly to villages. Strengthening these programs and continuing breastfeeding education will help reduce infant and maternal mortality. The volunteer team left with a deep appreciation for the  dedication of local healthcare workers and an awareness that even small improvements in  breastfeeding support can save lives

Dated: 26th May 2025. 

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