Cindy Tryniszewski, RN, MSN, Executive Director, Clinical eLearning for Elsevier, recently traveled to Uganda with a 19-member volunteer team of nurses, nurse practitioners, physicians, and non-medical people. This 15-day medical mission is one of many organized by Project Helping Hands (PHH), of which Cindy is a member of and secretary for the Board of Directors. The purpose of this trip was to provide medical care and health education for the people of Uganda. The team set up clinics in the slums of Kawempe and in the remote village of Nangaiza. As the education director for the mission, Cindy worked closely with the team leader, Jean A. Proehl, RN, MN, CEN, CPEN, FAEN, who is the author of the Elsevier publication Emergency Nursing Procedures, to plan and implement an overall education program, with a focus this year on empowering grandmothers.
Project Helping Hands (PHH) is a not-for-profit humanitarian organization that provides health intervention services for those lacking access to health care, develops sustainable, locally run health promotion and prevention programs and facilitates safe and affordable personal growth opportunities for its volunteers in the third world countries. Beyond treating illness and disease, the teams help build medical services in remote areas with the goal of seeing them become self-sufficient and able to replicate these efforts in other places of need.
Why focus on grandmothers?
Education is an essential component of all PHH missions. During their 2014 trip to Uganda, Jean and Cindy implemented an organized education plan and developed several guides for teaching the hundreds of people waiting to be seen in the clinic. This year, Jean was inspired to expand the education program after reading an article about the importance of grandmothers in the community of developing countries. Jean and Cindy began researching more about global efforts and found an invaluable resource in Grandmother Power: A Global Phenomenon by Paola Gianturco.
Jean and Cindy uncovered some interesting facts:
- There are more grandmothers on this planet than any time during history.
- Many grandmothers are raising their grandchildren.
- There are 14.8 million children younger than 15 who are AIDS orphans in Sub-Saharan Africa and 60% of them live in grandmother–headed households. 
It is known that grandmothers are respected members of the community and are often sought for their advice and guidance. They have years of life experience, vast stores of knowledge, and can teach values and help build character. Grandmothers will not leave the community, whether or not they complete basic education, as younger people might do. Instead they stay and are an incredible resource for the people and committed to their communities. Armed with this information, Jean and Cindy developed a plan to specifically educate grandmothers with the hope that they will then serve as the educators and disseminate this information to their communities.
Developing the Plan
Before embarking on the trip and implementing the plan, Cindy and Jean sought and received the support and approval of the team’s in-country hosts, Robert and Rose Nabulere. The next step was to discuss the plan with the clinic operations manager upon their arrival to the clinic. The grandmothers would need to be gathered and moved away from the general crowd for one hour every day. This would allow for 4 or 5 topics to be taught. The grandmothers were presented with 22 topics from which to choose:
- Back Exercises
- Back Pain Causes
- Breast Self-Exam
- Diabetes Mellitus
- Hand Washing
- Head Lice
- Itchy Eyes
- Oral Hygiene
- Safe Drinking Water
- Women’s Hygiene
The most requested topics were back exercises, breast self-exam, diabetes, hand washing, heartburn, hypertension, and malaria. In an effort to appear credible and quickly relate to the grandmothers, the classes were taught by the 3 grandmothers on the team, Jean, Cindy, and Chris Gisness, RN, MSN, FNP, CEN, FAEN, who is a contributor to Sheehy’s Emergency Nursing: Principles and Practice, 6th ed. The PHH grandmothers wore t-shirts that said “Grandmother Power, The Force is With You” which delighted the Ugandan grandmothers.
Implementing the Plan
As with any plan, challenges arose. To conduct teaching, one translator needed to be allocated and this proved to be challenging. Each provider needed a dedicated translator as did the triage nurses and the pharmacist. Additionally, the clinic operations director was juggling many responsibilities and was focused on ensuring that as many people as possible were seen by providers. Ultimately, with much persuasion, a translator was assigned and the grandmother groups were organized and moved to an area away from the crowds.
The grandmothers greatly appreciated the recognition and the time spent with them. They posed many questions and offered great feedback about the challenges they face in Uganda, such as a lack of clean water. The grandmothers wanted more education that time simply didn’t permit. The classes lasted about 1 ½ hours and may be extended next year.
When the team revisits Uganda in 2016, the education plan will be revised based on some of the challenges encountered. More time may be allocated to the grandmothers, other topics may be developed and a dedicated translator will become a high priority.
Now that the team has been conducting formalized education for a few years, in 2016, they will begin to measure the outcomes with the input of the in-country hosts.
Jean and Cindy are also part of an ad hoc group that will use the Uganda teaching model as the foundation for a more structured PHH education plan that will be brought to the board of directors. The intent is to provide consistent, evidence-based, culturally-appropriate teaching to all regions visited by PHH missions.
To learn more about Project Helping Hands, please visit www.projecthelpinghands.org.
 Gianturco, P. Grandmother Power: A Global Phenomenon. New York, NY: Powerhouse Books; 2012.