Mukono Aging Community Health Initiative

What is the MACH Initiative?

Allie Trask: MACH is an acronym for Mukono Aging Community Health Initiative. The project is a group-based exercise program for older adults in Uganda. We are creating this health initiative in collaboration with older adults in the Ugandan community plus a local nurse, currently based in Kampala, Uganda. We also partnered with the African Center for Aging and Dementia (ARCAD), an NGO in Mukono Uganda. We are working with these partners to create a group exercise program with added information for older adults with bone and joint pain. The goal of this health initiative is to decrease social isolation and increase general well-being and quality of life for this population.

How does it work?

Anna Solfest: Right now, things are a little bit tricky [due to COVID-19]. We are working with ARCAD’s executive director and a local nurse to recruit participants who already receive the services provided by ARCAD. We were planning on having two members of our own team go to Uganda to collaborate in person, but, right now, we are doing everything remotely so we are hoping to do a community based participatory research design. Which we are working on the IRB for. After that, we will be creating outcome tools to make sure that we are capturing what we are trying to measure such as quality of life and improved pain. Part of the community participatory design is to have community members and participants in the program help us with the research design. They will provide feedback about what they want to see changed, what they feel their strengths are, and areas they want to improve in. We are making general plans for these outcome measures, exercise programs, and consulting with a physiotherapist who is employed at ARCAD for the exercises. We expect it to be a 2-3 times per week program, depending on what community feels is appropriate. Hopefully, it would last for 6 weeks the first time it is offered. Then we can reevaluate with everybody involved and see what we could change. ARCAD has offered to host it permanently so it can be a continuous program there.

Allie Trask: And eventually move into other locations. ARCAD is a really good place to start and we are thankful for their help, but we are excited to expand in the future.

How did you come up with the idea?

Allison Berry: This is an original idea that we came up with in our GCC course. It’s interesting and it has changed significantly from the initial vision we had in class. Our GCC class connected us to our partner, Faith, who specializes in bone and joint pain in older adults in Uganda. In conversation with Faith and our instructors, we determined that a group exercise program would be the best and probably the simplest and cheapest way to address health and wellness in older adults. We also saw a video of a bunch of elders in China doing Tai-Chi together. That inspired us to go with group exercise rather than individual exercise.

Anna Solfest: We realized along the way that we need to keep our project open to change and to see what our community members really want.

What is it like working together coming from different departments?

Allie Trask: I really enjoyed the experience. I am a nursing major. Anna was a Kinesiology major as an undergrad and is in grad school right now for physical therapy and public health. Allison is a Biology major and a Public Health minor. We all came from different colleges. It was super interesting because nursing is very structured, and I have 90% of my classes with the exact same people. Because of this, I work with people who are very like-minded because we all chose to come to the same college and are pursuing the same career. We have very similar interests and ways of thinking because we all take the same classes. GCC is unique in that I got to work with students who came from different backgrounds and then looked at problems in different ways. There is still diversity in nursing, but because it is such a rigid program, I only ever had classes with nursing students. Working in a more interdisciplinary environment was a good experience. Hearing about peoples’ different backgrounds, context, and different approaches to things was amazing to be a part of. Everyone had different strengths and it showed. In the future, everything in hospitals is going to be interdisciplinary, so this is a great chance to experience that and get more prepared for working in an interdisciplinary field in the future.

Anna Solfest: I would like to echo that. I think part of the reason we are drawn to public health and this global health class was that it is interdisciplinary. Like [Allie] said, the world is interdisciplinary. It has been awesome to learn from each other because we bring different things to the table.

What challenges did you run into?

Anna Solfest: We didn’t want to start by making assumptions about what is needed in this community that we are not a part of. That’s a big reason why we want to do this community participatory approach. Right now, the pandemic is a challenge for everyone, especially considering we want to bring together higher risk populations in a small space. We are continuing to lay the groundwork. Hopefully when it is safe, we can do that. Those have been our main challenges. Remotely collaborating with our partners is different than meeting in person. We have been in contact since the start and it has been really helpful. Google Docs has been really great. We perceive this as a need or a problem, but we don’t fully know that. We have seen needs assessments done, but we also want to make sure that we hear from the people we are working with. Faith and Isaac have been super helpful with that in helping administer some surveys to some potential participants. It has been a learning curve.

What’s the biggest thing you learned?

Allison Berry: We have gained a deeper understanding and respect for other cultures. Through that [we have] developed our cultural competency in a way that wouldn’t have been possible without the help or push from our professors. They really stressed that and the need to work with the community as a partner and not just go in and say “Hey we think this is a problem and this is how we want to fix it.” Instead, going into a community and seeing what they need and how can we help them. They really started off the class with that lesson and it has been a recurring theme throughout the course. We need to understand and respect the culture in Uganda rather than just relying our views and our cultural lens. [We need to] view everything through the lens of the community we are working with. Constant and frequent communication is especially important.

Allie Trask: We have learned that you don’t have to go back and invent some brand-new thing. We don’t have to reinvent the wheel here. There a lot of solutions out there that are not being implemented in the right way and in the right populations that can have so much impact. This is a very low cost and sustainable solution and the impact it can have on the community and on other communities is so far reaching.

Do you plan to continue?

Allie Trask: Yes, we are all very excited to continue. We have had some funding that we plan to be using within the next year or so. Honestly, a lot of the things we are doing with this program align with our career goals. Like Anna, she is going to be a physical therapist. So a group exercise program is amazing. There are so many public health applications from a nursing standpoint. Even for Allison who is interested in public health and healthcare in general, this program lines up with what our group members want to do in the future. We want to continue to have a meaningful impact on these health issues and in populations that don’t have the resources or support to fix these kinds of problems.

What are the next steps?

Anna Solfest: Our next step is to get IRB approval and since it’s a collaborative project, we need approval from both institutions, in both countries. We are also in the process of filling positions within the operation for the project. For example, we are talking to the physiotherapist at ARCAD to see if they are interested in joining the team and helping with the exercise program. We collaborating on and designing some outcome tools, outcome measures, and study tools to use to ensure the project is helping the community. We are hoping to have almost a bucket of different tools that we can use. Once we get IRB approval and recruit participants, [we can] work together and choose which tools would be best to use. This has to wait until we can hear more from our participants. We are excited to gain more input and see how this project can also link to other resources that this organization might want better access to and see how it can best serve this community and be led by the community.