Background
Since 2011, Drs. Ann Markes and Matthew Kane have been going to Uganda, specializing in maternal and newborn care through training of WHO-supported curricula. In 2023, the medical program became an independent organization, Well On their Way (WOtW), committed to training frontline providers in lifesaving obstetric and neonatal skills.
Executive Committee:
• Megan Carmel MD – Medical Director
• Matthew Kane MD – Financial Director
• Dr. Ann Markes MD – Executive Director
To date, WOtW has trained 100+ healthcare workers at 26 health centers, serving ~135,000 residents (6,000 pregnancies annually). Facility deliveries remain around 50%.
Program Expansion
1. Village Health Team (VHT) Training
In 2025, WOtW received an iCATCH grant from the American Academy of Pediatrics to train 180 VHTs annually (2025–2028) using Uganda’s “Wheel of Good Practices” curriculum.
Focus areas:
• Promoting facility deliveries
• Prenatal/postnatal education
• Immunization awareness
• Addressing barriers to healthcare access
During the 2026 visit, WOtW will:
• Gather feedback from VHTs and Health Assistants
• Review successes and challenges
• Evaluate early data to refine Years 2–3 training
2. Obstetric Ultrasound Training
In June 2025, WOtW received $28,000 in private donations to launch an ultrasound training initiative, aligning with WHO’s recommendation for at least one early pregnancy scan.
Program Overview
• 10 midwives will complete an online course and a two-week hands-on course.
• 5 Lumify portable ultrasound units will be provided for ongoing use in rural clinics.
• Training led by a skilled sonography team, with oversight from WOtW’s executive team and Gulu specialists.
Sustainability & Quality Assurance
• Continued mentorship and remote image review
• Integration of ultrasound into routine antenatal care
Background
Gulu District, located in northern Uganda, has a population of approximately 130,000 people. The district was deeply affected by the 20-year conflict between the Lord’s Resistance Army (LRA) and the Government of Uganda, during which the majority of residents were displaced into Internally Displaced Persons (IDP) camps. The prolonged conflict severely disrupted community structures, eroded traditional support systems, and left a legacy of physical, psychological, and socioeconomic trauma.
Although stability has returned, Gulu remains impoverished, and most families rely on subsistence farming. Health services are stretched across 156 villages covering about 1,300 square miles, connected largely by dirt roads.
Health services in Gulu District are provided through a network of facilities at varying levels of capacity:
• Level IV Health Center (1): District referral facility with inpatient, maternity, and surgical services.
• Level III Health Centers (8): Each has a delivery room and limited inpatient capacity.
• Level II Health Centers (16): Small rural units with 1–2 staff, offering basic outpatient and preventive care.
• Level I Health Centers: Community-based services delivered by Village Health Team members from their homes.
An estimated 6,250 pregnancies occur annually, yet only about 3,000 deliveries take place in health facilities. This means fewer than half of births are attended by skilled providers, while many home deliveries go unrecorded. Traditional birth attendants (TBAs), though banned from conducting deliveries under Ugandan law since 2013, continue to assist some births due to cultural familiarity and limited access to skilled care.
Gulu district currently has only one antiquated ultrasound machine and one trained ultrasonographer.
Strengthening community-level engagement and enhancing the capacity of health workers are critical toward ensuring that every mother and newborn has access to skilled care.
Expected Outcomes and Sustainability
Ultrasound Training
Expected Outcomes:
• Capacity Building: 10 midwives trained and able to independently perform basic obstetric ultrasounds.
• Access to Care: Increased availability of early pregnancy scanning services across Gulu District.
• Improved Health Outcomes: Earlier detection of complications leading to improved maternal and neonatal outcomes.
• Quality of Care: Enhanced diagnostic accuracy and confidence among midwives during antenatal care assessments.
Sustainability:
• Integration into Routine Care: Ultrasound services will be embedded into standard antenatal care at health facilities and outreach clinics.
• Local Ownership: Equipment will be maintained locally by trained staff, ensuring continued functionality.
• Ongoing Professional Development: Continued skills improvement through collaboration with local ultrasound professionals and periodic remote mentorship and quality assurance reviews.
• System Strengthening: Development of local expertise will reduce reliance on external trainers.
Village Health Team (VHT) Training
Expected Outcomes:
• Community Engagement: VHTs will effectively promote facility-based deliveries and educate families on prenatal and postnatal care.
• Health Behavior Change: Increased awareness and uptake of immunizations, as well as improved attendance at antenatal and postnatal visits.
• Early Detection and Referral: Improved identification and early referral of mothers and infants showing danger signs.
• Health Access Facilitation: VHTs will help families overcome social, economic, and logistical barriers to accessing care through the government health system.
Sustainability:
• Integration with Existing Systems: VHTs are already embedded within the community and the government health system, ensuring program continuity.
• Empowerment and Confidence: Enhanced knowledge and skills will boost VHT confidence in community engagement and strengthen their advisory role.
Hopefully, the whole community in the Gulu District of northern Uganda will be impacted by our visit. We worked with 10 midwives who are now competent in a few key areas of obstetric ultrasound. They all completed 2 online ultrasound basic courses before we arrived. Upon arrival, we reviewed the didactic material for 2 days and then the trainees used phantom models to practice their skills for a day. Our group then divided up and went to several health centers to scan on actual pregnant mothers. The trainees literally had multiple hours of practice and most of them became proficient in the important points of POCUS use. The trainees will start using their skills in the next few weeks and will have real-time backup from 2 local OB/GYN’s. Several incomplete abortions, breech deliveries and anatomic abnormalities have already been diagnosed. We expect that the health care of pregnant mothers will improve significantly with this training.
We also worked with Village Health Team (VHT’s) members on basic health care management such as identifying danger signs. They had received some training through our program and during our meetings with them, they told us that they felt more confident in knowing when to refer their village members to the health centers.
