Project Description

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

Population Served

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 Impact

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

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Trip Photos & Recap

Our February trip to Gulu, Uganda was a fantastic success! We trained 10 midwives on POCUS units purchased through a single large donation. Our trainees were engaged and enthusiastic! The impact was seen immediately, when in the first two weeks we found an abdominal pregnancy, a life threatening emergency that otherwise would go undetected. Since leaving, they have performed over 300 scans and the QA review has been very positive! The women of Gulu district Uganda now have five more places to seek ultrasounds, what would have previously taken long travel and full days waiting in the local city, essentially unavailable to nearly all pregnant women there. We hope to continue to expand this project with teaching more skills to our newly minted sonographers and, with any luck, more donations for more POCUS units!

We were also able to bring much needed headlamps for deliveries when the lights are out and speculums to assess for bleeding and ruptured membranes.

Finally, we deepens our connection and love for our amazing Ugandan colleagues! I can’t wait for next year!

Thanks so much to Doximity for supporting our travel for this important work!!!