Oli Otya from Mbarara, Uganda! I just arrived last week and it’s been a whirlwind ever since (in a good way!). I landed late last Sunday in Kampala and woke up just as early to get started at the IOM Medical Offices. It was a bit surreal, seeing the other half of the screening exams and testing. (We always see the reports from these screens during new arrival screens at CIH). But that was only to prepare us for the road trip, and just as I was getting settled in Kampala, I was whisked away to Mbarara to start working at the camps. So far it’s been just as hectic and crazy (we’re planning on screening over 500 people!), but honestly it’s been a blast. I couldn’t ask for a better group of people to work with.
I’m trying to keep a journal during my time in Uganda, and I’ve had a couple things on my mind ever since I arrived. One thing that I always think about as I travel is how to be a good guest. As many times as you travel or visit a country, sometimes you just feel like a tourist. You don’t fully understand how things work, where things are, or who to talk to. We have to sometimes ask what's going on to catch the cultural context and richness of a situation; but that can be difficult because it takes a level of humility and delicacy if you want to avoid seeming ignorant, rude or disrespectful.
What's more, it's always hard to transition from the U.S. to less resourced countries. Sure, the changes in the setting and personal accommodations always push you out of your comfort zone, but what’s really striking is the changes in medical resources. There’s always a change in mindset that comes with treating and working up a condition that you know will be difficult to manage in that setting. There are plenty of conditions that cannot be properly diagnosed, but one issue I’ve run across a few times is the diagnosis of Hepatitis B. IOM screens refugees for Hepatitis B prior to their departure (mainly for vaccination purposes), but if patients are positive, it’s rarely possible to initiate treatment right then and there. This is frustrating because it just doesn't sync with our view of medicine in the U.S., and while I doubt my colleagues here feel any different, their mindset has to shift to relocation in order to get these patients the treatment they need.
Another issue I came across this week was more structural. During my first week in Kampala, I came across the scene of an accident while walking to work. There were a few minor injuries, but two gentlemen were thrown from their vehicles, and we ended up staying with them waiting for the ambulance. I’m not sure what happened after they were taken to the hospital, but I found myself just as frustrated by this situation as the issue with hepatitis treatment. The road isn’t well kept, there aren’t any traffic signs, and it was easy to see the vehicle wasn’t equipped seat belts. It’s frustrating because the events leading up to these injuries were preventable, and as much as it seemed like a normal motor vehicle accident, it was precipitated by the area’s lack of resources and underlying poverty.
None of this is entirely new to me, and I've seen these sorts of frustrating things during trips before. But it doesn't take away the sting of how it makes you feel. While none of these specific incidences resulted in deaths (that I know of), I can easily imagine scenarios that do and each time I see things like this it reminds me of what Paul Farmer calls "stupid deaths."
Ultimately, I know I have little power to change large things like a country’s infrastructure or economy. But a Ugandan colleague of mine put it best: “We can ask for better.” Our partners recognize their lack of resources, but aren’t content with this norm and constantly advocate for better. That's what's incredible about working in global health. We as clinicians can have a role with the individual patient, but can also join our partners as advocates to push for larger, structural changes that lead to a better system. I’m honored to be part of that here, and I think that’s why it’s been so incredible so far (even if it's frustrating at times).
Another issue I came across this week was more structural. During my first week in Kampala, I came across the scene of an accident while walking to work. There were a few minor injuries, but two gentlemen were thrown from their vehicles, and we ended up staying with them waiting for the ambulance. I’m not sure what happened after they were taken to the hospital, but I found myself just as frustrated by this situation as the issue with hepatitis treatment. The road isn’t well kept, there aren’t any traffic signs, and it was easy to see the vehicle wasn’t equipped seat belts. It’s frustrating because the events leading up to these injuries were preventable, and as much as it seemed like a normal motor vehicle accident, it was precipitated by the area’s lack of resources and underlying poverty.
None of this is entirely new to me, and I've seen these sorts of frustrating things during trips before. But it doesn't take away the sting of how it makes you feel. While none of these specific incidences resulted in deaths (that I know of), I can easily imagine scenarios that do and each time I see things like this it reminds me of what Paul Farmer calls "stupid deaths."
Ultimately, I know I have little power to change large things like a country’s infrastructure or economy. But a Ugandan colleague of mine put it best: “We can ask for better.” Our partners recognize their lack of resources, but aren’t content with this norm and constantly advocate for better. That's what's incredible about working in global health. We as clinicians can have a role with the individual patient, but can also join our partners as advocates to push for larger, structural changes that lead to a better system. I’m honored to be part of that here, and I think that’s why it’s been so incredible so far (even if it's frustrating at times).
Until next time!
Matt
