This past summer I had the opportunity to travel to Rukungiri, Uganda, as part of the curriculum for the Global Health Track at UTMB. Although I would consider myself a reasonably seasoned world traveler, I had never had the chance to travel to Africa before heading to Uganda for those six weeks. I will admit, that the thought of simply getting to go to Africa was far enough of an attraction for me to consider spending the majority of my “last true summer” participating in the global health preceptorship. I was also very interested to learn about “global health” though, on the ground getting my boots wet, as opposed to in a classroom or from a book. My senior year of undergrad I took a course on global health, and had essentially became a disciple of Paul Farmer’s way of looking at the issue, but I had never actually participated in global health in a tangible way.
Rukungiri is what people in Uganda would call a small town. When I, a second generation Iranian-American born and raised in Texas, hear the words “small town”, I’m thinking maybe 2,000 people, a single “main” street, a Whataburger, and a place where everybody knows everybody. But Rukungiri is actually a town of 37,000 people, within a larger district of Uganda also called by the same name. There is no single “main” street, but rather a meshwork of paved roads, dirt roads, and paths winding every which way imaginable. There is no Whataburger, which didn’t surprise me, but a guy can hope right? As far as everyone knowing everyone, that’s not exactly the case, but people do seem to be much friendlier in passing on the street, and everyone walks everywhere so you run into people you know all the time. Rukungiri is just as beautiful as any part of Uganda that we were able to witness. To me, it was kind of like the “hill country” of Uganda, inundated with banana trees and lush foliage as opposed to mesquite trees and rock.
Nyakibale Hospital, where we spent the summer, is located on the outskirts of the town. It is a private, non-profit mission hospital that functions essentially as a one-stop shop for every possible healthcare need of the people of Rukungiri, ranging from primary care to eye care to emergency care. Most of the clinical experience was watching in the surgical “theatre” or waiting in the Emergency Department (ED) for new patients to arrive. As an American medical student, I spent most of my first year of school with my nose stuck in a book, so the opportunity to see so much real patient interaction, surgeries and emergency situations up close and personal was an absolute blessing. I witnessed the way that Ugandan physicians tactfully used the limited surgical OR’s to deliver an extremely impressive variety of procedures to the patients. I simply needed to make sure to stay out of the way and not contaminate anything. My first time “scrubbed in” for a surgery, we were watching a caesarian section, my only job being to hold my hands in a “sterile” manner and not get too close to the mother. I was overcome with the heat of the OR, and admittedly the flow of blood from the patient, and beginning to feel weak and wobbly, nearly passed out in the middle of the room. Talk about a way to let the locals know you are truly out of your element. After that first surgery, I was good to go the rest of the trip, witnessing surgeries ranging from that initial C-section to hernias (okay a lot of hernias, like too many hernias) to exploratory laparotomies (something I might never have had the chance to see with the modern use of imaging in the States). Meanwhile, in the ED, I was shocked by the way the emergency care clinicians delivered cool, calm care to motor vehicle accident patients, while the patients themselves seemingly bled out all over the floor of the ED. All I could do was hand over IV bags or medications that were being asked for from the stock in the closet.
I left the experience I received in Uganda with a definite desire to become a better clinician for my patients, and less caught up in simply learning the material laid out in front of me in school so I can hopefully rock a standardized exam one day. By that, I mean I’ve come to understand that all physicians will eventually know about the same amount of material. We will all be able to make a diagnosis given all of the pertinent information on the patient. We will all know which antibiotic to administer, given what bacteria is the source of the infection. What seems to differentiate the average, the good, and the best physicians though is the way in which they are able to interact with their patients. The way the physician is able to ask the “right” questions so as to gather the most relevant information from their patients. The way the physician is able to encourage and care for their patients in their most dire times of need. These “intangibles” are what make a patient feel at ease and comforted around a physician, and dictate how much more likely that patient is to follow the instructions of the physician and to trust their judgement.
My time spent in Uganda also lent me an understanding of what my place in “global health” could be in the future as an actual practicing physician. As of right now, I’m most interested in entering the field of psychiatry. I’ve always worried that psychiatry is not “compatible” with global health though, which has kept me hesitant about whether or not it’s the right specialty for me. While at Nyakibale Hospital, I entered into numerous conversations with staff there about the mental health needs of their specific community. During one such conversation, a friend of mine at the hospital told me about the need to educate the children of Rukungiri on suicide prevention and the teachers of the region on recognizing the warning signs of depression in their students. Global health in actuality is a broad, umbrella topic, but before my experience I would have relegated the role of physicians to strictly forming patient-physician relationships. Now I see their role more clearly to include education for local practitioners and advocacy for patients, which gives me much hope moving forward to pursue any specialty in medicine, trusting that a beneficial role within global health will surely exist.
Rukungiri provided many more opportunities than just clinical or research experience though. I spent the six weeks there with three first year classmates from UTMB. I like to reminisce on how much free time we had each day, at least six to seven hours, sitting together and talking about every single political or religious or healthcare issue under the sun, or playing card games until we were sick of the one person winning each time, or reading more books for leisure than I had since the start of college. The relationships that I was able to foster while in Uganda were definitely the most fulfilling and rewarding part of the trip. And it wasn’t limited to just my classmates either. I was able to get close with the ED clinicians, who were actually around the same age as us. We were blessed by the Sisters at the hospital who prepared all of our meals. We played frisbee with the local kids and they were both enthralled at the thought of playing a game other than soccer and so amused seeing “mzungus” (aka white person/foreigner) having fun in their own way. I would be remiss not to mention the friendships of an American emergency medicine resident from the northeast and a fellow first year medical student from the midwest who were with us during most of our trip.
The single biggest reason to travel to Uganda, in my opinion, is independent of the relationships or the clinical experiences. Traveling to Uganda takes one to a place where there is seemingly never a rush to get anything done. That is definitely not to say that it’s a lazy country, but rather a country full of people that seem to value the things in life such as relationships and blessings, over productivity and achievements, unlike in America. It took a while to get adjusted to that pace, but once I did, I embraced it and began enjoying the rest rather than eagerly anticipating coming home to the “rush”. The “rush” is seemingly life itself in the States. As a medical student, that “rush” means learning more material, at a much quicker pace, than I ever have in my life up to this point, while also being meaningfully engaged in extracurricular activities that I am passionate about such as St. Vincent’s. As a fiancé, that “rush” means planning a wedding and preparing for the biggest commitment one can make in life with the love of my life. As a friend/son/brother, that “rush” means making the most of opportunities to invest in and enjoy deep, authentic relationships with those people in my life. The “rush” is real no matter who you are or where you are from. But in Uganda the “rush” seemed to simply not exist. I consistently was able to enjoy waking up in the morning and eating a single piece of toast with peanut butter and a cup of instant coffee. Such a small, not spectacular, breakfast was always such a joy. I sat around with a group of friends who would simultaneously wake up around one another, while also dreaming of food we missed back home, enjoying each bite of dry toast as it came. On most mornings in the States, I eat a big bowl of cereal, have a banana, and make a fresh cup of pour-over coffee. Rarely am I able to enjoy that breakfast over here nearly as much as compared to when I was in Uganda, eating that much more simple, not praiseworthy breakfast. Most mornings in the States, I gulp down that bowl of cereal by myself, and drink the cup of coffee on my way to campus. Being back home I am reminded every so often to enjoy the bowl of cereal, to savor the banana, to slowly sip the coffee, and be thankful for the moments as they come. Going to Uganda gave me a taste of what not living in the “rush” was like, so now being home I can try and live a little less in it each day.
P.S. Seeing lions in real life, 15 feet in front of you, is basically a million times better than watching Planet Earth or Life (which is crazy I know!). Walking between two gorillas, each about five feet away from you, is way more exhilarating than seeing the gorilla hiding 40 feet away from you behind an iron gate at the zoo. If nothing else about Uganda is attractive enough to persuade you to visit, the chance to see the beautiful creatures that grace the country should be reason enough.