Hello again from Uganda, where I am already less than a week from my return home. As it would figure, this last week has been by far the most productive in respect to the project I have been working on, meaning it looks like I'm going to have a photo-finish to the end here to get everything I hope to accomplish done. I have made some good contacts at the government hospital in Iganga, including a doctor I've been shadowing a bit, which has led to both advancement of my project researching training, and some personal enrichment. The cases I have seen with him at the government hospital - a larger facility than the clinic where I am in Ibulanku - have been very different than what I would see on a "ward walk" back at OHSU. For example, yesterday we rounded on a patient with stab wounds, two who had been in collisions (including one who was on a motorcycle taxi), a boy with some sort of nephrotic syndrome complicated by TB (for all you medical nerds out there, the CXR showed a unilateral fluid line in his left lung that was almost 75% of the entire lung!), and numerous patients with AIDS and complications (TB, malaria, even Kaposi's sarcoma). While all these were fascinating, the most interesting was a 21 year old man who had attempted suicide via poisoning. Apparently, he had fallen in love with a 16 year old girl in his village and made arrangements with her family to marry her, including paying a 1,000,000 shilling dowry (around $550, a lot of money here). They were then married, and he took her back to his village, until one day her parents came while he was at work and took her back. He went to her house and unsuccessfully first requested his wife, then the dowry payment he had made. He was given neither, and in his own words, "was so ashamed I didn't know what else to do." The story was a sad one, and obviously delicate, though being discussed openly in the large one room male ward. The nurse leaned over and told me, "This thing wouldn't happen if we had a social worker at the hospital." Then both she and the doctor began berating the man, telling him he needed to get up and go back to work, it was only money which he'll remake eventually. The treatment idea was to get him to stop feeling sorry for himself via brute force - a horrific idea juxtaposed with the training I recieved when working on the psychiatric unit at Seattle Children's. As we moved to the next patient, the staff continued to laugh at the man's stupidity, and kept repeating that he needed to get up and go to work.
All in all, the experience was an eye-opening one, and gave me a good idea of common doctor-patient, doctor-nurse interaction, none of which would fly if I were to try their methods in my clinical rotations. There was little explanations given to patients or parents of patients, they were jerked around like ragdolls, and the staff seemed to have almost a contempt for many of them. Keeping in mind this is only one experience at one hospital, it was nevertheless a disturbing and discouraging one.
Unfortunately, discouragement has been a large part of my experience here. I am here to learn. I am here to experience. I am here for the selfish reasons of wanting to feel like I am doing something good in the world. I am here to take in every foreign moment and process it and use it to make decisions about what I want to do with my life and the opportunities I have. I came in a month ago full of enthusiasm about what I hoped to accomplish and what I hoped this trip would be, and have seen that die down every day. Part of it is no doubt due to the frustration of a slow-moving, ill-defined project. But the part of it that worries me, and the part I've spent a long time turning over and over again in my head and in conversation with people here, is more a collision of passion with perception. The perception with which I am struggling is the lack of Ugandans who are truly invested in bettering their own situation. At least in the rural area where I am, there seems to be little push towards any sort of development, be it better education, better healthcare, or simply better quality of life. Don't get me wrong, I am the last person who would impose on all people a Western way of life, complete with Levi's, new cars, and air conditioning. But when lack of family planning leads to malnutrition, when you are guaranteed to have at least one of your children die before the age of 12, when you are paying what little money you have for malaria medications that the rest of world knows is ineffective, where is the desire to see these things changed? No doubt there are those who have tried, and been unsuccessful, which doesn't encourage others to spend their own time and energy to correct societal ills. But still, it is a revolutionary spirit, a passion for a better life that moves past those failures and pushes until change occurs. I have yet to see that here, from anyone. The healthcare workers I spend my days with are here because it is a job, and many who are working in the village are here only until they can get a better job at a government hospital. The doctors I've talked to seem to do this less for humanitarian reasons and more for status and salary.
All of this then begs the question: why should I give up the posh life that a physician's income and status in the US could give me in order to come to a place like Ibulanku and try to help a community whose concept of helping themselves is getting as far away as they can. For many, the answer IS money. The concept is that cash, perceived to be abundant among us foreign whites, will solve their problems - be it school fees, new clothing, or a purchasing a cell phone. Also common is the request to help them immigrate to the US: buy them a plane ticket, write them a letter of invitation, find them a job. It's an odd carousel, where people with big ideas for a poverty-stricken community pay their way into a country where a majority of the community they have arrived to assist are doing their damndest to work their way out, preferably using the money the expatriates bring with them. It's what I see here in this clinic on daily basis, from the highest level of local management to the lowest of nursing assistants, and it's frustrating.
I don't yet have the answer. I maintain that every humanitarian effort has some degree of selfishness involved, and I think that it's a big challenge to get past that and theoretically, be selfless in one's donation of time and energy into a project or community. It's a daunting task to be an individual up against hundreds of years of poor politics and economy, very real corruption, and the generally less-than-ideal motivation of the people you wish to serve. At times, it looks impossible, and those are the moments where I am very honestly discouraged and disheartened.
Well, I hope this post wasn't too depressing, but these are the things that honestly run through my head during the hot Ibulanku afternoons and the candlelit nights on our front porch...
Until next time,
jonah
All in all, the experience was an eye-opening one, and gave me a good idea of common doctor-patient, doctor-nurse interaction, none of which would fly if I were to try their methods in my clinical rotations. There was little explanations given to patients or parents of patients, they were jerked around like ragdolls, and the staff seemed to have almost a contempt for many of them. Keeping in mind this is only one experience at one hospital, it was nevertheless a disturbing and discouraging one.
Unfortunately, discouragement has been a large part of my experience here. I am here to learn. I am here to experience. I am here for the selfish reasons of wanting to feel like I am doing something good in the world. I am here to take in every foreign moment and process it and use it to make decisions about what I want to do with my life and the opportunities I have. I came in a month ago full of enthusiasm about what I hoped to accomplish and what I hoped this trip would be, and have seen that die down every day. Part of it is no doubt due to the frustration of a slow-moving, ill-defined project. But the part of it that worries me, and the part I've spent a long time turning over and over again in my head and in conversation with people here, is more a collision of passion with perception. The perception with which I am struggling is the lack of Ugandans who are truly invested in bettering their own situation. At least in the rural area where I am, there seems to be little push towards any sort of development, be it better education, better healthcare, or simply better quality of life. Don't get me wrong, I am the last person who would impose on all people a Western way of life, complete with Levi's, new cars, and air conditioning. But when lack of family planning leads to malnutrition, when you are guaranteed to have at least one of your children die before the age of 12, when you are paying what little money you have for malaria medications that the rest of world knows is ineffective, where is the desire to see these things changed? No doubt there are those who have tried, and been unsuccessful, which doesn't encourage others to spend their own time and energy to correct societal ills. But still, it is a revolutionary spirit, a passion for a better life that moves past those failures and pushes until change occurs. I have yet to see that here, from anyone. The healthcare workers I spend my days with are here because it is a job, and many who are working in the village are here only until they can get a better job at a government hospital. The doctors I've talked to seem to do this less for humanitarian reasons and more for status and salary.
All of this then begs the question: why should I give up the posh life that a physician's income and status in the US could give me in order to come to a place like Ibulanku and try to help a community whose concept of helping themselves is getting as far away as they can. For many, the answer IS money. The concept is that cash, perceived to be abundant among us foreign whites, will solve their problems - be it school fees, new clothing, or a purchasing a cell phone. Also common is the request to help them immigrate to the US: buy them a plane ticket, write them a letter of invitation, find them a job. It's an odd carousel, where people with big ideas for a poverty-stricken community pay their way into a country where a majority of the community they have arrived to assist are doing their damndest to work their way out, preferably using the money the expatriates bring with them. It's what I see here in this clinic on daily basis, from the highest level of local management to the lowest of nursing assistants, and it's frustrating.
I don't yet have the answer. I maintain that every humanitarian effort has some degree of selfishness involved, and I think that it's a big challenge to get past that and theoretically, be selfless in one's donation of time and energy into a project or community. It's a daunting task to be an individual up against hundreds of years of poor politics and economy, very real corruption, and the generally less-than-ideal motivation of the people you wish to serve. At times, it looks impossible, and those are the moments where I am very honestly discouraged and disheartened.
Well, I hope this post wasn't too depressing, but these are the things that honestly run through my head during the hot Ibulanku afternoons and the candlelit nights on our front porch...
Until next time,
jonah