Discovering the True Meaning of Social Medicine

5 minute read

For seven months I called Mbarara, Uganda my home. I say this not only because it is where I lived and worked, but also because it is where I was embraced by a community and a mission to an extent that I had never experienced before.

This was not my first exposure to the magic that is Africa. In my junior year of college, I spent six months studying and volunteering in Cape Town, South Africa. It was the most unbelievable experience of my adult life, so when I arranged for a gap year before medical school, I knew that I wanted to spend it in that region of the world doing health-related work. Thanks to InterExchange’s generous support, I was able to fulfill this dream.

My position in Uganda was as a Research Fellow for Massachusetts General Hospital’s (MGH) Global Primary Care Program (GPC). GPC is a sub-residency program within the Department of Medicine that emphasizes health equity in the U.S. and around the world. For a few weeks each year, medical residents rotate through a clinical site in Uganda, splitting their time between the in-patient wards at Mbarara University of Science and Technology (MUST) Hospital and the out-patient department at Bugoye Health Center (BHC). Bugoye, a rural village three hours northwest of Mbarara, is also where GPC co-runs a clinical research project with MUST’s Community Outreach Program. Called the Bugoye Integrated Community Case Management Initiative (BIMI), this project was an effort to give back to the community for offering its health center as a training site for GPC residents and MUST medical students.

I spent approximately 80% of my time in Uganda working on BIMI, a longitudinal study of the effects of Uganda’s Integrated Community Case Management (ICCM) on malaria, pneumonia, and diarrhea in children under five. These three illnesses are the leading causes of infant mortality in Uganda, and the Ugandan government has made it a priority to expand treatment beyond facility-based strategies via ICCM and the use of localized village health teams (VHTs). The MGH-MUST partnership provides the funding, training, and management in carrying out the ICCM program in Bugoye, which was conceptualized shortly before my arrival in mid-2012.

My first few months in Uganda involved a lot of troubleshooting. For those who have committed to capacity building in Africa, they are probably thoroughly familiar with the term “Africa time.” Our efforts moved very slowly due a more lax and protracted way of doing things. This modus operandi was only compounded by logistical complications, such as difficulties procuring the ICCM drugs in-country (drugs that were prescribed by Uganda’s Ministry of Health, nonetheless). So while the village health teams, made up of local volunteers, were trained and ready to go, we were unable to begin treatment and data collection.

In this interim, I took on BIMI’s on-site administrative tasks. I assumed primary responsibility for all aspects of the Institutional Review Board process - from the logistical aspects of annual renewal to keeping our entire team on top of the details of our protocol - and helped plan and execute the Bugoye VHT Community Sensitization Meetings, a necessary step before enacting the actual ICCM treatment process. I also used this opportunity to get involved in other aspects of MGH’s contributions to the resource-poor, developing community. At the Mbarara Regional Referral Hospital, I attended a pediatric HIV clinic, rounds on the Internal Medicine ward, surgeries in the operating theatre, and lectures by Ugandan professors to MUST medical school students. I joined the GPC residents in Bugoye and observed them treat the masses of patients at the Bugoye Health Center. I also worked closely with the Director of the MGH-MUST Research Collaboration to develop partnerships between MGH and MUST’s Pathology and Otolaryngology departments. These partnerships will include student exchanges, a one-year MGH fellowship at MUST, and telecommunication training courses.

By February 2013, we had finally procured our drugs and were ready to roll out ICCM. I worked closely with our partners at the BHC to develop standard operating procedures to help avoid stock-outs of necessary supplies and was the principal organizer of our initial drug acquisitions. I attended and assisted with VHT refresher training classes and helped to monitor and collect monthly activity reports. I independently researched different options for database development and designed the database for significant portions of the data that the project will be collecting for the next several years. I believe that our joint work with MUST and BHC will permanently change the quality and scope of treatment of malaria, pneumonia, and diarrhea in an entire district.

This summer I will be starting medical school at Yale School of Medicine, and I know that my experience in Uganda was invaluable in preparing me for this next stage of my career development. Firstly, Uganda and its people transformed me on a personal level: I learned to rely on myself for emotional strength in challenging situations and to learn from others, sometimes reaching over cross-cultural boundaries, in achieving a collective mission. I evolved professionally and was able to develop the skills and relationships necessary for driving sustainable projects in low resource, collaborative environments – tools which will serve as the foundation for my career in medicine and scientific research.

Lastly, I changed philosophically in understanding and appreciating what it means exactly to be a physician. Specifically, I learned the true meaning of social medicine, and its primary care and community health components. It means on a micro-level, connecting personally to treat patients and families, and on a macro-level, understanding the pathologies and socio-economic causes of diseases endemic to the local people. It means going the extra mile for your patients, (sometimes literally) as I did once with the GPC team, trekking through the Rwenzori Mountains to find and bring a deathly ill child to the local referral hospital. Perhaps most importantly, it means helping to empower local community members, such as the volunteer VHTs and BHC staff, to create lasting and effective health care systems.

I will be forever grateful to InterExchange Foundation for allowing me to reach these personal breakthroughs, meet the extraordinary individuals of Uganda, and explore East Africa. I could not have achieved my goals without the financial support and freedom granted to me through the Christianson Fellowship. I can only hope that I will have the privilege of continuing my work with the Ugandan community and the developing world as a medical student and one day, as a physician.