Ugandan Perspectives

"I have heard that in the US there is a machine for which you just push a button, and you get a drink of clean water without paying. Is this true?"

From January through July 2005, I served as an honorary lecturer and Fulbright scholar at Makerere University in Kampala, Uganda. My goals were to teach and assist development of Family Medicine, and to live in a developing country with my daughter Heather, age 20 and son Isaac, age 15. I wanted the children to experience life in a developing country while they were still young, and to appreciate how privileged we are in the United States.

My husband Bob and I had lived in Kasangati, Uganda with our three oldest children in 1986. With approval from Marc Hansen, MD, then residency director, support from the Minnesota International Health Volunteers, and a grant from the United States Agency for International Development, I served as the medical director of a rural health center and received elective credit for the University of Wisconsin Family Medicine residency. My charge was to train village health workers to improve child survival in a network of rural villages where nearly one child in four did not live to the age of 5.

Looking back nearly 20 years, I appreciate how my brief work in Kasangati changed the course of my professional career. In Uganda, I learned about the profound impact of "social determinants" of health; I saw how politics, economics, culture, education, poverty and geography impact health outcomes, and the relatively small impact of medical care in the context of extreme poverty and instability. I learned about the powerful potential of doctors as agents of social change in addition to their important roles as clinicians.

Work in Uganda nearly 20 years ago still affects the way I am a doctor in Belleville and Madison today. When I meet patients, I recall the importance of greeting, welcoming and joining the patient; sincere greeting puts the patient and me at ease and opens the door for long term trusting relationships. When I care for patients, I recall that they are rarely alone; the patient is a part of a rich network of family, clan and tribe that impact the patient's health and illness. As I conduct the patient's history and physical exam, I appreciate that this is where the most valuable information is gathered; laboratory tests and other diagnostic evaluations only supplement vital information gathered from the patient and family. When I prescribe treatments, I tend to choose basic, low cost interventions unless there is clear evidence that more costly alternatives offer clear benefits.

When the opportunity arose, I was delighted to return to Uganda. This year my work was focused on teaching at Makerere, a major African university, to strengthen the first program to train family doctors in East Africa. I could write volumes about the extraordinarily courageous and hard working doctors and nurses, students and staff, about the patients living and dying with HIV/AIDS, about the cholera outbreak in the adjacent neighborhood of Katanga, about debates at the Ministry of Health, hilarious cross cultural misunderstandings, and about our gorilla trek, safari adventures, visiting monkey and leaping lion.

Many brilliant and experienced local colleagues generously contributed to support my efforts. Together we established plans to train family physicians to deliver comprehensive, high quality health care tailored to the conditions and needs of individuals, families and communities throughout Uganda and East Africa. I am very grateful to my colleagues in Belleville, the Department of Family Medicine and the Global Health Program who supported me and cared for my patients and projects while I was on leave.

While I have returned to Wisconsin, my international work has not ended. The UW Academic Planning Committee approved the new UW Madison Center for Global Health in September (see www.pophealth.wisc.edu/ghp). I'm fortunate to serve as the first director and work with a steering committee of extraordinary faculty and staff to coordinate global health activities on campus. Our mission is to promote global health education, research and partnerships. We look forward working with and supporting others who share these interests.

Yes, we do have fountains in the US where you can push a button and drink clean, cool water. Realizing that access to clean water is a luxury for millions reframes my own life. Initially I went to Uganda to teach; I returned with new perspectives and skills and a deeper appreciation for my life in Wisconsin.