It’s circumcision season here in Mbale. We occasionally approach celebratory processions of men and children of all ages pumping handheld tree branches in the air, trotting to the beat of chants and drums along the roads just outside of town. The 18 year-old of honor is in the middle of the parade covered in mud, on the way to his public transition into manhood. If he flinches or falls to the ground it will be the subject of gossip for years to come. The circumcisions occur in eastern Uganda during every even year, but two weeks ago was a ceremonial day marking a spike in the procedure, following a month-long festival at the cultural grounds. A local colleague described it: “If all year was the regular season, this month is the Champions League.” Our minivan matatu crawls slowly, splitting through the middle of the groups that continue uninterrupted around us like a school of fish.
How did I get here?
Multiple short-term stints in a health center in Kenya, a diploma course in tropical medicine and hygiene, and a four-month job teaching in a new postgraduate residency (MMed) program in central Kenya have all been strides on my persistent search for where my professional experience and academic interests meet a need.
Fortunately, during my Masters in Public Health a professor pointed me towards Seed Global Health. Seed, founded by Dr. Vanessa Kerry, sparked the Global Health Service Partnership (GHSP). This is a new public-private partnership with the United States Peace Corps and the President’s Emergency Plan for AIDS Relief (PEPFAR), a groundbreaking US governmental program put into place by President George W. Bush and reauthorized by President Obama which now funds half of all HIV/AIDS testing and care around the world. The GHSP places physicians, nurses, and midwives in faculty posts at 29 different universities alongside local lecturer peers to help train the future health workers of Uganda, Tanzania, Malawi and now Swaziland and Liberia, for one academic year. There were roughly 30 GHSP volunteers sent in each of the first three cohorts and there are 59 new volunteers serving in this fourth iteration.
In my struggles to stomach the inequalities of access to basic necessities that promote health in areas of extreme poverty, the seemingly simple answer of how I, a Family Medicine physician, could contribute to the solution has proved more challenging than expected. Considering my skills and experience thus far, what is the proper way to have a sustainable impact?
Enter GHSP. Instead of delivering healthcare, GHSP health workers, upon request from the host government and university, are partnering with faculty to assist the public systems in teaching, and thus scaling up, their future human resources for health (HRH). There are numerous non-governmental organizations (NGOs) working on many critical projects in low-resource areas, some better coordinated with like-minded NGOs and host country priorities than others. GHSP is inherently aligned with US governmental positions and initiatives, augmented by the conferred experience and reputation (largely positive) of the Peace Corps. Financial stressors born mostly from the burden of educational debt are a reality for young American health workers, and thus one of Seed’s major yet simple innovations is to essentially remove this barrier through generous loan forgiveness during each year of service. Given my policy interest, this opportunity could not be a better fit.
What am I doing here?
School started as scheduled this week at Busitema University’s Faculty of Health Sciences despite the nearly three-week non-teaching staff strike affecting all public universities in Uganda. This is the fourth year of the medical school’s existence and thus the first year (first week!) we have students on clinical rotations at Mbale Regional Referral Hospital, one of 14 regional hospitals in Uganda. Within the Internal Medicine department, we have started with 13 students on a five-week rotation, and we have been working on taking a patient history and basic physical exam skills. Our first week has been busy with some bedside teaching, a few board room tutorials, a discussion regarding tuberculosis after a visit to TB clinic, and an end-of-week practical assessment of their general exam skills.
On Tuesday a group of four students and I saw an end-stage AIDS patient who had recently fled South Sudan to stay with her family here in town. Her brother at her bedside claimed she did not know of her HIV diagnosis. The students and I adjourned to the board room for a lively ethical debate first on if she truly was unaware of her diagnosis and secondly the “if” and “how” of communicating to her the true diagnosis given her anticipated limited life expectancy.
Why am I here?
Day 1 of orientation in Washington, DC, ended with happy hour on the Washington Harbour waterfront. I was privileged to meet Aaron Williams, the most recent former Director of the Peace Corps and current Seed board member, who originally worked with Dr. Kerry to establish the GHSP. He told me that creating the GHSP was one of the most significant accomplishments of his career, right up there with working with Nelson Mandela.
Day 2 of orientation ended with Dr. Kerry closing our day at 4:45 p.m. “You are totally free to leave, but if you can hang out about 20 more minutes, Dad wants to stop by.” The surprise visit by our Secretary of State John Kerry complete with an informal 10-minute speech on the history of the Peace Corps, the legislation that gave birth to PEPFAR, and the health implications of diplomacy, to a room of about 75 left us in awe. To motivate our year ahead, he left us with a quote from Nelson Mandela: “It always seems impossible until it’s done.”
In 2014 I visited Robben Island where Mandela was held captive for 17 years, where our group was led through the maximum security prison by a tour guide who was himself a former political prisoner there in the 1980s. On my way out, I bought a postcard that I displayed on my bathroom mirror throughout 2015 as a reminder of the goal ahead. The card quoted Nelson Mandela: “Overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life.”
The reinforcing guideposts featuring Nelson Mandela have provided powerful reassurance that this new step on the Path is right and quickly feeling familiar.
One thought on “Why We’re Here”
Really interesting, and a great combination of descriptive and explanatory/more technical writing. The ethical debates you mentioned are of great interest to me, and peoples’ underlying motivations and existential perspectives really come through, even within the medical paradigm. I observed similar discussions working in roving medical clinics among Haitians in rural Dominican Republic – there is tremendous pressure, and when you’re an outsider (and you always are, no matter how long you’ve resided somewhere), it’s difficult to know what action to take. And that’s an individual process, not to mention group-think! Great post, would love to read more about those ethical challenges in your work. Best wishes!