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.
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| The view from my office. |
