By justin-list (Friday, Mar 27, 2009)
Greetings from Kampala, Uganda!
This is Justin List, and I am a former PHR-chapter president at Loyola University’s Stritch School of Medicine. Currently, I live in Kampala where I am completing a NIH/Fogarty International Clinical Research Scholarship in between my third and fourth years of medical school. I work on a tuberculosis (TB) active case-finding study and analyze data looking at TB and alcohol use. You can read more about my research year on my blog HealingNumenor.
Being a US student in Uganda provides a new perspective on global health disparities. In my research position, I do not have typical clinical responsibilities, and our research-funded clinic provides care with a pace and efficiency different from that in the public facilities on the larger Mulago Hospital campus. But over the past 8 months, the stories of my American medical student colleagues, exposing the stark contrasts between academic US hospitals and the main hospital, never cease to remind me of the work to be done here. There is a great article about Mulago Hospital from an American perspective in a back issue of Yale Medicine.
Based on my own experience and on what I’ve heard from Ugandan/expatriate physicians and students, these are some of the barriers to ideal clinical care:
- health care worker shortage
- hierarchical inefficiencies
- lack of resources
- under-funded public healthcare structure
- patronage affecting the rapidity of patient care in some situations
- stock-outs of essential medicines.
Poverty and a public health sector needing improved coordination compound all these issues. (About one-third of Ugandans live on less than $1 per day.) Patients often die preventable deaths. Not every story ends poorly or sadly, but the number of stories that do has deeply affected me and continues to challenge me to actively become involved and respond constructively.
In addition to my research projects, my participation on the steering committee for the upcoming East African Health and Human Rights Leadership Institute in Kampala, and my independent writing on systemic health care issues affecting Ugandans, have given me additional ways to apply skills I originally developed as a PHR member and US medical student. Additionally, PHR and its partner in Uganda, the Action Group for Health, Human Rights, and HIV/AIDS (AGHA), have empowered Ugandan medical students and me to become involved. Currently, I am engaged in (and inspired by) a recently launched Ugandan civil society movement to end stock-outs of essential medicines. AGHA and PHR were the reasons I could publicize this issue with anti-TB drugs in particular. As a US student, I am thankful to join in solidarity with local health and human rights advocates in addressing these and other pressing health issues.
The East African Health and Human Rights Leadership Institute will strengthen a health professional student network for the next generation of health and human rights advocates in this region. Students will learn how to better identify, organize around and respond to human rights issues affecting health in our respective countries. Strengthening an East African network so students know how to get support from local civil society organizations and others will help students and health professionals when they feel nervous or threatened in speaking out. While one person can make a difference, strength in numbers provides security and support and possibly earlier identification of concerns. Additionally, we will have the excellent opportunity to learn about similarities and differences among student struggles for health and human rights in our respective countries. The Ugandan medical students and I are extremely excited for the conference to come here to Kampala!
Justin List is on the steering committee for PHR’s first East African Student Health and Human Rights Leadership Institute being held in Kampala Uganda, April 2-4. Justin, Pete Witzler and 2 other US students will be blogging about their experiences with the conference starting next week here.