East Africa Health and Human Rights Leadership Institute
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.
When you use the phrase “labor shortage” or “talent shortage” you’re speaking in a sentence fragment. What you actually have to say is: “There is a labor shortage at the low salary level I’m willing to pay.” That statement is the correct phrase; the complete sentence, the intellectually honest statement. If you raise your wages and improve working conditions enough, you’ll have people lining up around the block to work for you even if you need to have huge piles of steaming manure hand-scooped on a blazing summer afternoon.
[...] Monday, Justin spoke to the rest of us about his work in Uganda over lunch. I gained a deeper understanding of the TB-drug shortage and inadequate media and public [...]
Tina, thank you for your comment. It is certainly true that there is a “labor shortage at the low salary I’m willing to pay” if we are looking at the government as the payor in the public sector as it is here in Uganda. While the private sector offers additional wages, it still may not be enough to encourage retention of health care workers given the current statistics of “brain drain” in Uganda. The issue has additional nuances.
“Health care worker shortage” as a bullet point listed above also refers to health worker training in addition to salary. That is, there is a shortage also because more health workers need to be trained to meet the country’s needs, even if all stayed. Additionally, many health professionals have expressed a desire for systematic continuing medical education and protections (e.g., adequate equipment to take care of patients, safe working conditions, etc.). These issues also relate to the labor shortage beyond supply-and-demand economics of payment as incentivization to stay in one’s “source country” as the parlance goes.
The March issue of the American Journal of Bioethics debates the ethical dimensions of describing the “brain drain” and may be of interest to you and other readers. The language used to describe the “brain drain” is debated there. You can read it at: http://www.bioethics.net/journal/index.php?jid=55. Additionally, PHR has a number of reports and recommended steps forward on the “brain drain”/health care worker shortage. Whatever we call it, patients often suffer where health professionals are few.
[...] travel to Uganda with a group of PHR leaders and other students. We’re here to be part of the East African Health and Human Rights Conference, which is going to bring together health professional students from all over East [...]