PHR Student Blog

On Tuesday, after a bumpy four hour drive along the countryside, we arrived in the Lyantonde District Hospital. Lyantonde is a small, rural district of 74,000 people, about 200 km from Kampala. Dr. Obbo, the Medical Superintendent, was one of two doctors at the hospital, which serves about 250 people a day. Two other doctors were supposed to be on staff, but they have been on “study leave” for years. There are five Clinical Officers, which include midwives and locally trained nurses, that also work at the hospital. Dr. Obbo has often tried to fill vacancies for health care professionals, particularly positions for a surgeon and an ob/gyn, but has received no applications each time. Retaining staff is also particularly difficult.

Most of the residents of the district are either subsistence farmers or cattle ranchers. Malaria is the number one cause of death. Lyantonde also has a particularly high rate of HIV/AIDS. It is located on the transport corridor between Kenya, Uganda and the Democratic Republic of Congo, where the trucking industry has attracted many commercial sex workers. The District Hospital has been a pioneer in the region, working to reduce stigma and barriers to testing and treatment for HIV against all people, including commercial sex workers.

When funding and resources were more available, two community health workers would visit the local bars one night weekly, providing sex workers there with testing, counseling and condoms and treatment for HIV and other STIs. The health workers had reached and monitored 268 sex workers in five months. More recently, resources have been limited, and the weekly trips to provide health information and support for some of the most stigmatized women in the community has come to a halt. The hospital is hoping to revive the program soon.

Dr. Obbo also spoke about widespread domestic violence in the community. He described treating an average of one woman per week that had been battered by her significant other. Domestic violence is not taken as seriously as it should in these communities. The police infrastructure does not provide protection, and women are often coerced by family or socioeconomic pressures to return to men that abuse them. Dr. Obbo’s own sister had been abused by her husband and returned to him. He and I both hope to see more community engagement and advocacy for a reduction in these crimes against women.

(For more about the trip to Lyantonde Hosptial, see Neil Chawla’s post on Health Rights Advocate.)

Hello from Kampala!

My name is Neil, and I am a second-year medical student at the Keck School of Medicine. I have been incredibly lucky to have the chance to 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 Africa—Uganda, Burundi, Rwanda and Kenya. The issues that students face here are vastly different from the ones we face in the US, but the strategies we can employ to make changes are similar. The goal is to share experiences and make new friends whom we can help and support as we continue in our careers.

We touched down in Kampala on Sunday night. The cab driver took us straight to the guest house we are staying at, and we pretty much just passed out. Getting to Africa is not a short journey by any means!

Monday was a whirlwind tour of the city. We started by walking down to the main road and soliciting a ‘matatu,’ which is basically a minivan which functions as a public bus. There are hundreds of matatus buzzing around the city constantly but each one will try to charge you a different amount. Haggling for prices seems to be part of life here, as I soon found as we entered the main market of the town. Fruits, vegetables, spices, lentils, animals, all squeezed closely together with almost no room to walk, and people everywhere made this market hard to navigate but exciting to explore.

The city is overwhelming, especially for foreigners. The city is dense with people, and the streets are filled with cars, vans, motorcycles and bikes moving in a sort of organized chaos. It is a surprise to me that more people aren’t hurt in the traffic, but I think that being able to navigate the roads as a pedestrian or hail down a matatu is definitely a rite of passage here.

Later that day, we met with a couple medical students from Makerere University, which is one of the largest and most prestigious universities on the continent. The students here have formed a group called Students for Equity in Healthcare (SEHC) (PDF), which is similar to PHR in the US. We got a tour of Mulago Hospital where they do their rotations, as well as their medical school. It was simply amazing to see so many highly motivated medical students who are doing such positive things in their country.

The medical school itself is quite large, but is also very old and not up to standards that we hold as the norm back at home. Can you imagine preparing your own microbiology slides and studying Biochemistry from donated books published in the 1950s? Would you be able to survive in medical school without a laptop or easy access to the internet? Many of us might have shied away had we been required to study in an environment such as this; I know I certainly would have thought twice. But that is where the difference is; I didn’t realize how privileged I am until I came here and saw how hard these students work.

Worse still, graduating students here are not guaranteed good jobs or decent pay. It is not uncommon to find trained health professionals selling vanilla beans in the market because they can make more money that way. Even though I don’t know the SEHC students very well yet, I already have an immense amount of respect for them. They chose this profession out of such genuine commitment to health as a human right and out of desire to protect that right no matter how difficult it might be.

The rest of our week promises to be quite eventful. On Tuesday we are going out to the rural Lyantonde district to visit a healthcare facility that uses a community-based approach. On Wednesday we will meet with officials from the Ministry of Health as well as some NGOs that are working on health equity and justice in Uganda. Thursday through Saturday will be the conference, which is what I am most excited for!

(Cross-posted on Health Rights Advocate)

Hey Everyone! My name is Mona Singh, and I’m a first year med student at Virginia Commonwealth University School of Medicine, actively engaged in my school’s PHR chapter. As a student advocate for PHR’s Health Action AIDS Campaign, I am excited to be writing to you from Kampala, Uganda. I am here with two other American med student leaders for the East Africa Health and Human Rights Leadership Institute on April 2-4, 2009. The event is organized by Physicians for Human Rights and Action Group for Health, Human Rights and AIDS (AGHA).

Though I have spent time on the African continent before, this is my first time in Uganda. I arrived a few days early with three national PHR leaders, Neil Chawla, a second year medical student at USC, and Justin List, a med student from Loyola currently living and researching TB in Kampala. We wanted to visit some rural and urban sites in Uganda and gain a better sense of the unique health and sociopolitical issues that affect the region. Seventy-five other medical and paramedical student leaders from schools in Uganda, Burundi, Rwanda and Kenya will join us later this week for the conference. The Institute will serve to strengthen a community of health professional student advocates both regionally and internationally.

On 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 attention to the critical lack of available therapy.

After lunch, Nixon, a fifth year medical student and one of the founding members of the Students for Equity in Health Care (SEHC), and Herbert, a fourth year medical student and current president of SEHC, gave us a tour of Mulago Hospital, Uganda’s largest hospital. Based in Kampala, it is the main National Referral Hospital. It has 1500 beds, and the emergency department sees about 100,000 patients a year.

Nixon took us to the maternity ward. Although the maternity ward has provisions for delivering ten babies a day, a startling 60 babies are delivered on an average day. There are also twenty private rooms available for mothers that can afford the 40,000 shillings per night rate, a hefty sum for a nation with 9.5 million people living on less than a dollar a day. On a given day, there are usually five to ten empty private rooms, but when beds have not been available in the public rooms, some mothers have given birth on the floor.

Nixon and Herbert also took us on a tour of the medical school. The visit was a particularly sobering experience. The medical students lack some of the most basic supplies that my peers and I take for granted in the US. Their curriculum is 100% problem-based learning, and they do not receive syllabi. The students are expected to research and learn the material on their own. Textbooks are too expensive to buy, and the vast majority of students do not own a computer. The students do not have access to PubMed or journal articles. They study at the library, learning from the few, mostly donated books that are available on reserve. Most of the books at the library are drastically outdated, gathering dust from the early 20th century.

I walk away from the day with a lot of perspective and gratitude for my medical education system. I am in awe of these students. I also hope to learn more about ways in which students in the US and East Africa can work together to address the needs of these students. Since the medical class of 100 has a ratio of about 2 males to 1 female, I’m also hoping to meet some of the female medical student leaders at the conference to gain a better understanding of the unique challenges women in medicine face in East Africa and how they compare to issues we face in the US.

I know that a week here will not be enough time to fully understand health, human rights, and the medical education system in East Africa, but my time here will provide invaluable insight on health care justice and advocacy locally and globally. I’m excited for the upcoming week.

(Cross-posted on Health Rights Advocate.)

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.