The six weeks I spent with physicians and clinical officers in Uganda were a lesson in the fundamentals of medicine. In Uganda, doctors do not enjoy the luxury of being able to order any lab test they may need. Imaging is often performed off-site and rarely returned with an interpretation. Medications are purchased only if the patient can afford them, and the two EKG machines I saw seen were donated by Danbury Hospital in Connecticut.
Doctors in Uganda must be exceptional at history taking and physical exams. They carry an encyclopedic knowledge of diseases and pharmacology in their heads, and they must have endless reserves of patience, creativity, and perseverance. Being in Uganda took me to the very heart of the practice of medicine.
Through observing their practice, I have realized that Ugandan medical professionals rarely have the resources to arrive at a concrete diagnosis. It is uncommon to know with certainty which pathogen or precise disease process is ailing a patient. What Western practitioners may take for granted, such as bacterial cultures or chest X-rays, pose a logistical challenge here and are thus not always considered a good use of resources. Doctors learn to trust their instincts, manage symptoms, and accept that they may not receive hard and fast answers about their patients. Out of necessity, they have learned to accept and be comfortable with uncertainty.
My most valuable lessons learned while in Uganda were about patient interaction. I watched physicians be a calming and reassuring figure to frightened patients and their families. I saw them sit amicably at the bedside and listen to a patient while holding their hand. I respect their advocacy for financially appropriate treatment plans when families cannot afford more. I have watched in amazement as they unflinchingly tend to horrific wounds and ulcers. I have observed their tireless patience and teamwork as they navigate the barriers of working in a country with more than forty recognized languages and a virtually non-existent medical records system.
I may not have learned as much textbook medicine as I had anticipated, but I certainly learned how to become a more skilled and complete physician. I will carry these lessons forward in my career and I will try not to allow the desire for a definitive diagnosis to cloud my recognition of the patient’s humanity.