This week both Janel and Sruthi arrived in Uganda, and Reiko and Ian left. I definitely enjoy having some classmates with me, even if they are working in different departments. It is great to hear about their experiences and have really thoughtful discussions about global health and the disparities that we see daily. I feel like most of our conversations center around how differently patient care is administered, and how skillful the physicians and nurses are here.
I find it interesting that some of the other foreign students here tend to focus on the differences in management of medical issues, like the Ugandan and European healthcare systems can be compared. Many of the ex-patriots who live in Kampala are working for NGOs or other organizations that focus on improving the Ugandan healthcare system. Listening to some of them talk about issues has really made me reconsider my role in global health along with the roles of anyone coming from a developed country to “help” Ugandans. I think some people who are here approach the Ugandan system like it is the same system they come from, but I think they fail to realize that a European system or an American system will not succeed in Uganda because it is not the system that Ugandans need. I hear the frustration in these people’s voices, but I don’t think they understand that the change for Uganda needs to come from Ugandans, and that we can just be here to help facilitate the change.
I realize that this is a hard concept for people to understand and of course I think I’ve only recently come to understand this notion. For example, I thought about bringing a Doppler ultrasound with me so I could measure fetal heart rates, and I figured I would leave the Doppler there for the department to use afterwards, but what I didn’t think about was the gel that needed for each use, or the waste produced in cleaning the gel off of the patient. Had I brought fetoscopes instead, there would be no gel and no waste. Fetoscopes are what Ugandan obstetricians use to listen to the fetal heart rate, and they work just as well and don’t need gel or batteries. In fact, I have seen old Doppler ultrasounds floating around the hospital, out of batteries, or broken and no longer of any use; that I am sure were brought by foreigners who thought Mulago needed some newer technology. But instead of helping, they have just left trash to accumulate in the admissions ward.
Many of the people here seem to be of the idea that what they are doing will and should have immediate effect, but they don’t realize that culture can’t change immediately and neither can a nation. The idea that white people, or really any person who isn’t Ugandan can come into this country and affect great change without the help of a large portion of the population is absurd. This process is slow, and will always be slow. It is a hard thing to understand when you see so many people suffering from a disease or condition that is easily curable in other countries and not feel as though something should change immediately. I think many people get bogged down in this and fail to see the amazing people working side by side with us in the hospital and see how much they do with so little.
It is so easy to only see the bad, and not notice the miracles that happen every day. It is hard to think that humans can survive the way we do, when you’re used to giving birth with epidurals and private rooms, and you’re put in a situation where people have never even heard of an epidural. I think a lot of people approach developing countries with the idea that they should have the same medical protocols as developed countries, but really this isn’t realistic and tends to make people uncomfortable when they see uncomfortable things abroad. I hope I never become immune to this uncomfortable feeling, but I do think I’ve been able to accept it with much more understanding of the underlying issues than most.