The Uncertainty of Medicine

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Melvin Philip, M.D., medical resident at the Greater Danbury Community Health Center Internal Medicine Residency Program

Naggalama has become my “home away from home.” A small community hospital run by Sister Jane, St. Francis Hospital caters to the underprivileged villages of Naggalama and is contained within a small Christian community consisting of a primary and secondary school, a nursery, a church, and housing for hospital staff. The medical director, Dr. Otim, has been our guide and resource in introducing us to the art of medicine in Uganda. The faculty have welcomed us with open arms.

I am becoming increasingly aware of the privilege of easy access to lab work, imaging, and an array of pharmaceutical drugs that we have in the United States. Here, the basic tools of medicine and a complete history and physical exam are sometimes the only means with which to determine a diagnosis. I find myself fine-tuning the skills I learned in medical school and relying on clinical judgement to treat patients. I have learned that trending complete blood counts and basic metabolic panels on a daily basis is just not feasible here. For the first time in my career I find myself stepping back and asking questions such as, can the family afford this lab or imaging study, and does the hospital have the resources to obtain the labs or tests that I want?

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Dr. Philip with his wife and fellow global health elective participants at the Source of the Nile in Jinja, Uganda

I am also being reminded of the uncertainties in medicine, and learning that sometimes you have to be comfortable not knowing the exact diagnosis. This fact tortures the curious scientist side of me but reinforces and makes me appreciate the uncertainty of medicine present not only in Uganda but in America as well. I am gaining appreciation for the lost art of the physical exam, finding deficiencies in my own clinical skills, and sharing this knowledge with medical students.

From a cultural perspective, we have been warmly welcomed into the communities in which we have stayed. From playing soccer with the locals to lunching with hospital staff, I have felt accepted by the community. I am learning about the “elasticity” of time in Uganda, where a start time is just a suggestion and not a fixed entity that has to be followed. I am witnessing how genuinely kind and loving Ugandans are, and learning that being called Muzungu, a Luganda word meaning “a person of foreign descent,” is a means of welcoming rather than segregating. Everyone has gone out of their way to make Uganda a home for us. As I near the end of my trip, I feel increasingly at home and hope to return in the near future to rekindle the many friendships I have made.

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