Kampala, 12th January. After 11 intensive days in Uganda, the 3rd edition of the Global Surgery course of Karolinska Institute has come to an end. I will always be grateful for how the doctors, nurses, students and other staff at Mubende Regional Referral Hospital and Mulago National Referral Hospital, who welcomed us with open arms, who were always willing to share their impressive knowledge with us, and who always took their time to help and guide us in spite of busy schedules and difficult work.
15 Swedish medical students had this honour of learning more about healthcare in low resource settings, supported by a competent team of supervisors. We had prepared for this through a number of lectures and seminars during the autumn, but of course few things can substitute observing and experiencing events first hand. During these few days, we have seen a glimpse of some health system and health financing challenges, we have seen how unequal global distribution of resources can affect the individual patients, as well as some consequences of decisions and priorities made on an international level. It’s great to hear that antimalarials, TB drugs and antiretrovirals are readily available because they have been prioritized, subsidized, sponsored or similar, at the same time it’s heartbreaking to hear how many other things are lacking.
Open heart surgery (Fallots tetrad) at Mulago National Referral Hospital (Kampala)
We have seen patients lying in hospital beds without receiving lifesaving interventions although healthcare is free because they cannot afford to buy necessary supplies such as gloves, without receiving adequate pain medication because they are out of stock, without undergoing radiological examinations that we take for granted in Sweden because the devices are not available. And the doctor says that there is no evidence supporting their choice of treatment, because research has not been done on this population. I know this is everyday life for many health workers, but for us it was a new reality.
Pediatric surgery (pyloromyotomy) at Naguru General Hospital (Kampala)
We have seen doctors, who seem to know all about everything from general surgery and orthopaedics to infectious diseases and dermatology to obstetrics and paediatrics by heart, and who are doing an absolutely amazing job with the means that they have. We have met young women with life threatening complications after unsafe abortion procedures, children with severe malnutrition, and patients with enormous T4 tumours that could’ve been cured if only they had seen a doctor earlier.
Mubende District Local Government Office
We are constantly, and painfully, reminded of the global injustice and of our own privileges, both inside and outside of the hospital. And I keep thinking that as long as the system is unfair, whatever we do will not feel completely right. We could donate items, but will that create dependency and negatively impact the local market? We could contribute with our time or our hands, but honestly is that what is lacking and what is needed? We could provide financial support, but how will that influence other actors and stakeholders, and is that really a long term solution? Maybe we just need to change the system – if fairness even exists. And suddenly, the importance of international collaboration and policy once again becomes clearer.
Mubende Regional Referral Hospital
Talking about being fair nevertheless, it’s maybe also fair that we’ve also met a bunch of patients with similar complaints as we would find in Sweden, and participated in procedures more or less identical to what we do at home – everything from anaesthesia to cystoscopy to heart surgery. We have many things in common, in spite of the differences between our countries. Furthermore, there is so much potential to increase the availability, accessibility and quality of the healthcare with the right interventions – and with increased research as to ensure evidence based action. Most of us students would have loved to spend more time here, because we have so much left to learn. But then I’m thinking maybe it’s also good to leave with a feeling that you have not yet seen, done or learned enough; before you feel saturated, and with the hope of someday returning. I’m going home with new inspiration to become a better doctor, a better health advocate, and a better fellow human being.