Gulu Trip 2015

shirley

Shirley Huang is a 4th Year Medical Student at the University of Manchester, which she joined after completing her undergraduate education at St Andrews. Shirley travelled to Gulu with a delegation of students from Manchester to deliver the Introduction to Clinical Learning Programme. This is a programme developed through the Manchester-Gulu University Link, facilitated by the Manchester Global Health Society. Whilst in Gulu Shirley also too part in the Northern Uganda Village Health Outreach Project.


 

A friend of mine recently taught me the German word “fernweh”, through there is no direct translation into English – it conveys an ache for distant places, the desire to leave one’s familiar surroundings and experience something far away from home. In some ways it can be said to be the opposite to homesickness. During my two week trip to Gulu, I was introduced to a world vastly different from ours and if I were to use one word to describe how I felt, it would be fernweh.

A group of us from The University of Manchester travelled to Uganda to assist our colleagues at Gulu Medical School in the running of their ICL Week. Our experience however extended far beyond medical endeavours. Gulu offered us the opportunity to meet, and get to know, the most incredible and generous people. It offered an insight into a post-conflict society that had overcome countless obstacles to establish itself as a resilient community full of vitality, culture and inspiration.

Ugandan Doctors

In Uganda, our colleagues are expected, as medical students, to clerk their own patients without senior supervision or review, a stark contrast to the roles and responsibilities expected of us here in the UK. At home, this would be deemed irresponsible and may even cause outrage. In Uganda, however, medical students are a vital resource.

Ugandan doctors’ ability to effectively treat is threatened not only by limited resources but also a very influential network of Witch ‘Doctors’ – these individuals, without any formal medical training, often pose as health professionals, spreading health-related misconceptions that are prominent in Ugandan society. Therefore, medical students, even with their limited training and experience, are necessary to the functioning of the Ugandan Healthcare System. Observing the interactions of our colleagues with each other, and with patients, it was evident that this requirement instils a deep sense of responsibility and high level of confidence early in their careers.

Ugandan Healthcare

At our first Outreach in Awoo, consultations took place in a small room consisting of two tables and an examination bed. We set up at a long table by the window and carried out rapid diagnostic tests for malaria while three consultations occurred at the same time beside us, contending for space with the doctor, a translator and children who would be found lying or sitting on the examination bed. Confidentiality, in a room with barely enough space to move, was a luxury. In fact, we often saw multiple generations of a family together.

Due to time constraints, and the number of patients needing attention, taking a full history was not possible. Even spending ten minutes with a patient, the average time allotted to a GP, was considered slow, and doctors would be asked to speed up if they decided to take an in-depth history or carry out a focused examination!

Supplies and resources at the outreach clinics were limited. Programme organisers would start off each day by handing team members with a list of medication they could prescribe. This presented numerous challenges and often meant we were unable to treat multiple conditions, let alone consider the most effective treatment for patients. When a girl with epilepsy presented, we were not able to do anything other than refer her to the regional hospital – knowing that referrals often weren’t effective alternative as most patients would not be able to travel so far nor afford to do so.

A lady we saw had two children who were going blind, although she had been referred by a colleague to the regional hospital for further investigation and surgery months earlier, she was unable to afford this. This meant that her children’s conditions deteriorated further and she had to wait a further five months before she was able to seek medical help. It is a harrowing feeling as a medical professional to recognise that a patient needs help, know what is possible, but be unable to do so due to circumstances outside of our control.

Often we ran out of medications by mid-afternoon, and had to tell the patients that we were unable to fill their prescriptions. On one occasion we ran out of analgesia and antibiotics, as well as multivitamins, anti-fungals, and Omeprazole, leaving us with only cardiac aspirin and malaria treatment for the rest of the day. This was incredibly frustrating and disappointing, especially when patients had waited for hours (in some cases the whole day) only to be told they couldn’t receive the treatment they required. Without money or resources of their own, they would have to remain unwell.

At the time, there had been an outbreak of Malaria so we would conduct RDTs for almost three out of four patients. Language barriers made obtaining proper consent difficult. Often, I had trouble simply establishing the patient’s identity and had to confirm this with the doctors or translators. This language barrier was especially challenging when conducting blood tests on children – I was unable to offer them reassurance or condolence. Many would start to cry as soon as I pricked their fingers, or draw away when they saw the needle as I was not able to tell them that it would only hurt a bit, and that it would be over before they knew it. It also meant I was not able to commend them on their bravery once it was done.

Each day was incredibly hectic and we faced many physical challenges but I was grateful to be able to participate in the program and do what little I can to help my patients. They were always incredibly trusting of the medical professionals, and so patient in waiting to be seen. Here in the UK, there seems to be constant debate around the inefficiency of the NHS and “long” waiting times; however, after seeing Ugandan patients wait a full day in a packed, stifled room, often with multiple children, our complaints about the NHS seem trivial. Despite the difficulties and frustrations of waiting in such conditions, the patients were always respectful and soft-spoken. No one complained – even those who did not get seen before we packed up for the day. It broke my heart to watch these patients sitting outside the Health Centre as our bus drove away.

Despite the challenges, it was touching to see the patients set up small markets to selling fruits, and maize, and share food with one another as they waited outside the Health Centres. There was a strong sense of community amongst the villagers, and it was incredible to witness how people who have so little were still so willing to share their possessions.

During my time in Gulu, many individuals I met shared deeply personal and moving accounts of their horrific experiences. Daily life in Northern Uganda was contextualised by war, trauma, and displacement from 1986 to 2006 – leaving a population dealing with a high prevalence psychological disorders, such as PTSD.

One lady recalled how she remained hidden in the bush for two whole weeks, too afraid to leave after an ambush in the street which killed her father, reemerging only to find bodies hanging from power lines. Another lady told me how she was forced to watch her husband’s arms and legs severed, and seven of her eight children murdered. Listening to these stories, I felt humbled by their courage, unfailing faith and kindness. Getting to know the people of Gulu was the best part of my trip – I am grateful for their openness and willingness to share incredibly difficult moments of their lives, helping us to understand their struggle.

Though I witnessed hardships and felt frustrated that I was not able to do more, it was the little things, and fleeting connections that made this a positive experience – like a child peeking through the window, exchanging a smile, wave or handshake as I worked.

Shirley Huang

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