Musawo= Healthcare Worker (Doctor, nurse, midwife, etc) in Lugandan
Being completely immersed in a culture that is completely different than your own brings its own set of challenges. Being completely immersed in a healthcare system that is completely different than your own brings a set of challenges that you never knew could exist.
Over the course of the past two weeks, I have started to take notes on differences and similarities between the healthcare systems in Uganda versus the United States. Although the majority of my interest lies at the comparison between Obstetric and Gynecological care between the two, I have also taken both mental and literal notes on the healthcare in general. At its surface, one may not think that the two countries have almost any similarities aside from caring for sick people, but that could not be farther from the truth.
The most obvious difference is the lack of resources. Although there are many places in the US where resources are extremely limited and there is profound need, it largely pales in comparison to the lack of resources experienced in Uganda. From things as simple as alcohol swabs, gloves, masks, surgical attire, basic surgical stools, fetal dopplers (had to throw in the OB), working blood pressure machines, hospital beds, hospital linens, working surgical beds—the list goes on and on, the resources for the most part are not there. This is not to say that all hope is lost because there is a great deal of amazing NGOs as well as local organizations, churches, individuals that have donated a large amount of money as well as supplies to help the health clinics and hospitals remain afloat. However, resources remain the most significant difference because even at some of our “worst rated” hospitals in the US, we have more resources available to us than most of the top-rated hospitals in Uganda.
Another significant difference is health insurance. Although it exists to an extent, the people who have some sort of health insurance, are easily in the minority. It is rarely talked about and people rarely mention having it because no one really does except for maybe the 1%. Additionally, there is no sort of Medicare or Medicaid for the elderly, impoverished, chronically ill or children. Everyone essentially pays out of pocket and if you can’t afford it, then you typically go without that service. This is something that truly breaks my heart and I do not think anything will ever change that. I have already seen multiple patients who have presented to our hospital for a specified reason but there is a graver diagnosis at hand, ie Malignancy (which has already been diagnosed), but they cannot afford the treatment, so we have to just treat the symptoms of their worsening malignancy. I will never be able to internally reconcile having to put a metaphorical band-aid on a hemorrhaging wound. In the US, although it is not ideal, our emergency department and trauma system acts as a safety net in many situations but there is no safety net for Ugandan healthcare.
There are more differences that I could discuss but what I was not prepared for was the numerous similarities. One of the most significant similarities is the shortage of physicians. According to an article in the Observer in 2017, the Uganda doctor: patient ratio was 1:25,725 and the WHO recommends a 1:1000 ratio. There is severe burden on physicians, and it is extremely common for physicians to see patients and/or perform surgeries at 2-4 hospitals during the course of the day, hospitals which might take 30min-2 hrs to get to. From a numbers standpoint the physician shortage in Uganda is much more severe, but the effect of the lack of physicians on the healthcare system and delivery of health care has a similar effect on the communities in both countries similarly.
Similar to the physician shortage, both the US and Uganda are currently struggling to switch from a primarily treatment-based healthcare model to a preventive medicine healthcare model. Each country faces a difference subset of obstacles in this venture, but the pervasive nature of treating disease rather than preventing disease is significant in both countries. This is most notably demonstrated in both cultures through the access to healthcare education and the presence of health literacy. I have found that in Uganda just as in the US, there is a tremendous amount of misinformation regarding diseases, diet, medication, vaccinations, and medications among other topics and this discourages many members of both communities to seek the correct information to improve their own health.
There are many more similarities to discuss but the most important to me is the care of the providers. Just like at home in the US, the majority (key word being majority) of physicians, midwives and nurses that I have come into contact with in Uganda care deeply about the health of their patients. They work long hours, they go above and beyond, and they take care of patients as if it were their own family member. Once they have exhausted their expertise, they seek out assistance and transfer if necessary, but they do not give up on their patients. This level of dedication, sacrifice, and possible burnout-inducing work ethic is at the core of both healthcare in Uganda and the US. I see providers that despite the limitations of access to health care insurance and money just want to heal their patients.
Some of these revelations should not have come of such a surprise to me but they were. As I plan to discuss more differences and similarities in the future, I will also plan to try and see what ways both countries are attempting to address their shortcomings and if there is any overlap between the two. But the sad truth is that the healthcare systems in both the US and Uganda are broken. The reasons and circumstances surrounding their brokenness have similarities and differences, but improvement is critically needed in both.
Picture 1: Gave my First health talk to new mothers!
Picture 2: A "medication" given to help improve Anemia
Picture 3: Fetascope! What we use to detect a fetal heart rate in pregnant mamas