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After the Match

After the Match

Insights about EM in a Tiny Ugandan Town

Cook, Thomas MD

Author Information
doi: 10.1097/01.EEM.0000526866.61306.29
    global health
    global health:
    Dr. Cook on his recent trip to Uganda.

    In the jigsaw puzzle of nations that make up Sub-Saharan Africa lies a small, landlocked country to which I traveled on a sort of pilgrimage. Months of planning and 24 hours of flying landed me at Entebbe International Airport. With only two gates, the airport lies just south of the capital city of Kampala, a ridiculously cramped maze of asphalt and dirt roads with roaming livestock. Six more hours in a cramped van with 26 other Americans who knew nothing about each other took me to a remote area on the west side of the country.

    My 17-year-old daughter accompanied me on this journey. Courageous, beautiful, and wise beyond her years, she chose to go with me to work in Africa over getting a new car. This was a decision that I doubt I would make now, much less as a teenager.

    When we arrived in the small town of Masindi, we pried our bodies from the van, collected our gear, and headed to a cramped room in the back of a resort compound. Our accommodations consisted of two metal-framed beds with mosquito netting, five square feet of additional floor space, a bathroom with no hot water, and a toilet that required the tank to be reloaded with water before flushing. No luxuries, but it was exciting.

    Uganda is one of the 25 poorest nations in the world. It is the size of Oregon and home to 35 million people, many of whom are refugees from wars in nearby nations from the past two decades (e.g., Sudan and Rwanda). Its southern border sits on the equator, and the weather is perfect. Every day the high is 80°F, and the low at night is 72°F. English is the national language (a byproduct of British colonialism), but more than 100 local dialects are spoken. Everyone has body odor; they cannot afford deodorant. The flip side of this is that I never saw a Ugandan smoke. They simply do not have the money for it. The people are genuinely happy and friendly. They shake your hand vigorously with beaming smiles.

    Unique Insights

    There are no stoplights in Uganda. Every so-called highway is a two-lane road clogged with overloaded trucks and stripped gears that prevent them from exceeding 30 miles per hour. Your driver will scare you multiple times each day by passing these trucks into oncoming traffic on bad roads. Everyone has (or has had) malaria and schistosomiasis. (I did not even remember what schistosomiasis was before I started this trip.) During our week there, all my patients had chest pain, paralysis, or both, but I did not look at a single ECG or head CT.

    Why did I pay a lot of money and take time off from work to do this? I had my reasons, but another physician on the mission summarized some of them while speaking to our group over dinner one night: “I came here to get away from you.”

    ED patients in the United States have a talent for grinding the life out of us. As the saying goes, “Everyone talks about the weather, but no one does anything about it.” Are EPs doing the same thing by just pumping out more shifts without really thinking about what it is doing to them? The statistics are dismal. Our specialty is number one in burnout and illicit drug use. Add to this that doctors commit suicide at a rate well above that of the general population. Nonetheless, I receive more than 100 applications for every residency position our program offers each fall. On the surface, this does not make a lot of sense.

    I had four goals for my trip. I wanted to spend time with my daughter, a wonderful teenager pulling away from her parents a little bit more every day as she gets ready for college. I wanted to lead my residents by example. Our program is extraordinarily fortunate to have a great global health director. Over the past four years, 70 percent of our graduates have participated in trips to international locations, with Uganda being one of the most popular. I wanted to create personal bonds with great people who share a common vision for helping others. I also wanted to rethink my professional goals and figure out how global health fits into my future.

    Most readers may think they have no interest in this part of the world or anything to do with Uganda. But trust me, there are insights to be gained in this small, hard-to-find country that are not available in our current lives.

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