Student Reflection from the Field: Elizabeth Bernard in Uganda

It is difficult to begin to describe how truly wonderful my trip to Uganda was. As I sit to write this reflection, I am still in amazement that I was able to have this experience, see the sites and patients that I saw, and meet so many magnificent people. It provided more educational and personal growth than I could have ever imagined. I met so many remarkable people along the way, including the clinic team that I worked with. I feel so lucky to have traveled and worked with this group of people. Everyone was positive, caring, hardworking, and willing to do whatever was needed. Even after long, tiring days, I never heard any negativity or disputes.

I also gained a great appreciation for Palmetto Medical Initiative (PMI). PMI is a fantastic organization to travel with and is doing great things for sustainable medicine in Uganda. They initially established the Masindi Katara Medical Center a few years ago, which is now a full-time, Uganda-run hospital that houses inpatient, outpatient, and maternity wards, as well as a laboratory and a pharmacy. Having the medical center there hugely impacts the community and allows the Ugandan people to receive quality medical care at a fraction of the cost of the other hospitals in the area. We were able to refer patients to this medical center when they needed extended care or greater resources than we had at the remote clinics. This was a huge benefit to the care that we provided because we knew that there was a place for our patients to go when additional care was needed.

Our team saw several hundred patients at three different clinic sites over the course of one week. There were a variety of diagnoses that came through and many different treatments that were needed. However, one thing remained among the patients- they were kind-hearted and very appreciative. I was able to spend one day working in the pharmacy and observe the other areas of the clinic throughout the week, but most of my time was spent in the therapy room. In the therapy room, we performed wound care, taught therapeutic exercises, provided wheelchairs and other assistive devices, made seats for babies, and gave out many pairs of shoes.

One patient that the therapy team was able to give a wheelchair to was a young man with polio. He arrived to the clinic in a wheelchair that he had been using for the past ten years. He had received this chair as a child and then adapted it over the years to accommodate his growth. This chair had no seat back or front wheels and the seat bottom was made of a woven net. He used incredibly impressive techniques just to be able to maneuver his chair. The new wheelchair that he left with was specifically designed for rough terrain so it was perfect for the challenging Ugandan environment. We also saw numerous patients with low back pain. Before departing for Uganda, one of my teammates and I made handouts that instructed in proper body mechanics for different activities of daily living and various exercises to help lessen low back pain. Most of the patients were farmers so we instructed them in proper body mechanics during farming. We then demonstrated exercises that they could perform at home to further alleviate their pain. We provided handouts that displayed proper body mechanics and how to perform the exercises. Sometimes we would have several patients at once that had similar back pain problems. In such cases, we would hold a group therapy session to instruct multiple patients at once on proper farming mechanics and helpful exercises to perform. Patients seemed to enjoy being with others that had similar diagnoses and being able to learn the exercises in a group setting.

The therapy room also saw babies that had developmental delays, which often hindered them from sitting upright. Using whatever supplies we had, we would construct seats for these children that would provide support and allow them a way to sit up. My team and I were able to take the lead in constructing one of these chairs for a 15-month-old child with cerebral palsy. We used foam for the base and cut out a hole for the baby to rest in. We added a lap belt to help hold the baby in and a tray table to provide a surface for the baby to play and eat. The baby seemed very pleased to be able to sit and look around. The mother was extremely grateful and so happy to have a way for her baby to sit. The trip was filled with learning opportunities, one of which was communicating via a translator. Working with translators presented both challenges and rewards to the clinical setting. However, even with the challenges, it became a great way to get to know the people of Uganda. We would usually work with one or two translators over the course of the day and by the end, you felt like you had made a new friend. These kind people gave up their days to help us in the clinic. By working with translators, I learned the importance of communicating clearly and using non-medical terminology. It also challenged my clinical reasoning skills because there were certain words that could not actually be translated so we would have to come up with other ways to convey our messages, such as re-phrasing or demonstrating what we wished to say. I feel that I now have the skills necessary to be able to effectively utilize a translator in a clinical setting.

These are just a few examples of the countless stories and memories that I have gained and will forever cherish. I am so thankful to have had this incredible opportunity. Uganda is a beautiful place with beautiful people. I have thought about the patients that we treated every day since we returned, and I know they’ll remain on my mind for years to come. I’m so grateful to have these memories to serve as constant reminders for the rewards of this profession. I really appreciate the MUSC Center for Global Health for this travel grant and for giving me the opportunity of a lifetime.