Resident Reflection from Masindi, Uganda: Nima Golchin

When the opportunity came up to travel to Uganda for this rotation, I knew that I had to do what was necessary to go. I found the idea of traveling to Africa intriguing – I have traveled extensively, but I had yet to travel to anywhere in Africa. One hears about the challenges of healthcare in developing countries and I knew that I had to see and feel those differences first hand to be able to say that I had a true, organic understanding of them. There are not many opportunities for global experiences in radiology and it was exciting to be able to have this global experience while continuing to build the breadth and depth of my work in radiology. In short, this trip fulfilled my desire to travel, to appreciate the complexities of medicine in a developing country and the challenges of global health, and to continue to care for people through my work.

Arriving in Uganda, I found myself completely overwhelmed - complete sensory overload. The sounds, the smells – Africa is a challenge to take in all at once. The first few days in the clinic I was completely struck by how skilled and adept the medical staff of the clinic were at their work. The clinicians were excellent in every way that they could be excellent. As I spent time there, it was obvious that their limitations were in resources and time and not at all in their compassion and skill in medicine. Dr. Godson and the radiology technologist Samuel regularly stayed at the clinic for hours into the evening, sacrificing their personal time without question or complaint. While I had heard about how good the Masindi clinic was in comparison to other healthcare in Uganda, I was also surprised with just how at home I felt there. Every single person I met there was kind and cared about me – about how I was adjusting, how I was navigating the environment, and especially how I was faring when I was sick (pro tip – don’t eat the moist cabbage!). Their kindness was real and honest, and I was grateful for that kindness so far away from my real home.

As my experience developed, the challenges of practicing medicine in Uganda became apparent. The lack of resources was particularly noticeable to me during procedures. I am used to having all of the equipment and materials set up and right where I need them during a procedure. In Masindi, I was asked to do several joint aspirations and I had to scramble to try to get everything together – to make sure I had the correct medications and supplies on hand, and even to keep everything sterile as I worked. It simply was not within the capacity of the clinic to have dedicated staff and supplies to run procedures the way I was used to. The procedures happened and had good outcomes but it gave me a new appreciation for how much I take for granted in how much support I get during procedures.

As physicians, we learn through our patients and I was fortunate to have several very impactful patient experiences during my time in Masindi. These cases were challenging both clinically and personally. One of the most interesting patients I cared for was a pregnant woman who presented to the clinic with an advanced pregnancy. She was a Sudanese refugee and she had not received any prenatal care prior to her visit to One World Health. Her ultrasound revealed a non-viable pregnancy. Although I have delivered difficult news to patients many times, I found myself nervous about how to tell this young woman that she did not have a viable pregnancy. Although she spoke English, there were obvious communication and cultural differences between us. As I told her what was going on in her body, she did not move and barely looked at me. Even though I braced for the emotional reaction that I prepare for in these situations, it did not come from this woman. I realized that it was her way and her culture that was driving her reaction. It wasn’t until later when her family members approached me and offered some very significant gestures of thanks to me that I realized just how much it had meant to her and her family that I had delivered this news with respect and care.

The cases I saw there were things that I have never had the occasion to see in the US – anencephaly, pseudoarthrosis of the arm with no hope of regaining limb function, gunshot wounds from poachers – each of which were dramatic medical issues that engaged me in the stories of the patients. The first anencephaly case I diagnosed was clinically interesting, but when I learned her story – a long trip to the clinic by motorbike, no other prenatal care, needing to leave her other child with neighbors in order to obtain care, and then finally abandonment by her husband and family when they learned of the diagnosis due to their beliefs about the fetus – I realized the depth of the impact my care had for this woman because, despite all of those challenges, she came back to the clinic for care. The patients may have been in physical or emotional pain but their gratitude was real and palpable.

Perhaps the thing that impacted me the most was the experience of teaching the clinic staff. One of my initial goals for the experience had been to teach the clinicians how to do image-guided procedures – joint aspirations for example. I had shown them the technical steps of the procedures and had them help with a case where the patient experienced almost immediate relief of chronic shoulder pain from calcific tendonitis, and within a few days, the staff were doing these procedures on their own. It was so meaningful to me to know that I have provided clinic staff skills to help them grow as clinicians and to help patients that otherwise would not have had that chance for care.

Looking at the whole of the experience now I realize that people, regardless of where they are or what their situation is in life, have so much more in common than they have in difference. I could see the determination in the desire to live a better life, to take care of their family, and to seek medical care. The things that stand between my situation and theirs have far more to do with the random chance of birthplace than from anything organic within us as humans. In Uganda, you can see it happening right in front of your eyes – you can see their determination to live their lives and support their families, and that they do well for themselves despite things that might seem like insurmountable challenges. In the medical clinic, what those patients lacked in access to medications and machines, they made up for in the community. The family and friends that stayed with them by their beds, the people in the villages that treated and cared for them. More often than not the patients I see in the hospital in Charleston have a huge lack of community, social, and family support. The Ugandans are rich in a way we are not.

The biggest lesson I will carry forward with me is the realization that community is one of the most important things that people can cultivate in their lives. I found community there and I wasn't expecting to - in the patients, the staff of the clinic, and the other people I met along the way. I have brought many of these friendships home with me and I stay in touch with many of the people I met there. Samuel, the radiology technician at the clinic, has reached out to tell me that I am a mentor to him – a role that I am honored to have. I also remain in close contact with Dr. Godson, the primary Ugandan physician for the clinic, as he prepared for and has since been accepted to a U.S. residency program. I hope that my experience inspires others to immerse themselves in a place and to really challenge themselves to grow. I can now say that it is the experience of immersing yourself in the lives of others – patients, colleagues, communities – that brings the greatest meaning to my role as a physician.

As I reflect on my experiences in Uganda, I find myself feeling grateful and humbled for the things I was able to witness, the care I was able to provide, and the community I was able to find during my time there. The experience deeply moved me as both a physician and as a person; I am appreciative to have been given the opportunity.

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