John Bowman Reflection – Completing a Rotation in Uganda

John Bowman is an internal medicine and pediatrics resident at MUSC. He was awarded a Center for Global Health Student & Trainee Travel Grant in the spring of 2023 to pursue a project with OneWorld Health in Masindi, Uganda. View more photos of John's time in Uganda in this Flickr photo gallery.

I had the opportunity to complete a four-week rotation in Uganda in April 2023 by partnering with OneWorld Health. During my time in the country, I worked at Masindi-Kitara Medical Center (MKMC), a small rural hospital in central Uganda. MKMC is a private hospital sponsored by OneWorld Health, an international humanitarian organization based in Charleston.

Uganda has a free public hospital network for its population, although their hospitals are often overrun, understaffed, and frequently run out of necessary medications and supplies. OneWorld Health has opened MKMC and two other hospitals in the region to serve as a low-cost, high-quality alternative to the public hospital system. The medical center features an outpatient department with an attached emergency room, a radiology department with the ability to perform x-rays and ultrasounds, an inpatient ward, a mother-baby unit, two operating theaters, and a soon-to-open neonatology unit.

On any given day there will be about 10 to 20 patients admitted to the hospital including adults, children, and expectant mothers. Cases range from simple dehydration, trauma, respiratory infections to other diseases uncommon in the western world such as malaria, typhoid, yellow fever, tuberculosis, and organophosphate poisoning.

Days at MKMC begin at 7:30 a.m. with a morning devotional service led by a local pastor. Doctors, nurses, and hospital and administrative staff attend these morning meetings which often conclude important daily announcements. Hospital rounds begin at 8 a.m. The doctor on service will round on each admitted patient, perform any necessary surgeries, and help with any complex cases from clinic or the emergency room that require their expertise.

Central Uganda is characterized by a tropical and temperate climate, with bountiful rolling hills littered with mango and avocado trees. The largest local industry is farming, with many people living off their own land. Sugar cane is the cash crop and the factory is the largest employer in Masindi. Weather is separated into a rainy season and a dry season. With the rainy season comes more mosquitoes, which in turn brings more malaria.

In addition to my time spent at MKMC, I was able to join an outreach team one week. For this week, each day we drove to different areas in need to set up a clinic in a church or school. We brought with us bins of medications and medical supplies and were joined by a group of volunteers from the Insight Global organization.

We set up a fully functional outpatient clinic with the ability to perform a small set of lab tests, provide wound care, dental services, family planning services, and dispense medications. By the time we arrived at 8 a.m., there would already be a line of about 200 to 300 patients waiting to be seen. For some, it would be the first time they had ever seen a physician.

Most patients had simple chronic conditions such as hypertension, diabetes, reflux. Although there were some others with very difficult issues such as chronic wounds, leprosy, seizures, or strokes. We unfortunately had some patients with newly diagnosed HIV/AIDS, syphilis, and many children that were malnourished or whom had contracted malaria. As a group we saw 1,239 patients that week. It was exhilarating and exhausting at the same time. After this week, our group was able to relax for the weekend and go to a safari park.

Preparing for this rotation, I think I was expecting an outdated hospital with a hodge-podge of donated supplies and a bit of a, “do the best we can” attitude. This was not the case. While we didn’t have all the “bells and whistles” available in American medicine, MKMC is a very modern hospital. I never felt that any patient received substandard care and I was often shocked to see how excellent the quality of care was.

I learned a lot from my time in Uganda. It showed me how much we ‘over-engineer’ medicine in America. How we order too many labs and too many scans. We spend too much time buried behind a computer screen and too little time with our patients. We are worried about billing and coding, insurance companies, and mountains of paperwork. There, these issues are virtually nonexistent. You can practice medicine the way you’re supposed to.