3 osteopathic moments in Uganda

In the fall of 2022, a colleague proposed to take medical students to Uganda for a new global health elective. She mentioned needing a clinical faculty member for the trip.

“I’ll go!” was my immediate response.

I love to travel and had not been abroad since COVID. Plus, I love to be involved with new projects, so why not?

As we prepared to travel in July 2023, my goals were to support student learning, form professional ties with international colleagues and fulfill specific requests for first aid supplies from an orphanage in a remote village. The students in our group had a varied set of experiences: They were invited to observe autopsies, to attend hospital rounds on both an adult pulmonary and a pediatric oncology ward, to pack clean birth kits for rural midwives and to meet with a traditional healer. Pursuing each of these opportunities brought unexpected experiences that, upon reflection, were “osteopathic moments” that touched me deeply.

Visiting the national hospital

The first such moment occurred while we were meeting with a faculty member at the national medical school. This faculty member was the individual who had set up the hospital rounds for our students. While there, the students also toured the high-tech research building next door, which was set up by a U.S. institution. The best word to describe the building is “gleaming.” The entire place is full of equipment shipped halfway across the globe and wired for constant upload of data. Access to the gleaming building is by special invitation only. 

Outside the national hospital, families camp on the ground for as long as their relative is in treatment. We learned that there is only one functioning CT scanner for the entire nation’s population. At a dinner with the faculty physician that night, our students shared their reflections and what they had learned. The next day, I met with the faculty member, and he shared that he hadn’t previously known anything about osteopathic medicine. After meeting with our group, he looked up osteopathic medicine online, after which he told me, “I am so happy to learn about your profession. I feel that with your emphasis on serving rural and underserved communities, you can understand more and perhaps collaborate on solving our mutual challenges.”

Meeting the Batwa people

Later in the trip, we all helped at an outreach clinic in a village established for the Batwa people, formerly known as Pygmies. It operated a lot like free clinics do in the U.S., with an intake table, a brief exam by a clinician, a dispensary with small supplies of basic medications and referrals to the nearest community clinic. The village was nearly 8,000 feet above sea level on the edge of a national park, with views for miles beyond the mountaintops. When the national park was established in 1991, the Batwa people had been forced to leave their ancestral forest where they had lived for thousands of years. In one fell swoop, a way of life was eliminated.

The Batwa are now provided with basic shelter, education and health care by the government, and are also unfortunately the targets of bias and discrimination. One of the students in our group has Native American heritage and reflected on how similar the Batwa situation is to the reservation system in the U.S. A doctor in the outreach group asked with disbelief, “Are you saying you have tribes in the U.S.?” A great discussion resulted. 

As part of our visit, we asked if we could thank the community by bringing a gift of some kind.  We were told that pencils and small copybooks would be very helpful. In the schools of that village, three children share each booklet, and each child can write only on every third line. As the children lined up for their anti-parasite tablet, each child was also given a copybook and a pencil or pen. They were delighted and cheered us back to our van with big smiles. Yet on the way back down the mountain road, our group was quiet and thoughtful. As one student put it, although we brought some fun stuff and much-needed medical care, we hadn’t done anything to change their lives. Another student said that she was beginning to see how much institutions and policies set limits on people’s ability to flourish. I told them I was so proud of their whole-person osteopathic thinking! Being in a different environment helps us drop some of our assumptions and take in more of the details.

A simple treatment

My third osteopathic moment happened after a day visiting an orphanage and school in a rural village near where mountain gorillas live. We were asked to bring first aid supplies, and when we delivered them, we were asked to show the staff and teachers how to use them. A few students and I put together instruction booklets, organized the supplies and created an impromptu class on wound care and treatments for common simple ailments. One of the orphanage staff recorded everything on his simple cellphone so they could all watch and study the information later. The orphanage director asked all the students age 12 and older to sit in on our class, and they paid rapt attention and asked great questions.

I asked the director what her greatest daily health challenge is, and her answer was coughing.  The children age 2 to 18 sleep three to a twin mattress and on triple bunks placed side by side in mud-walled buildings. Every illness spreads quickly and there are always lots of children coughing. I had seen beehives in their gardens and let them know that the most updated recommendation for pediatric cough in the U.S. is honey. They were amazed and insisted we dose each child then and there, so we did.

There was only one spoon and one jar of honey, so we placed a dollop in each child’s palm and encouraged them to lick it up. That evening they roasted a goat we had gifted them so that the children could have some meat. The students who attended and shared a bit of goat said that in her farewell remarks the orphanage director began to cry and said, “Other people visit us and give money, but you also gave your knowledge and treated us like equals.”

Of course, listening to and partnering with patients to help them get well and stay well is at the heart of osteopathic medicine.

Related reading:

Practicing medicine in New Zealand: Tackling 3 misconceptions about working abroad

What I learned from my medical mission trip to help Ukrainian refugees in April

DOs go global: What to know about practicing osteopathic medicine abroad