By Alec Helmke, PD4
I’m wrapping up week two in Uganda, and there are many
updates to share! As I alluded to in my last post, I was fortunate to spend
this last weekend on safari in Northwest Uganda. Along with several other US
medical trainees, we left far too early in the morning on Friday for the long
trek to Murchison National Park. My eyes struggled to stay open as we lurched
over speed bumps along the Ugandan highways. Along the way, we stopped at the
national rhino sanctuary, where we travelled with a guide to see the herds in
their natural habitat. “A safe distance away” seemed a bit too close, and I
certainly didn’t feel comforted when the guide pointed out how the rhino was
sharpening its horn. I was more comforted to hear, however, that after local
extinction in the 1980s, rhinos had been very successful following their
reintroduction. Local conservationists were especially excited following the
recent birth of a male rhino to a mother imported from the United States and a
father from Kenya. They named him “Obama.”
That was only the first stop of many on a jam-packed and
frequently tiresome journey. We arose early in the morning for game drives,
during which our guide would point out the many unique animals I had previously
only seen in zoos. Among the most thrilling sightings for us were giraffes,
water buffalo, hippos, antelope, and even the elusive lions. Travelling in the
safari van—with
the top open to ensure a panoramic view and to enjoy the fresh savannah breezes—was
a surreal experience. As the sun set on our nighttime game drives—although
I knew The Lion King is based on Tanzania and Kenya rather than Uganda—I
still couldn’t help playing “Circle of Life” over an over again in my head.
But, to save you all the trouble of reading more (when we all know pictures are
worth a thousand words), I’ll include some photos of the many animals we saw
during our game drive experiences.
During the weekend, we spent some time on the Victoria Nile,
which connects Lake Victoria to the Lake Albert delta. The watersheds from both
lakes feed into the Nile River, which winds its way North into South Sudan,
Sudan, and finally, Egypt. The first day we arrived, we viewed the waterfall
for which Murchison Park is named. As the most powerful cataract in the world,
Murchison Falls was an awe-inspiring sight, and the spray from the falls
certainly felt nice to cool down in the Ugandan heat! We also viewed the falls
from below. Moving upstream from the park in a barge, we saw many aquatic
animals, including massive African alligators, before arriving at the base of
the falls. We even got to enjoy a Nile on the Nile, that is, a Nile brand beer
while floating on the river.
Although the game drives were undoubtedly beautiful, they took a serious toll on my sleep schedule. In fact, I had to laugh when the manager of our hotel described how beautiful the grounds of the property were. I knew that, leaving before sunrise and returning by sunset, I’d never get to see the hotel in daylight! We ended our trip with chimpanzee tracking in a nearby forest and sighted several of the agile climbers high up in the trees before hopping in the van to return to Kampala.
On Tuesday and Wednesday, I joined Arnold in the IDI
pharmacy. This pharmacy reminded me of the retail pharmacies you’d find in the
United States—except the drugs you encounter are a bit different. In the
IDI pharmacy, they stock a variety of HIV and TB medications, along with a
smattering of medicines used to treat other conditions. These medications are
provided entirely free to IDI patients, which is critically important, as
almost all medicines in Uganda are paid for out-of-pocket. Considering this, if
medications were not offered for free, many patients simply wouldn’t be able to
take them.
During my experience, Mike, another one of the pharmacists
in the department, commented:
“The two biggest problems with healthcare in this country
are poverty and ignorance,” he stated.
Mike’s comment struck me in its verisimilitude, not just for
Uganda, but across the world. Here in Uganda, and throughout sub-Saharan
Africa, infectious disease burden is remarkably high. HIV, TB, malaria, and
diarrheal diseases kill millions each year. Poorer local governments frequently
lack the financial resources to respond to these concerns with public health
interventions such as widespread vaccine and prophylaxis distribution, parasite
control, and sanitation. And many poorer patients—having to purchase treatments and
medical supplies out-of-pocket—tend to avoid care until it’s too
late.
Yet, poverty isn’t limited to sub-Saharan Africa. The United
States—despite
possessing the largest GDP in the world—still faces concerns of inequity. And
for many of the conditions listed above, poor and marginalized patients are at
high risk. For example, TB in the United States is particularly common among
patients experiencing homelessness and among incarcerated individuals. Recent
research even quantified poverty as the fourth most deadly disease in the
United States.[i]
Mike continued to explain how ignorance can kill. He mentioned that millions of people in Uganda lack an understanding of the risks posed by infectious disease. Some individuals who receive mosquito nets choose to use these nets for fishing, failing to recognize that mosquito-borne malaria may lead to serious morbidity. Similarly, folks with HIV often fail to realize the risks of stopping treatment, even when they feel well. Particularly in Uganda—where AIDS is so stigmatized as to be called by a different name (ISS)—patients may disregard their medications and appointments to avoid the shame of being recognized as HIV positive.
Again, ignorance isn’t a problem specific to Uganda. For
many healthcare workers, what immediately comes to mind are vaccine skeptics,
who fail to recognize the risks they face by choosing not to receive
immunizations. I wonder if—given a chance to see the amount of detail that goes into
clinical trial design like I saw with John—these folks would be less
hesitant about vaccines. Another example pharmacists love to mention is
antibiotic resistance. Like the HIV patients in Uganda, many patients with
infections in the United States may stop taking antibiotics as soon as they
feel better rather than continuing for the entire recommended course. In doing
so, some particularly hardy germs may survive the medication’s onslaught and
return later as drug-resistant bacteria. Our healthcare system is rapidly
exhausting our supply of antibiotics to treat these superbugs, so patient
education is crucial to keep us from running out for good.
Poverty and ignorance are the greatest healthcare challenges in
sub-Saharan Africa, the United States, and across the globe. And I hope
to use the tools I am learning here in Uganda to fight back against these
killers. To address poverty, I will follow in IDI’s footsteps by making it my
goal to expand patient access to vital, low-cost medications. And to address
ignorance, like I mentioned in my last post, I must become an adept educator. Hopefully
my fourth year will be great practice!
It’s hard to believe that the next week will already be my
last. However, I’m excited to continue my learning next week in a new hospital,
Kiruddu, where I will be rotating with several clinical pharmacists. Although
there is so much more to share—including dancing alongside a
traditional Ugandan troupe and an enlightening visit to an HIV prevention
clinic—I’ll
sign off for now!
[i] Brady,
D., Kohler, U., & Zheng, H. (2023). Novel Estimates of Mortality Associated
With Poverty in the US. JAMA Internal Medicine, 183(6), 618-619.
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