The social study of disease in Uganda

Brian Blank photo

A Ugandan medical student examined slides under a microscope as part of a course on social medicine in Uganda that also involved US and European students and was taught by a Boston doctor and his wife. Brian Blank, a premedical student at Harvard Extension School, was part of the group. He is writing a book on primary care doctors. For more photos, click here.

By Brian Blank

GULU, Uganda -- By the way our Ugandan friends were leading the goat around, eagerly snapping pictures with whichever of us foreigners they could find, I began to suspect they knew slaughtering animals was not an everyday affair for most Americans. In fact, I’d say they seemed more excited about seeing how we handled the goat than about the upcoming party.

The goat was, naturally, the guest of honor at a cookout held for eight Americans and one European, all medical students, at Lacor Hospital in northern Uganda last month. The class of Ugandan med students they joined thought it might be fun to have the foreigners participate in every part of the festivity’s food prep -- from soup to nuts, as it were.

Later, as I worked my way through that chewy, spicy goat meat, I was reminded that any meal is much more than what initially presents itself. While it's one thing to have a nice kebab dinner, it's quite another to know you were petting that kebab just a couple of hours before. The meal itself has a backstory.

The cookout, then, was an excellent introduction for two dozen Ugandan, American, and European medical students to the concept of social medicine. Dr. Michael Westerhaus, a resident in Brigham and Women’s Global Health Equity program, and his wife, Amy Finnegan, a PhD studying sociology at Boston College, led the monthlong course at Lacor Hospital in Gulu, Uganda. I went along as a premedical student to help coordinate
logistics.

Together, the Ugandan medical students and their foreign counterparts took a hard look at how social factors such as poverty and war perpetuate poor health. They saw people at Lacor struggling with diseases common to sub-Saharan Africa, such as malaria, tuberculosis, and HIV/AIDS. With some of the Ugandan students translating, they administered care and practiced taking detailed personal histories. Their goal was to work on understanding not just the disease, but also the context surrounding the disease.

I assumed that social-oriented approaches to medicine were common to medical training.  Apparently, that doesn’t seem to be the case. Though this sort of holistic approach first became popular in the 19th century, the recent surge in popularity of evidence-based medicine and advancement of technology has pushed social considerations out of medical classrooms.   

This class, then, presented an opportunity to examine Uganda itself, to see how the country was coping in the relative calm after a 23-year civil war. Uganda is a place many know for its infamous former dictator Idi Amin, or for the horrific tales of child abductions over the past three decades by the rebel group the Lord’s Resistance Army, or LRA. It’s a country where hundreds of thousands of people are still slowly vacating camps for internally displaced persons, or IDP, making it significantly tougher to stem the spread of disease.   

The remnants of some IDP camps are within walking distance of Lacor. It’s a gritty trip. Because of the dry season, vehicles that pass along the red dirt road outside the hospital leave huge red plumes in their wake. The locals simply call it the Dusty Road. But only five years ago, the Dusty Road saw, each night, thousands of kids hiking for sometimes hours at a time in search of safety. They came to be known in the international community as "night commuters." Their parents, unable to protect them should the LRA come at night, would send their children to places such as Lacor for protection. The health and well-being of so many children became a major concern for the hospital and community. The barracks used to house the night commuters still stand, though they’re thankfully mostly empty.  

The students in this class who grew up in the area were very familiar with the night commuters. And that’s part of what made the class work so well -- the rich mix of cultures and experiences the students brought with them. One of the Ugandan students, Ojara Sande, used to be a nurse at Lacor Hospital before deciding he wanted to become a doctor. He was able to put into context an awful terror that gripped almost 10 years ago: a brief but deadly outbreak of the Ebola virus. He explained that it is sometimes common in that part of Uganda to touch the entryways of buildings as you pass through them. But all that stopped when Ebola struck.

Medical workers like Sande kept their arms at their sides when they entered buildings to avoid contracting the disease. It was a very sad time, he recalled. Only workers who volunteered were asked to stay and serve at Lacor. Sande volunteered. Though tested twice and quarantined once, he never caught Ebola. Sadly, 14 of his co-workers died. 

Ebola is an incredibly feared disease, Sande explained. The families of those who catch it, even if the infected people recover, could be shunned by their communities. Thus, the impact of the disease could sometimes endure far longer the virus itself.  

It’s that sort of context, I think, that makes social medicine such a rich and valuable subject for medical students anywhere.  It contextualizes the science, and as beautifully demonstrated this past month, can promote greater understanding across cultures.

To learn how you can blog for Passport, e-mail Lydia Rebac at lrebac@globe.com