Back in Kampala for the start of another week. I have been feeling quite homesick today and generally exhausted by the effort it takes to do simple things like laundry. I have also never been to Uganda when it is this hot and humid—the damp heat is reminiscent of SE Asia. However, the evenings are amazingly breezy and cool and as the sun sets in the city, I feel like I can breathe again.
Last Friday, we took a tour the different wards of Mulago Hospital. Although I have seen the hospital before, I found it upsetting in an entirely new way. Mulago has over 1,000 beds and is almost filled to capacity. The fragility of life is overwhelming. You can see and smell death everywhere and I wonder how patients emerge alive. Due to a lack of resources, it is a environment of communal suffering and healing, with patients and their families sharing the same small emotional spaces that exist between life and death. I think that I found the gynecologic oncology ward the most upsetting. Women, young and old lying side by side–90% of them dying of cervical cancer. This is not supposed to happen, this does not have to happen. The disparity in resources is outrageous and unacceptable, but I hate to admit that it does not enrage me as much as the health disparities that exist in the United States. Most of the patients at Mulago live their lives in conditions of crushing poverty, with little or no access to things as basic as clean water…but at Mulago at least they are treated and cared for with the resources that are available. The same cannot be said of the United States. I have lost track of the progress of healthcare reform in the United States, but I can say that I am leaving this country with a renewed vow to use my voice as a physician to fight like hell for universal healthcare.
On a more personal note–I have been feeling slightly unsettled since starting at IDI last week and I do not know why. I am not sure what I expected out of this rotation—out of this return trip to Uganda. Seven years ago, I left this country convinced that a medical degree was the answer to the feelings of personal and professional impotence that I experienced in this country. Now I feel handicapped by my lack of experience in public health. It is almost as if I have lived in this strange slightly unpleasant educational vacuum for the past seven years—driven towards the single goal of achieving a medical school diploma. Out of necessity, I have focused almost entirely on learning the language of medicine and now I feel like I cannot communicate in a way that is essential and important in global public health. I have come full circle back to my senior year of college when I was at a professional crossroads—contemplating whether or not to pursue public health or medicine. I realize that I can and need to do both, but I feel a little stuck. Residency stretches out before me—another three years (thankfully short) of total and brutal immersion in the culture of medicine. I am mostly excited for residency, but am feeling a little frustrated that I still do not know how I want to use my medical degree. This is a weird time and I am sort of stuck in an uncertain netherworld between a beginning and an end. I experience moments of overwhelming excitement and extreme apprehension and I cycle between these emotional moments on a daily basis (poor Jake—he has to deal with it). Here, in Uganda, I feel very far from where I began and very far from where I am going.…..
Not sure what this week holds in terms of clinical assignments, but it is the week when I/we need to finalize our residency rank list. This is the hardest and most purposeful decision Jake and I have ever made (both individually and as a couple) and I hope we are making the right decision. I think we are.
Tonight, I will go to sleep with a silent mind, dreaming of snow.
Globe Napper 