Spent this morning in the Department of Family Medicine, interviewing a young family practice resident. I must admit it was refreshing and exciting to find that we spoke the same language of medicine after a week with infectious disease physicians. The Department of Family Medicine at Makerere was founded way back in 1989 under the title of Community Medicine and currently has 5 full-time faculty and 4 residents (2 first year, 1 second year, and 1 third year). There are 30 family medicine physicians in the country of Uganda—that is 30 family med docs/30 million people. Residency is structured a little differently than in the United States—students are required to complete one year of general internship followed by 3 years of post-graduate training in the “specialty” of family medicine. Two years of family medicine residency are spent in 10-week rotations through internal medicine, pediatrics, obstetrics and gynecology, and surgery followed by one year of community practice, during which residents staff government health centers and work on community organizing activities. According to the resident I spoke with, the “science” of family medicine is rooted in patient-centered and community-centered care with an emphasis on understanding how communities impact health. I was elated by his description of the science of family medicine and felt such a kinship with him as he described his interest in qualitative, community-based research (he has recently submitted a research proposal to investigate perceptions of family medicine in Uganda). I kept thinking about how much we have to learn from each other and I am a bit frustrated that I was unable to spend more time in the department. Through our discussion, I learned that the specialty of family medicine in Uganda faces many of the same challenges as in the United States—for example, family medicine is not well-recognized within the specialty driven culture of Mulago Hospital, high specialty attrition rates (many family medicine physicians are pulled away from government health center and community work by NGOs willing to pay much higher salaries), insufficient funding for education and research, and the perception that students who pursue family medicine do so only because they cannot do the other specialties. The resident, who originally planned on pursuing neurosurgery, decided to specialize in family medicine because he feels that it is the specialty most relevant to the health of his country. I could not agree more….One of the things that really frustrates me is the global lack of recognition of the role of a family medicine physician in resource-poor settings. Family medicine physicians are broadly trained to provide comprehensive care and have the potential to be the foundation of a health system built on primary care. Why would it make sense to staff a rural health center in Uganda (that lacks most specialty services) with a general internist or general pediatrician? Why not employ a family medicine physician, who can handle up to 80% of reproductive, surgical, obstetric, pediatric, and adult medical issues (and pay them accordingly)? Why do family medicine physicians, here and in the United States, have to convince other medical professionals that they are capable and essential players in health systems? Europe recognizes this……Ahhh, the healthcare system is so incredibly frustrating in the United States….That said, it is an interesting time in history to be starting my training in family medicine. What will our health system look like in 10 years? Will my clinical practice be obsolete or essential? In any case, it was a great morning and I feel re-energized about starting my career and hopeful about continuing a meaningful dialogue and (maybe) partnership with my new colleagues. I also received a much-needed infusion of excitement regarding research. In an environment dominated by bench and quantitative research, I often get discouraged that my research interests and questions are best addressed using qualitative research methods.
On a much more personal note, Jake and I have had incredible Indian food here in Uganda and I will miss it when we move to Kalisizo. This weekend should be quite an adventure—one that I am a little nervous about. We leave at dawn tomorrow for 2 days in Bwindi Impenetrable Forest, where we will embark on a day long gorilla trek followed by a day or so in Queen Elizabeth National Park for another game drive. I don’t know why I am nervous for the gorilla trek—it has been safe for years, but to me it still seems like an unpredictable part of the world. We end our extra long weekend in Kalisizo, where we start our rotation at the Rakai Health Sciences Program. I suspect internet access will be limited until we arrive in Kalisizo, but will post again as soon as I can.
Globe Napper 