I have been working as a family doctor in Brampton for the past five years. My practice includes obstetrics, surgical assists, palliative care, and primary care for people of all ages. Prior to my work as a doctor, I was an occupational therapist for six years. I worked in various areas but most of my work was in paediatrics.
Soon after starting up in practice I went on a hiking vacation in Peru. When visiting a national park, a woman working at the gate noticed that I was a doctor and confided that she needed medical assistance. I met her for a quick consultation behind a small hut. She could not afford to purchase medicines, and she was unable to make the half-day walk to the doctor. Yet in five minutes I was able to give her the help that she was very unlikely to receive otherwise. At that moment I decided that I wanted to work in the developing world. It took me over three years to get myself organized and to find someone to cover my practice. I contacted MSF to volunteer as they had a good reputation and one of my classmates had worked for them in the past.
I have just returned from my first mission to Gulu in Northern Uganda. I was struck by many things on this mission. The situation in Northern Uganda is awful and it doesn’t get much press. The war has been going on for 18 years and has created a generation of lost children. They have been abducted, tortured, and raped. They have lost any hope of having a good education. They have grown up without parents to guide or protect them. If they do have parents who are alive, those parents are living in camps and have no hope for themselves or for their children. Northern Uganda is not sexy. It does not make the front page. It is not like a heart attack where the team springs in to action to use all of the latest and greatest medicines. It is a cancer. The situation is eating away at the hopes, hearts, and lives of an entire generation. It is a different world.
Uganda December 2004: I arrive at Awere health centre and am immediately called to the delivery room. The midwife is off and the traditional birth assistant is having difficulty with a delivery. I work hard to convince the assistant and the mother to allow me to help with the maneuvers for this difficult birth (a mild shoulder dystocia-head out, shoulders stuck). The baby is delivered and we all breathe a sigh of relief. I then review the patients in the observation rooms to discuss the potential referrals for the hospital. The clinical officer points out four people who need to go to the hospital. An old man with severe pneumonia, a woman with severe cough and bloody sputum (suspected TB), a man with ascites, and a child with what appears to be a severe abscess on her entire buttock, unable to walk. The child is burning with fever and can’t move her hip at all. Is this just superficial? Am I dealing with a septic hip here as well? She looks terrible.
We realize that all four can’t fit into the car. Neither the old man nor the child can sit and each need a caregiver to go with them. The clinical officer decides to send the man with ascites first because he missed transport the week before. I take one look at him, find out that this ascites has been present for at least one month, and decide that he can wait. I know that the child has to go. I make my decision and tell the others. We load up the child and the old man and I feel relief. I wouldn’t have slept if the child stayed and I can feel good with the decision – I got to decide. But how horrible it is a millisecond later as I realize what I got to decide: to choose which of the four very ill patients actually made it to the hospital. What a terrible decision to have to make – triage of patients, not just who will be seen when, but who has a chance at life and who does not.
In the end, the old man died. The child was doing better despite the fact that there were no doctors to see her at the hospital for the first three days of her stay. The man with ascites and the woman with suspected TB got to the hospital later that week.
Though our health care system has its problems, we are exceptionally lucky to enjoy the standard of health services available to us. For many people diseases such as measles, cholera, polio, and leprosy are a part of every day life. I had to consider such diseases on a daily basis during my work in Uganda.
I never had to worry about the line up for a CT scan. The line up for specialists wasn’t a concern. Instead, I worried about being able to transfer a child in respiratory distress to a centre that had oxygen before he died. Sometimes we made it-sometimes we didn’t. I transferred many tiny bodies back to the camps for burial. I worried about the cholera outbreak getting out of control as the people in the camp continued to use unsafe water simply because there was not enough safe water to drink. Daily I worried about death.
There is a war in Uganda and it is killing people, not just with guns, but with poverty, malnutrition, disease, and almost non-existent health care. And Uganda is just one place among many. Here, in Canada, we have much to be thankful for. And we have much that we can give. Some may want to volunteer overseas themselves. Others choose to help with donations. Still others will change the world by teaching their children to share. I have faith in the world. We just need to keep our eyes and our hearts open.