Kampala, Uganda

It was easy to realize that I had many preconceived notions about Africa. Like most westerners I had developed a concept for Africa without ever having stepped foot in the continent based on media, movies, news and other people’s opinions. In the months leading up to the trip I read some books about Africa and spoke to a few Ugandans who were in Chicago to give me a better idea of what to expect. Here are the ideas I wrote down on the plane ride over the Atlantic:

1. Fear – I have a healthy fear of getting robbed.

I couldn’t have been further from the truth on this one. I left $100 shoes in a hotel room for 6 days and they were properly placed in lost and found waiting for me when I got back. We left computers, phones, money, and more out in the open and our house cleaners never touched it. Additionally, Kampala was extremely safe at night. We walked around very late and never ran into a problem. One caveat: Kampala is notorious for safety compared to Nairobi and other big cities. The only sketchy story I heard was a Dutch girl was “arrested” by the police one night when she was dressed very scandalous. She wasn’t harmed but it was fucked up ordeal at the police station where she was mildly harassed.

2. Beauty – I think Africa will be rugged with crazy terrain, colors, trees, and animals.

I couldn’t have ever predicted how true this one is. The scenery is so pretty in Africa that you get completely over saturated. You have to constantly remind yourself to look around or else you’ll just superficially look over miles of breathtaking sights.

3. Ambivalence towards Caucasians: I think Africans won’t want to befriend or heckle with white travelers for the most part. I think they must allow history to taint their feelings towards Europeans and Americans.

This was another horrible misjudgment. East Africans are the nicest people I have ever met. It was so easy to make friends that it was a necessity here to buy a phone and make the most of it. Additionally, all salesman and street vendors (of which there are thousands in Kampala) love to heckle and sell stuff to travelers. The amount of attention I got here everyday walking down the street was actually a bit overwhelming and at times too much to handle. As a Caucasian you are looked at as someone with plenty of money that can always afford to buy items on the street or donate to the poor (which is how most tourists are treated in the US as well).

4. Food will suck – bland, gross and no fiber. I am hoping for some good meat however.

This one is complicated. The local food is pretty decent……but you rarely get a good size portion of meat with it and it’s mostly just starch. And no…there is no fiber here outside of fruits and veggies. The Indian food in Kampala however was AMAZING and cheap. It opened up a whole new world of eating.

5. Corrupt: Doctors, nurses and all government officials on being bribed. I wonder if this will make traveling more expensive?

This is a hard myth to dispel or prove to be true. From the gossip I heard the current government is pretty corrupt and is obsessed with staying in power in the 2011 elections. The RNs and doctors however are just operating in the system that they have to deal with. I didn’t see any bribing or shady stuff in the hospital. Traveling through borders and getting permits was not more expensive than advertised and we didn’t have to bribe anyone.

6. Patients will like foreign doctors because we are just there to help without getting paid.

This was fairly true. Patients did treat us with respect and awe. They were largely happy to have a foreign doctor on their care team.

It sounds sexy doesn’t it? “I am traveling to Uganda to work at a hospital.” Global health trips often have a nice ring to them. But take it a step further. Do you walk into a hut in the village and start saving lives? Do you walk into a clean, stocked clinic and do a 12 hour shift that would have gone unfilled? Do you travel to a third world country and drop off a check?
The truth is that global health is very complicated and interdisciplinary. Obviously there is a void in the third world that global health is trying to fill. But filling a hole has never been more complicated. This void must be filled with endless types of material: people, culture, money, supplies, infrastructure, education, etc. Global health is now the vogue term used to represent all of these necessities.
I was lucky enough to meet an attending from the US who was analyzing her school’s ability to help at Mulago hospital. Instead of the more obvious aid most people know can help (money, supplies) this project was based on bringing American doctors to Uganda. This is obviously not a new concept but one that hasn’t traditionally been done intelligently. Imagine dropping doctors from the first world into the insanity that is Mulago hospital. They wouldn’t know the system in any way and would need to work alongside a Ugandan doctor. In effect you have a foreign doctor rounding with an all Ugandan team watching medicine be practiced that they would never approve of at home. They would wear disbelieve on their sleeve and give “advice” on how to manage each problem on the ward. As you can expect this doesn’t bode well in the eyes of the Ugandan doctors. They see it as neocolonialism. Furthermore, the foreign doctors will be shocked to find out that local physicians spend most of their week in a private clinic. This gives them a chance to make much more money than they do at Mulago even though they are the government doctors running Mulago. This presents two fundamental barriers between foreign doctors helping in Africa: being over bearing without knowing the system and judging local doctors by their standards from home.
Local physicians concede that help IS necessary. They know the hospital is horribly under staffed and teaching often suffers because of it. It’s really a matter of working together in a way that is negotiated on Ugandan terms. The world’s superpowers aren’t used to working with other people’s stipulations no matter where on earth they find themselves but this is the only way we will know how to help. It’s almost impossible to help someone who doesn’t want the help you are providing. This rings true when foreigners try to transplant their medicine to Uganda.