Living In Good Health Together_blog

Living in Good Health Together: The Engeye Health Clinic From the moment I stepped off the plane I felt like I was home. Though I was immersed in the sweltering heat of Uganda, the environment was oddly familiar to me. Perhaps this was because I had been to Uganda twice before – both times on medical missions to the Engeye Health Clinic in rural Uganda. There was, however, something different about this time. I felt this intense feeling of excitement, wonder, and confidence. We were opening the doors to the Engeye Laboratory, a building we had been constructing for over one year, for the first time ever. I was going to see something that had only existed virtually to me in person – and I was confident it would refine the diagnosis and treatment of patients. I had an extra spring in my step from the moment I landed at Entebbe. Moreover, the other two board members and I were going to meet with several Ugandan organizations during this trip to establish partnerships that would accelerate the Engeye Health Clinic towards become self-sustaining. Perhaps the three meetings we were most hopeful about were the ones with the Ugandan Ministry of Health, FINCA, as well as UgandaCares (all in Kampala). These meetings were going to help us learn more about Ugandan medicine, microfinance implementation, and HIV/AIDS prevention and treatment, respectively. This third trip to the Engeye Health Clinic was going to be the most productive trip ever. I could hardly contain my enthusiasm. Since the opening of the clinic doors approximately two years ago, roughly 1,500 patients have been seen. Thanks to the hard work of our hired Ugandan nurse, doctor, and lab manager, the Engeye Health Clinic is able to treat patients 6 days out of the week. We are a USbased non-profit organization focusing on the long-term sustainability of this facility and eventually want to hand it over to the people of Ddegeya Village, where it was born. We want them to love this clinic as much as we do and to embrace it with pride. And they already do. After a 32-hour trip and 7,000 miles away from Japan, I met up with the rest of the 16-member team at the BackPacker’s Inn (Kampala). Though we were all incredibly jetlagged and fatigued, we met to discuss our goals and objectives for the relatively short time we would be in Ddegeya Village. Our main

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objective was to treat as many patients as possible while simultaneously learning from and educating our Ugandan nurse, Joseph. Our team was comprised of medical students, family practice doctors, pediatricians, architects, as well as public health officials. We were truly a renaissance team. Considering that our team consisted largely of medical personnel, we were in a great position to educate. Moreover, we wanted to make sure that the learning would be reciprocal – that we would learn and be cognizant of the way they practice medicine in Uganda as well. Our objective was not to mold their system into ours, but to combine the two in order to fine-tune treatment for our patients. The Engeye Health Clinic, more than anything, is a partnership between Ugandans and Americans who are both passionate about improving health care through the practice of compassionate medicine in this little village. My purpose, specifically, was to act as “Chief of Operations” for the Engeye Laboratory. Basically, this meant that I was to make sure that nothing blew up or harmed patients in the laboratory. There were three of us who shared this role. From creating protocols for the Wright/Giemsa stain to carrying 80-pound suitcases from our respective countries to Africa, we were a committed bunch. Through the generous donations and support of the community, we were able to open our laboratory with close to $15,000 worth of equipment. We were fully stocked and ready to go. There is nothing as beautiful as the progress resulting from teamwork. After our epic general meeting, we finally went to sleep around midnight to prepare for an early morning commute to Ddegeya Village (home of the Engeye Health Clinic). After spending 5 hours at the most frequented medical store in Uganda and 4 hours in an overcrowded taxi van, we finally arrived. It was late at night at this point, though no one was tired. We were all filled with excitement for what some had only seen in pictures – the Engeye Health Clinic. Retiring early, we wanted to gather enough strength for a long and tiring day. Patients would inevitably arrive for treatment early in the morning and we wanted to be prepared and ready to serve. The next day we awoke to one of the most beautiful sunsets I had seen in my entire life. The village was covered with rays of sunshine seeping through the lush banana trees. I knew it would be a good day. And it was. We treated 100 patients that day – some who had come from 7 miles away by foot. We did not know that we would see at least this many patients per day for the remainder of the trip. It was an honor to watch Joseph, our Ugandan nurse, in action and to learn from the special relationship he shared with many of the patients. In Uganda, medical treatment doesn’t start after the diagnosis, but begins from the moment the patient walks in the door. You greet them, you smile, you ask how their family is doing while embracing them warmly. It is a Ugandan custom and the one we practiced the entire two weeks we were there. It is this type of medicine – compassionate medicine – I hope to practice for the rest of my life.

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We decided to open the laboratory during the second day of the trip so that all members would have the opportunity to work in the medical clinic the first day. This was fortunate for me, as I was able to see and treat many patients alongside one of the pediatricians on the trip (who also happens to be the dean of my medical school). What an amazing opportunity. By far, the most common ailments we saw were: malaria, malnutrition, and osteoarthritis. These diagnoses did not surprise us – though they highlight a key point in healthcare. It shows how public health and medicine are NOT mutually exclusive and how one can not exist without the other. People were walking into the clinic with chronic, recurring malaria because they were selling the mosquito nets they had been given by the clinic to make much-needed money. This shows that distributing mosquito nets is not necessarily a foolproof solution to eradicating malaria – making sure they were being used and used properly was the solution. When you are the responsible caregiver for a family of eight and you need some shillings to buy matooke (a staple food in Uganda), selling a mosquito net is a very reasonable solution. Moreover, people were suffering from malnutrition in this village because of poverty. They did not have the resources to provide enough food for themselves and their families, as most villagers in Ddegeya live below the poverty line. Finally, osteoarthritis was a major diagnosis, since most villagers exist as subsidiary farmers who work in the fields to make ends meet. The repetitive motion of hoeing and harvesting the crops was taking a toll on their health such that it was painful for many of them to even walk. All of these chief complaints point to the importance of public health measures in both prevention and treatment. It is not as simple as prescribing a medication or performing a medical procedure to improve someone’s health. We really need to understand the Millennium Development Goals and strive towards achieving them by 2015 in order to tackle some of the biggest problems from start to finish. We can not tell people in third world countries how to live, though we can help them access and utilize critical resources to bolster healthcare in general. One case in particular touched me. A 21-year old lady came into the clinic who was seven months pregnant. She appeared relatively healthy and was excited about her second pregnancy. She was concerned, however, as she was bleeding every month as if she were having a menstrual period. After a thorough patient history, her story became more and more convoluted. She had many sexual partners and really wanted to have a second child. She apparently went to the hospital very early on in the pregnancy, where they confirmed

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that she was indeed pregnant. However, the bleeding came at approximately the same time every month and lasted for two days. Ideas were already forming in my mind after spending 50 minutes on this patient’s history, demonstrating that sometimes a patient history can be just as important (if not more so) than a physical examination. After examining her stomach with the pediatrician, it became clear – this woman was not actually pregnant. We did not know for sure, but once she relaxed her abdominal muscles, the nice third-trimester bump we had noticed suddenly flattened into nothing. We used two pregnancy tests to make the official diagnosis – Pseudocyesis. The first test was slightly positive, as the second band was barely visible beneath the control. After taking the second test, however, it became clear that this woman was NOT pregnant. A component of this disorder is the concept of mind over matter – sometimes women can actually elevate the level of HCG hormone in their bodies when they think they are pregnant (or want to be pregnant). What was once an OB/GYN case transformed into a psychiatric case before my very eyes. I was concerned that this young lady would take the news poorly, though she seemed to be perfectly fine with the diagnosis (we told her she was not pregnant). We explained that the blood she was seeing every month was a menstrual period and that it was normal. Surprisingly, she seemed relieved. Whether she had Pseudocyesis or not is still up to debate. The next day, and for the majority of the trip, I split my time between the medical clinic and the diagnostic laboratory. When I saw the laboratory for the first time, I was floored with how beautiful the structure was and how it would easily improve the quality of care for our patients. The laboratory consisted of 4 large rooms: Two were to accommodate patients, one served as the pharmacy, and the final room held our diagnostic equipment (also referred to as our “laboratory.”) Three of us spent an entire day sorting all of the equipment we had been donated – pipettes, tubes, microscopes, slides, etc. – so that we could have a relatively organized room and system. After spending the day hanging up protocols, sorting equipment, and trying to make the most out of our solar panel energy, the diagnostic laboratory was born. It officially had a heartbeat of it’s own and we were ecstatic. The laboratory served a vital purpose during the trip. It was a central meeting ground for all clinicians, considering that blood draws, pregnancy tests, and urine samples were processed and further investigated in this room. We were able to test for strains of malaria, run each urine sample through a battery of tests, as well as test blood hemoglobin and sugar levels for anemia and diabetes, respectively. Moreoever, we were able to perform blood smears to utilize the few stains we prepared for this trip. The laboratory was a bustling place and it was exciting to see it come to life and serve it’s purpose. Sprinkled in between the clinic and laboratory work, myself and the other board members met with several Ugandan organizations. We were able to introduce ourselves, the purpose of the Engeye Health Clinic, as well as our hopes for the future. Ultimately, we were able to establish partnerships with the Ugandan

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Ministry of Health, FINCA, as well as UgandaCares (HIV/AIDS organization). Through these connections, we hope to be able to subsidize the cost of antiretroviral HIV/AIDS treatment for patients using local government funding as well as refer our patients to specialists for counseling and complicated procedures. In addition, we hope to introduce microfinance to the village starting in 1-2 years so that the villagers will be able to obtain small loans, pursue options once unavailable to them, and improve their overall quality of life. One of the most fascinating aspects about the Engeye Health Clinic is that it is a clinic built in the middle of an incredibly rural village in Uganda. The clinic is submerged within this village and the doors are wide open for everyone. During the day, while patients are being seen and treated, the local children often visit the clinic and just hang around to watch the “Mzungus” (white people) in action. They usually chant, “Hello Mzungu,” though it was an extra special treat to hear a few of them say, “Misty!” with glee. The children want desperately to help in anyway that they can and often just play in the grass until they see when they are needed. For example, I walked to the giant water canister we have (it collects rain water) to grab some water to take back to the clinic. I was having trouble carrying two jerry cans by myself, so two children quickly saw me struggling and came to my rescue. Together, the three of us were able to carry the jerry cans to the clinic and I would have never been able to do this (in one trip) without their kind attention and help. They were little angels and did this out of the kindness of their heart. During all three of my trips to the clinic, the children have been an integral part of my experience. They are more than just some of the patients we see – they are our friends. I have become close to many of the children, in fact, and have watched them grow over the two years I have known them. They have helped many of us with our medical work at the clinic as well as played soccer with us until the Ugandan night covers the village in darkness. I have seen some of them overcome sickness and malnutrition and some of them perish. To me, this has been one of the greatest blessings and hardships of being so actively involved in the clinic – watching these children live life below the poverty line. It is a true miracle when they become better and I am so thankful for the magic of medicine that has resulted in many of these recoveries. For those who don’t recovery, however, I am saddened beyond words. Many of these children pass away from preventable illnesses and it is completely inexcusable to me that their lives have been sacrificed due to lack of resources and access to healthcare. It is for them – for the smiles that will no longer light up Ddegeya Village – that Team Engeye fights. We are determined to meet the high demand for healthcare in this village and see that this progress permeates other impoverished areas of the third world.

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During one of the final nights, we were able to introduce the children to a special treat – movie night at the clinic! With our relatively recent installation of solar panels and our ability to properly harness the energy (thanks to the two Union College Minerva fellows who currently live and work in the village), we were able to project the movie “Wall-E” onto the wall. This was the perfect movie to show the children, as the messages presented throughout the film were conveyed more through actions and body-language than through English words (which would have been foreign to them). Something seemed perfect about this night as I sat on one of the 4 benches placed in the center of the clinic. Two children crawled on my lap while the others huddled close together to make room for the crowds of children that would see pictures in motion for the first time. Their laughter made the stars sparkle even brighter around the equator that night. Having returned to my life in Japan, I feel more compelled to help now than ever. Thank you, Engeye Health Clinic, for reviving this intense desire I have to help this little village and for reinforcing our collective team’s conviction to help change the world.

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