Global Health Volunteers: Educating for Change

Laura A. Stokowski, RN, MS

Disclosures

January 21, 2015

In This Article

Matthew Robinson, MD: Uganda

Matthew Robinson is a physician with a longstanding interest in global health and a desire to work with an organization such as Doctors Without Borders. When finishing his residency, he heard about the GHSP program. It seemed like the ideal way to blend his desire for clinical experience and his interest in global health, so he signed up.

Matthew spent a year in northern Uganda, where healthcare has lagged behind the rest of the country, having higher HIV rates and lower economic indices. The area also has a great need for more trained healthcare providers. The university where Matthew  worked offers a diverse range of degrees, including bachelor's and master's degrees in medicine. Medical students spend their preclinical years doing class work, reading, and taking tests. Their clinical years are divided between a government referral hospital and a religious charity hospital. For patients, there is a critical difference between the two—patients have to pay for care in the charity hospital, whereas care in the government hospital is free.

Figure 1. Matthew Robinson, MD, on the right, at work alongside fellow volunteer Kiran Mitha, MD, on the left, in Northern Uganda. Courtesy of Seed Global Health.

Matthew compared the medical education in Uganda and the United States. "There were more similarities in the education of doctors than you might think. Differences were mostly the result of resource limitations, but academic rigor was almost the same as in the United States. The students were quite brilliant—they could compete with anyone in the world on medical knowledge."

Matthew taught internal medicine to third and fifth year students, interns, and medical officers. "When we got there, the students were basically teaching themselves," explained Matthew. "We were able to help make sure that the lectures were given and improved the standards of the tests."

What made it difficult to teach, requiring him to tailor his approach, were the resource gaps. "If they don't have a CT scanner, it's difficult to teach them when to obtain a CT scan and how to interpret it." Health and disease priorities differed as well, which influenced the teaching. "You teach malaria rather than Alzheimer disease," said Matthew.

One problem in Uganda is that the government cannot afford to pay all of the physicians it needs. Furthermore, physician pay is lower in Uganda than it is in many neighboring countries, but the country's standards for medical education are higher. The incentives to leave the country to train and work elsewhere contribute to brain drain; and for those who decide to stay in Uganda, there are often stronger incentives, such as better pay, to work for nongovernmental organizations as opposed to public hospitals. An effort is underway to try to keep more Uganda-educated doctors in the country.

In spite of the progress made during the year he spent as a GHSP volunteer, Matthew knows that unresolved problems persist. He explained, "Local physicians are faced with trying to educate a large number of students with the clinical challenges that are typical of resource-limited environments. Northern Uganda has only a few fully qualified internal medicine physicians. There are no specialists at all. No one can give chemotherapy; no one can do echocardiograms."

Nonetheless, when he left Uganda, Matthew had been told by hospital leadership that the mortality rate had been drastically reduced in his department since he and his co-volunteer began their work. Furthermore, the goal of having more Ugandan doctors work at public institutions was beginning to show progress. Previously, most students would leave the government hospital as soon as they could. At the end of the year, however, Matthew overheard five graduating students ask whether they could become interns at the hospital. Instead of leaving or staying because of lack of choice, these doctors were choosing to stay.

How has the GHSP experience changed him? "It got me more interested in clinical education. I had always been interested in doing global health work, and medical education is a key piece of that. It was very rewarding. If you go to Uganda for a year, you can treat X number of patients. But if you train 50 doctors, that capacity is multiplied many times."

"It was an incredible opportunity on many different levels," said Matthew. "You are really helping out and accomplishing things that otherwise might not get done. You are improving the care of patients, but what is underappreciated is the effect on your own personal development. You can really develop your skills as a physician when you take away all the fancy tests. You have to use your fingers and your stethoscope and hone your clinical skills."

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