Uganda experience - a thankyou from Andrea...

September 20^th, 2011

Dear Dr. Macnab,

I am writing to say thank you for the trip with Brighter Smiles Africa I was selected for through the UBC Global Health Initiative.  I am so grateful to have had the experience I did.  

I immigrated to Canada in 2006 and one of the biggest reasons I turned to medicine as a career was I wanted to be able to work internationally.   I have always dreamed of going to Africa, and I have a particular interest in international medical aid work.   I was inspired to apply for Brighter Smiles Africa after hearing what a great training opportunity it was, and I am so happy to report that it was completely aligned with my goals and more than met all my expectations both personally and professionally. 

As a student in the Northern Medical program we have an unprecedented chance to experience rural medicine both in Prince George and the outlying communities.  It was so nice to see how well the Brighter Smiles program complimented what I had been taught, but it was also great to find how much it added, both on the team’s visit to Hartley Bay, and during project delivery in Uganda.  (I was also very happy to have the Hartley Bay experience for my DPAS project on Aboriginal health).  I was fascinated to see how the work we did in Ugandan rural communities like Kalisizo was a natural extension of what we did in Hartley Bay.  So many of the health concerns and challenges the BC and Ugandan communities face proved similar, and I particularly like the way you have connected the children in the BC and Ugandan schools through your program.

Medicine is truly an international endeavor and I was very pleased to learn so much from the many health professionals you were able to connect us with in Uganda.  Also the variety of the medical experience we were able to gain in the different communities we visited (Urban Kampala, Kampala slums, family practice with Dr. Emma, community clinics and hospitals, and outreach), and the inter professional time spent with the Makerere students and professors. I even had the chance to watch a variety of specialists in Kampala; and being called out with you at night to see a child with hydrocephalus was something I will never forget. 

However, I really think that most of the experiences I had would have been wasted on me without the effort you put into teaching and guiding us.   I am so grateful that I had someone like you to learn from; and it really helped to have you as a guide when I felt overwhelmed.   What you taught me about pediatrics and international medicine was invaluable, as was the real world experience you gave us of medical ethics in a developing country.  Because of the connections and history that Brighter Smiles Africa already had in Kampala and Kalisizo I was able to step into a fully functioning long-term alliance.   Time is so limited for medical students and I think that Brighter Smiles Africa neatly blends the energy of a first-timer to Africa into an established collaboration with a history, local reputation, and track record of sustainability and returning volunteers.

As you know, I am going in to third year now.  At the end of second year, I was starting to feel like I would never survive medicine.  Being a member of Brighter Smiles gave me a new and much-needed perspective on the role of a doctor in society.  I particularly enjoyed what I learned from you about kind, empathic, and integrated patient care.  I am doing my full-time rural rotation now in McBride BC and I feel so much better about seeing patients in the clinic than I did prior to the Brighter Smiles Africa trip.  The hands-on practical medicine that I learned in Uganda, from you and our Ugandan colleagues has guided and informed my clinical reasoning in McBride.  I feel much more comfortable with what I am looking for in a clinical assessment after the opportunity to see so many patients in Africa.

I can't help but thank you as well for the opportunity to realistically assess my future goals in international medicine.   Having such a broad and well integrated program really allowed me to see many aspects of global health delivery and western funding at work.  I have an understanding now of how western aid is used, and what is effective and efficient and what isn't.  It was so neat to see how your link with African Hearts helps them to integrate their service work in the community and support the vulnerable children in their care in culturally appropriate ways.  I also enjoyed our chances to collaborate with western aid workers like the Peace Core and Rotary on the trip.  Being able to participate in fund-raising for Brighter Smiles Africa in Canada before we went, and then to see the funds at work in Uganda was also a great experience, and I think I will be much more effective as a fund-raiser, and as a donor because of that balanced view.

Of course I must mention the fantastic opportunity we had to experience so many aspects of Ugandan life and culture.  I really felt lucky to associate with people from so many different walks of life; from the street kids in the slum to medical students and doctors, rural community members and urban politicians, women and men, children and teens, westernized and traditional.   The cultural experience was invaluable, the ideas shared amazing, and I am so grateful for everything I learned. 

Some of the medical experience I garnered in Uganda I would never have been able to see in Canada, especially so much exposure to tropical medicine and third world medical concerns.  We receive excellent lectures at UBC, and I felt I had the factual knowledge needed about many of the conditions I saw.  But I was immensely grateful to have you there to add the clinical perspective to the theory, and underline the social relevance of illness, as we saw malaria, HIV, malnutrition, untreated congestive heart failure and so many other conditions in person.

I must also thank you for all the time, help, and encouragement you gave me over my research project.  I had never considered doing research before I signed up with Brighter Smiles.  Now I have written a research proposal, written an ethics proposal, applied for funding, conducted clinical research on the ground as part of a team, and am in the process of submitting results!  I can't thank you enough for taking the time to teach me about clinical research, the research process, and how to interpret data.    For the first time EVER I can see research as an integral part of my future career as a doctor, I never thought I had the skills to do research before this experience. 

I think a great strength of Brighter Smiles Africa is that while you engage us full-time, 24/7, the program is flexible and your leadership lenient.  Thank you for giving me so much leeway to become involved with social issues that I encountered that particularly interested me.  I really felt like I had the best of both worlds in so many senses; full time support and direction, but the invitation to be open, creative, independently explore. Obvious highlights of the program are having so much patient contact with your guidance, seeing real global health issues first hand, participating in a truly international partnership, being constantly reminded of issues of social conscience and debating ethical conduct, and experiencing both the challenges and practical solutions of aid programs in the context of balancing Ugandan and Western culture and values.   

 I guess we all look for "synergy" when we work together, but as a member of Brighter Smiles and the African Hearts collaboration I really felt like I was part of something bigger, both in my personal growth and in our changing world. 

Thank you.

Third Year Medical Student

Northern Medical Program (Southern Medical Program)

Bhavna writes... (May 2011)

I loved my medical elective at Rose Rehabilitation/Rose eye clinic in Cambodia! I sit in clinics now wondering what I would be doing if I was still out there and reminiscing about this unique experience. 

Cambodia as a country is amazing, it is full of the friendliest people I think I’ve ever met; everybody is keen to help you and make you feel welcome.  This was no different at Rose Rehabilitation centre in Takhmao.  It was a slightly awkward moto journey arriving there from Phnom Penh (capital city) but all the angst quickly disappeared once I saw Joanna, Sophak, Rith and the rest of the team.  They were extremely welcoming, friendly and inclusive; even when there were no medical issues for me to be getting on with – Joanna always invited me to visit the rehab patients in the community to take histories, examine them etc and even teach me.  She (and the rest of the team) answered my questions; always allowing time for me.  It was truly extraordinary to see the healthcare running successfully with limited resources and the variety of patients that Rose Rehabilitation deal with; the immense clinical signs really tested my (limited!) medical knowledge and allowed me to see the aftercare involved in a surgical patient – something I rarely see in hospitals back at home.  This was such a great opportunity to really test my clinical skills too and offer some medical tips back to the team.

I have to stress though that this is not always the case for visiting medical students – it just so happened that my visit coincided with Dr. Sarom’s (the head surgeon) visit to Australia and so I was only able to spend about a week with him.  I had applied for this elective because I am highly interested in surgery and did get to see some cool cleft palate repairs, plastics and grafts but never got a chance to assist unfortunately as I believe Dr. Sarom was training a Khmer doctor at that time. 

It was lucky for me that I have a keen interest in ophthalmology and so I split my time between takhmao (Rose Rehabilitation) and the eye clinic (based in Phnom penh) where I sat in the clinics for the morning and then assisted – that’s right – ASSISTED in ophthalmology surgery in the afternoons!  The eye centre is run by Dr. Vra (who predominantly performs cataract surgery) and his Ukrainian wife – Dr. Natalie (oculoplasty etc) – the rest of the team are lovely however, language is a major problem.  If, by chance, you speak Russian or Khmer – then great!  You will be fine – but if however, you only speak English – it makes life somewhat interesting.... Of course you pick up little things here and there but you can’t really run the clinic or ask the patients much yourself – without a translator.  I was lucky that Dr. Natalie was so keen to teach and wrote everything in English.  She was also very eager for me to practise my surgical skills and although I’m sure I was the local attraction/entertainment at the clinic – her teaching was invaluable.  The very first day there, she made me do an interrupted suture with tiny thread on a blepharoplasty . It soon progressed to me doing complete operations on my own – supervised of course.  If you’re keen or even interested in ophthalmological surgery – this is the place to be, there is nowhere in England that you will get such experience at our level – it is impossible so I am truly grateful for the opportunity I had to complete my elective here.  However, if you are squeamish, then I suggest maybe just attending morning clinic (start at 8am-12pm) as all the patients are under local anaesthetic only for their surgeries!

Bits of advice/ things I wish I’d known before I came:
-    Bring your own scrubs especially for eye clinic and id suggest taking your own crocs too but they all wear flip flops.
-    If you can get sterile hats then bring them too.
-    I’d suggest staying in Phnom Penh – purely as there’s so much more to do there, and it really caters for westerners.  I stayed in Europe Guesthouse on Street 136, which had the perfect location and was run by the loveliest family!
-    Take a book with you to read if you’re spending time in Takhmao as everything runs on “Cambodian Standard Timing” and you do end up waiting around for patients etc.  There is a medical ward there but the doctors speak only Khmer or French.  Dr. Sarom is excellent and speaks good English however. 
-    Getting to Takhmao – if you can arrange for the directions to be written in Khmer and find yourself a nice tuk tuk driver that will do you a deal – take it! I went with a friend of mine (Physio volunteer) from Phnom Penh via tuk tuk there and back and it came to $7 a day but I’m sure it can be done cheaper.
-    At the eye clinic – there is a nice canteen around the back where doctors and other volunteers from the opposite surgical centre eat – lovely dinner ladies and you can eat as much as you want for 2000 riel – that equates to around 25p!
-    Definitely try sugar cane juice when the lady comes around on her moto too.
-    Uniform – it’s so hot (esp. during march-may) that I wore cropped trousers, shorts, and decent tops – there’s no need in dressing too smart as everybody is pretty laid back.
-    Be prepared for things to “go with the flow” – it is not a regimented elective – which I think is good as it really allows you to immerse yourself in Cambodian nature.
-    Ooh if you’re vegetarian – learn the words in Khmer for “no meat, no fish” etc and just re-iterate that when you go to eat. I found it difficult to find vegetarian food – esp. in Takhmao but it’s understandable as it’s not in Cambodian nature to not eat meat!  However, Sophak, Sokney and Joanna all made sure the dinner ladies at Takhmao had some vegetables for me; they really look after you during your elective so just remember to have fun!

Jess 'Summary of time at Chea Chumeas Hospital

A Summary of Our Time At Chey Chumneas Referral Hospital

It's difficult to summarize our experience volunteering with Rose and observing physicians at the Chey Chumneas Hospital in Takmao. There were aspects that were disconcerting, such as watching a hernia repair and a total hysterectomy performed with only local anesthesia. Other differences between US and Cambodian surgical procedures seemed more comical and adaptive to the climate. Operations were performed in flip-flops, some doctors went shirtless under their surgical gowns, and every now and then the anesthesiologist would grab a bug zapper shaped like a tennis racket and swing it through the air, making a loud cracking sound as it killed mosquitoes.

The hospital itself was beautiful. Although the buildings were rather plain and poorly stocked compared to the high tech hospital rooms I worked in last year, they also seemed more inviting and family-oriented. Doors and windows were wide open, Bougainvillea blossoms surrounded most of the compound, and families took a more active role in feeding and caring for the sick. This may have been necessary, since the hospital probably doesn't have a budget for kitchens or extra nurses or aids, but it was still nice to see. Danielle and I had several talks about how the US could learn a thing or two from Cambodia about creating an environment conducive to healing. As long as that environment still includes general anesthesia.

Of course, the most inspiring part of our experience was watching the work of intelligent, dedicated people as they tried to improve the lives of others. Many of the doctors had worked longer and harder than ever would have been necessary in the US to obtain an education and competently practice medicine. While a few seemed like stereotypical type A achievers, others took the time to carefully explain complicated procedures in a foreign language to 2 clueless American girls, made room around the operating table and invited us to peak over their shoulders, let us take a few pictures for Bill to share with Rose supporters, and managed to play host to us while holding someone's life in their hands.

And then there was the Rose staff. Dr. Sarom was performing surgeries from dawn to dusk the entire time we were there for an Operation Smile initiative, but still helped us observe surgeries at the hospital in his absence. Sokny played tour guide during our trip to the countryside, showed us some of his amazing work, and let us practice our dismal Khmer on him over lunch. Rith, the office administrator, introduced us to doctors and helped find people for us to shadow. And of course our BFFs Bill and Jan went out of their way to find opportunities for us, entertained us with dinners, serenades, trivia nights, and stories from their travels, and generally spoiled us.

Despite a few miscommunications and the fact that a few of the doctors didn't seem to know what to do with us other than lose us like Jason Bourne losing an FBI tail, the time we spent at Rose gave us an incredible opportunity to observe the everyday operation of a health care system that is vastly different from the one we're used to. Our experiences were more than we'd hoped for, and probably much more than we are entitled to as an art/math grad and a premed student. We've become believers in the effectiveness of Rose, and with the help of Bill and Jan are already lining up more Rose-endorsed charities to volunteer with in Uganda and Nairobi. If any of you have cash burning a hole in your pocket and want to find a reputable charity to donate to, this one's a keeper.

Jess writes...

Cambodia 

During a brief study abroad in 2005, I toured a clinic operated by RoseCharities in Phnom Penh and was impressed by the efficiency and dedication of the medical workers there. In fact, this was the clinic that first sparked my interest in becoming a doctor. It was one of the few NGOs my class visited that offered both immediate and long-term relief to people struggling through the effects of poverty: immediate relief through life-saving medical procedures that would have been otherwise impossible for the clinic's patients, and long-term benefits through community outreach programs and an emphasis on improving the quality of life in Cambodia.

Even in the few short weeks we spent in Cambodia studying aid organizations, it was easy to become discouraged by the waste, and sometimes obvious corruption, that plagued well-intentioned charities, but the Rose Clinic seemed to stretch every dollar it received. As I saw firsthand in 2005, a $20 donation to RoseCharities can restore a person's sight, and $50 can repair a cleft palate or give a child the ability to walk. For more information on how to donate to RoseCharities, please see http://www.rosecharities.info/donate.htm.

The organization's efficiency can be traced to its formation, as outlined on the RoseCharities homepage:

"Founded by aid workers who were disillusioned by the waste and bureaucracy often seen in international aid, we started in Cambodia in 1998. The aim was to deliver effective, sustainable programmes directly to those in need, with minimal bureaucracy, and with transparency at every stage....We are run by volunteers, so administration costs are kept to a bare minimum, with 98% of donations going directly to support our work."

- RoseCharities
http://www.rosecharities.info/

I contacted Rose last October and asked if they'd be willing to take us in for a few weeks as volunteers, and they graciously agreed. Since then, Bill and Jan Johnston have been bending over backwards to find opportunities to put our random interests and talents to work. We started last Wednesday with a short tour of the gynecology ward in the Chey Chumnas General Hospital in Takmao, the hospital where Rose Cambodia is based. That afternoon we helped enter patient files into the computer (data entry is a rare example of a skill that Danielle and I both possess).

Thursday we traveled to the countryside with Sokny, the physical therapist on staff at the Rose office, to work with a woman who had laid in bed for 30 years after a debilitating bout with encephalitis (for more info visit the Rose Rehab page: http://www.rosecambodia.org/?page_id=12). The physical therapists at Rose have been working with her to help her gain the strength to sit up, and in order to get her hands moving Danielle brought a bunch of art supplies. We made simple shapes for her to paint in, and Danielle taught her a few strokes. Danielle and I were so absorbed in watching her work that it took a while to notice the dozen or so kids from the village in a semicircle around her, jealously watching her paint. It was a great visit. As we left, Danielle hung some of her paintings next to her bed with ribbon.



On the way back to the office, we stopped to visit a woman who had been badly burned on her legs by gasoline, and the physical therapists changed a bandage for her. Apparently a skin graft had failed to take, so there was still a gaping wound behind her left knee months after the accident. While we were visiting her, her neighbors brought another potential patient to see the therapists and placed him on the bed next to her. The man had been in a motorcycle accident and could no longer move the left side of his arm. The physical therapists assessed him and made an appointment to see him later at the clinic.

As we were about to leave, the neighbors convinced the therapists to see a woman next door who was having trouble walking. While the physical therapists did their thing, Danielle and I hung back and smiled shyly at some very friendly older women, who seemed to be staring at us. One of them started talking, half at us and half at the women around her. She then started wiping at her nose, as if to inform me that I powdered sugar on the end of mine, so I self-consciously started doing the same but she just laughed. One of the therapists translated, "She wants your nose." This seemed hysterical at the time, so Danielle and I giggled about it for a while.

After the therapists had finished their work we got back in the tuk tuk, but before we could go there was some kind of commotion. The lady who couldn't stop looking at my nose jumped into the tuk tuk and handed us each a coconut and a straw. We very gratefully accepted and drove off.


We made one last stop to see a beautiful young girl who was working with the therapists to build the strength in her arms and legs, and then we took a holiday all weekend (2 working days is long enough...)

Today Bill gave us a tour of the Rose Eye Clinic just outside Phnom Penh in the morning, and Danielle and I returned in the afternoon to observe glaucoma surgeries. We watched for 2 and a half hours as nearly a dozen patients underwent the 20-30 minute procedure. It was one of the most amazing things I've ever seen.

I may move to Cambodia when I'm a doctor just so I can operate in flip flops

More to come on what we've been doing with our play time in this wonderful country.

Posted by Jess at 2/21/2011
The rest of Jess' blog 

Living costs - elective

Brian asks... ": I was just wondering if you could give me an estimate of living costs and perhaps an average amount that is spent on living there for two weeks? Thank you very much".

 

Reply   "Hi Brian:

 

I can give you some rough estimates but please don't hold me to them!

 

Guest house accommodation ranges from around $10 to $20 -- there is a guest house very close to the hospital which is clean and spacious and includes hot water, a/c, etc for $10 per night.  However - Takhmao is fairly quite and rural, most students end up moving to Phnom Penh which is about 15-20 mins by tuk-tuk.

 

Food can be very cheap if you are ok with local food (Cambodian food is actually really good) - beer is cheap - around $1 to $1.50!  If you prefer western food you'll end up paying more obviously.  Here is a menu from a pretty good restaurant recommended by Lonely Planet -  this would be 'middle range', if you eat at street stalls it will be cheaper.

 

http://www.frizz-restaurant.com/frizz-menu-khmer.html

Tuk Tuk to and from Phnom Penh to the hospital is around $4 each way -- crazy price considering you can get to Saigon for $8 - but that's westerner prices.  If you ride a moto (motorcycle w driver)  it is cheaper - $1.50 to $2.00 but you are strongly advised to wear a helmet, if you can bring one with you.

 

I hope this helps -- this is all my personal experience.   Rose is not accountable if you find your own experience to be different.

 

~Jan "

 

 

___________