Medical mission: Gulu, Uganda

March 2019 – Vol. 38, No. 2

Andrew J Holcomb, MD

In September 2018, I accompanied the Medical Missions Foundation on a service trip to Gulu, Uganda. Under the supervision of Brandon Johnson, MD, we treated patients at Saint Mary’s Hospital Lacor in the clinic and performed surgeries during a week at the hospital. In addition to providing direct patient care, we worked with local nurses and doctors to exchange our experiences and knowledge and better understand cultural nuances essential to proper patient care.

Some of our teaching opportunities were formal, including a training day focused on cardiopulmonary resuscitation led by our nursing colleagues and primary care providers. Other exchanges of ideas came at unexpected moments and occurred through forming friendships with our hosts. These relationships were essential not only to providing patient care, but also to understanding the larger context in which we were working.

Making medical decisions in a completely different context than we were used to, was the most challenging aspect of our work. Incorporated into every medical decision are a series of assumptions pertaining to the patient, the hospital, and the country as a whole. We take for granted in our usual practice that a patient will have access to levothyroxine after a thyroidectomy. We believe that we have achieved informed consent before every surgery and that we have understood the patient’s perspective in deriving a mutually created plan of care. It is assumed that a patient undergoing a cancer surgery will have access to radiation, dental care, social services, and reliable follow-up. These assumptions must be completely re-evaluated on medical service trips, and each decision must be approached with careful consideration of just how different the circumstances are in our host country.

Going forward, Medical Missions Foundation continues to partner with Saint Mary’s Hospital Lacor, working to ensure proper follow-up care for patients and to plan future trips. We continue to build relationships founded on trust and focused on the shared goal to heal, whether through medicine, surgery, or simply companionship and care. As we reflect on our trip, we think of ways to improve our partnership and sharpen our focus on education. I am grateful for the opportunity to work with the foundation and to my hosts and friends in Uganda for their gracious hospitality. I want to also express my gratitude to the American Academy of Otolaryngology—Head and Neck Surgery Foundation and to the University of Kansas Department of Otolaryngology for their financial support of my trip.