Child Family Health International (CFHI), Uganda

FINAL REPORT

This summer I was fortunate enough to spend eight weeks working at Kigezi Healthcare Foundation (KIHEFO), a Level III Health Center in Kabale, Uganda.  This organization provides services in Kabale Town by way of its nutrition, HIV, general, and dental clinics, as well as its new maternal hospital.  It also engages in frequent medical outreaches to rural communities in order to provide care to populations with incredibly limited access. KIHEFO provides integrative and sustainable programs by coupling its medical care to avenues for economic growth. For example, it runs a rabbit breeding project, which gives families living in extreme poverty with malnourished children two female rabbits, one male rabbit, and the knowledge about how to breed these animals in a way that will provide food and an income, if they breed a surplus of animals.  The combination of the rabbit breeding project and the work of the nutrition clinic staff has significantly reduced the incidence of malnutrition in the Kigezi Region. KIHEFO’s Executive Director, Dr. Geoffrey Anguyo, works hard to engage in partnerships with universities in Uganda and around the world to ensure a constant supply of novel ideas and enthusiastic allies to implement them.  The dedication of staff and volunteers to improving health access in Western Uganda makes KIHEFO an exciting and inspiring place to work.

My role at KIHEFO was mainly grounded in observational learning and engaging in dialogue with clinicians and other staff members.  Child Family Health International (CFHI) grounds its internship programs in ethical practices, such that students are barred from providing care abroad in ways that would be prohibited in their home countries.  This stipulation allowed me to engage with the healthcare system without feeling compelled to do anything that I was not qualified for.  It also reinforced my dedication to learn about care delivery in Uganda without imposing my Western ideas about what appropriate care looks like.  

I was able to rotate around each of the clinics, spending at least one week in each facility.  During these shadowing days, I observed the patient consultations and medication prescription processes, saw nutrition assessments, HIV counselling, the births of two babies, an ultrasound training provided by an external nonprofit organization, a breast biopsy, and facial sutures.  Because I had witnessed similar clinical operations in the United States, it was incredibly interesting to draw comparisons and mark contrasts between these experiences.  

I was also able to accompany KIHEFO on its outreaches to rural communities, where we set up temporary clinics inside school or church buildings. These days involved some of the most stimulating and challenging incidents I have ever experienced. I was exposed to many more patients during one day in the field than in an entire week at the clinics.  The patients presented unique cases that spurred later discussions with clinicians about how to tackle such issues with limited resources.  The large quantity of patients also demonstrated the pattern of common health issues in Uganda, particularly pelvic ulcer disease (PUD) due to overconsumption of the readily-available sweet potatoes, urinary tract infections (UTIs) due to unsanitary toilets, respiratory tract infections, and back pain due to the physical strains of farm labor.  The outreach days best conveyed the limited healthcare access in Uganda. Laboratory tests were incredibly limited, forcing clinicians to rely solely on physical exams to make diagnoses. Antibiotics were frequently prescribed even without confirmation of a bacterial infection because it was unlikely the patients would be able to see another clinician for several months, and patients with severe medical conditions that could not be treated on site often did not have the financial or transportation resources to get to a higher level health center.  

In addition to these observational opportunities, I took on two projects to contribute to KIHEFO’s work.  In one capacity, I entered and began to analyze the HIV testing data from 2017. This process was lengthy since their data collection consisted of a handwritten form for each patient that had been stored in a box without being sorted chronologically.  I organized these forms and designed an Excel spreadsheet to digitally record the information.  I used the software’s formula capabilities to analyze the demographics of those being tested for HIV, with a special interest in the proportion of people that were tested as a couple, which seemed to be quite low from the analysis I performed on the limited subset of data I was able to enter.  I also worked with another CFHI student to launch the KIHEFO Research and Innovation Club, at the request of Dr. Anguyo.  We collaborated in performing a literature review and writing a paper about the importance of building local research capacity, rather than bringing in foreign “experts”, and the benefits of community engagement in research.  We also defined the objectives of the Club and constructed a baseline curriculum to be used at each group meeting.  I was able to watch this project mature from a hopeful idea, through the member recruitment stages, and finally to fruition as I presented our paper in the role of Guest Speaker at the Club’s first meeting.

I am hopeful that these efforts provided some level of assistance to KIHEFO, given that I learned so much during my time spent working with them.  The feedback from staff and continued meetings of the KIHEFO Research and Innovation Club suggest I was successful in these endeavors. I entered this experience with the goal of developing reciprocal relationships with the members of this organization, such that we could all benefit from each other’s insights.  In my shadowing experiences, conversations with clinicians, and global health lectures led by Dr. Anguyo, I learned more than I could have imagined about how clinicians are trained, the current strategies for reducing HIV prevalence, the lack of healthcare-seeking behavior, impact of international aid in Uganda, and so much more.  I formed true friendships with the clinicians, staff, and members of the Kabale community that I hope will continue to grow in the future.  My understanding of global health improved exponentially by witnessing its challenges firsthand.  I saw the amazing work that KIHEFO staff and other Ugandan medical professionals are doing to improve the quality of care that local patients receive.  

My time in Kabale pushed me out of my comfort zone as I was immersed in a new culture with a remarkably different language.  I was forced to come to terms with my unearned privilege and understand the experience of being a minority, as one of the only “mzungus” or white people, in town.  This internship challenged me personally, academically, and professionally, while substantially improving my initiative, adaptability, and communication skills. I am so grateful for the Kellogg Institute for International Studies allowing me to have such a meaningful experience.