On June 29, 2018, medical students Katherine Callahan ’21 and Christina Dawson ’21 arrived in Kampala, Uganda, not quite sure what to expect. They returned to Vermont six weeks later with a deeper understanding of medicine across cultures, and what it means to be a physician.

In their weekly reflections, they write about feeling lost, frustrated, and out of place. They worry about their lack of medical knowledge, and question their ability to help patients in any meaningful way. As they work through the learning curve and the inevitable frustrations, they also forge deep bonds with patients and providers at St. Stephen’s Hospital. They witness births, and also their first patient deaths. They care for patients at a rehabilitation home, help at an anti-retroviral clinic for HIV patients, and scrub in on surgeries.

Perhaps most importantly, they gain from the Ugandan physicians and healthcare providers they work with a framework to better understand healthcare on a global scale. They witness resourcefulness and commitment in the hospital wards and in the community on a daily basis, while at the same time they experience the systemic challenges and socioeconomic inequalities that impact patients’ and providers’ lives. Although there are no easy answers, students come home ready to advocate for patients on a global scale.

Key to the success of the global health program is the integration of faculty alongside students: Mariah McNamara, M.D., an emergency medicine physician and assistant professor of surgery at the Larner College of Medicine, accompanied students for the summer rotation, as did Paul Bachman, M.D., a geriatrician at clinical partner Hudson Headwaters Health Network. Sharon Sukhdeo, M.D., a resident at Norwalk Hospital, also participated in the trip.

"During their first global health rotation I see students find inspiration for their identity as physicians. I have no doubt that what they have experienced will make them better doctors. Their curiosity and humanity bring hope for a better future."

- Mariah McNamara, M.D.

St. Stephen's Hospital, Uganda

Rounds on the men’s ward at St. Stephen’s Hospital: Mariah McNamara, M.D. (at right), speaks with the patient while Catherine Nakibuule, M.D. (at left), medical superintendent for St. Stephen’s Hospital, reviews notes. The rest of the team includes (from L to R): Christina Dawson ’21, Norwalk Hospital resident Sharon Sukhdeo, M.D., Katherine Callahan ’21, Paul Bachman, M.D., and Andrew Mawejje. McNamara, an assistant professor of surgery and an emergency medicine physician, serves on the global health committee and is an important advisor and mentor for students.

Dr. RockyRocky Kisekka, M.D. (above), known to all as Dr. Rocky, reviews an X-ray with Dawson and Callahan outside of the hospital, where the light is better to interpret results. Dr. Rocky, an orthopedic surgeon, proved to be a frequent presence and key teacher for students.


Callahan, Dawson, McNamara and others welcome Samuel Luboga, M.MeD., Ph.D. (below), back from a trip to London with a festive song before dinner at his home. In addition to serving as a medical doctor and priest with the Anglican church of Uganda, Luboga and his family host medical students in the Global Health Program. The homestay model provides students an opportunity to connect with community in a deeper way: Dawson and Callahan visited the Luboga’s farm one weekend, and also had the chance to participate in an introduction ceremony, an engagement party for a new bride and groom.

Dr. Luboga

Quality Improvement ProjectStudents work on a quality improvement project for St. Stephen’s Hospital related to compliance with Uganda Ministry of Health HIV Guidelines. They note that although compliance with recommendations for viral load testing appears to be low, the manual recording in patient logs and lack of dedicated personnel for data entry may mean that what is recorded in the medical registry does not capture actual activity. Callahan and Dawson are submitting their abstract to the Consortium of Universities for Global Health for potential presentation in 2019. 


ABOUT THE UNIVERSITY OF VERMONT/ WESTERN CONNECTICUT HEALTH NETWORK GLOBAL HEALTH PROGRAM
The UVM/WCHN Global Health Program creates international partnerships with the vision of improving patient care and medical education through cooperation and the exchange of ideas. As participants are exposed to vastly different health care systems and socioeconomic structures, the goal is to foster a deeper understanding of the challenges faced by partner countries in providing high quality care to their underserved populations. Students, residents and faculty have the opportunity to complete rotations at five partner sites around the world.

ABOUT ST. STEPHEN’S HOSPITAL
St. Stephen’s Hospital Mpererwe is a private non-profit organization founded in 1987 by the Christians of St. Stephen’s Church of Uganda Mpererwe. Located seven kilometers from Kampala city center, it serves eight parishes with a catchment area of about 80,000.

ABOUT MAKERERE UNIVERSITY COLLEGE OF HEALTH SCIENCES
As the oldest medical training university unit in East Africa, Makerere University College of Health Sciences has been training medical and health professionals for over 80 years. The college is located on Mulago Hill within the Mulago National Referral and Teaching Hospital complex northeast of Kampala.



Travelling to Home visit



"This afternoon we got the chance to accompany Dr. Okello on some home visits. Despite the vehicle's flaws, offering a solution to the challenge of even getting to a medical facility is one of the most important things one can do here."
-Christina Dawson ’21

Catherine Nakibuule, known to the students as Dr. Cathy (at center in the photo at right, with Dawson, Callahan, and Norwalk Hospital resident Sharon Sukhdeo, M.D.), is the medical superintendent for St. Stephen’s Hospital and a key partner for the global health program. She teaches students at the bedside and helps to organize learning opportunities, like a presentation the students gave to new mothers bringing their children to an immunization clinic.

Journal entry

During their global health rotations, students are required to submit weekly reflections, in part as a way to process what they’re experiencing. Dawson took the opportunity to add color and texture to her reflections. Here, she provides a glimpse into Ugandan food. The page is illustrated with a drawing of the entrance to St. Stephen’s Hospital.

Dr. Cathy
Eric Bennett, M.D.'17

Callahan examines a patient during a home visit. These trips into the communities surrounding St. Stephen’s provide much-needed medical care to patients who may not be able to make it to the hospital. They also give the students the opportunity to get to know patients in a deeper way.

Says Dawson: "We see two patients. A sweet older woman who invites me to stay longer so she can teach me Luganda and a man who reminds me of my Grandpa Jack. It's fascinating to be invited into people's homes. It gives me clearer insight into the lives of the patients we see everyday."

Examining patient at St. Stephen's

Dawson and Callahan (at left) during rounds at St. Stephen’s Hospital. As time goes on, the
students gain confidence even as they continue to acknowledge how much there is left to learn.

"This week is the first week I have noticed a significant
change in myself: I am comfortable. That is, during Monday
morning rounds, I found myself as less of a bystander and
more of an active participant."
Katherine Callahan '21
Meeting Room

The communal meeting room serves as a nerve center of St. Stephen’s Hospital. The entire staff — from cleaners and social workers to surgeons and visiting medical students — sits down together for lunch almost every day.

Katherine Callahan '21 in the operating room
"Every time I step into the OR, regardless of country, there is a sanctity and sterility that I cannot get enough of. I love the constants and rules that surpass any geographical boundaries. I love that techniques remain - more or less - unvaried. Needless to say, I have not doubt that surgery will be my future."
— Katherine Callahan '21
Katherine Callahan and Christina Dawson
Heading Home: Reflections on Uganda

“Dr. Cathy and Olivia surprised us with a cake. It was so kind, and I was so touched by the gesture. We cut the very delicious cake into a bunch of small pieces and shared it with all of the staff at the hospital. It was a great way to say goodbye. Everyone has been wonderful and generous and open to us, and everyone has been so willing to teach us and help us learn. I could not have imagined spending the last six weeks any other way. I have learned so much, and have met many wonderful people. I look forward to coming back.” — Christina Dawson ’21

“Every day we see a parade of people without adequate resources, suffering from diseases and injuries that would otherwise be managed differently, or at a higher level. In my six weeks here, there is no way I will change the structure of the Ugandan healthcare system, or really have any significant impact on the patients receiving healthcare. However, in these six weeks I have begun my career as a physician and member of the global community. My impact will not come in the next three weeks, or even next years, but eventually I hope to be a driver of change on the global level.” — Katherine Callahan ’21

For More Information
  • Visit the Global Health Program website.
  • Read the Global Health Program blog.
  • Follow the Global Health Program on Facebook.
Web Extra
  • Get to know photographer David Seaver and learn more about what goes into planning and executing a multi-day photography shoot in a different country in a Q&A feature.