As my last week with CFHI in Uganda is wrapping up, I’ve been able to reflect on my time here and think a lot about what I should take home from this month. Before embarking on this venture, I had hoped to gain insight into how medicine differs in Uganda from the United States and other countries I’ve visited, such as Peru and India. I’d hoped to understand what part of medicine was so different that the average life expectancy of Ugandans is 59 years, while the average Indian lives to 68 and Peruvian to 75. I’d also wondered whether I’d feel an obligation to make more of a presence internationally.

I’ve come to find out that medicine itself isn’t practiced very different at all. I’ve seen a myriad of tropical diseases, such as elephantiasis, typhoid, and tuberculosis, as well as a higher prevalence of HIV and its complications. I was so impressed that I didn’t see a single smoker during my time in Uganda, and no patients with COPD. Targeting HIV is largely combated the same way as it is in the States: patient education, medication compliance, and social support. The biggest difference I’ve observed in medical care, however, is a lack of access to subspecialists and equipment due to insufficient funds by patients and hospitals. Undernutrition is additionally rampant and contributes to many patients’ diminishing health status, especially in the pediatric population. Unfortunately, poverty is the limiting factor for health in many Ugandans. And foreign aid hasn’t helped the problem.

I’m not going to pretend to be an economics expert, but as I’ve read in Dambisa Moyo’s Dead Aid so far, government aid from the United States, Europe, and Japan has had detrimental results on the African continent, as government aid makes it easier, and more enticing, to corrupt government. Many sub-Saharan and central African governments remain some of the most corrupt governments in the world according to the Corruption Perception Index, and government aid hasn’t helped this problem. It’s also had a negative impact on the development of African nations. Moyo gave a specific example of how an African manufacturer of mosquito nets was put out of business due to the generous donation of 100,000 mosquito nets from Americans. She also states that the average African is actually less well off financially relative to the rest of the world today than in the 1970s. Despite exceptional financial aid from developed nations, poverty hasn’t improved in much of Africa. Blindly giving money and donations to African nations needs to stop.

However, I’m not suggesting that we need to stop helping individuals who are in need. What I believe must happen is a more intelligent approach to giving assistance to African nations. My next read is Smart Aid for African Development by Richard Joseph and Alexandra Gillies so that I can have a better idea of how to do this. This week, I visited “Alongside Africa Uganda,” an NGO dedicated to helping street children of Kabale attend school, cultivate marketable skills, and stay off drugs and alcohol. Alongside Africa provides a place for children to stay during the day and get healthy meals. They also sponsor some children to attend boarding school. I was able speak with George, the director of operations, and spend some time with the kids. It was a rainy day, so we watched a movie after working on the garden. The kids were all so well behaved, a refreshing impression given that I’ve seen quite a few street kids sniffing glue and begging for money. I love their slogan: Opportunities, not Aid.

Take-homes from Uganda:

• Foreign aid (especially loans and grants) has been detrimental to the development of many African nations.
• There is a way to give smarter aid to Africa (with a discussion to be continued).
• Medicine is practiced very similarly in Uganda as it is in the United States, with some notable differences being the minimal number of smokers, a much higher prevalence of HIV, and unique tropical diseases such as malaria, African sleeping sickness, schistosomiasis, and other parasitic infections.
• Undernutrition is far more rampant than I had anticipated, as 80% of the inpatient pediatrics ward was hospitalized for malnutrition.