Ari Hoffman had just completed his residency in Internal Medicine at the University of California, San Francisco, when he arrived as a visiting faculty member at Mbarara University of Science and Technology (MUST) in Uganda in 2013. Sam Olum had arrived a year earlier as an Internal Medicine resident, after having completed medical school at Gulu University and working for two years as a medical officer at Lira Hospital and Lacor Hospital in northern Uganda.
Both of them anticipated Ari’s arrival as a Global Health Service Partnership (GHSP) Volunteer with a mixture of excitement and trepidation. Ari worried that the residents he would be teaching, including Sam, had already worked as medical officers and probably had more clinical experience than he did. Sam was concerned that the GHSP Volunteers, including Ari, would expect them to know all about medical procedures and equipment that are commonly available in the US but not in Uganda.
By the end of their year together, all trepidation was long gone. Ari and Sam considered each other good colleagues and friends. Recently they connected on Skype to reminisce and reflect on what they had both learned from each other.
Ari – When I came to Uganda, I was just coming out of residency and from a very different system. And I realized that the way you guys work as medical officers between internship and residency meant that you had a lot more clinical experience on the ground than I did, especially with the breadth of what you had done as an intern. I knew you had done much more procedural work than I had. And on top of that, you had obviously seen a lot of things that are common in Uganda but that we don’t see at all or very infrequently in the US.
So I was very intimidated at first. I was thinking, how am I ever going to teach anyone about stuff that these residents – like you, Sam – already know so much more about than I do.
Things like Cryptococcal Meningitis [a potentially fatal fungal disease that often infects HIV patients] – where Mbarara was one of the main sites of an international study that taught everyone how to take care of Cryptococcal Meningitis and HIV. So that was an intimidation factor for me.
But then I realized that it’s just a sharing thing, that everybody’s got their strengths and that I had more background and training in some of the subspecialties, like cardiology and just basic cardiology for an internist. I’m not a cardiologist, but my training at UCSF helped me think about sharing how I learned to take care of acute coronary syndromes or some of the more basic cardiology problems, like atrial fibrillation.
Sam – Well, when we heard that you volunteers were coming, we were a bit scared. We were thinking this means more work because these people are coming from a place that has everything, so now we’re going to need to read and know about everything that we don’t have here.
So we were a bit scared as well. But when you got here, it turned out you were very knowledgeable and understanding. We realized that you were friendly and actually very willing to teach, and that’s what we wanted.
What we especially appreciated was the way you brought in the concepts, integrating our system and yours by using slides that showed both what you would do in Mbarara and what you would do in the US. Because it would not have been very helpful if you were only teaching us about the systems you have in the US. Your approach gave us the perspective both of what we should know and what we can do [with the resources and systems available in Uganda]. So that was very helpful.
Ari – Well, we were able to go over things and work on protocols together. I remember thinking through how we would deal with somebody with a heart attack in Mbarara, not in the abstract but in the real world environment that we were practicing in. And you guys built that, you know. I helped with the background, but you guys built that.
Sam – Another thing we really appreciated was your approach to teaching. We used to wonder how you could do it. Every time you would come for a lecture, even if you had already done 10,000 things and were really exhausted, you would come with a smile on.
The way you approached teaching the post-graduates especially – like when you had us practice questions for our exams by playing Jeopardy – was very interactive and not intimidating. And it actually did a lot in terms of our output in the exams. I think if you had not done that for us we might have had a hard time with the exams.
And another thing I learned from you and from school was that you need to see your patients as people – not just as a body that is there for you to work with, but as a human being who needs care and love. So I am also trying to do that now in my practice. Some people are already saying to me that the way I handle them is very nice. One of them actually came and said, “But why are you very kind?” So I said, “Well, I don’t know. Maybe I am trying to imitate someone.”
So you’ve done so many things that motivated and inspired me. And I am trying to imitate that here [as an internist physician at Lacor Hospital in northern Uganda, an honorary faculty at Gulu University, and a national trainer for the Ministry of Health on pediatric HIV/AIDS care]. It’s a hard thing to do and maintain, but I just hope I can inspire people like you did, at least for me.
And I am grateful also to GHSP. As I recall you were part of the pioneer group [the first group of GHSP Volunteers]. That really meant a lot to us. Sometimes we are used to our way of doing things and there is a decay of things that we don’t do. We read about them in textbooks, but no one reminds us about them because we aren’t doing them, and then we forget. But when someone who has been doing them comes and tells you practically how it is done, it gives a lot of meaning to the teaching. So I think it was really a great time. I am hoping to meet you guys again and you will probably teach me more ways of doing other things as an internist.
Ari – That’s a two-way street, Sam. I don’t think you guys realize how much you teach and inspire us, too. You know, it changes the way we practice, whether it’s in Mbarara or in San Francisco. Coming back here I’ve definitely brought the experience with me. It’s a year and a half later and I still think about it all the time.
In a lot of ways, we are on the opposite ends of the problem. In Uganda we didn’t have enough resources and here in the US, we have too many resources and we are overusing them. It’s actually costing too much money and the value is not that great. That’s the focus of the health policy work that I do. It’s the opposite end of the resource spectrum, but the whole focus is to try and find that sweet middle ground.
So the experience in Uganda really taught me that global health is truly global — it’s everywhere. And I learned a lot about how to think through what is the value of the test that I’m about to order, how much does it cost, is it going to be worth it? Am I getting the bang for my buck when I spend this much money on this test? You guys really taught me a ton about how to do that because that’s part of every day life there.
GHSP is one of the most influential and important things I’ve done in my life, and I think about it every day.