Dr. James Yuan is a General Pediatrician at Cincinnati Children’s Hospital in Ohio. He previously worked as a Pediatrician at Montefiore Medical Group for three years. He received his MD degree from Albert Einstein College of Medicine. Dr. Yuan received the Chairman's Award for Research (2020) and the Daniel C. Leicht Award for Excellence in Social Medicine (2020) from the Children's Hospital at Montefiore, Bronx, NY.
During the 2nd year of medical school, Dr. Yuan traveled to Soroti Regional Referral Hospital (SRRH), Uganda, as part of the Global Diabetes Institute to contribute to the implementation of a diabetes education program for patients with diabetes in Uganda. He created brochures for diabetes foot care and delivered a training program for local healthcare workers on non-communicable diseases. The perspectives gained, and lessons learned from his trip to Uganda helped him understand the importance of social determinants of health in his medical career. He believes that his experience in Uganda subconsciously influenced his decision to pursue a Social Pediatrics residency program at Children’s Hospital at Montefiore.
My experiences in Uganda
In the summer of 2014, as a rising 2nd -year medical student, I traveled to Soroti, Uganda, as part of Einstein’s Global Diabetes Institute (GDI) to help implement a diabetes education program at the Soroti Regional Referral Hospital (SRRH). I had the privilege of working with Dr. Wilson Etolu (a gifted internist) and the staff of SRRH to gather information about diabetic patients who visit the weekly diabetes clinic and to educate patients on diabetes management.
We compiled data regarding their social demographics and clinical characteristics—this included BMI, smoking history, education level, family history of diabetes, and more. Additionally, I was able to shadow the interns during ward rounds, help educate diabetic patients on the proper management of the disease and assist staff whenever possible. During my time at the clinic, I noticed that educating patients on their conditions to improve health literacy was not always prioritized. I think to make diabetes care more robust it needs to start with educating the patients and family. They need to be taught diabetes prevention, and if diagnosed, then management and avoidance of complications. So, I distributed foot care brochures for patients with diabetes and led a training for healthcare workers about NCDs (non-communicable diseases). Taking a public health approach and enabling patients to take ownership of their bodies and health could reduce the incidence of diabetes and associated complications (and other diseases prevalent in the area).
My experiences in Uganda opened my eyes to the challenges and obstacles many healthcare facilities face in poorer countries, but also the resilience and dedication providers and staff have for their patients’ health despite those shortcomings. I was most amazed by how the hospital and staff were able to run with such limited resources. Several of the tests and exams we take for granted here in the US—such as an HbA1c machine, an ECHO machine, specialists (the hospital has an eye and ear clinic but no ENT doctor, only an audiologist), proper cancer treatment—all were too expensive for the hospital to have. Most of the aforementioned services had to be performed in the capital city of Kampala, 4 hours away by bus, which costs 18,000 Ugandan shillings one-way (about $7 US). Even basic items necessary for diabetic treatment, such as glucometers and glucose test strips, were not always available. Just prior to my arrival, the entire hospital had run out of glucose strips, and they gratefully accepted the 1500 I had brought with me, along with four glucometers. However, they did have adequate treatment for malaria, TB, and other infectious diseases, which are very common there. I believe a big reason for low resources is poor funding; the hospital simply isn’t given enough from the government to meet the needs of the population.
Despite such shortcomings, something that stood out to me was the kindness and patience of everyone in the community: providers, staff, and patients alike. the doctors and interns still provided quality care for the patients. Patients would wait hours to be seen in the diabetes clinic, lined up in the hallways, and not once did I hear a complaint or shout or a raised voice. And it was similar for the hospital staff; everyone was so friendly and calm, and they treated each other with respect. I always felt like I could ask anyone for help, and they were willing to bring me where I needed to go or to whomever I needed to speak with.
After working both in Soroti, Uganda, and the Bronx, United States, I think there are some striking similarities and parallels to be drawn between them. Both have patients with poor health outcomes by several measures. Both are mostly comprised of patients from low-income families relative to the surrounding areas. Both contain dedicated healthcare providers who choose to work in these regions, providing the best care possible despite limitations. With regard to social determinants of health, I noticed that these two places faced similar challenges in terms of food insecurity and poor health literacy.
The time I spent in Uganda showed me that although some areas may lack in funding or resources compared to others, one can still positively benefit the health and lives of patients. Sometimes, you must simply “do the best with what you’ve got,” and it has been a privilege to serve families in Soroti and the Bronx. I hope to take the lessons learned from my travels and strive to continue bettering the lives of the patients and families I see.
