Observations from the Field
Fellows share notes on health professions education, health care, and life around the world.
David Cameron, M.B.Ch.B., M.Med., M.Phil., Reflects on Providing Care in Rural South Africa
David Cameron, M.B.Ch.B., M.Med., M.Phil.
Associate Professor, Department of Family Medicine
University of Pretoria
Here's a brief reflection I wrote two years ago following a home visit in a small rural village where I was working:
Home based care?
Flies circle like lazy vultures parting the air saturated with the smell of
cervical cancer. Too weak to sit up, she reached out and grasped my hand, 33
degrees outside, it felt like 40 under the low tin roof.
"Hospital?" I suggested.
"No, people die there."
Six pairs of weary eyes watch my every move.
My Experience in Sierra Leone
Elsie Kiguli-Malwadde, M.B.Ch.B., M. Med.
Head, Department of Radiology
Makerere University
At the beginning of this year, I found my self in Sierra Leone. If you had asked me a few years back whether I would ever go there, I would have asked you, “What for?” Here I am in Sierra Leone and enjoying it.
Sierra Leone is a small country of 71,740 sq km with a population of 6 million, in comparison to my country, Uganda, of 236,000 sq km and 26 million people. In many aspects, both countries are similar: they have had civil wars and are developing countries that are on their way to recovery. Uganda has had a relatively longer period of peace, 20 years, compared to Sierra Leone, which has been peaceful for seven years. Both countries became independent around the same time in the early 1960s and were colonized by the British.
The people of Sierra Leone are friendly and very welcoming. They will greet and welcome you to their country in a warm way that makes one feel welcome instantly. They have many languages but the local official language, Krio, is the one that’s widely spoken. Krio is a mixture of English, Portuguese, French, and local African languages. It is distinct from Pidgin English. Most people are fooled into believing at the beginning that English speakers will understand Krio, but they get surprised when they start hearing it. I have started taking classes in Krio and I love it. It is challenging but enjoyable.
The health structure in Sierra Leone, like in so many African countries, is not functioning properly and the hospitals are poorly equipped. Brain drain has not spared it, with most of the professionals working in developed countries. Life expectancy is 46 years. There is one radiologist in the country. They have one medical school and their basic training takes six years. Their curriculum is community-based and teaches radiology in an integrated manner. Both aspects are similar to what is done at Makerere University where I teach; my university has just started this while, in Sierra Leone, they have been doing it for a long time. Unfortunately, most of their doctors don’t stay.
Sierra Leone is a beautiful country; it is green and has tropical forests but what have attracted me most are its beaches. This may be because I am from a landlocked country. They have great beaches with clean sand and ideal conditions for swimming, especially since the temperatures can be quite high — 30 degrees Celsius. Freetown, its capital, is a hilly city and one can see the beach from most places in the city. I learned from Page at FAIMER to look out for the good in life and appreciate it, and that is the attitude that has made my life a lot more enjoyable far away from home.