17 Mar, 09 | by BMJ Group
What to do when you are a sexagenarian physician who has retired from hospital practice with 40 years in the NHS under your belt and golf/Sudoku not really appealing? Well, my health visitor wife and I applied to Voluntary Service Overseas (VSO) and I am writing this from a hospital in Kampala, Uganda, where I have been working for five months.
VSO did seem to want us and so long as your health is good, age is not a bar; the average age of volunteers is climbing all the time. So, off to Uganda and although it was hard adjusting to a huge change of lifestyle and temperature I recommend it. It’s great to be blissfully unaware of crashing stock markets and to be in a continent where everyone thinks Obama is their president too.
I really believe VSO and Africa do need doctors of my age. 30+ years of general and chest medicine gives experience which is so useful to hospitals in Uganda who aspire to provide quality care. I can treat and manage TB which is useful and I am fast becoming expert in HIV, but Uganda needs experienced generalists. Senior doctors who can make decisions (usually right ones), can’t operate but know when you need a surgeon, can reasonably confidently manage sick kids, teach and mentor and bring management skills both clinical and general, are certainly needed.
My ward is a charity ward in a private hospital, so I’m lucky to have good facilities, good nurses and doctors and a clean hospital. The patients are destitute and come from all over Uganda and they are very sick. I don’t think we’ve had a CD4 count over 10, and the TB presentations are extraordinary, not to mention extra pulmonary. This is a country where 58% of the population of 30 million is under 18, yet abortions are illegal, where the government hospitals are understaffed and oversubscribed. Even in government hospitals health care is not free. Life expectancy is under 50 and HIV may affect 10% of the population with half having TB. Uganda is a member of “the bottom billion club” and the sad stories of patients selling their HIV drugs to buy food are all too true.
Many of my patients are babies or young people. It’s very different to the average age of a UK medical ward. They mostly have HIV with complications, but they are remarkably resilient. Rehydrate, feed them with naso gastric porridge (works wonders), restart their TB and HIV treatment and they seem to get better even though they look at deaths door on admission. Initially as an adult physician I was scared stiff of managing the babies and although many still cry when I pick them up (I’m told it’s my white skin!), we seem to manage.
I’m really busy, and my range is from pneumocystis pneumonia (PCP) in a 9 month old to myasthenia gravis in an 82 year old…both survived!! Of course there are lots of lows, and you have to keep reminding yourself you can’t cure all of Africa. I get really tired because it’s hot and humid with unfriendly mosquitoes, but I think I’m making a difference. A year might be enough but we’d do it again.
It’s good to go with your wife and support each other through the ups and downs. She’s working with the National Community of Women Living with AIDS (NACWOLA), an organisation staffed by dedicated women many with HIV and giving help to women and children with the disease. Her role is to develop child protection policies and a youth strategy.
HIV has wiped out many parents and it’s elderly grandmas who often bring up the children. We are socially very busy both with locals and other volunteers. We have just been to our third wedding out here!
Winston Churchill called Uganda the ”Pearl of Africa” and it is a beautiful country with lovely friendly people. Its only blemish is appalling roads and heavy smelly traffic in Kampala.
So, that’s it, I am a physician, paediatrician, house surgeon, TB and HIV specialist and a fundraiser. I teach, do appraisals and appointments, go to hospital meetings and have good friendly colleagues. Patients are universally grateful, even when I get it wrong, and I’m not being complained about or sued.
Come on you bulge-baby doctors…Africa needs you.
Richard Feinmann is a 62 year old general and chest physician who retired a bit early after a serious health scare. He felt he had more to give and jumped at the chance to work with his health visitor wife in Uganda.