Social Medicine

This course is called, “Social Medicine Beyond the Biological Basis of Disease: The Social and Economic Causation of Illness”.  It is organized by American physician Mike Westerhaus and his wife Amy who is a sociologist.  Mike and Amy have been coming to Uganda for over 10 years to study both medicine and social determinants of health as well as learning about the conflict that has taken place in Northern Uganda.  They have developed relationships with St. Mary’s Lacor (say, “La-chore”) Hospital and Gulu University Medical School in order to organize this course. 

The goals of the course are “(1)to provide a structured global health immersion experience for medical students…, (2)to study issues related to global health in a resource-poor setting with and emphasis on local and global context, (3)to foster critical analysis of global health interventions in resource-poor settings, (4)to facilitate the development of a clinical approach to disease and illness, (5)to build and understanding and skill set associated with physician advocacy, and (6)to promote international solidarity and partnership in generating solutions to global health challenges facing societies throughout the world.”  The course is mainly composed of classroom lecture and discussion time, field visits, and clinical teaching in tropical medicine/application of social context to patient care and health determinants.  There are 12 fourth-year International medical students (11 from the US and 1 from Canada) and 15 third-year Ugandan medical students (medical school in Uganda is 5 years long). 

Each week has a different theme/topic that is addressed and is as follows:

Week 1: Social and economic determinants of health and causation of illness

Week 2: Global health interventions (paradigms of charity, humanitarianism, and structural change) and social justice in health interventions (models of community-based healthcare

Week 3: Health and human rights and the healthcare worker as an advocate

Week 4: Tools for effective application of global health experience: writing, photography, research, and political engagement

We meet from 9am-1pm every morning (except Sundays) and from 3pm-6pm Monday through Friday with some evening films addressing topics we have discussed in class.  We typically have lecture in the morning and student pairs (every international student is paired with a Ugandan student.  My partner is Kepha) take turns “clerking” patients on the wards in the afternoon.  The patients are selected based on their disease presentation and after we have presented the cases to the rest of the class, we visit the bedside for physical exam teaching, then return to the classroom for a lecture on the specific disease including diagnosis and treatment as well as how social factors impact patients with the disease.  For example, a patient with malaria doesn’t just get malaria because there are parasite-infested mosquitoes in Africa.  They get malaria because they don’t have access to a bed net, they may live next to a swamp/marsh or in crowded areas where many other people are also infected, and so on.  We are taught what questions need to be asked of our patients in order to better understand their living situation so that we can not only treat the disease with medications, but prevent reoccurrence and educate them about how disease is transmitted.  We also seek to understand their beliefs and background: do they believe in traditional healers (“witchdoctors”)? What has been their experience in the past with this type of illness (personally, or in  friends or family members)? What are their expectations for treatment?

Additionally, there are several guest speakers that teach us.  We have weekly Acholi language lessons.  We have heard from Ugandan medical students who took the course last year who grew up in the war-torn town of Gulu.  Religious leaders and local human rights activists give us their perspective on the conflict in Northern Uganda and how that impacted the health of many Acholi people.  Speakers from Partners in Health (please learn more about this amazing organization…”Mountains Beyond Mountains” by Tracy Kidder is a fantastic book about PIH and founder Dr. Paul Farmer) working in Rwanda have flown in to share their experiences and model of healthcare delivery in Uganda’s neighboring and also war-torn country.  We also visit local organizations and regional clinics to see how they provide care to citizens.

So far this has been an extremely intense class.  There is a lot of participation from all the students and at times, quite heated discussion of human rights issues as they pertain to healthcare.  I feel as there is so much for me to learn from everyone here (from students from the States and well as local Ugandans to the lecturers and patients) and at times it is a bit overwhelming.  At this point, I feel a bit paralyzed by the devastating health disparities and social/economic structures that have caused those.   I look forward to the next few weeks as I tools that will help me effectively answer difficult questions, push myself to do more, become more involved, and advocate for the underserved.