By Patty Huston-Holm
It’s not unusual for a doctor to be from the Kabale village of Uganda. The rural, southwestern community that is about a 30-minute drive from the border of Rwanda has been a breeding ground for many who dreamed and realized a career in medicine. Yet, with degree in hand, they don’t come back.
“Most of them are practicing in the UK or the United States – or at least in an urban location,” said Dr. Gilbert Mateeka, superintendent of Kabale’s Rugarama Hospital since 2008. “It’s not easy to get doctors wanting to work in a rural area.”
70% of Uganda’s doctors serving 12% of country’s patients
According to a 2016 report of Parliament Watch, an initiative of the Uganda Centre for Policy Analysis, 70% of Ugandan doctors work in cities serving 12% of Uganda’s population.
“There was never any question that I would come back,” Dr. Gilbert said. “Most people see being a doctor as something prestigious. I see what we do as that of a servant.”
Rural or urban, the Uganda health problems are the same. Non-communicable conditions of hypertension and diabetes are on the rise. While tuberculosis is nearly wiped out in developed countries, the infectious disease exists and is on the rise among the Ugandan 15-49 age group, largely because of HIV-weakened immune systems. Malaria, diarrhea and pneumonia are commonplace.
Rural challenges – lower literacy, less technology
While doctors are needed everywhere, rural areas tend to be more challenged by illiteracy among the population and substandard technology in facilities. Residents outside of cities aren’t as open to lessons about nutrition and malnutrition and cautions about traditional healers and witch doctors.
“The healers are unregulated,” Dr. Gilbert said. “While they aren’t all bad, the spectrum of who they are and what they practice is so broad that people can’t know what they are getting.”
“Bonesetters,” for example, may be able to attend to some medical problems with success. On the other hand, more complicated fractures if attended to by a bonesetter can result in a deformed limb, chronic bone infection and other complications. The risk is much less with a licensed medical doctor.
In the midst of a September work day, Dr. Gilbert, age 45, reflected on what brought him to a career in medicine. There was no dramatic event but simply his childhood exposure to the problems that members of the congregation brought to his father as a pastor and watching a UK nurse, Jenny Tustian, who lived nearby. As a 10-year-old, he was most impressed with how the British nurse embraced not only her job but also the understanding of the Rukiga language.
“I knew early on that I wanted to do something to help people,” he said.
In a toss up between careers in medicine and in the clergy, medicine won, largely due to a scholarship from China Medical University in Shenyang, China. When finished, he knew he was coming home to practice.
“It was a bit of a shock at first,” Dr. Gilbert recalled. “The medical technology, hospital systems and the organized reliable supplies I learned with were no longer at my disposal. In the first month while on internship at Mulago National Referral Hospital, for any procedure on the patient, I kept looking for a standard procedure room and appropriate ready-to-use sterile procedure set but in vain.”
Creative with God attending
He laughed at the remembrance of seeing another doctor being “the procedure room” by making rounds at Mulago Hospital with gauze swabs and syringes falling from his pockets.
On completion of an internship at Mulago in Kampala, he came back to Kabale to work with Rugarama Hospital, a Church founded Hospital. For a number of years he was the only medical doctor at the facility.
With some adjustments, much is the same today for the five Rugarama doctors weaving in and out of triage, emergency, abandoned baby, eye care, dental care and maternity sections to see an average of 120 patients a day. While the scope of services has widened significantly at the Rugarama Health facility to include surgery and health training, the daily care routine and cost to patients has remained much the same for 10 years. The cost to deliver a baby, for example, is 90,000 shillings, or just over $25.
“In a sense, it’s more creative this way,” he said. “You must think outside the box to do everything with nothing.”
For Gilbert A. Mateeka, there has never been a look back to a career where he might be making more money and be better known. He is pleased to be in rural Kabale – living with his wife (an English lecturer at Bishop Barham University College/UCU Regional Campus) and four children, including one who was once an abandoned baby at the hospital.
“This profession is a ministry,” he said. “We respect our patients as God’s children. God is watching by the patient’s side as an attendant to both the patients and us the health workers. Our mission is to show the love of Christ in whatever service we offer our patients.”
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For more information about how you can support Uganda Christian University School of Medicine so that future doctors can make a difference as Dr. Gilbert is, contact Mark Bartels, UCU Partners executive director, at mtbartels@gmail.com.