Greetings from Gulu, Uganda!
What is Social Medicine and how do I
implement it into my practice and day to day life? How do I truly work for
social justice and health equity? These are the questions that led me to Gulu.
I have
the privilege and the opportunity to spend 4 weeks learning and teaching about
the social determinants of health with
medical and nursing students, physicians, anthropologists, sociologists,
economists, allied health professionals, village health workers, and patients. The
course is called Soc. Med, and is crafted by Amy Finnegan (Sociologist)
& Mike Westerhaus (Physician/Anthropologist). This is the 5th year
of the course which is held here in Northern Uganda. The 27 medical and nursing
students taking the course bring their perspectives from various regions of Uganda,
as well as from Rwanda, Zimbabwe, Argentina, USA and Lebanon.
The Soc. Med experience challenges my understanding
of why injustice exists in our society and subsequently leads to health
inequity. We dissect topics ranging from colonialism to neoliberalism to
intellectual property and the WTO. It is emotional, exciting, confusing, eye
opening, awe inspiring, and an exercise in humility. It is also really fun.
I’m still processing
a lot (which is part of the reason it has taken so long to write this post),
but will briefly offer some reflection. Additionally, I invite the broader
community of health professionals to engage in critical, reflective and
constructive dialogue about health equity that goes beyond the biologic basis of disease.
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Students come together to “look upstream” at the structural
and societal factors that influence biologic illness
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The “3Ps”, and unofficial mantra of Soc Med.
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Getting Personal
The Danger of a Single Story. (this is a link to an awesome TED talk)
Part of my role as a facilitator for this course is to help incorporate concepts of narrative medicine into the Soc. Med curriculum. Narrative medicine shakes up the traditional structure of the doctor-patient interaction by challenging (as well as complementing) the biomedical model. In an era where health professionals are busy, focused on diagnostics, and patients don’t feel listened to, this method of of history taking deserves some attention. It involves bearing witness to the patient’s story (referred to as an “illness narrative”) while at the same time pushing the provider to examine his/her own biases and assumptions which are inevitably carried into the encounter. Students are encouraged to make statements like “Tell me about your health” or “What worries you?” instead of the more traditional questions which focus on symptoms and reason for admission. In debriefing, many of the students bear witness to stories of suffering, poverty, living through war, and injustice in the health system. Equally as important, students learn who their patient’s are, what is most important to them, and what brings them joy. Narrative Medicine is intensely personal, and getting personal is part of social change.
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Social Medicine students visit Paimol and take a walk
through the community with local village leaders. They learn about the economy, daily life, the effects of the war
on the area, and some cultural health beliefs. We discuss the ways in which
community members negotiate their health
by engaging with local healers as well as government health services.
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You may or may not know that the place where I am right now sitting,
as well as the place the students above are walking, was in the midst of a
bloody civil war from 1989-2011. The war was between the Ugandan government and
a rebel group called the Lord’s Resistance Army (LRA). Many women and children
were displaced from their homes to IDP camps. Young boys were coerced into
becoming child soldiers. Human rights atrocities were committed from both
sides. I feel mildly ashamed that my only prior exposure to the conflict was a
youtube video created by an organization called Invisible Children. But I
think it is safe to say that the narrative about the war created by Invisible
Children was the dominant narrative (and sometimes the only narrative) most
Americans were exposed to. Now, I have seen the movies Uganda Rising and War
Dance (highly recommended), and I have engaged in dialogue with historians. I have
listened to the stories of student
colleagues and friends in this class who lived through, navigated, and are
personally affected by the conflict. I am beginning to really understand
the danger of a single story.
I will end here for now, though expect more
to come.
Love from Gulu!
Aarti
