Director, Medical NGO - Canada & Uganda

Can you tell us the story of how you came to co-found Bridge to Health?

In my final year of medical school, I went to work with the Kigezi Healthcare Foundation (KIHEFO), a non-profit organization based in southwestern Uganda. KIHEFO operates a primary healthcare clinic, dental clinic, and maternity hospital in Kabale, Uganda. They’re also committed to ending poverty by promoting agriculture and economic development activities in rural communities. During my time in Uganda, I was really impressed with KIHEFO’s work. I saw they were doing something unique. It wasn’t just a healthcare organization. They were promoting the idea that you can’t resolve healthcare issues without addressing poverty and education. I didn’t realize it at the time, but that’s a public health approach.

When I came back to Canada, I finished my residency. I switched from surgery into family medicine and emergency medicine. The Executive Director of KIHEFO, Dr. Anguyo Geoffrey, came to visit in Canada. He asked if I would meet with several Toronto-based dentists and dental hygienists who were interested in organizing a dental bridge to Uganda. After our meeting, I sent them an email and said, ‘We have really similar interests – why don’t we work together to create something that can support organizations like KIHEFO?’ Over eight months, we put together a team of 14 doctors, dentists, and nurses. Together, we travelled to Uganda to work with KIHEFO and organize six medical/dental outreach camps in 2013; these provided services to over 1,000 Ugandans living in rural communities.

It’s been such an interesting process to grow the organization. Our teams have grown to 30 health professionals, ranging from doctors, dentists, nurses, hygienists, nutritionists, pharmaceutical students. At this point, we’ve involved more than 100 Canadians in our medical/dental camps in Uganda. That number is growing all the time.

What does Bridge to Health do? What are the goals of the organization?

Our mission is to partner with local healthcare providers, including KIHEFO, to support and empower their ability to provide effective healthcare to populations in need. Our organization has three major platforms. One is providing high quality medical and dental care at the level that would be suitable in Canada, the U.S., or other developed countries and transporting that expertise to Uganda. Two, education: working with local healthcare providers to provide training in the field, while learning from them, as well. Also, we strive to promote public health education to the broader population in Uganda. Every outreach camp we organize in rural Uganda involves, typically, 500 to 600 children at primary schools. We distribute toothbrushes, toothpaste, and teach them how to brush their teeth. We also teach them how to brush their teeth with locally available sticks, so once their toothbrushes run out, they still know how to clean their teeth.

Our final approach is infrastructure. In 2014, we did a study to see if we could engage more Ugandan mothers – during their pregnancies – in the healthcare system by offering free ultrasound screening. We used portable ultrasound technology to screen women, but at the same time, we engaged women to consider screening for other diseases, such as malaria and HIV/AIDS. Through the outreach, we realized we could attract three times the number of pregnant women to medical camps by providing the ultrasound incentive.

How did you end up here? Please tell us about your career trajectory.

From my first days at university, I was always very involved in volunteering for different organizations. At medical school in Calgary, I led a charity called Manuary – a similar idea to ‘Movember’– where we asked men to grow facial hair and raise money for the Alberta Cancer Society. During my first year at medical school, I opted to go to Tanzania to do a rotation with this amazing doctor, Dr. Khan, who is a local Tanzanian pediatrician. Dr. Khan’s goal was to expose Western medical students to the Tanzanian healthcare system. At that time, I was interested in specializing in surgery, so Dr. Khan took me to a public hospital to work in the operating room with a surgeon. I remember watching them perform an abdominal surgery on a male patient. The man was wide awake for the entire surgery. I remember the horror of this man being cut open with only local freezing in his skin. He was wide awake, screaming and clenching his fists. I had this moment, standing up over time of him, I thought, ‘My God, you must be thinking you’ve died and gone to hell.’ It was a nightmare. This was just one of my very revelatory experiences working in East Africa.

What do you most enjoy about working internationally with Bridge to Health in Uganda?

When I go to Uganda, I do practice medicine – I see patients, treat medical conditions – and I enjoy that. But it’s interesting because my favourite aspect of my work is partnering with the Ugandan healthcare officers (the equivalent of nurse practitioners in Canada) seeing patients together, and teaching them. When I’m working with Bridge to Health in Uganda, I definitely see myself as a clinician, but my main role is to organize the teams, organize logistics, and ensure the health camps are functioning. More than being a physician, I love the idea of actually organizing the camps, to make sure everything is running smoothly, and at the end of the day, we’ll have seen 1000 people at the camp. To me, that’s what it’s about. As a clinician, I could not treat 1,000 people alone. But I love organizing the team of healthcare professionals because together we can have a much bigger impact.

At last year’s medical camp, a Ugandan nurse practitioner and I saw a woman who was suffering from pain in her stomach. My Ugandan colleague took the patient’s blood pressure and I could tell from the expression on her face that something was wrong. She looked me and said, ‘Maybe you should try.’ So I took her blood pressure again and was shocked to get a result of 60/0 – very low. I wasn’t sure what was going on. We did a physical exam and found that the woman was very tender in her belly. We did a mini-code on her – running fluids through an IV. Then we used the portable ultrasound machine to do a scan on her. It showed that she had perforated appendicitis, so we immediately gave her antibiotics and got her to the hospital for an operation. In the end, she was fine. But it was a life or death situation. Had she not come to the medical camp that day, she would’ve been dead by the following day.

What are some of the challenges you’ve encountered working in Uganda?

It’s always difficult working in a cross-cultural setting. We grow up differently and develop our worldviews based on where we’ve come from, studied, worked, and so on. It can be challenging to work through these cultural differences, at times. For example, North Americans are very straightforward with people, for the most part. When something goes wrong, we tell people it’s going wrong. In places like Uganda, that can be interpreted very negatively. It’s a very polite culture. If you approach someone in the wrong way – without greeting them, or asking them how they are, for example – the person will never work with you again. Fortunately, I’ve never had that happen to me before. That’s why it’s important to work with local partners, such as Dr. Anguyo Geoffrey and his organization KIHEFO. He also has a greater understanding of Western culture and helps us to negotiate differences between Canadian and Ugandan culture.

You’ve observed many Canadian health professionals working in Uganda over the years. What aptitudes, or skills make people successful in their international work?

What makes someone really well-suited for this work is, firstly, just being really laid back and knowing that anything can happen. For example, the van might break down on the way to a medical camp in a rural community, or something doesn’t go just right. You have to be able to roll with the punches that are always going to happen while working in a low-resource setting. People also need to be prepared to handle different living environments. We remind our Canadian teams that they won’t be staying in 5-star hotels. They stay with our community partners in town, as opposed to being neo-colonists and staying in fancy hotels. We prefer to put our dollars into the local organization. In general, those who do best in this kind of work are, simply put, humble. It’s important not to have a neo-colonialist approach, where you’re coming in thinking that you’re General Montgomery, riding in on your tank. You have to realize that you’re just another healthcare provider coming in to work with equally competent healthcare providers. If you’ve been fortunate enough to receive your education in a developed country, it’s imperative to be humble about that, but also to find ways to share what you’ve learned and empower local healthcare providers, as well.

Do you think having a specific education, or specialization is important to working in the field of global public health?

It’s a good question. The answer is no. People tend to think of global public health in ‘silos’. The term global health is a bit of a misnomer. It’s just health. Some people say ‘global health’ is a completely separate discipline. I don’t know what the right answer is, but what I do know is that global health is inter-disciplinary and inter-professional.

In order to attack a problem like healthcare, it’s vital to incorporate everything: environmental health, legal health, medical health – all of these various factors are interplaying. Let’s say you’re dealing with a child who has diarrhea. You might think you need to be a medical doctor to treat him. Well, actually if you’re a water specialist, you might go to his village and find out why he got diarrhea in the first place. Maybe the local sewer system overflows every time the rainy season hits and pours E.coli into their only drinking water source. You might be able to dig a deep water well for fresh drinking water. You eliminate the need for doctors entirely because you prevent children from getting diarrhea. Or, you might be a lawyer who realizes that next to the child’s village, the government runs a heavy metal refinery and it’s actually dumping waste into their drinking water. You might be able to help them draft a legal brief to lobby the government. There’s so many ways to get involved in public health.

What really helped me expand my thinking was doing a Master’s of Public Health at Johns Hopkin’s University last year. There are many different facets of public health. At Hopkins, there were people doing research on gun policy, water health, environmental health, climate change – because these are all public health issues. It really taught me how everything is interconnected when it comes to global public health.

For people who are either just starting out in their careers or looking to move into this kind of work, what’s your best advice in terms of tangible steps a person could take to move in that direction?

When people think about global public health, they think of these ‘sexy’ jobs where you go and work in Africa, or Southeast Asia, maybe working as a Program Officer for the World Health Organization. But in reality, those jobs are very far and few in between. There’s many jobs back home in North America, helping organizations – those that have a focus on local and international healthcare – to run. For example, for Bridge to Health, we just hired a Program Coordinator for the first time. This person is based in North America, but absolutely critical to our international work. They are responsible for developing budgets, applying for international grants, coordinating with Canadian volunteers, liaising with Ugandan partners. It’s important to realize that your options aren’t just limited to overseas jobs. There’s so much you can do back home. When I was in school, people used to always say that to me, but I didn’t always listen or understand exactly what they meant. They’re right, though. There are many opportunities at home to work in this field.

Regardless, the best way to break into the field of global public health is when you’re a student at college, or university. Get involved with student health-focused organizations and – especially at a time when you have more flexibility in your life – volunteer. It’s critical to gain a window into how the global health scene works. By volunteering, your network will broaden and you’ll be able to get your foot into the door for various opportunities. Try to find the right people who inspire you – and find ways to work with those people and learn from them.