Resident Travel Blog November 14, 2013

This blog documents the medical experiences of our residents as they travel abroad and experience healthcare in different parts of the world.

November 14, 2013 by Brigette Gleason

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I've been asked to impart some wisdom on how to prepare for a trip abroad, so I've composed a list, based on my experiences, to help any of you who may be venturing out of The Cleve. And I encourage you to do so-it likely will be far more rewarding than you could ever imagine! Some things to consider in preparation for traveling to Uganda (although likely applicable to other nations with similar developmental status):

  • Give yourself a history lesson. In order to better understand the local political and social structure, it's helpful to look back at how it came to be. Colonialism played a big role in many developing countries, and while a country may have since gained independence, the aftermath of colonialization has a lasting impact. Africa ended up quite fragmented, and even within a single country there may have been dozens of cultures and languages. Creating a national identity amid such diversity has often led to conflict (and in some places, continues to do so). I recommend learning about conflicts, especially those wrought by ethnic or religious differences!
  • Be mindful of social norms. Many basic acts such as how you dress or greet someone may affect how you are perceived. Before you get there, or soon after you arrive, find a local to help you navigate standard etiquette. I found the Bradt guidebook to be a very helpful and entertaining resource. Along those same lines, know that you are a guest in another culture. Don't assume that your cultural values or expectations are correct. Don't get upset if someone cuts in front of you in the grocery store, for example, because that may be totally normal there.
  • You definitely need to get a good map! I used "Kampala A to Z" from a local bookstore (recommended by a former Case resident-thanks!) that was extremely handy. Some taxi drivers were surprised to learn that Kampala had maps. It is especially valuable given that most roads are not labeled.
  • And as for getting around, walking isn't always safe - especially after dark as a lone female! Try to learn if some streets are more dangerous than others. I had several friends who had purses, phones, cameras, and passports stolen during their short stays in Kampala. Buses weren't always in the best shape but sometimes were essential for longer trips. The Post Bus has the best reputation in Kampala. Get the phone numbers of trusted taxi drivers. It may cost a bit more (~$5 to go a couple of miles), but definitely worth the peace of mind. The U.S. Embassy can give you numbers if you don't know anyone else in the city you can trust. Shared taxi vans can be useful and cheap for set routes during daylight, but use caution. Don't ride a boda boda (motor bike). Lots of people die. Enough said.
  • Read the local newspaper. I found it fascinating to read reporting of local events: not only the kinds of things that made the news, but also the interpretation of events, which offered insights into different perspectives. More practically, you might find out about a strike, riot, or national holiday that closes parts of the hospital, grocery stores, etc.
  • Get a local cell phone - they're less likely to be stolen and cheaper than using your U.S. phone. You need it for calling taxis and getting in touch with coworkers, friends, etc. Also, you should memorize the U.S. embassy phone number. Local police may not be reliable in an emergency.
  • In terms of medical work: try to teach and learn. You will be exposed to so much pathology that you've only read about before. You'll also see late stages of disease and need to find out how to provide medical help without the tools and funds to which we're accustomed. Don't forget that you're a doctor with experience in a fairly ideal setting. Share your knowledge because the people you're working with are likely curious to pick your brain just as much as you are theirs. Brace yourself for young people with bad outcomes. It sucks. And seeing preventable or treatable illnesses not get treated also sucks. Bring a thermometer, BP cuff, and pulse oximeter-otherwise you may not know anyone's vital signs. Also bring gloves and an N-95 face mask. TB was everywhere, but adequate masks for prevention were not.
  • For your own health: take loperamide everywhere you go. Be prepared because your gut flora may not be. Save cipro for fevers and hematochezia...
  • Be flexible. As an American-and especially as medical personnel-it's easy to expect strict schedules and have structure for your daily life. Try to anticipate that things may not go as predicted (Wi-Fi not working, campus on strike, electricity out, water off...) and have a backup plan ready.
  • Be smart about your safety. You will be surrounded by traffic, street food, and malaria to name just a few health hazards. Please don't forget to go to the travel clinic with enough time before you leave the U.S. to get in all your vaccinations and prophylaxis!
  • Be proactive in exploring and experiencing. There is so much to learn about the culture, social life, wildlife, and other aspects a new country. Embrace the adventure! Check Facebook for groups like "Expats in Uganda" that may have fun ideas or helpful info. Staying busy and meeting new people, both locals and other travelers doing interesting work, will definitely make for a more satisfying trip.
  • Yay for Skype! Set up an account before you go and make sure your loved ones have one (and know how to use it). The mobile app works really well, too, and voice or video chatting is free with Wi-Fi. I was lucky enough to be able to Skype with my grandmother-who doesn't have a computer or email-and my dog! If you'll be away for a long period, staying in touch with family and friends may help quell homesickness. Also helpful is finding an outlet for storing your experiences (diary, pictures, whatever). Then again, remembering that you're not doing a 24hr+ call every 4 days may be enough to ward off any homesickness...
  • Now for the-don't-forget-to-bring-it list: bugspray, mosquito net (if not provided), "mini-pharmacy" or first aid kit, tampons (they don't have them there), sunscreen (again they don't have it), enough undergarments to last until you feel like hand-washing your clothes (although you can always pay someone to do almost any domestic task), flashlight, money and a plan for getting more money (wire transfer, Western Union, MoneyGram). Bring a book for downtime (like sitting-on-the-bus time or oops-there's-no-electricity downtime). It may be a good time to prep for the Medical Boards or read the next book club book!
  • Before you go: get travel insurance (I used MEDEX); sign up for travel alerts at travel.state.gov; and give your bank a heads up. You may need a Ugandan Medical License, which takes a few weeks and a lot of paperwork, plus $200. And you'll need a visa, which also requires paperwork, but you can get this in the airport when you arrive. If you do it in advance, it requires mailing your passport to the Ugandan Embassy in the U.S. with enough time before you leave.

I think that's enough advice for now! Not that I'm an expert by any stretch of the imagination, but feel free to let me know if you have other questions or concerns.