The Whole Patient – by Caitlin Pastorek

Caitlin Pastorek is a 2nd year medical student who participated in the GHI: Uganda Access Project in 2013.

Embarking on a journey to the rural village of Nakaseke, Uganda, I had developed a convincing and vivid mental image of the world I was about to enter. We were met with a bustling city upon arrival in Kampala; chapati and fruit being sold roadside, traffic that would make even the most experienced drivers nervous, children giggling and chasing us, and the masses of curious onlookers. Through a cloud of dust we emerged into Nakaseke a few days later, seeing for the first time true mud-and-stick huts, piles of homemade bricks, cattle grazing while tied to a small thin rope, and a much larger population of said giggling children. Amongst the beauty, mango trees, happy smiling faces and dirty bare feet, we made our home for five wonderful and eye-opening weeks.

I had this idea in my head that a global health project was something that would give me worldly experience, a few words in Luganda, and a bit of knowledge about the community we were to visit. It became so very much more than that. We wanted to collect data via focus groups with community members regarding early childhood nutrition – with a plan to eventually implement a better seminar that would help to spread the knowledge. We knew that we would likely find it was not merely lack of knowledge, but I did not fully expect just how complex of a picture we would face.

Nakaseke is a rural village with run-down red dirt roads, intermittent electricity at only a few homes, shortages of fuel at gas stations, and markets of fruits and starchy goods. It is not generally what one would think of as wealthy, though smiles regularly broke through the hardship. I began to think of Nakaseke as a large family – everyone greeting his neighbour; everyone joining in saying “sorry” if someone were to trip over a pothole. It was a place unlike any other I had ever visited.

We conducted focus groups, expecting to hear much more discordance between villager beliefs and the current recommended early childhood nutritional practices published by WHO. However, especially among the Community Health Workers and Village Health Teams, we found that knowledge was generally very good and up-to-date. Though there were common issues which could be addressed through nutritional seminars in the future, one common theme emerged for me personally. This was a true example of the importance of the biopsychosocial model of health. Many of the issues described by community members had their origins in long-standing social traditions, current government policy, or general poverty. I found myself thinking as we learned of such issues, “what could we possibly do to improve the situation?” I had gone into this project hoping to gain a few points to add to an educational seminar, and perhaps an idea of community resources where people could obtain assistance to access clean water or healthy food. It was certainly not that simple.

We learned of many male-female dynamics that shaped how nutrition was provided to babies. Although mothers regularly attended nutritional seminars, fathers were much less represented. Since changes in the household are generally spearheaded by men, such new education for these women was almost of little use. As well, there was much mention of the desire of many fathers to have large families. Lack of family planning and huge numbers of children made the situation difficult for mothers, who were given most of the burden of caring after their young.

We also met face-to-face with the devastation that poverty can create. Without enough finances, families could not afford nutritional food for their children. In fact, they often could not even afford the transport to attend seminars teaching about nutritional food. Mothers found themselves needing to work, thus being away from their infants and experiencing early cessation of ability to breastfeed. Families found it difficult to afford transport to hospitals, certain medications, and we even witnessed the absence of mosquito nets in the hospital. There are so many things that could be prevented with the addition of some sustainable financial assistance, yet I found myself at a loss. I was a medical student, not a policymaker, and not a government official. Where would I play a role in such substantial changes?

Though I learned much about a distant country from my own, I have taken this question home with me. As future physicians, where do we stand? How can we play a role in advocating for patients and their biopsychosocial wellness? I think leaving a global experience with more questions than you brought is extremely valuable. I now find myself approaching patients with a wider view of what it is that is making them “ill”. We need to consider so many factors when trying to truly heal; though it will be an ongoing challenge, it seems the outcomes would be much more holistically helpful. I do not have answers to my own questions yet, but there are resources^[1] written by people who have faced the same issues we all will come across. I hope that physicians will continue to gain resources to help people truly heal, and to one day feel that I am able to help the whole patient.