For Jessie Lu, a summer in rural Uganda was just the ticket.
“I’d wanted to go abroad but wasn’t sure if I was going to find an organization that would allow me to do what I wanted to do,” says the College senior, who is studying medical anthropology and global health. She applied for an internship working at the Philadelphia-based headquarters of the Foundation for the International Medical Relief of Children (FIMRC). “Then I interviewed with them and their international opportunities seemed so up my alley. I really liked the way they approached the internship process, and they required the intern to stay for at least three months to establish long-term engagement.”
She was accepted and assigned to the Bududa district in rural eastern Uganda, where she worked at a non-profit primary care clinic that offers wound care, a lab, a pharmacy, and a maternal and child health ward. The clinic also provides community health educators, as an alternative to the Village Health Team volunteer program started by the Ugandan government, and runs programs for orphan and vulnerable children and for adults who have tested positive for HIV.
Lu spent her first two weeks talking to clinic staff to learn what she could do to help them provide care. “They all, interestingly enough, wanted to learn Microsoft Excel,” she says. “They have a robust electronic medical record system, which is pretty unique in Uganda. The staff members wanted to be able to use Excel to better analyze and use the data.”
Her students became her friends, and she still gets emails from them about the different things they are able to do with the program. “It validated what I’ve been taught: if you actually talk to people and hear what they want, that’s better than going in like, ‘This is what I’m going to do for you.’ It’s also a pretty self-sustainable thing, because once someone understands [how to use Excel], they can teach other people, and then that’s huge.”
Along with her work at the clinic, Lu conducted research for her thesis, supported by a grant from the Penn Program for Democracy, Citizenship, and Constitutionalism. Because the district was rural, she focused on how individuals there understood their relationship with the state through the government-provided health care system.
On paper, Lu says, Uganda “has a really democratic welfare system in terms of health.” This includes decentralization of medical system decisions to district officials, who ideally will have closer relationships with the people, and the elimination of user fees. Ultimately, though, she found that the people measured the quality of the medical system by its ability to provide them with pharmaceuticals and drugs. By that standard, the non-profit clinic was a better option for care than the government clinic.
“The government clinic will give them the prescription, but then they’ll have to go to the local pharmaceutical markets to buy drugs, which are often tens of thousands of shillings,” says Lu. (There are about 3,300 shillings to one U.S. dollar) “If they go to [the FIMRC] clinic, they have to pay 2,000 shillings and they can get whatever drugs they need.” Other reasons she found for the preference included perceptions of government healthcare workers as unhelpful or corrupt and a western standard of health being perceived as better.
Uganda is commonly seen as an international development health success story, says Lu, including an HIV treatment program in the early 2000s during which the rate of HIV and AIDS went down significantly. At the same time, non-governmental organizations that had begun to move in to replace some state services because of the political instability under Idi Amin in the 1970s increased their hold. But now, she says, they must address these implications. “What are the impacts on sustainability when individuals are going to nonprofits for care? How does that motivate government clinics to get better?”