Resident reflects on his time at Bugando
A Weill Cornell resident reflects on his time at Bugando: Great needs and great promise, by Gil Ascunce
As I entered my final year as a medical resident at Weill Cornell Medical Center, my program director asked me to assess my “…interest, ability, and willingness...” to work in Tanzania for a month. I had no idea what this month would entail, but in a moment of instinctive boldness I signed up. I have now been back in New York City for almost two months, and it is clear that my life as a physician has been permanently altered by my experience at the Bugando Medical Centre.
I arrived in Mwanza, Tanzania on a placid afternoon in late January. The road from the airport to the hospital was crowded with children and young adults walking along in small groups or herding skinny cattle. Men on bicycles transported fruits and other goods, while others advanced gracefully to unclear destinations. Water pooled in gutters along the roadway, and dust clouded the small huts scattered in the near distance.
I walked through the gate to my new home with markedly less boldness than I had possessed months prior when I signed up for this trip. After being enthusiastically greeted by a guard at the entrance, I made my way into a large apartment that would eventually be filled with other young physicians from Weill Cornell, but for now loomed empty and bare to its new, lone inhabitant. I felt the overwhelming need to get to work; and work we did.
In the one month I spent working at the Bugando Medical Centre, I was continually inspired by the dedication and commitment of the young Tanzanian physicians, who are vastly outnumbered by the patients occupying beds in the crowded wards. These young men and women are working not only against overwhelming numbers of people with advanced disease, but with limited resources to carry out diagnostic and therapeutic interventions.
Shackled by my own reliance on the myriad of diagnostic tests readily available to me back home, I sometimes felt as if I had never even gone to medical school. I was often asked to diagnose and treat seriously ill people with the use of my eyes, ears, and hands alone. At times, the challenge of this was overwhelming and I felt helpless with my inability to deliver a definitive diagnosis. At other times, the diagnosis was all too evident, but the disease was late in its course, or optimal therapy was not available. Accustomed to the guidance of experts, colleagues and X-ray beams, I was in awe of the newly graduated Tanzanian physicians who were working virtually alone and unsupervised in a world of unreliable power, faulty water supply, and indiscriminate pathology.
I was graciously welcomed into the Bugando community where my Tanzanian colleagues and I shared in the wonderful language of medicine. I had gone to Mwanza to learn and to teach, and I soon found that the greatest contribution I could make was as a listener and a mediator. I encouraged the young physicians to discuss their cases, so that we could exchange ideas, share the struggles of difficult situations, and collectively celebrate the successes that were achieved.
The potential energy of the Bugando Medical Centre is immense. I cannot say I was immune to frustration or the occasional loss of heart, but to see the positive work that prevails in difficult conditions, it is impossible not to imagine what this medical center could be. Bugando has great needs, but it also has great promise. The young doctors are full of energy, knowledge and good intentions, but they need the resources to fully utilize the knowledge and skills that they have learned, and they need more attending physicians than are available to support and guide their work.
With the progress that is being made, Tanzania will one day have enough doctors to create the environment of support and guidance that has been so critical to my own training. In the meantime, visiting doctors just may be able to fill this critical need, and bring Bugando Medical Centre closer to a center of excellence.