Working "up the hill"

     As a team member in 2009 I can second some of the comments already made, particularly regarding the contrasts between previous missions with the Uganda Heart Institute and our work this year in “peds acute”.  I had not visited any of the other pediatric areas scattered throughout the hospital and across the medical campus in 2009 so my adjustment to our new setting was almost as great as for the first timers.
     Working in peds acute meant a dramatic increase in the number of patients, the severity of illness and the types of illness at the same time that there was a decrease in the resources available in material, facilities and personnel.  Managing one’s own stress in this situation required a dramatic lowering of expectations and a focus on those goals that might be attainable in a short time frame.
     The successes we can claim are a result of hard work, a focus on physician and nurse education, modeling a systematic, problem solving approach and the readiness of our Ugandan colleagues to accept our contributions of energy, expertise and ideas, and to patiently decipher our American accented English, including one New York variation.
     If we helped bring the attention of administrators to this under-resourced area of the pediatric service more good may come.  The needs for both basic and advanced pediatric health care extend far beyond Mulago Hospital though, as the team that visited Mbarara can attest.
     My respect goes out to all of the Ugandan physicians and nurses, who work day in and day out under these difficult conditions, and to all of the volunteers, who contribute measures of time, concerted effort and resources at Mulago and elsewhere.
     The UNC team that made the trip this year was a combination of old and new members, including our first librarian, Mellanye Lackey.  It is incredible to work with such strong, positive, resourceful individuals.
     Each evening we processed the day behind us and planned for the day ahead.  The challenges we faced were difficult physically, mentally and emotionally.  It is a tribute to every member of the team that we engaged these challenges vigorously, constructively and supportively.  As a result we grew in our understanding of and appreciation for one another and left Uganda with a sense of accomplishment despite the failures we also witnessed.
     We are not under any illusions about the small scale of our contribution in the face of such great needs and deficiencies.  But any one of us could talk at length about what more we could do in partnership with many of the wonderful Ugandans we met.
     How this mission proceeds in the years ahead is an ongoing question.  The progress of the Uganda Heart Institute reflects what is possible when resources are available and applied to a complex but limited problem.  Working “up the hill” will require a longer time frame, a greater investment of resources and effective partners within the institution.  Like any project in a poor country, this is a great undertaking.

John Bryson