In 2016, I found myself deep in rural Uganda once again, in a vibrant yet underserved community called Kamengo. I was introduced to this community by a good friend, Jimmy Sebulime, who was originally from there. We were there on a medical mission, running a primary care clinic. Kamengo, like many rural communities in Uganda, is a place of resilience. The people live in modest homes surrounded by lush greenery, their lives intertwined with the ebb and flow of the seasons. Yet, beneath this beautiful landscape lies a harsh reality—limited access to healthcare, particularly for women and children, and the ever-present challenges that come with that scarcity.
Our medical missions usually focus on treating common, primary care illnesses—malaria, respiratory infections, diarrheal diseases, malnutrition, and the like. These are conditions we can often address with medicine, basic treatments, or some practical medical advice. We set up clinics where people from the community can come to receive care that would otherwise be out of reach. For many patients, this means receiving antibiotics, antiparasitic medications, or nutritional supplements, while for others it means discussing how to prevent recurring illnesses or learning basic health practices. The goal is to offer relief, reassurance, and medical attention that is immediate and life-improving.
A typical day in one of these missions is busy but rewarding. We arrive early, often greeted by long lines of families who have traveled from miles around to seek help. We perform medical check-ups, distribute medications, and treat wounds or infections that have worsened over time. The environment is modest—sometimes under a tent, sometimes in a small building—and supplies are limited. But the gratitude of the people, many of whom are experiencing a doctor’s visit for the first time in months or even years, keeps us motivated. Our work is about offering care where there is none, and the impact is tangible.
However, the nature of medical missions means that we are only there for a short time—days or a couple of weeks. Once we leave, the day-to-day struggles of the people continue. That is why sustainability has become such a critical part of our work. As humanitarian physicians, we have to think beyond the immediate treatment. It is not just about the antibiotics we give or the advice we offer; it’s about what happens when we’re no longer there. Our missions are designed to build long-term capacity. In Kamengo, for example, the Women’s Health Centre I supported offers not only maternal care and reproductive health education but also trains local healthcare workers, equipping them with the knowledge and skills to manage their community’s health long after we’ve returned home.
The case of the 14-year-old boy I encountered during that mission stands out as a reminder of the fragility of healthcare in rural Uganda, and in many places around the world. On the first day of the clinic, his family arrived, carrying him in. He had suddenly lost the ability to speak or walk, the result of a traumatic brain injury caused by an accident. The boy had been hanging on to the back of a truck, as was common for many children in the area when trying to save time on their walk home from school. This time, however, the truck was moving faster than usual, and when he let go, he was thrown off balance and struck his head against a nearby pole.
This was not the kind of illness we were accustomed to handling in these clinics, where most of our work involved primary care treatments. His condition was urgent and life-threatening, something far beyond the scope of what we could treat on-site.
Recognizing the signs of increased intracranial pressure, I knew he needed neurosurgery, something Kamengo could not offer. We had to act quickly, coordinating transport to the capital, Kampala, where he could get the specialized care he needed. When we arrived at the hospital, we faced the usual challenges—waiting for diagnostic tests, navigating a system already stretched to its limits, and advocating for the child’s urgent need for care. After hours of coordinating, we were able to get him a brain scan, which confirmed a dangerous bleed that required immediate surgery. The boy was taken into the operating room later that day, and after a tense wait, we received the news that the surgery had gone well. He survived and, after a long recovery, eventually returned to his community.
His case exposed a critical gap—one that highlighted the importance of thinking about sustainability in our medical missions. How do we ensure that when a child needs urgent care, they have access to it even when our teams are not there? This question has shaped my approach to the intersection of public health and humanitarian response, whether in resource-limited rural areas, crisis zones affected by emergencies, or war-torn communities transitioning from survival to long-term resilience and sustainability.
Being a humanitarian physician is about more than just providing immediate care. It’s about understanding the larger health challenges communities face, thinking long-term, and striving to build systems that allow for ongoing healthcare access. For communities like Kamengo, sustainability means empowering local health workers, ensuring they have the training and resources to handle the most common health issues, and providing support for when emergencies arise. Each time we return, we build on what we’ve learned and what we’ve left behind, working to improve healthcare systems that will continue to serve the people long after our mission ends.
For me, Kamengo is a symbol of hope and resilience, a community where we’ve seen real progress, yet one that reminds us of the work still to be done to ensure sustainable healthcare for all.
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