I did my elective at Kiwoko Hospital in Uganda because I was drawn by its Christian ethos and witness, reflected in the motto 'we treat, Jesus heals'.
This mission hospital was founded in the late eighties by Dr Ian Clarke in the district of Luwero. This area of Uganda became known at one point as 'the killings fields of Africa' due to the civil war that cost the lives of thousands in the eighties. What started as a clinic at the footsteps of a church, in order to respond to the pressing medical needs of a local rural community shattered by war, malnutrition and disease, has grown to be a hospital with 220 beds, theatre, neonatal intensive care unit, laboratory technician and nursing training courses and an active community programme. Kiwoko Hospital is the only functioning hospital in the district, and as such, provides an essential service and Christian witness to the surrounding rural communities.

I went into medicine with the purpose of becoming involved in missionary medical work in the future. I found that throughout my years in medical school, however, that original vision had somehow dwindled and given way to a more cynical attitude, perhaps partly due to an environment fairly hostile to Christian values in the UK. The elective would a golden opportunity, then, to revive that flickering missionary zeal and to experience first-hand the challenges and joys involved in practising medicine with the aim to extend God's Kingdom in practical ways. I was looking forward to the relative freedom there is in Sub-Saharan Africa to communicate the gospel to people. I was expecting to be changed and shaken out of my 'comfort-zone' by the harsh realities of rural Africa. I was also looking forward to expanding my clinical skills and knowledge.

Clinical skills

In terms of clinical skills, Kiwoko Hospital offered an excellent opportunity for learning. I clerked many patients from the local rural community coming to hospital in critical conditions, many with malaria, pneumonia and HIV-associated infections. Many of these patients travelled for many miles before reaching the hospital. This, coupled with the fact that many avoided coming to hospital in the first place, due to the expense that this would incur, meant that, unfortunately, a number of patients would reach the hospital when it was too late for treatment to be effective. It was difficult to come to terms with the fact that many of these patients would have survived or had a better outcome had they been treated in the UK, yet on the other hand; it became clear that without Kiwoko Hospital the local community would be seriously limited in terms of access to health-care and life chances.

Even though Kiwoko Hospital charges are heavily subsidised by donations received, many of the locals, mostly subsistence farmers, still struggle to pay for treatment. This, and the relative lack of investigations available, has a massive implication on how medicine is practised:

• the cheapest drug that is effective is prescribed first, only if needed
• chest radiographs are only ordered if they are essential to management
• choice of antibiotics is decided upon clinical grounds and white cell differential, since blood cultures are unavailable
• inhalers are not prescribed since most patients cannot afford them
• length of stay in hospital is often limited by how much the patient can afford to pay and whether they have an 'attendant' (someone to see to their needs) whilst they are in hospital
• shortage of donated blood means that sometimes difficult decisions must be made as to which patient has the priority for a life-saving transfusion, e.g. a profoundly anaemic child with severe malaria or a woman with profuse post-partum haemorrhage.

I found that my clinical skills were expanded in this setting, as I continually had to force myself to rely more on clinical judgement rather than investigations, and when choosing investigations, I had to ponder over which investigations were essential i.e. whether or not they would alter the management. Also, one had to take into account the patient's resources and support when deciding on length of stay and follow-up arrangements. It was encouraging to see many patients recover, the massive difference that small interventions made and how grateful people were, despite the relative lack of facilities.

I was inspired by the dedication and sacrifice displayed by most of the doctors at Kiwoko Hospital, both expatriates and Ugandans. The hospital should run on eight doctors: it was running on four! This put considerable strain on them, yet they were committed to serving the local community and willing to go the extra mile. The day would start early with a morning service attended by most of the staff, launched by worship with drums in true African style and followed by a short sermon and prayers. This was an excellent way to start the day, I found, as it placed the focus on God from the outset.

Eternal lessons

Spiritually, this experience challenged me, but not in the way I had expected. I had anticipated that it would be easy to share spiritual truths with patients in Africa. I found, in reality, that I still had to take the initiative to offer prayer to patients and to look to God for the many cases, when medically speaking, we could not offer anything else. I found that when I took the opportunity, patients and their families, welcomed the input. This taught me a big lesson: that a Christian doctor's witness is to be evident both in terms of works and words. Many of us hide away behind our medical works, professionalism and political correctness, thinking that we are doing enough to advance God's Kingdom. We thus shy away from both seeking and taking opportunities to share eternal truths and point patients, colleagues and friends to God, or even identify ourselves as Christians (!), often for fear of being ridiculed in what has become a fairly hostile environment to Christianity in Europe. Yet, it is still required of us to 'preach the good news to all creation' (Mark 16: 15) and 'make disciples of all nations' (Matthew 28:19).

I had expected the harsh realities of rural Africa to shake me up and soften my heart: they did not! I have come to realise more than ever before, that only God, by His Word and Spirit, through walking closely with Him daily, can soften my heart, rid me of the cynicism and unbelief of Western society, and give me that compassion for the multitudes that Jesus had. Learning compassion starts in that secret place, with Jesus, when no one else is looking. Only then can I see Him in the faces of patients, relatives and colleagues I come across on the wards in the NHS or Africa, and realise that whatever I do for them, I am actually doing to Him. (Matthew 25:31-46) This newly gained insight has made me more motivated to make a difference, both here and in forgotten corners of the globe, and has thus re-kindled my interest in missionary work

Thank you

A big thank you to Healthserve for helping me towards the cost of the elective.