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Practicing low-tech medicine in Africa

Patients at Mulago Hospital in Uganda are entitled to receive only one thing: a thin mattress. Everything else -- meals, fresh clothes, sheets, blankets -- must be supplied by the patient himself or his family. "If a patient has no blanket, that means he is an orphan," Majid Sadigh, MD, told a group of doctors July 11 at Stanford. Sadigh offered a sobering introduction to volunteers in the Johnson & Johnson Global Health Scholars Program, which will send 14 Stanford physicians to Africa this fall to provide essential medical care. The doctors will spend six weeks in one of five countries, all regions where medical essentials -- drugs, equipment and even physicians -- are in gravely short supply.

"There really are no doctors in this country," noted Simon Kotlyar, MD, the program director in Monrovia, Liberia. "It's a rough place to work." Liberia, still recovering from 13 years of brutal civil conflict, has only one doctor for every 133,000 people, one of the worst doctor-patient ratios in the world, he said. There is no surgeon at the capital's main hospital, JFK Medical Center, so the visiting physicians from Stanford will have to patch up patients who come in with traumatic injuries from car accidents and other mishaps, he said.

The global health scholar awardees seemed undaunted by the circumstances they are likely to encounter. Danit Ariel, MD, a third-year resident at Stanford who will be traveling to Uganda in September, said she hopes not only to help patients in Africa but to return home a better physician, with richer values and experience. That is precisely what Michele Barry, MD, said she intended when she started the program more than 20 years ago. Barry launched the program while working at Yale University and merged it with Stanford earlier this year when she arrived as the new senior associate dean for global health. She said her main goal is to build capacity at underserved sites through long-term partnerships involving Stanford and Yale faculty. For instance, Barry once brought a Ugandan colleague to the United States to train in ultrasound and mammography interpretation and then sent him back home with a piece of ultrasound equipment. Now many more patients in Uganda are benefiting from cancer screening.

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