Jeannie Juster, MD

For a month she was tested by the elements of a third world country, but was able to give more of herself than she imagined possible to the local refugees with numerous medical problems. Jeannie was kind enough to share her extraordinary experience of volunteerism abroad through an email she wrote to colleagues and friends.  She gave us permission to publish these excerpts.

Have you ever wondered about what stroke of fate allowed you to be born into privilege and opportunity?  I do think about it quite often in Portland...but here, I think about it all the time. In fact, if one is occupied in Africa in some capacity other than Tourist, one can't help being impressed by the huge disparity between the abjectly poor and disenfranchised refugees or nationals and the wealthy practically anywhere else.  Starting with the basics...not just potable, but ANY water that doesn't need to be carried in jerry cans plugged by a banana or an eggplant so the water doesn't slosh out, electricity, food, mosquito nets, medicines, school, opportunity for university, permanent housing...  

Take my translator, David.  He's been in the camp for 15 years...fled war in the Congo age 7 with his 5 sibs and parents...two sibs shot and killed as they fled.  He is so bright and such a motivated, hard worker...and yet not allowed to have an education beyond high school...can never hope for a house other than mud and sticks (because the UN policy is to disallow tin roofs or cement floors or walls as that would constitute "permanency" and then the refugees wouldn't want to leave their "nice" houses to return to their countries), may not be able to save up for a dowry to get married for years on his translator salary...he banks by saving to buy chickens.  Ugandans and Ex-Pats query me, "Are they still there?  Why don't they go home?"  That question belies a blindness or ignorance of the political and economic realities affecting this region.  Although 81,600 refugees from 8 countries are in Nakivale, my Health Center primarily sees Congolese, Rwandans and Burundi.  The Congolese flee war, the Rwandans have shifted...many Tutsis returned to their country and Hutu took their place.  I had a really weird encounter with one man who initially pretended that he didn't know much French and claimed to be Burundi, but then it turned out he'd been covering up...probably a Hutu who'd perpetrated unmentionable atrocities in hiding.  When someone recognizes the bad guys, they go hide out in another village in the camp where no one knows them.

Mondays and Fridays are the heaviest days...we see 400 patients; other days 200-350. And they're sick.  Presently the bottleneck is Lab (sound familiar?).  But that's because one of the two techs had a baby 1 week ago.  Jeffrey gamely does all the tests himself.  We have a Catch 22...the Rapid Diagnostic Test for malaria is expensive and so is Coartem, the best anti-malarial, but Blood smears are labor intensive.  So we let Jeffrey decide which test he'll do as we don't want to use expensive meds without sure dx.  We use 50 adult packs of Coartem per day and at least that many pediatric.  If we are caught up with patients, but waiting for labs, we screen patients for glaucoma using the Tonometer Avia that Reichert Medical Devices loaned me.  The problem is...glaucoma meds are not on the priority list of the Ugandan Ministry of Health.  We're working on getting the meds as dx'd 3 patients with IOP greater than 25 torr in past week alone.  

It is quite distressing for me to practice with such limited diagnostics.  Yesterday had a deeply jaundiced 2 year old, febrile, negative for malaria, hep b.  I couldn’t get liver functions...will have to do nothing (ie treat it as infectious hepatitis and hope for the best).

The ER has been a great platform from which to jump into medical volunteer work.  (No need to go exotic...the Free Clinic of Southwest Washington in Vancouver is plenty appreciative.)   I find my time most well spent when I am filling a provider position at a project with an intact infrastructure, some diagnostics, and ongoing daily operation so that the patients are not showing up out of curiosity but out of real health needs.  Any MD, PA or Nurse Practitioner would be most appreciated here.  One month is all I can handle...I don't know how the dedicated national staff does it...they have to live on site without running water or electricity.  We volunteers, with MTI (Medical Teams International...formerly Northwest Medical Teams,) are driven to a guest house with a cook/housekeeper.

I am here with a retired Pediatrician and a retired Nurse Practitioner.  Knowing our presence makes a difference to the refugees and the national staff makes the horrid 1.5 hour increasingly dusty and bumpy trip to and from camp tolerable. So far have done asthma, meningitis, eye conditions, and patient positioning for various conditions (the last 3 were staff requests). We're more than halfway through our month here...I may not have time to write a BIG letter again...preparing for staff continuing medical education.  It's so enjoyable to hear from friends and colleagues.  Thank God for email. It's nowhere near the isolation of yesteryear!