Another cold, dreary day goes by and Susan Linn, second year medical student at the Medical University of South Carolina (MUSC), hears of another preventable death. Had the only clinic on the island where she worked been staffed the decedent would have received much needed treatment. Alcoholism ravages the island—it is hard to discern the causal relationship between heavy consumption and mental illness in either direction. Public health education is nonexistent. The healthcare system is almost irremediably splintered. The North Slope of Alaska may have public health conditions comparable to the third world, but the area home to the Inupiats, Alaskan Natives, is still in U.S. territory.
Linn was prepared for the conditions she would face on her most recent trip to Iganga, Uganda having worked in places like Peru and Ecuador. However, her work in Alaska’s North Slope is largely why she is pursuing global public health and medicine.
Prior to her time at the MUSC, Linn conducted ecological research on coastal lagoons in the Arctic Ocean. Most of her time was spent conducting community outreach to the Inupiat people in Kaktovik, Alaska, who are stricken with severe alcoholism and one of its most dire consequences, fetal alcohol syndrome. Linn had an epiphany in Alaska: the abysmal public health landscape led her away from research and to the clinic, where she felt her impact could be greatest in a place like Iganga or Kaktovik.
“Ever since I wanted to be a doctor, I’ve always wanted to practice abroad,” said Linn. “And I think you can have a lot of romantic ideas of what practicing in a developing country would be like until you arrive in a place like rural Uganda.”
Linn traveled to Iganga, Uganda with Uganda Village Project (UVP) as a 2014 Trainee Travel grant recipient. UVP’s mission is to facilitate community health and well-being in rural Uganda through improved access, education, and prevention. UVP focuses on five key areas: family planning, obstetric fistula, HIV/AIDS, malaria, and sanitation and hygiene. Access and education were the operative words that appealed to Linn when she researched the group knowing the importance and underlying barriers to accessing medical services in places like Kaktovik and Iganga.
“It’s hard to understand the public health system without being immersed in the culture and living as the locals do,” remarked Linn. “We were able to do that, as hard as it was at first.”
In Iganga, Linn was introduced to a number of chores and tasks fit for zookeepers and Mike Rowe of the Discovery Channel’s, Dirty Jobs. Occupants of the home where Linn and her colleagues resided were not just of the homosapien variety: bats, rats, lizards and houseflies would often make their presence known. Fending off the nonessential vermin was difficult—lizards were welcome for ridding the flies. “You want some pests to help kill and eat smaller, more dangerous pests,” quipped Linn.
The group eventually grew accustomed to the pests save for the houseflies. The only way to reduce exposure to houseflies and the diseases they carry was to “smoke out” pit latrines—a vital, sanitary convenience in the underdeveloped world. This was done by placing a ball of banana leaves in the small cesspool and lighting it afire to repel the flies. Linn and her colleagues assisted in smoking the latrine every other day for the obvious reasons, chief among them was that latrines represented the higher levels of sanitation in the village. By doing a census, Linn and her team found that most dwellings had a pit latrine which dramatically limited open defecation.
Linn found herself challenged—at first—by the need to not only “smoke” out the infamous pit latrines, but the daily hike to retrieve Gerry cans of water for bathing, drinking and cooking. The great lengths that the people in the village went through to have something as simple as drinking water blew Linn and her colleagues away, changing their perspective on how things should be valued.
“While we had the help of university students from Uganda, we chose to do some things ourselves,” said Linn. “By doing these types of tasks, it made me grateful for the things I too often take for granted.”
The rurality of Iganga and its underlying effects on public health cannot be overstated. Nor is it unique. Just as needed sustenance takes a planned effort to obtain in Iganga, the same is true for Kaktovik and, for that matter, most rural areas of the United States.
For instance, a gallon of milk was about $32 a gallon in Kaktovik, where it had to be flown in—in Iganga, water was about an hour away by foot. Linn said that access issues compounded the public health problems, whether they were medical services, proper nutrition or health education; its scarcity and demand make for more tenuous conditions.
“It is always tough breaking through in public health interventions where language, culture, socioeconomics and religion often work against your efforts,” explained Linn. “But if you work a little harder and get creative, you start to see solutions.”