In February 2011, my wildest dreams came true. I had been selected as an infectious disease physician for Médecins Sans Frontières (MSF) and had been posted to Uganda, East Africa. Having always wanted to work in Africa, I jumped at the opportunity. I was to be a “TB doctor” in a remote town called Kitgum. I rushed to google Kitgum and Uganda. After numerous pictures ranging from war-torn villages to music icons to national parks, I decided to go and see for myself.

The team in Delhi was very encouraging. I arrived in Kampala late one evening in March 2011. After a series of briefings, I was on my way to Kitgum in a Land Cruiser. As we drove further from Kampala, lush green tropical sights gave way to desert and dry lands. After eight long hours over rough roads, I was warmly welcomed by the team in Kitgum.

My first impression of Kitgum was that it could pass for an Indian village, barring cultural differences. The weather was hot and dry, the sunlight blinding and the locals friendly. We were a ragtag team, full of spirit and positive energy but ever-changing. I never really got used to fellow expats leaving the project to go home. My team leaders were very capable and experienced. They taught me about aspects of project planning and human resources management that I had not been previously exposed to.

Before I knew it, I was off to remote villages in Kitgum district, overseeing the care of TB and HIV patients. MSF clinics were located all over Kitgum and neighboring Lamwo districts at authorised Ministry of Health units. Outreach workers spread awareness of TB in the community and helped refer patients to the mobile clinics. Our clinics comprised a clinician, a counsellor and a lab technician working tirelessly to diagnose and treat patients. We aimed to work in collaboration with government staff, but this was often not possible owing to absenteeism amongst the latter. In early 2011, MSF also ran a health unit for basic healthcare at a village called Madi Opei, very near the South Sudan border. Although living conditions were difficult, it was very uplifting to live and work there.

Our patients hailed from deep within forested lands and walked an average of 15 km to seek healthcare. Some even made the effort to come all the way from border villages in South Sudan. A common and often heartbreaking sight was that of a weak, elderly individual carrying a sick, immobile patient to the clinic.

As the local staff became more comfortable with me, stories of the dark times in northern Uganda slowly unveiled.

For 20 years, a rebel group called the Lord’s Resistance Army (LRA) had laid siege to northern Uganda. Fighting between government forces and the LRA had forced people to leave their homes and live in camps. Thousands of children were abducted by the LRA and forced to become soldiers. Many were forced into horrific acts of murder under threat of death or worse. Many of my Ugandan colleagues had escaped the clutches of the LRA as children and had seen untold horrors.

The war had left the health system of northern Uganda in a shambles. MSF had started to work in camps for internally displaced people in 2003 in a town called Lira. The initial focus was basic healthcare and nutrition. MSF activities had slowly migrated northward to the treatment of individuals with TB and HIV and in response to emergencies. Over time, it was noticed that the government, with the aid of NGOs, was slowly getting back on its feet. MSF worked in collaboration with the Ugandan Ministry of Health in the treatment of TB, HIV and basic healthcare. But we were the sole providers of care for MDR-TB as the Ugandan government did not have drugs available. Owing to the increasing capacity of the Ugandan government health facilities, a large part of our efforts involved handing back healthcare activities. However, our responsibility towards MDR-TB patients keeps us in Kitgum.

One MDR-TB patient stands out in my memory: a young man from a neighbouring district who was severely ill. As our agreement with the Ugandan government was restricted to Kitgum district, we had to negotiate for months before enrolling this patient for treatment. I had the satisfaction of starting him on therapy and seeing him improve before I left the project. In the near future, he hopes to complete his education and start working. This patient and a few others underlined the need for a dedicated place of care for MDRTB patients from northern Uganda. For this reason, MSF chose to construct an isolation unit at the Kitgum government hospital.

An unpleasant but essential part of our job as expats was termination of staff contracts (as we scaled down the project) and dealing with disciplinary issues (theft, misconduct). I learnt to take responsibility for my staff and not just for my patients.

My experience with MSF in northern Uganda was an eye opener. I learnt to look at diseases from a public health perspective, to deal with difficult human resource issues and to cope in a multicultural environment. I was fortunate to work with people with tremendous capabilities and strength of character. I made friendships which I hope will last for a lifetime. We shared food, drink, laughter, tears and occasionally conflicts. MSF and Kitgum have made a lasting impression on me and I hope that I have emerged a stronger and more mature person.

-Dr Pratibha Seshadri