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Global Health Course in Uganda


Written by:   Jerry Paccione M.D.









I.                   Goals and Objectives:


A. Overview:


The program of the Global Health Elective in Uganda is designed to provide the house officer with the familiarity, skills and experience to diagnose and treat diseases of the developing world, particularly Subsaharan Africa, and to perform competently in delivering care in resource-limited settings.


The GH Elective consists of one block of 4 weeks in which the resident works both on the wards and in the clinics of Kisoro District Hospital in Uganda. The resident is supervised by either local hospital physicians or internists from Montefiore, and by regular case-based email contact with Dr. Paccione.

Additionally, all take the required pre-requisite course in Global Health in June, of the PGY II year. The GH Uganda rotation is available to all Internal Medicine  PGY IIIs.   


B.  Level based Rotation Goals and Objectives:




Competency 1: Patient Care

Provide patient care that is age-appropriate, compassionate, and effective for the treatment of health problems and the promotion of health in Uganda.

1.  Use a logical and appropriate clinical approach to the care of patients in a developing country setting, utilizing locally available resources, and applying principles of evidence-based decision-making and problem-solving.

2.  Understand the approach to patients with the following presentations in developing countries and initiate appropriate work-up and management:

Respiratory Distress


Seizures/Altered Mental Status

Malnutrition (including Severe Acute Malnutrition)

Chronic Disease: HT, DM, Epilepsy, etc

HIV and wasting illnesses


            CHF, ascites, etc.

3.  Provide culturally sensitive care and support to patients and their families.

4.  Participate in health promotion and injury/disease prevention activities in an international setting, utilizing local guidelines and practices.


Competency 2: Medical Knowledge.

Understand the scope of established and evolving biomedical, clinical, epidemiological and social-behavioral knowledge needed by a pediatrician; demonstrate the ability to acquire, critically interpret and apply this knowledge in patient care and community health.

Epidemiology/Public Health:

2.  Recognize the major underlying socioeconomic and political determinants of infant/child health, maternal mortality and adult health maintenance and their impact on the patients cared for in the hosptiatl

3. Identify epidemiological trends and significance of emerging infectious diseases in the developing world.

4.  Understand the impact of environmental factors, including safe water supply, sanitation, indoor air quality, vector control, industrial pollution, climate change and natural disaster on health in developing countries.

5. Competently care for common injuries, ingestions, burns and motor vehicle accidents, that contribute to morbidity and disability in the developing world..

Malnutrition and Infectious Diseases:

6.  Recognize signs and contrasting features of the following conditions and know how to treat them:


Stunting (chronic malnutrition)

Acute Malnutrition – severe/moderate, complicated/uncomplicated

Micronutrient deficiencies (iron, vitamin A, iodine, zinc)

Low birth weight and associated maternal risk factors

Understand and compare the different anthropometric measures used to diagnose malnutrition, and principles of prevention and management of these different disorders.

7.  Become familiar with the presentation, diagnosis, management, and prevention strategies of the following specific diseases in resource-limited settings, based on local and international guidelines:

Malaria - uncomplicated and complicated/severe (e.g. Cerebral malaria)


Diarrhea and dysentery


HIV/AIDS and related infections/complications


Typhoid Fever

Dengue Fever

Specific Populations

8.  Deal effectively with the unique challenges of immigrant and refugee populations in Uganda. vis-à-vis accessing, affording and continuing  in care.

9.  Understand and negotiate the challenges faced by people living with disabilities in resource-poor settings, and develop personalized models of support.

Competency 3: Interpersonal Skills and Communication

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families, their communities, and professional associates.

1.  Appropriately utilize interpreters and communicate effectively with families who speak another language. 

2.  Communicate effectively and respectfully with physicians and other health professionals in an international setting, in order to share knowledge and discuss management of patients.

3.  Develop effective strategies for teaching students, colleagues and other professionals in settings with varying levels of knowledge or understanding of medical English.

4.  Demonstrate awareness of effective communication approaches for delivery of health care and promotional messages in communities with limited literacy and education.

Competency 4: Practice-based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one's patient care practice.

1.  Identify  and use when appropriate standardized guidelines (e.g., WHO/UNICEF) for diagnosis and treatment of conditions common in Uganda and adapt them to the individual needs of specific patients.

2.  Know and/or access appropriate medical resources and apply them to the care of patients in the developing country setting.

3.  Understand the principles of evidence-based medicine and apply them when reviewing recent literature and considering the implications for impact on practice.

4.  Work collaboratively with health care team members to assess, coordinate, and improve patient care practices in settings with limited resources.

5.  Apply and improve upon physical examination skills and clinical diagnosis in settings where diagnostic studies are limited.

6.  Identify and collect the resources needed for working in Kisoro, Uganda.


Competency 5: Professionalism.

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity when caring for patients in a developed or developing country setting.

1.  Demonstrate a commitment to professional behavior in interactions with staff and professional colleagues and be respectful of differences in knowledge level and practices.

2.  Give examples of cultural differences relevant to care in Uganda and how traditional medicine and Western/scientific medicine can conflict with or complement one another.

3.  Identify common ethical dilemmas and challenges confronted when working in a setting with limited resources or different cultural values.

4.  Recognize personal biases in caring for patients of diverse populations and different backgrounds and how these biases may affect care and decision-making.

5.  Plan a responsible and ethically-guided international rotation experience, ensuring adequate preparation and appropriate expectations both for yourself and your international hosts.

7.  Act with sensitivity to the profound inequities in global health and contribute to diminishing these disparities.

Competency 6: Systems-based Practice

Understand how to practice high-quality health care and advocate for patients within the context of the health care system.

1 Work  effectively in different health care delivery settings in rural Uganda, including hospitals, clinics and the community, and with different health care workers such as the physician, nurse, community health worker, traditional birth attendant, etc.

2.  Identify the major governmental and non-governmental organizations active in the setting within which you work, and understand how the policies and funding structures of these organizations impact health in your community.

3.  Develop understanding and awareness of the health care workforce crisis in the developing world,  and through your efforts contribute to its amelioration in one setting.

5.  Identify different health care systems and fee structures  in Kisoro, Uganda,  including the public and private sectors, and understand the impact of these systems on access to patient care and quality of care. 

6.  Demonstrate sensitivity to the costs of medical care in countries with limited resources and how these costs impact choice of diagnostic studies and management plans for individual patients. Integrate these issues into your negotiation of care strategies with your patients.

7.  Witness the advantages and disadvantages of different approaches to implementing health care interventions in developing countries, such as vertical or targeted programs vs integrated, focused vs comprehensive, facility-based vs. community. 

8.  Advocate for families who need assistance to deal with system complexities, such as lack of money, multiple appointments, transportation, or language barriers.