Living in Good Health Together: The Engeye Health Clinic

From the moment I stepped off the plane I felt like I was home. Though I was
immersed in the sweltering heat of Uganda, the
environment was oddly familiar to me. Perhaps
this was because I had been to Uganda twice
before – both times on medical missions to the
Engeye Health Clinic in rural Uganda.
There was, however, something different
about this time. I felt this intense feeling of
excitement, wonder, and confidence. We were
opening the doors to the Engeye Laboratory, a
building we had been constructing for over one
year, for the first time ever. I was going to see
something that had only existed virtually to me in
person – and I was confident it would refine the
diagnosis and treatment of patients. I had an extra spring in my step from the moment I landed
at Entebbe.
Moreover, the other two board members and I were going to meet with several Ugandan
organizations during this trip to establish
partnerships that would accelerate the Engeye
Health Clinic towards become self-sustaining.
Perhaps the three meetings we were most
hopeful about were the ones with the Ugandan
Ministry of Health, FINCA, as well as
UgandaCares (all in Kampala). These meetings
were going to help us learn more about Ugandan
medicine, microfinance implementation, and
HIV/AIDS prevention and treatment,
respectively. This third trip to the Engeye
Health Clinic was going to be the most
productive trip ever. I could hardly contain my
enthusiasm.
Since the opening of the clinic doors approximately two years ago, roughly 1,500 patients
have been seen. Thanks to the hard work of our hired Ugandan nurse, doctor, and lab manager,
the Engeye Health Clinic is able to treat
patients 6 days out of the week. We are a US-
based non-profit organization focusing on the
long-term sustainability of this facility and
eventually want to hand it over to the people
of Ddegeya Village, where it was born. We
want them to love this clinic as much as we
do and to embrace it with pride. And they
already do.
After a 32-hour trip and 7,000 miles
away from Japan, I met up with the rest of
the 16-member team at the BackPacker’s Inn
(Kampala). Though we were all incredibly jet-
lagged and fatigued, we met to discuss our
goals and objectives for the relatively short time we would be in Ddegeya Village. Our main

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objective was to treat as many patients as possible while simultaneously learning from and
educating our Ugandan nurse, Joseph. Our team was comprised of medical students, family
practice doctors, pediatricians, architects, as well as public health officials. We were truly a
renaissance team. Considering that our team consisted largely of medical personnel, we were in
a great position to educate. Moreover, we wanted to make sure that the learning would be
reciprocal – that we would learn and be cognizant of the way they practice medicine in Uganda
as well. Our objective was not to mold their system into ours, but to combine the two in order
to fine-tune treatment for our patients. The Engeye Health Clinic, more than anything, is a
partnership between Ugandans and
Americans who are both passionate about
improving health care through the practice
of compassionate medicine in this little
village.
My purpose, specifically, was to
act as “Chief of Operations” for the
Engeye Laboratory. Basically, this meant
that I was to make sure that nothing blew
up or harmed patients in the laboratory.
There were three of us who shared this
role. From creating protocols for the
Wright/Giemsa stain to carrying 80-pound suitcases from our respective countries to Africa, we
were a committed bunch. Through the generous donations and support of the community, we
were able to open our laboratory with close to $15,000 worth of equipment. We were fully
stocked and ready to go. There is nothing as beautiful as the progress resulting from teamwork.
After our epic general meeting, we finally went to sleep around midnight to prepare for an early
morning commute to Ddegeya Village (home of the Engeye Health Clinic).
After spending 5 hours at the most frequented medical store in Uganda and 4 hours in
an overcrowded taxi van, we finally arrived. It was late at night at this point, though no one was
tired. We were all filled with excitement for what some had only seen in pictures – the Engeye
Health Clinic. Retiring early, we wanted to gather enough strength for a long and tiring day.
Patients would inevitably arrive for treatment early in the morning and we wanted to be prepared
and ready to serve.
The next day we awoke to one of the most beautiful sunsets I had seen in my entire life.
The village was covered with rays of sunshine seeping through the lush banana trees. I knew it
would be a good day. And it was. We
treated 100 patients that day – some who
had come from 7 miles away by foot.
We did not know that we would see at
least this many patients per day for
the remainder of the trip. It was an honor
to watch Joseph, our Ugandan nurse, in
action and to learn from the special
relationship he shared with many of
the patients. In Uganda, medical
treatment doesn’t start after the
diagnosis, but begins from the moment
the patient walks in the door. You greet
them, you smile, you ask how their family
is doing while embracing them
warmly. It is a Ugandan custom and the one we practiced the entire two weeks we were there.
It is this type of medicine – compassionate medicine – I hope to practice for the rest of my life.

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 We decided to open the laboratory during the second day of the trip so that all members
would have the opportunity to work in the medical clinic the first day. This was fortunate for
me, as I was able to see and treat many
patients alongside one of the pediatricians on
the trip (who also happens to be the dean of
my medical school). What an amazing
opportunity. By far, the most common
ailments we saw were: malaria, malnutrition,
and osteoarthritis. These diagnoses did not
surprise us – though they highlight a key point
in healthcare. It shows how public health and
medicine are NOT mutually exclusive and
how one can not exist without the other.
People were walking into the clinic with
chronic, recurring malaria because they were
selling the mosquito nets they had been given by the clinic to make much-needed money. This
shows that distributing mosquito nets is not necessarily a foolproof solution to eradicating
malaria – making sure they were being used and used properly was the solution. When you are
the responsible caregiver for a family of eight and you need some shillings to buy matooke (a
staple food in Uganda), selling a mosquito net is a
very reasonable solution. Moreover, people were
suffering from malnutrition in this village because of
poverty. They did not have the resources to
provide enough food for themselves and their
families, as most villagers in Ddegeya live below the
poverty line. Finally, osteoarthritis was a major
diagnosis, since most villagers exist as subsidiary
farmers who work in the fields to make ends meet.
The repetitive motion of hoeing and harvesting the
crops was taking a toll on their health such that it
was painful for many of them to even walk. All of
these chief complaints point to the importance of public health measures in both prevention and
treatment. It is not as simple as prescribing a medication or performing a medical procedure to
improve someone’s health. We really need
to understand the Millennium Development
Goals and strive towards achieving them by
2015 in order to tackle some of the biggest
problems from start to finish. We can not
tell people in third world countries how to
live, though we can help them access and
utilize critical resources to bolster healthcare
in general.
One case in particular touched me.
A 21-year old lady came into the clinic who
was seven months pregnant. She appeared
relatively healthy and was excited about her
second pregnancy. She was concerned,
however, as she was bleeding every month
as if she were having a menstrual period. After a thorough patient history, her story became
more and more convoluted. She had many sexual partners and really wanted to have a second
child. She apparently went to the hospital very early on in the pregnancy, where they confirmed

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that she was indeed pregnant. However, the bleeding came at approximately the same time
every month and lasted for two days. Ideas were already forming in my mind after spending 50
minutes on this patient’s history, demonstrating that sometimes a patient history can be just as
important (if not more so) than a physical examination. After examining her stomach with the
pediatrician, it became clear – this woman was not actually pregnant. We did not know for sure,
but once she relaxed her abdominal muscles,
the nice third-trimester bump we had noticed
suddenly flattened into nothing. We used two
pregnancy tests to make the official diagnosis
– Pseudocyesis. The first test was slightly
positive, as the second band was barely visible
beneath the control. After taking the second
test, however, it became clear that this woman
was NOT pregnant. A component of this
disorder is the concept of mind over matter –
sometimes women can actually elevate the
level of HCG hormone in their bodies when
they think they are pregnant (or want to be
pregnant). What was once an OB/GYN case transformed into a psychiatric case before my very
eyes. I was concerned that this young lady would take the news poorly, though she seemed to be
perfectly fine with the diagnosis (we told her she was not pregnant). We explained that the
blood she was seeing every month was a menstrual period and that it was normal. Surprisingly,
she seemed relieved. Whether she had Pseudocyesis or not is still up to debate.
The next day, and for the majority of the trip, I split my time between the medical clinic
and the diagnostic laboratory. When I saw the laboratory for the first time, I was floored with
how beautiful the structure was and how it
would easily improve the quality of care for
our patients. The laboratory consisted of 4
large rooms: Two were to accommodate
patients, one served as the pharmacy, and the
final room held our diagnostic equipment
(also referred to as our “laboratory.”)
Three of us spent an entire day sorting all of
the equipment we had been donated –
pipettes, tubes, microscopes, slides, etc. – so
that we could have a relatively organized
room and system. After spending the day
hanging up protocols, sorting equipment, and
trying to make the most out of our solar
panel energy, the diagnostic laboratory was born. It officially had a heartbeat of it’s own and we
were ecstatic.
The laboratory served a vital purpose during the trip. It was a central meeting ground
for all clinicians, considering that blood draws, pregnancy tests, and urine samples were
processed and further investigated in this room. We were able to test for strains of malaria, run
each urine sample through a battery of tests, as well as test blood hemoglobin and sugar levels
for anemia and diabetes, respectively. Moreoever, we were able to perform blood smears to
utilize the few stains we prepared for this trip. The laboratory was a bustling place and it was
exciting to see it come to life and serve it’s purpose. Sprinkled in between the clinic and
laboratory work, myself and the other board members met with several Ugandan organizations.
We were able to introduce ourselves, the purpose of the Engeye Health Clinic, as well as our
hopes for the future. Ultimately, we were able to establish partnerships with the Ugandan

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Ministry of Health, FINCA, as well as UgandaCares (HIV/AIDS organization). Through these
connections, we hope to be able to subsidize the cost of antiretroviral HIV/AIDS treatment for
patients using local government funding as well as refer our patients to specialists for counseling
and complicated procedures. In addition, we
hope to introduce microfinance to the village
starting in 1-2 years so that the villagers will be
able to obtain small loans, pursue options once
unavailable to them, and improve their overall
quality of life.
One of the most fascinating aspects
about the Engeye Health Clinic is that it is a
clinic built in the middle of an incredibly rural
village in Uganda. The clinic is submerged
within this village and the doors are wide open
for everyone. During the day, while patients are
being seen and treated, the local children often
visit the clinic and just hang around to watch the
“Mzungus” (white people) in action. They
usually chant, “Hello Mzungu,” though it was an extra special treat to hear a few of them say,
“Misty!” with glee. The children want desperately to help in anyway that they can and often just
play in the grass until they see when they are needed. For example, I walked to the giant water
canister we have (it collects rain water) to grab some water to take back to the clinic. I was
having trouble carrying two jerry cans by
myself, so two children quickly saw me
struggling and came to my rescue.
Together, the three of us were able to
carry the jerry cans to the clinic and I
would have never been able to do this (in
one trip) without their kind attention and
help. They were little angels and did this
out of the kindness of their heart.
During all three of my trips to the
clinic, the children have been an integral
part of my experience. They are more
than just some of the patients we see –
they are our friends. I have become close
to many of the children, in fact, and have
watched them grow over the two years I have known them. They have helped many of us with
our medical work at the clinic as well as played soccer with us until the Ugandan night covers the
village in darkness. I have seen some of them overcome sickness and malnutrition and some of
them perish. To me, this has been one of the greatest blessings and hardships of being so
actively involved in the clinic – watching these children live life below the poverty line. It is a
true miracle when they become better and I am so thankful for the magic of medicine that has
resulted in many of these recoveries. For those who don’t recovery, however, I am saddened
beyond words. Many of these children pass away from preventable illnesses and it is completely
inexcusable to me that their lives have been sacrificed due to lack of resources and access to
healthcare. It is for them – for the smiles that will no longer light up Ddegeya Village – that
Team Engeye fights. We are determined to meet the high demand for healthcare in this village
and see that this progress permeates other impoverished areas of the third world.

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 During one of the final nights, we were able to introduce the children to a special treat –
movie night at the clinic! With our
relatively recent installation of solar panels
and our ability to properly harness the
energy (thanks to the two Union College
Minerva fellows who currently live and
work in the village), we were able to project
the movie “Wall-E” onto the wall. This
was the perfect movie to show the
children, as the messages presented
throughout the film were conveyed more
through actions and body-language than
through English words (which would have
been foreign to them). Something seemed
perfect about this night as I sat on one of
the 4 benches placed in the center of the
clinic. Two children crawled on my lap while the others huddled close together to make room
for the crowds of children that would see pictures in motion for the first time. Their laughter
made the stars sparkle even brighter around the equator that night.
Having returned to my life in Japan, I feel more compelled to help now than ever.
Thank you, Engeye Health Clinic, for reviving this intense desire I have to help this little village
and for reinforcing our collective team’s conviction to help change the world.