By Dr. Jill Hilty August 12, 2020 Wherever the art of medicine is loved, there also is a love of humanity. – Hippocrates Dr. Jill Hilty is a family practitioner based in rural Colorado. When she found out about Medical Teams through a colleague in global health, she felt compelled to volunteer in Uganda. When her fourth volunteer trip to Uganda was canceled, Jill pivoted her plans to serve alongside our U.S. Programs team doing COVID-19 testing in Seattle. We asked her to share her experiences and reflections from serving with Medical Teams abroad and in the United States. The first time I went to Uganda to serve with Medical Teams, we were at our settlement only a few days when the war in the Democratic Republic of Congo (DRC) escalated. Thousands of people were fleeing the rebels and crossing the western border of Uganda. The staff at the border needed help, and we were transferred to Kisoro in southwestern Uganda to serve the many medical needs of the people flooding in. Kisoro is a picturesque town with rolling green hills and a 14,000-foot mountain range that bursts out of the farmland. It is located at the border of the Congo and Rwanda. Working at the intake camp in Kisoro was less chronic disease management and more emergent care. As a primary care physician, I am comfortable wherever there is need. The inpatient ward, the outpatient clinic, and specialty clinics such as family planning, HIV, and labor and delivery. I appreciated the support that everyone at the medical clinic provided, but when I started working at the border crossing, I became acutely aware of how valuable one person in particular can be – your translator. They can easily make or break a difficult patient encounter. The Medical Teams translator I worked with, Alex, grew up living at the Uganda border with the DRC and Rwanda. Growing up on the border helped him learn many languages, such as the mix of French and Swahili spoken in the Congo. Alex and I both started working for Medical Teams on the same day. He was hired as a translator at the border camp a couple of days before my arrival. The translator is vital towards building a sense of trust with patients. The proper choice of words or hand gestures is critical toward not offending or alienating others. There we were, two strangers that hadn’t had time to get acquainted, and we were having intimate conversations with people who didn’t know either of us – and who had just been through the most horrifying experiences of their lives. I remember the tense atmosphere in our time at the border. The patients arrive under great distress. They are still in shock from what they had just witnessed or endured at the hands of the rebels. They are grateful to have survived, but their fear is palpable. I became very familiar with the brutality of war from witnessing their pain. I’ve learned how to communicate bad news about test results and prognoses. I’ve learned how to be by someone’s side through a fatal illness, and I have a place I can emotionally retreat to when I take care of abused children. However, I had never had to learn how to relate to people who have been tortured. This was a heartbreaking education and a process for me. Celina: Escape from the Rebels One of my fondest patient encounters was with a woman who was helped into the medical tent by the Medical Teams staff. Her name was Celina. She was 32 years old and frightened. She was wearing what looked like a burlap sack. I thought that this was likely something she had been given to cover herself, because it didn’t look like clothing. Celina stated that she had been captured by one of the rebel groups and tied to a tree in the forest for 2 weeks. She was sexually assaulted and beaten many times each day. She eventually managed to loosen her ropes and escape. She ran naked for two days before reaching the border. I reassured her that she was safe now and that we were going to do our best to take care of her. I knew that doing her exam in a room with a gaping breezeway and no privacy would just add to her trauma, so after she finished answering my questions, we moved to small tent out back. Alex thought it best to obtain a female interpreter while he went to pick up the medicines and supplies that I knew I would need. Unfortunately, the new interpreter spoke very little French and even less English which may have contributed to Celina’s increasing unease. I told the interpreter that she could return to the main tent and assist others. As silence ensued between us, I sat with Celina and held her hand, and she was able to relax. When Alex returned with the supplies, I completed her exam while Alex waited outside the tent. Then he rejoined us and explained to her the lab tests I performed, my plan of care, and the medications being prescribed. Later, as we were exiting the camp in our vehicle, I saw Celina leaning on the exit gate. She must have been there a long time, and she appeared to be waiting for me. I caught her eye as she smiled and waved. Two days later, Alex and I were seeing the usual load of patients alongside the Ugandan clinical officers when a very attractive woman came in and sat down. She was wearing a beautiful dress and her hair was wrapped smartly in a scarf. She had a sparkle in her eye and had a very proud look about her. Her main complaint was vague pain and nausea. No fever. No chills. And no to many other symptoms. When I examined her, I noticed that she was unusually sweaty and breathing a little faster than normal. I knew this was not a common constellation of symptoms for malaria, but this is what I suspected and I ordered a test (which eventually confirmed it). I looked at her triage card and saw that this was Celina. The woman we had seen that was held captive in the forest. She was unrecognizable as the same individual. I pushed her triage card over to Alex as I asked him, “Do you know who this is?” He shook his head no, and then I pointed at her card and her name. He was shocked. And then he smiled – a big, satisfied smile. I congratulated him on a job well done. His help with translation had made a huge difference in this woman’s path to recovery. Serving in Seattle Due to the coronavirus pandemic, my Spring plan to return to Uganda with Medical Teams in 2020 was put on hold. There was, however, a volunteer request to help with COVID-19 testing in Seattle. Medical Teams was working with Seattle/King County Public Health to identify potential cases of the disease in the underserved population of the city. These included people in homeless shelters, people in multi-generational living situations, and people without access to health care or proper disease prevention measures such as social distancing, mask-wearing, and hand washing. With the Uganda mission on hold, I had time set aside in my schedule and signed up to assist. I signed up before the tragic death of George Floyd and its impact across the country. Seattle testing sites were moved in order to meet changing needs, since many of the protestors were also part of the population that we had intended to screen for COVID-19. Part of being a volunteer is to remain flexible and help solve problems. Medical Teams’ mobile testing site was busy, but it didn’t seem that many of the campers were coming to the tent for free testing, so I decided to take some flyers and other information into the area and talk with people. After all, this population had been living in a camp for two weeks without easy access to social distancing, mask-wearing, and hand hygiene. I couldn’t help but reflect that, in an obscure way, this role had similarities to when I was working in the border camp of Uganda. Although reacting to and processing a much different kind of experience, these patients were uneasy and suspicious about who they could trust. People asked me all kinds of questions: Were we there to spread COVID with our nasal swab? Were we going to force people into isolation and quarantine? I heard their concerns and then worked to build trust. I spent hours talking with protestors and campers and eventually, many of them desired testing. Thankfully, our positivity rate was low and those that were positive were amenable to assistance with isolation options. I have found that while worlds apart in their circumstances, people wherever you go have similar, very human concerns. They are not always sure who to trust, particularly when it comes to medical workers. They have hopes and dreams for a better future. My role as a physician is to help build that trust – to make sure our patients receive the holistic care they need so that a future is possible. To help restore hope through healing. For this reason, I am grateful for the opportunities I’ve had to serve and to help heal through Medical Teams International. You can help restore hope through healing, volunteer today!