Chasing Mountaintops

Friends,

This past year, I have been living and working in Uganda as a medical research fellow. (Yes, despite what you may see on Instagram and Strava, I do in fact have a job and am doing work I find very meaningful). My fellowship is a 12-month clinical research training program. It is designed to be bi-directional, funding trainees from the United States and from our partner countries, with the aim to launch careers in global health through research, support, and mentorship. As a general surgery resident with aspirations for a career in global health, this opportunity has been invaluable to me as it is one of very few pathways to do this kind of work. What is global health, you may ask? To me, global health is the belief that quality healthcare is a human right, no matter where someone is born. In the words of Dr. Paul Farmer, “the idea that some lives matter less is the root of all that is wrong with the world.”

My work this year has been based at Mulago National Referral Hospital in Kampala, Uganda. It is the largest public hospital and referral center in the country. While care at public facilities in Uganda is free, there is no getting around the fact that the Ugandan public health system is extremely resource-constrained. There are never enough nurses, never enough doctors, never enough medications or supplies – and whatever is not available falls on the patients and healthcare workers to provide. For anyone coming from a high-resource setting, the acuity and volume of preventable human suffering and death is jarring. For my Ugandan colleagues and patients, it is the daily reality of the system they work in and the world they live in. I am continually inspired by the generosity, compassion, creativity, and strength with which they carry these mental burdens. On a personal level, the first 4 years of residency were not easy ones for me. The friends I’ve made and the adventures I’ve had this year, both in and outside of the hospital, have helped me remember and reclaim my reasons for going into medicine in the first place. That’s something that will benefit my patients wherever I am.

My research addresses sepsis in pediatric surgical patients. While sepsis is a leading cause of death worldwide, babies and children in resource-limited settings suffer disproportionately, with Sub-Saharan Africa having the highest burden and death rate of anywhere in the world. (Shoot me a message if you want the scientific articles backing up these facts). Despite this need, there is very limited research on sepsis. This is especially true regarding sepsis in children, in surgical conditions, and in resource-limited settings. A wide variety of surgical conditions can lead to sepsis, and surgery is part of the treatment for sepsis in many cases. This study is, to our knowledge, the first to look at sepsis in pediatric surgical patients in a resource-limited setting. I am fortunate to have support for this project from my fellowship program and my home program in the US. I am very proud to be leading and learning from an excellent research team, with mentorship and guidance from surgeons in Uganda and the US. We are seeing data come in which is already helping children on the ward. We hope that once our research is published, our findings will have an impact beyond Mulago as well.

You may be asking by now, where do mountains fit into this picture? Let me frame it this way - the work we are doing can be quite heavy. So far in our study, around 60% of our patients have died. Anyone working in healthcare, and especially on the ground in global health, knows that personal well-being is not just a luxury- it is an essential part of maintaining longevity in this field. We celebrate the wins, and we find ways to move past the losses so that there will be more wins in the future. In other words, we’re always climbing toward that next summit.

I am someone who finds rejuvenation in wild places and joy in pushing myself physically. Being in the mountains gives me time to process and reflect. East Africa just happens to have some of the most beautiful and unique mountains in the world. This year, I’ve had the opportunity to climb 2 of the 3 highest mountains on this continent. So, I thought, why not make it 3 for 3 and add an extra layer of meaning while I struggle up to the summit of Kilimanjaro? I’ll be making a solo trip to climb Kili this June, in a last hoorah before returning to the US to finish general surgery residency. By solo, I mean I’ll be with a guide, a porter, likely a chef, and whoever else we link up with along the way – as that’s how things are done in this part of the world. While I’ll be paying for the trip myself, any funds I raise from this effort will go directly towards the work that the pediatric surgery team is doing at Mulago Hospital.

THE MOUNTAINS:

Mount Kenya

Mount Kenya is the second highest mountain in Africa. It’s an extinct volcano located in central Kenya, a biodiversity hotspot, and a sacred mountain for the local communities. I had the opportunity to take a little road trip from Kampala to Nairobi to Mount Kenya in October and made it up to Point Lenana on October 27th. At 16,355 ft, this was my first real high-altitude experience. (The true summit is at 17,057 ft and requires multi-pitch technical climbing - something I haven’t quite worked up to yet.) I was blown away by the beauty of the place and the kindness of the people. I left wanting more.

The Rwenzori Mountains

The Rwenzori Mountains are a mountain range that forms the border between Uganda and the Democratic Republic of Congo. While the Rwenzoris have been legendary since at least the 2nd century CE when an ancient Greek philosopher referred to them as the “Mountains of the Moon”, they remain elusive due to their remoteness and the ruggedness of their terrain. European explorers didn’t learn of these mountains until the 1860s, and even today only around 1,000 people per year visit. They have some of the last remaining glacial ice on the equator (which is melting fast), and some of the most unique flora and fauna in the world. I feel incredibly proud and grateful to my family, who came to Uganda in March to trek in the Rwenzoris with me. We spent 5 days in the mountains, experiencing everything from tropical heat to pouring rain, hail and thunder, to a glacial traverse. We summitted Margarita Peak (16,760 ft) on March 5th. This was truly one of the most memorable experiences of my life, and probably the most gnarly hiking and “intro mountaineering” any of us has ever done. We had an incredible local team who made it possible and forged many new friendships along the way.

Mount Kilimanjaro

Kilimanjaro, in northern Tanzania, is the highest mountain in Africa and the highest free-standing mountain in the world. I could see it on the horizon from the summit of Mount Kenya, and you could say it called to me. At 19,341 feet, it will be a significant altitude challenge. To make things spicier (and because I don’t have the 7-10 days typically used for the most popular routes), I’ll be attempting the Umbwe route in 3 days. This route, which essentially goes straight up the mountain, has been described as “the best views but also the hardest.” Of the 30,000-50,000 people who climb Kili each year, fewer than 1% opt for the Umbwe route. If you know me, you know that’s all I needed to hear. I’ll also be scouting the route for my friends at Sunny Outdoors, a Ugandan owned and operated adventure company that facilitated my other two climbs, and a community of like-minded people who love the outdoors.

THE MISSION:

Mulago National Referral Hospital in Kampala, Uganda is one of 2 hospitals in the country (population 48 million) with a dedicated pediatric surgery department, having 7 fellowship trained pediatric surgeons on staff and 3 fellows actively in training. It is the center of excellence for advancing pediatric surgery in Uganda, and in East Africa more broadly. The team is dedicated to continued improvement in both patient care and research and has been instrumental in my work this year. This team has given me so much- I would like to give a little back.

The funds I raise on this platform will be used in whatever ways the clinicians and nurses see fit. Those on the front lines know best what gaps exist and what resources are needed where. Some examples of things we may use this money for include vital sign monitors (currently 2 - 3 monitors are shared by the entire ward), replacements for broken CPAP machines, specialized surgical instruments in pediatric sizes, cleaning supplies and other equipment to combat the spread of infection on the ward, funding for education initiatives, or a fund for patients who need extra support. One priority is incubators for newborns and premature infants. Currently, the team fills rubber gloves with hot water from a tea kettle and wraps them in blankets to keep these babies warm. While ingenious, I think we can improve this situation.

The pediatric surgery team has a nonprofit set up that I will transfer the funds to. You can read more about it at https://paedsurgug.org/. If you’d rather donate directly, you can also reach out to me and I’ll facilitate that.

If you’ve read this far, I doubt you need further convincing as to the worthiness of the cause (and if you’re not convinced, I doubt I’ll change your worldview with a few more words). That said, for me, the thought of returning to the United States in June to begin a rotation with the pediatric surgery team at my home institution is both exciting and profoundly sad. It is exciting in that I’ve learned so much about pediatric surgery in Uganda this past year, have participated in amazing cases with talented surgeons, and am excited to take that knowledge back and apply it in a setting where we do have what we need at our disposal. It is a beautiful thing to know that most children in the US with surgical conditions are treated, recover, and go on to live healthy lives. It is devastating that we see these same conditions in Uganda every day, perform the same surgeries, and do not have the same good outcomes. We see the same pain, the same love, the same hope – and I can’t unsee the children dying. We know how to prevent these deaths, if only we had the resources.

These are tumultuous times in the global health community, in our country, in the world. There are many just causes to support. Of course, this work is complicated. Some may ask about the sustainability of a fundraiser like this. Sustainability can be framed in many ways. I hope to be in this work for the long haul. The relationships I’ve formed this year and the trust we’ve built will be the foundation for that. It is also important to see the patients in front of us today. Sometimes the team just needs more than they have, and more money in combination with the right people will save lives. If you are fortunate enough to be able to give and feel moved to do so, it will be deeply appreciated and used thoughtfully. You’ll have to trust me on that. If now is not the right time, thanks for the read and please consider sharing. Let’s keep fighting the good fight, in whatever form that takes for each of us.

With gratitude,

Julia