Imagine a single mother rising very early in the morning to take her sick newborn to the clinic. She barely slept because the baby had been irritable and febrile all night. She grabs the empty gallon containers next to the door and heads to the nearest water pump which is at least a mile away from her house. She has to prepare breakfast for her five children on an open fire in the yard. As they eat, she gathers her medical documents and searches her bag for any remaining cash from her market sales. She puts on her best dress and her only pair of flats. With her newborn baby tied to her back, she takes the boda-boda (a motorcycle used as public transportation) to the hospital. All of this happens before dawn.
At the hospital, she joins the line for triage. The nurse tells her that she must pay the consultation fee of UGX 10, 000 in order to be seen. She pays the required fees at the cashier’s booth and awaits her turn to see the doctor. The wait is very long, and the baby becomes more irritable by the minute. The baby’s cry echoes throughout the hall and other patients are starting to look in her direction. She tries to breastfeed, but the baby vomits over her dress. Finally, it’s her turn. She walks into the room and greets the doctor.
After examining the baby, the doctor recommends several lab tests and imaging. She bows her head in embarrassment. Her voice is barely audible as she whispers that she cannot afford the tests. The doctor explains that the baby would also need to be admitted. Her shoulders drop. She is not prepared to spend the night here at the hospital. There is no one to call to check on her children at home. She has already been gone for hours. Besides, she most definitely cannot afford the bill. She would need to sell twice as much at the market or sell her last goat. She thinks about it for a few seconds then gets up to leave. The doctor feels frustrated that she is refusing admission and tries again to persuade her, but to no avail. He then offers to prescribe a few medications for symptomatic treatment until she can afford the labs. The baby is still crying and is beginning to look rather pale. She agrees to take the prescription. She thanks the doctor and leaves the consultation room. She heads to the pharmacy to pay for the medications with her last few shillings. There will be no boda-boda ride home. Although she is tired and thirsty, she begins the long dusty walk back home.
The admonition to “walk a mile in someone else’s shoes” means before judging someone, you must understand his or her experiences, thought processes, challenges, etc. As physicians, it is a reminder to cultivate empathy and develop compassion. Every patient goes through different experiences that make them behave and react in a certain way. You can never really know the reasons behind a patient’s actions until you have had similar experiences. Though this may not always be possible within the walls of the hospital, global health experiences such as this rotation grant us the opportunity to literally experience the world from another person’s perspective, to view life from their living conditions, and to feel what it feels like to be that person.