When less becomes more

May 1, 2006

James W. Young, D.O., was on a plane, about to land in Uganda as avisiting physician on a mission for the Washington-based HealthVolunteers Overseas (HVO) organization, when a scary notion ranthrough his mind.

"I thought, 'I know nobody here,'" he recalls. "It was quite a sobering thought."

Being alone in a country where natural beauty most often meets stark poverty wasn't his only concern. While most of the government and educational venues in the country are English-speaking, in Uganda there are about three-dozen tribal-dialect barriers with which to deal. In addition, it is an area fraught with political strife that sometimes leads to sporadic battles, when The Lords Resistance Army clashes with a government-sponsored military group.

"I knew then that I had to just put it in God's hands," he says. "I surrendered my trust to Him. He greased the grooves, and I was able to make it all happen through Him. It truly was a test of faith. I have only the modest skills that God provided me, and I remembered that I was arriving there that day to let these people know that God loves them and I love them."

The mission of acting as a visiting physician or educator is growing in popularity in the United States. Dr. Young's story illustrates how the visited country benefits from these efforts - and how the physician as an individual prospers.

Sobering statistics

Dr. Young, based at the Yankton Medical Clinic in South Dakota, is a 15-year veteran in the field of dermatology whose educational stops included Ohio University College of Osteopathic Medicine and the Chicago School of Osteopathic Medicine. He says that very early in his career he ran across some startling statistics regarding dermatology in the United States and in sub-Saharan Africa.

"There is one dermatologist for every 45,000 Americans," Dr. Young says. "In Africa, it is more like one to every 1.5 million people."

Specifically, there are 26.5 million people in Uganda, 2,000 doctors - and seven dermatologists. Three medical schools turn out about 50 new physicians a year; perhaps one of them is a dermatologist. In addition, there is no healthcare payment structure.

Patients seeking care often know what their specific problem is, but have no way to pay for it. There is a shortage of medications. And, as a result, many physicians don't have banner incomes.

"Knowing these issues, I said to myself, 'Wow, someone has to do something about this,'" Dr. Young says. "I became aware of the opportunity last May (2005) to go and teach in Uganda. I just had to go. Teaching was key. It's like the old saying: Give me a fish, I eat today; teach me to fish, I eat for a lifetime."

Uganda, part of the British Empire until 1962, has a predominantly black population, which presents a few unique treatment considerations. Dr. Young was confronted by another challenge, however: a startling HIV and AIDS population in need of care.

In sub-Saharan Africa, an estimated 25 million people are living with HIV, according to a 2004 report by the Joint United Nations Programme on HIV/AIDS. In Uganda, Dr. Young says, the prevalence is somewhat lower due than in other areas due to stronger education efforts. The plight of the AIDS population hit him hard as he went to his first day on the assignment.