IU School of Medicine student Mary Ann Etling shares the story of her experience in Uganda prior to medical school. Etling was selected as a Slemenda scholar by the IU Center for Global Health in 2020.
I remember when I first met Amony. The way we connected was typical in the small Ugandan town, where everyone seemed to know everyone. I was chatting with some friends at the local market about how I needed transportation for my fieldwork. Using a matatu (minibus) was affordable, but prone to breakdowns and delays. A private hire would be way too costly. Not to mention, neither option would get me down the narrow paths to the rural village homes.
One of my friends suggested that I hire a local boda-boda driver (motorcycle taxi), that way he could also work as a translator and a research assistant, both of which I also needed*. I told them while that seemed great, I was hesitant. The methodology involved in-depth interviews with caregivers of children of disabilities, many of whom would be women, sharing intimate details of their lives. Every boda-boda driver I had ever met was a man. Many of them were good friends to me, but I feared that the women I spoke with may feel uncomfortable being open with a man present. I thanked my friends for their help and started my walk home, fresh mangos and avocados in hand.
When I got back to St. Mary’s Lacor Hospital, I dropped off my market produce and rushed to the wards. After graduating college in small-town Indiana, I received a Fulbright grant to do research in northern Uganda for a year and Indiana University School of Medicine graciously let me defer admission. I was living in the hospital compound and it was a dream. I had permission from the medical director to shadow the interns in the evenings, so when I was not in the field, I was in the wards. I rotated between each of them, but Casualty and Children’s Ward were my favorite. Some of my deepest friendships were with those interns, or first-year Ugandan doctors. I observed quietly, trying to stay out of the way while they worked, but when they had a free moment, they would explain what they were doing or quiz me on something. My very first teachers of medicine.
As soon as I arrived, one of my friends called my phone, “Mary Ann, good news! I talked to Father Cyprian and he knows someone, who knows someone, who knows a FEMALE boda-boda driver! She’s the only one in Gulu! Can you imagine? But maybe she would work with you? I’ll get her number and send it to you.” A Catholic priest? It was divine intervention.
The next day, I called Amony and she pulled in on her red-and-green motorcycle to the bustling hospital entrance. She was extraordinary. A 30-something year-old woman with a vibrant, welcoming smile. She had earned a college degree in counseling, but employment across Uganda was dismal. Without a job and as a single mother of two primary school children, she needed to find income. She gathered the money she had and bought a motorcycle. At the time, she didn’t even know how to turn on a motorcycle, but she quickly learned everything. She became the first woman to get her boda-boda license in the entire region. I was in awe. I begged her to work with me.
Amony gradually became the natural lead of the project. She knew the region, the language, the culture, the traditions, and the Acholi people. She was an Acholi herself. Even with all the proper IRB approval and documentation, you cannot simply enter into a village and start asking questions, especially as a white foreigner. It would be hugely violating and confusing. There is a protocol to protect everyone involved and Amony knew it well. We submitted proof of our IRB to the sub-county and district leaders, called ahead and arranged meetings with every village leader (LC1) and village health team to explain our research goals, and traveled with each LC1, who personally introduced us to the families in their village. She taught me to set aside money, so that everyone who helped us could be rightly compensated for their work.
There were also unwritten cultural rules and local nuances that Amony was constantly teaching me. If a family invited us to stay for lunch, it was important that we stayed to eat with them, even if it meant they were slaughtering one of their last chickens for the occasion. At times, we would arrive at an interview and find ourselves invited to an unexpected village meeting, funeral, wedding, traditional ceremony, or nursery school parade. All too often, I would stress that we were getting behind on the research, but Amony reminded me that this was the research, being present with these families in their daily lives.
Together, we visited 16 villages across Gulu district and interviewed over 50 caregivers of children with disabilities. Amony was so tender with these families. As mothers would tear up talking about feelings of exhaustion or abandonment, she would tear up with them, offering words of encouragement. She was a single mother and a certified counselor. She could be there for them in an unparalleled way. She also remembered families and their stories better than I ever could. We would run into a mother weeks after our interview and they would greet one another like long-lost sisters, while I would be flipping through my notebook to try to recall her name. Over a year later, Amony will still check in with them to be sure they are doing okay.
I tell Amony Jennifer’s story, rather than my own, because she deserved the Fulbright more than I did. Over months of working together, it became her research, perhaps as it always should have been. I think in global health collaborations, we can lose sight of who the experts truly are. I would argue that they are always the locals, who have been witnessing these health disparities their entire lives and have a greater understanding of what their communities need. I think the more we recognize this in global health, the more equitable and mutually beneficial our collaborations can become.
As a Slemenda scholar, I got the opportunity to meet and talk to physicians, researchers, and leaders associated with AMPATH. One thing I deeply admire is that AMPATH requires that every project done in collaboration with a visiting university must have a Kenyan leader. No project or research study can move forward without a local expert co-leading the project. AMPATH recognizes that local leadership matters that much. This is the same reason that when I got the opportunity to create MSAADA, an interactive website for persons with disabilities in Kenya, I requested funds to add a Kenyan medical student to the project. Think about it. It would be silly for an American medical student to create a public health tool for Kenyans without having ever stepped foot in the country.
The other day, I was on the phone with Amony. A leader of a local NGO had heard about her work on our project and hired her to teach women at the prison how to fix motorcycles. She would be empowering local women to be able to generate an income in a male-dominated field when they were released. I was in awe again, but not at all surprised. Her Fulbright lives on.
*Editor’s note: IU learners in certain programs are prohibited from using boda-bodas or similar transportation for safety reasons.