What rural Uganda taught me about Lifestyle Medicine and how we can help our patients

Author: Dr Yakira Mishan

The wooden boats that provide transport between the mainland and the Island

This February I was fortunate enough to volunteer in Uganda . I was based at a clinic on an Island in the middle of Lake Victoria. The island taught me the true meaning of rural. They do not have electricity and at night it is pitch black with just an immense expanse of stars visible. They also do not have running water and use a borehole to get water which they then boil for drinking and cooking.

It took me some time to adjust to this way of living –especially cold showers with a bucket- but I feel exceptionally grateful to have been welcomed into their community and to have had the opportunity to learn from them. The village is mainly run by women and they truly taught me immense amounts about life and myself. That being said I want to share my 3 greatest lessons for Lifestyle Medicine:

1. Whole food plant based is the cheapest and most readily available source of food.

The island is isolated as there are no roads or bridges to it so access is only via motorised wooden boats. As a result the availability of processed foods is practically non-existent. The women grow their own corn, bananas, avocados, jack fruit and beans on their plots of land. They then harvest their yield for eating and selling. They eat mainly the food that they grow on their own plots. For example the one day we picked banana leaves and they used every part of the plant- the sinewy spines are used to make baskets and the leaves themselves to create vegetable baskets which they use as a steamer over a pot of boiling water. In fact this is how they make their mileie pap which they call Posho. This would be served with a fresh bean stew made from beans which we picked and sorted from the plot of land as well.

Oil on the island was very expensive so fried food was rare. The livestock are amassed as wealth and assets. For example if someone was sick and needed to go to hospital they could sell a lamb to raise the funds to get to the hospital. As a result most of the food is vegan, boiled and fresh. It is a mixture of bananas, beans, peanuts, maize and fruits and vegetables.

While it may not be practical for us to grow our own bananas and then spend the entire morning sorting beans it truly was a lesson that Plant Based eating is the cheapest way to eat and in keeping with the way our ancestors ate. I feel that in South Africa this is an extremely important point to emphasise to our patients. Very often we are working with patients who have limited money to spend on food. We often feel stuck and unsure of how to encourage them to eat more plant based and less processed products. This experience has highlighted to me how tasty , and familiar plant based foods are in traditional African cooking and that we should therefore be encouraging our patients to return to their roots and embrace the foods their ancestors ate.

Fresh beans in a peanut sauce with rice and avocado

2. Living an active lifestyle is a necessity

Throughout my time on the island I was acutely aware that just going to get water required a walk of a kilometre or so and not simply a quick few steps to the kitchen. There are no cars on the island because there is no large ferry or bridge so they have small scooters called “Bodah-Bodahs” which they can take for far distances or to transport goods but they are too expensive for most people to use regularly.

They would walk an hour at a time to come for lessons at the women’s centre or to the clinic. They never complained about the distance or walk as to them it was a normal part of their day . They do not walk for exercise they simply need a mode of transport. They approached farming, harvesting, picking and cooking with the same energy and constant level of physical activity.

The children are very involved in these routines and often go and collect water, clean dishes and assist with the cooking. They also have no TV and unfortunately not many toys so they spend their time running around and playing together. By simply being a part of their daily routine it was easy to understand how our current lifestyle is making us sedentary, overweight and prone to non-communicable diseases.

These factors combine to create a setting in which non-communicable diseases are not found in the top 5 causes of death in the country (CDC). They are still struggling with malaria and neonatal deaths which speaks to the poverty and lack of development in the rural areas in the country. It also poses the question of how they can develop further and improve their general health care without increasing access to fast food and sedentary behaviours.

The borehole

3. Culture informs our understanding and expectations of our lives

The women on the Island asked us what children at home do and when we explained that they do not assist with all the house work regularly and rather focus on school they told us that these children must be so lazy. While to us children studying hard is far from lazy they were coming for a different background and could not comprehend the difference. For me this was an eye- opening comment as it highlighted the immense cultural differences we can find between ourselves and our patients.

I often find this can be a challenge because we want to educate our patients and help them in a certain way- a Western way- which we understand and have been taught but this experience really highlighted that we do not always understand the challenges our patients face and more than that that sometime what we perceive as a challenge is normal to them and really does not bother them . I think the old advice to never judge someone before you have walked a mile in their shoes is very true especially when it comes to our patients’ lifestyles.

I think we are extremely fortunate in South Africa to be able to work with people from every walk of life. This is truly challenging at times because in general lifestyle medicine is not a 1 size fits all solution but it is especially not a one size fits all situation in our setting. As a community I urge us to take on this challenge and help our patients improve their lifestyle regardless of what that looks like to them. I also urge us to learn from them and their cultures, traditions and the aspect of their lifestyles which are promoting the 6 pillars of lifestyle medicine.

The borehole

The women walked over a kilometer to come and learn . Despite their being a small classroom for them to use they requested to rather learn in the shade of the tree.