The first time Dr. Margaret Lubwama got on a bus in Seattle, the driver greeted her with a cheerful, “Good morning!”
It left her speechless with surprise.
“That never happens in Kampala,” she said of Uganda’s bustling capital, her hometown. “If you’ve ever taken a [bus] in Kampala, they’re rushing you. They’re impolite. [Here], when I’m getting out, the driver says, ‘Have a nice day.’”
But Lubwama discovered a flip side to Seattle’s infamous politeness. Although bus drivers greet riders and riders thank drivers, no one actually talks to each other. That, too, is different from Kampala’s boisterous bus-like taxi vans, packed with 14 or more people.
“In Uganda, you can start a conversation on the taxi,” she said. “There’s a radio playing, and if something funny comes on the radio, or if somebody sees something out the window that’s funny, you talk about it.”
Lubwama, 31, is the latest of more than a dozen Ugandan physician-scientists to undergo training at Fred Hutchinson Cancer Research Center as a research fellow in its Global Health Program. Except for travel to Saudi Arabia, this is her first time outside the African continent. Like the fellows before her, she is getting a cultural as well as an academic education, from the nuances of bus etiquette to the lack of nuance in holiday displays. (“Americans love lights,” she said, with the appreciation of someone who has driven Uganda’s pitch-dark streets at night.)
Like her first impression of Seattle – “Everything is organized!” – most of her experiences have been positive. Still, polite-but-reserved Seattleites can be as alien as this northern latitude’s gray skies to community-loving, equatorial Ugandans. Fortunately, Lubwama packed a dry sense of humor, a resilient spirit – and a deep sense of gratitude that has helped her weather any bumps.
“This opportunity I’ve gotten at Fred Hutch – I don’t take it for granted,” she said. “My mom is always reminding me, ‘Maggie, don’t forget to thank God for this opportunity.’ It will allow me to really help the people” of Uganda.
Lubwama arrived in September with a clear goal in mind: To write a research proposal to guide her when she returns to Uganda’s Makerere University in June to complete a three-year doctoral program in microbiology.
She got her medical degree at Makerere in 2009 with plans to specialize in pediatrics. But during her internship, she had an “aha” moment that changed her career path. A patient came in with a fever. Lubwama suspected malaria, but the hospital had no one who could inspect a blood sample under a microscope to look for malaria parasites.
She was stuck. And she hated being stuck.
“I’m somebody who loves knowing,” she said. “It’s very important to know about the causes of infection. I don’t want to do something without knowing. And that’s what I felt I would have to do as a doctor in my kind of setting. I would have to prescribe antimalarials without knowing. I would have to prescribe antibiotics without knowing.”
So instead of becoming a pediatrician, Lubwama decided to pursue first a master’s and now a doctoral degree in microbiology. For her master’s project, she looked at blood infections in cancer patients. She encountered antibiotic-resistant bacteria, a problem worldwide but one that had not been studied in Uganda.
She will expand that research for her doctoral project, with the encouragement of physician-researchers at the Uganda Cancer Institute, or UCI, and Fred Hutch. The two cancer centers formed the UCI-Hutchinson Center Cancer Alliance more than a decade ago to strengthen cancer research, training, and clinical care in Uganda. (In addition to the Seattle fellows, more than 300 Ugandan scientists, doctors, technologists, and others have undergone shorter trainings in Kampala.)
Her initial project, Lubwama said, “showed us we probably had antibiotic resistance among all kinds of patients. … [But] we don’t know the risk factors. We don’t know the outcomes. Are infections in cancer patients the most common cause of death? We don’t know that.”
In the era of rapid, international travel, microorganisms – resistant or not – don’t stay in one place. So Lubwama’s research will have a global impact that extends beyond Uganda.
“It’s very important to know the local epidemiology if we want to strengthen surveillance,” she said. “Such a study hasn’t really been done in sub-Saharan Africa.”
Born in Kenya to Ugandan parents, Lubwama spent part of her childhood in Nairobi, moving to Kampala when she was 10. Both parents, now retired, have science backgrounds: her father was a lab technologist, her mother a pharmacist. Her brother, Michael, is a Makerere lecturer in mechanical engineering who has done fellowships in England and the U.S., including one at the Massachusetts Institute of Technology. Just 11 months older, he is Lubwama’s role model.
Knowing how often she checks her Facebook account, he had told her, “Maggie, I don’t think you’ll have a problem living in the U.S. People are always on their phones.”
But not like people Lubwama encountered in Seattle.
“Oh, no, no, no, no, no,” she said. “I’m somebody who likes checking Facebook, seeing what’s going on. But it’s more here.”
In fact, that’s what most of the people on her bus do instead of talking.
“People are disconnected from each other when they’re on their phones,” she said.
But what surprised her even more was that the neighbors in her apartment building near the University of Washington don’t talk to each other either. Only once has her customary “Good morning!” led to a conversation.
“If you’re neighbors, that’s an important thing in Africa. You can just go to the neighbor, and you’ll get whatever you need, if they have it,” she said. “If I was in Uganda, I would go and visit the neighbors, or they would know I was new, and they would come and visit me, and we would just sit and start a conversation.”
The lack of neighborliness made her sad, at least at first, but she never felt offended.
“I’ve learned that this is the culture here, so accept it and enjoy it,” she said. “The people are not bad. The people are nice and polite. I’m sure there are many things in our culture, at home, that would not be easy for people here. If everybody were to judge people based on that, it would be a miserable world.”
Despite missing her close-knit family – she Skypes with her mother and brother each morning and evening – and despite the unaccustomed reserve she has found in Seattle, Lubwama has had only one moment of collapse-in-tears homesickness.
She was alone at the time in the fellows’ office on the Hutch campus and worried about whether she was making progress on her research proposal.
“It’s an opportunity, but you have to give it direction, you have to have a protocol, you have to have objectives,” she said. “And at that point, I didn’t really have all that. And suddenly, it turned into homesickness. I said, ‘Maggie, don’t cry,’ but the tears just came out. And, oh, boy. I just cried. I didn’t want to bother anybody with this. But it helped, I think. I’m thankful that it happened because I think it makes me human.”
After four months at Fred Hutch, Lubwama is satisfied with the progress she is making on her research proposal. She will soon begin shadowing microbiologists in laboratories at Seattle Children’s Hospital. She even got to meet and participate in a roundtable discussion with Ugandan Minister of Health Dr. Elioda Tumwesigye when he visited the Fred Hutch campus in early December, an experience she described as “powerful.” (Playfully literal, Lubwama also pointed out that the table was actually rectangular.)
One of the joys of her time here has been the mentoring she is receiving, a tradition that is not established at Makerere. She wants to institute that practice when she returns home. Much like a Ugandan, Dr. Rhoda Morrow, head of Faculty Affairs for the Vaccine and Infectious Disease Division and one of Lubwama’s mentors at Fred Hutch “will just stop what she’s doing and she’ll just talk” whenever Lubwama comes by, the visiting researcher said.
“She thinks about me all around – as a lady, as a student, as a friend.” Lubwama said. “A mentor plays a very big role in the outcome of the person being mentored. I am so blessed to have her.”
She is also thankful for the help of Dr. Corey Casper, the head of Fred Hutch Global Oncology, and others in the program – many of whom have spent time in Uganda or are Ugandan themselves, and who understand the importance of community. Dr. Nixon Niyonzima, who was in her medical school class at Makerere and is now in his third year as a doctoral candidate with the UW-Fred Hutch Molecular and Cellular Biology Graduate Program, regularly walks across campus from his lab to check on her. And chat.
For her first two weeks in Seattle, before her apartment was available, the Global Health staff arranged for Lubwama to stay with a local family from Uganda, with whom she remains in touch. They welcomed her to their Presbyterian church. Best of all, they have two toddlers who remind Lubwama of her beloved 2-year-old niece, Yolanda. She takes pleasure in bringing them gifts.
One of the most visible differences between being in Kampala and being in Seattle: the color of her skin puts her in the minority for the first time in her life. This was one of many adjustments she has discussed with her new Ugandan friend, saying, “I have never been the only one like me.”
She found it “not alarming, just different.”
“At the beginning, it was very outright in my mind – ‘Hey, you are the only one who is like this,’” she said. “But I don’t really think about it much now because I realized it doesn’t matter. It’s not like anyone is treating me differently. I’ve found people here to be very respectful, very nice, very polite. We’re all people.”
Lubwama was determined to tough it out over the holidays, even if it meant being alone on Christmas. But it won’t. She is flying to Atlanta on Christmas Eve for a “miracle visit” with a friend she’s known for six years – through Facebook – but has never met in person.
As much as she misses family and customs now, she is treasuring the experiences she is having in America and knows that when she returns home, she will miss many things about the U.S. She has watched her brother go through a reverse cultural adjustment after returning from fellowships abroad, asking why Uganda’s roads were unlighted and grumbling about four cars cramming into lanes built for one. (Note to Seattleites: You have not experienced traffic until you have sat for an hour in Kampala’s infamous “jam.”) In Uganda, she eventually expects to experience reverse culture shock herself.
“If you need something here, you just follow procedures, and you will get it,” she said. “It’s not necessarily that way at home. Sometimes, electricity won’t be there, and there’s no backup generator. So you relax, take off your shoes and enjoy yourself until it gets back.”
In some ways, she has applied that same lesson to navigating the cultural differences and academic challenges in her current role.
“Not all the situations are going to be what you want them to be,” she said. “But if you learn that that’s how it is, and you learn to live with people and to love people the way everything is, it’s much nicer.”
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Mary Engel is a former staff writer at Fred Hutchinson Cancer Center. Previously, she covered medicine and health policy for the Los Angeles Times, where she was part of a team that won a Pulitzer Prize for Public Service. She was also a fellow at the Knight Science Journalism Program at MIT. Follow her on Twitter @Engel140.