In a perfect world, there would always be enough specialized physicians available to treat. However, as Dr. Rejani Kumari would tell you, this isn’t always the case. In Uganda, where she works as a physician, respiratory diseases are quite common, yet there is a severe lack of respirologists available. Physicians who want to specialize in respirology must receive training in other countries like South Africa, Canada, and the US, as this training is limited in Uganda. This training is what brought Dr. Kumari to St. Joe’s.
Dr. Kumari is a physician at the Mulago National Referral Hospital in Uganda and is completing a 12-month placement at the Firestone Institute for Respiratory Health (FIRH) at St. Joseph's Healthcare Hamilton. Mulago Hospital is a teaching hospital affiliated with Makerere University, a school that has collaborated with McMaster University for decades.
In 2000, the St. Joseph’s Health System-McMaster-Makerere International Outreach Program collaboration for Promotion of Health Care in Low Income Countries was established. Through this program, residents and faculty from Makerere can complete placements at McMaster University. Both McMaster University and St. Joseph’s Healthcare Foundation sponsor this exchange program, providing residents and faculty from Uganda with accommodations and stipends during their stay in Canada.
The exchange program began in other disciplines at St. Joe’s and has recently expanded to include placements at the FIRH.
Building a Specialized Respirology Practitioner Community in Uganda
Dr. Kumari is the second faculty member from Uganda to join the FIRH, and a third one will tentatively begin their placement in July 2026. St. Joe’s is planning to welcome more and more physicians from Uganda in the future, further bolstering the respirology department at Mulago Hospital.
“Staff at Makerere University have written a respirology fellowship curriculum, but right now we don’t have any faculty available to train students,” said Dr. Kumari. “As more and more faculty are trained at St. Joe’s, eventually Makerere will be able to kick off their own respirology fellowship, and physicians can complete their specialized respirology training right there in Uganda.”
The International Outreach Program gives physicians at the FIRH the opportunity to extend their impact beyond Canada, improving healthcare access for an entirely new group of people.
“I’m really excited about building the community of people in Uganda who have trained in respirology with us here,” said Dr. Joshua Wald, a respirologist and researcher at the FIRH. “We’re hoping that by having several people with a similar skill set and training, the difference they can make in their healthcare system when working together will be exponential. The Firestone aims to continue supporting these physicians once they’re back in Uganda to develop and grow respiratory training and care at Mulago Hospital.”
Dr. Kumari is dedicated to giving back to her patients at Mulago Hospital, as they have helped her and several other medical students develop their expertise.
“On a regular basis, our patients give us their time and energy to help us teach students or train them on a particular case,” said Dr. Kumari. “The least we can do is give them our best shot at diagnosis and care, free of charge. My hope is that by implementing a respiratory fellowship program, we will be able to achieve this goal.”
Bringing a Global Health Perspective to St. Joe’s
While Dr. Kumari completes her placement at the FIRH, the physicians and students there are gaining a new perspective in global health and medicine.
In Uganda, there is limited access to quick diagnostic technologies like CT scans and bronchoscopies, which makes it difficult to diagnose respiratory illnesses. Even in cases where patients can access these diagnostic tools, they must cover the cost out of pocket as Uganda doesn’t provide national health coverage.
Dr. Joshua Wald is the director of the Respirology Residency Program at the FIRH. The exchange program has made him and other FIRH physicians think of medical care in a new way, as they have had to consider respiratory care in a context they may have never worked with before.
“A lot of physicians here haven’t been in situations where they’ve had to diagnose and treat a patient without any access to tools like CT scans or bloodwork testing,” said Dr. Wald. “Talking to physicians from Uganda really encourages them to challenge their diagnostic approach and think critically about their own clinical skills, which is something that can help improve their skills and avoid wasteful ordering of tests.”
Dr. Kumari also brings a global perspective of respiratory diseases to the physicians at the FIRH as she has seen patients with illnesses that aren’t as common in Canada. For instance, although physicians in Canada are trained in how to treat tuberculosis, they may not have gotten any hands-on experience in this treatment, whereas Dr. Kumari and other doctors from Uganda have.
“By working with someone who is coming from a very different clinical environment, our residents get a chance to broaden their outlook on what care looks like outside of Canada,” said Dr. Wald.
Learn more about the FIRH on their website: www.firh.ca.