Hi! We are Anita and Ione, and we're writing today in the wake of our return from a four-week trip to Uganda and Rwanda where we participated in an experiential course about Social Medicine.

We first heard about this course nearly two years ago through the Global Health & Disparities Pathway of Excellence, of which we are both a part. At the time, we were in the midst of our core clerkship rotations, deep in the weeds learning about the presentations of various clinical pathologies and the process of disease diagnosis and management. The title of SocMed's course, "Beyond the Biologic Basis of Disease: The Social and Economic Causation of Illness," stood out as a chance to revisit and go deeper into the structural framework that shapes health outcomes. We both kept the course on our radar as we moved through the Branches phase of the medical school curriculum, and the stars aligned for both of us to enroll in the January 2020 course in Uganda and Rwanda, with the generous support of Global REACH.

On a village visit in Northern Uganda to learn about culture as it relates to health

Arriving in Uganda at the start of the course, we joined a diverse cohort of learners from a spectrum of nationalities, ethnicities, professions, and personal experiences for a truly global educational immersion. Approximately half of the course students were from African countries, and the other half were from Western countries. The structure of the lesson plans offered ample opportunities to share and learn about the similarities and differences of our different contexts. Thus, as students we were also each others' teachers, and through this approach we learned from our fellow classmates in ways that would have been impossible to organize into any kind of syllabus.

The curriculum of the course ensured that we spent our days exploring the structural causes of disease and the response of health systems to these structural causes, not only through conventional techniques like classroom-based lecture, discussion, and group projects, but also through reflective writing, dramatic expression, and place-based site visits. These layered exercises in critical thinking and action (termed praxis) encouraged us to interrogate how and why health systems are structured, and the considerations that must be given to demand, resource availability, and resource distribution. Moreover, the course structure left space to discern the values that define these health systems, and what implications that has for health equity.

However, we didn't stop at the level of health systems: we also investigated the role of social movements in addressing structural causes of disease, and implementing the principles of advocacy for change. We practiced engaging with these practices in an intrinsically personal way: by drawing upon our personal histories and situating those within the work we do, we can approach action, agency, and change from a place of authenticity and security. Moreover, we can give ourselves the space to reflect on how we, too, are a part of the structures we choose to critique, and how power dynamics and systems of oppression that we might learn about in an abstract sense unfold on deeply personal levels. After completion of this course, we both feel inspired and motivated to use our voices as future physicians to engage with our communities at a grassroots level, and organize to effect change at a structural level!