There is no doctor in my village.

I grew up in Logwerle, a small community in Central Equatoria State, South Sudan. When people got sick, they traveled far for care, or they didn’t get care at all. In 2003, my family moved to northern Uganda so I could get an education. I started primary school at Teremunga Primary School in Koboko, completed my O-levels at St. Charles Lwanga, and my A-levels at Buddo Senior Secondary School in Kampala. I completed my A-levels in 2012 and returned to South Sudan in 2013.

I applied to Makerere University that same year but could not afford the tuition. Then in November 2013, the U.S. Embassy in Juba announced the winners of their essay contest, 250 words on the topic: “How Can the U.S. and South Sudan Work Closer Together?” I was one of three winners. The announcement was posted on the U.S. Embassy’s social media. It is still there. When the Cuban government scholarship was announced shortly after, the undersecretary of our Ministry of Higher Education had seen that essay. I was selected. We were only two.

I flew to Havana with zero Spanish. I studied for seven years without coming home; my family could not afford the flight ticket. I returned only when I graduated, already fluent in Spanish, stethoscope in hand. Today I see more than 200 patients daily.

I became the first doctor from my village.

That mission now takes me between Al Sabah Children’s Hospital and Juba Teaching Hospital in Juba, where I rotate as an intern doctor. It also takes me, right now, to Kampala, Uganda, where I am coordinating a case series on pediatric cancer patients referred from South Sudan to Uganda Cancer Institute, because South Sudan has no chemotherapy, no radiotherapy, and no pediatric oncologist. And it takes me, perhaps most surprisingly, into a global Clinical AI Governance Advisory Panel.

I want to tell you what it feels like to sit in both places at once.

South Sudan has 12.4 million people and no residency training programs. Let that settle for a moment. There is no pathway for a doctor like me to specialize inside my own country. In our rural hospitals, clinical officers with three years of training manage cases that would challenge a specialist, because there is no specialist. They do it because someone has to. They do it with what they have.

What we have at Al Sabah is a CBC machine that is sometimes down, reagents that sometimes run out, and no flow cytometry. When I suspect leukemia in a child, I order a blood count and I wait. The diagnosis rests on clinical judgment and numbers on a page. There is no molecular confirmation. There is no immunophenotyping. There is no safety net.

Meanwhile, the global conversation about artificial intelligence in medicine is accelerating. Foundation models. Diagnostic algorithms. AI-assisted triage. The question dominating conferences and journal pages is: How do we govern these tools responsibly?

I sit on a panel trying to answer that question. And every time I do, I think about the CBC machine.

Here is what I want the AI governance community to understand: You cannot build a responsible framework for AI in medicine if the people building it have never practiced where the power goes out, where a child waits three days for a blood result, where the nearest oncology center is in another country. This is not a criticism. It is a gap. And gaps in governance frameworks become harms in practice.

When AI diagnostic tools are validated only on data from high-income settings, they will underperform in mine. When AI triage systems assume reliable internet connectivity, they will fail in my hospital. When AI governance panels meet without voices from South Sudan, or from any of the dozens of countries facing similar realities, the frameworks they produce will have blind spots the size of a continent.

I am not on that panel because I have all the answers. I am there because the questions I ask are different. Why was this model not tested on patients who look like mine? Whose outcomes were used to define success? What happens when the infrastructure your tool assumes does not exist?

These are not abstract questions. They are the questions I ask every morning before I walk into a ward full of children who deserve the same chance at survival as children anywhere else in the world.

I am currently in Kampala, sitting with data on pediatric cancer patients who crossed a border to access treatment that should have been available at home. Some arrived in time. Some did not. That story is still being written, as a case series, as a research record, as evidence that the gap between where medicine is practiced and where policy is made has real consequences.

I do not know yet what AI will mean for children with cancer in South Sudan. Perhaps one day it will help a clinical officer in a rural hospital recognize leukemia earlier. Perhaps it will support a referral decision that saves a life. That future is possible, but only if the people building and governing these tools understand what it means to practice medicine in a place like mine.

I became a doctor to give my village something it never had. Now I find myself in rooms where the future of medicine is being decided. I intend to make sure that future includes us.

Buga Charles George Kenyi is a physician in South Sudan.