Matt Alexander and his friend Ed O'Bryan, a Charleston doctor, were chatting at Chick-fil-A following an afternoon of surfing at Folly Beach in the summer of 2008 when -- for reasons that still aren't entirely clear to them -- the conversation turned from waves to global medical missions.

Alexander, now 29, and O'Bryan, 32, discussed their shared enthusiasm for caring for patients in parts of the world with desperate shortages of health professionals. They griped that many missions treat people on a limited-time-only basis.

The duo was still sandy-footed and salty-haired when they hatched the idea for Palmetto Medical Initiative, a Charleston nonprofit group that aims to bring high-quality health care to impoverished corners of the world.

They dreamed of building and staffing hospitals using a combination of short- and long-term American volunteers and paid locals.

The idea that started as a discussion over chicken sandwiches has become a reality. Palmetto Medical Initiative recently passed its first major milestone by opening an outpatient medical clinic in Uganda.

For Alexander, a consultant for nonprofits who is director of the initiative, and O'Bryan, a physician at the Ralph H. Johnson VA Medical Center, success means eventually pulling away from the host country. They want local professionals to run their new hospital independently.

Then the Americans would take the model to another needy country or perhaps a different city in Uganda, a country they chose because it had the right combination of medical need and political stability.

The clinic, built under the supervision of an American construction manager in just less than a year, is expected to treat up to 600 patients a month for malaria, typhoid and other illnesses common in the central African country.

It is the first of seven buildings that will form a medical complex scheduled to be completed by the fall of 2012. With 75 inpatient beds, the new complex will offer surgery, labor and delivery, primary care, pharmacy services, and occupational and physical therapy, according to plans.

The group, which raised about $1 million from private donors last year, has been interviewing Ugandan health professionals for permanent jobs at the facility, Alexander said. Already, nine Ugandans have been hired.

The organization also has three paid American staff members and two long-term volunteers. Dozens of American short-term volunteers will rotate through the facility on a quarterly basis to help get it off the ground.

"So much planning goes into short-term missions, but then people leave and the impact is limited," Alexander said. "This is a way to make sense of those shorter trips."

Among the volunteers is Britt Hinkson, a physician assistant at Doctors Care in West Ashley, who will be leaving for Uganda this month for a month-long rotation at the clinic.

Like dozens of other medical volunteers who will make their way to Uganda with the group, the Mount Pleasant resident is paying her own travel expenses and taking unpaid time off from work for the trip.

"I've got medical missions in my blood," said the 28-year-old who has been to Ecuador, South Africa and post-Katrina New Orleans on medical volunteer trips. "We're going to improve standard of care there."

About 200 volunteers a year -- many of them from South Carolina -- will help train health care workers and treat patients, who will pay for services as they can in order to help the hospital eventually become financially self-sustaining, Alexander said.

Alexander, whose parents adopted six children from Liberia, said he hopes to go to that country next.