Through the Duke Global Health Institute and Hubert-Yeargan Center for Global Health, I will be working alongside local physicians and trainees at Kilimanjaro Christian Medical College (KCMC) in Moshi, Tanzania for 8 weeks during my third year of pediatrics residency. KCMC is a large 650-bed teaching and referral hospital with a robust clinical and research relationship with Duke pediatrics and internal medicine as well as other academic institutions internationally. The majority of my time will be spent clinically in the inpatient setting working in the pediatric intensive care unit (PICU), on the pediatric wards (which includes general pediatrics as well as pediatric subspecialties such as gastroenterology and hematology/oncology), and in the newborn nursery. There are several outpatient clinics I will work in as well including neurology, general pediatrics clinic, and HIV clinic. Patients in the PICU and inpatient setting may be very critically ill, and it is not uncommon to have multiple pediatric deaths per day. Residents generally round on 10-30 patients during the day and are particularly helpful as educators for local medical students, interns and registrars. There are also structured learning opportunities including journal club and morning conferences to allow for cross-cultural medical education to take place.
Additionally, I hope to have the opportunity to volunteer with the organization Kiwakkuki (Women Against AIDS in Kilimanjaro), a community-based organization in Moshi that provides HIV/AIDS education, testing, home-based care and care for AIDS orphans. Now that I am nearing the end of my general pediatrics training, my hope is to help provide meaningful, resource-mindful medical care and support to a vulnerable patient population through collaboration with local Tanzanian physicians.
As a large referral center, KCMC serves the northern, eastern, and central regions of Tanzania and beyond, providing care for a population of approximately 11 million people. Annually, the hospital has approximately 20,500 admissions, 3,000 births, and 110,000 outpatient visits and is one of only four referral hospitals and medical schools in Tanzania. While patients of all ages benefit from the services of KCMC, I will be focused specifically on pediatric care.
I have chosen this population because I first discovered that I wanted to be a pediatrician nine years ago during a global health experience in Ghana, and I want to give back to a similar population now that I am at the end of my pediatrics training. I have been passionate about global health since shadowing at hospitals in Peru as an undergraduate student. As a woman from a small, homogeneous town in North Georgia, I had never left the country nor experienced cultures different from my own until 2015, when I took the opportunity to study medical Spanish in Peru for 4 weeks. After experiencing great disparity in healthcare for indigenous Quechuans, I felt unsettled and wanted to learn how to provide meaningful care in settings of extreme resource limitation. I earned a scholarship to study in hospitals in Ghana for 5 weeks the following summer, and it was there that I first fell in love with pediatrics. Some of it broke my heart: the 4-month-old with scalding burns from being dropped in a cauldron, the 2-year-old with HIV and tuberculosis who never left the hospital; but in the nutrition rehabilitation unit, I felt inspired. I worked closely with mothers and a pediatrician to fortify and prepare meals for the children, and not only did the patients improve, but the mothers felt empowered by the education they had received. I left the hospital every day feeling fulfilled and knew I had found the career I wanted to pursue – and that global medicine would be part of my journey as a pediatrician.
While in Tanzania, I hope to contribute to a positive impact on both the educational environment as well as in the clinical setting. Working in a large teaching medical center in an under-resourced area provides a unique opportunity for collaboration between physicians from different training backgrounds, ushering creativity in honing medical acumen and using resources wisely. This cross-cultural exchange between physicians allows for different perspectives to converge with the ultimate goal of improving patient outcomes. I experienced the benefit of such collective care during two month-long global health experiences in medical school, when I volunteered with an organization called Floating Doctors that provides free year-round healthcare for indigenous Ngäbe-Buglé communities around Bocas del Toro, Panama. The organization, which is sustained by local medical professionals as well as physicians from around the world, allowed me to recognize that input from providers from different walks of life can help to provide enhanced, culturally competent medical care.
Lessons from my experience in Tanzania will also be pivotal in determining my future career path, as I am entering pediatric rheumatology fellowship at Duke in summer 2025 and have the ability to extend my fellowship to include a global health master’s degree (which would include up to a year to work abroad, potentially in Tanzania). While I have learned and volunteered globally in multiple settings across my training, I have not yet experienced being a physician abroad, nor have I trained in pediatrics-specific global medicine. Working with individuals from different countries and cultures with the common goal of overcoming resource-limitation to provide medical care has been deeply inspiring for me, and I hope to continue global health work in some capacity for the rest of my career.
We worked in the pediatrics ward alongside local physicians to provide inpatient care for the children of the Kilimanjaro community and beyond. We served as an accessory to, not replacement for, local pediatricians and lended our advice on a case-by-case basis. We found that we were particularly useful in management of patients who could benefit from subspecialty pediatric care, as we are exposed to this quite frequently coming from a large institution in the US. We shared guidelines we’d use at home with the local residents, aiding us in making diagnoses and forming treatment plans for patients on the unit. We also focused our efforts on education for the medical students, both local and international, as KCMC hosts many European medical students for their pediatrics rotation. We ourselves learned so much too - particularly around management of infectious disease and how to navigate care in a low resource setting.
