During my time in Tanzania, I felt like I was learning constantly. Every moment, from working with members of the Epidemiology Department at KCMC on our cervical cancer screening research project, to discussing the Tanzanian health insurance policy with our research PI/mentor over chapati and chai during lunch breaks, to listening to management discussions among physicians on rounds during our sessions spent shadowing on the OB/GYN wards, was an opportunity to gain first-hand insight into a new culture, a different healthcare system, and a way of life so foreign from my own. I also had the opportunity to venture out in the community with members of the KCMC Community Health department, and on these trips, I talked with directors of small, rural hospitals who each faced their own unique obstacles, women who outlined for me their reasons for hesitation about cervical cancer screening, and patients who explained to me, in their own homes, how impossible it was for them to find affordable transportation to local health clinics.
During my 8-week stay at KCMC, I was able to gain experience conducting population-based research in a low-income country. Working with the epidemiology team at KCMC, I learned how to collect data using questionnaires, how to clean and code the data, and use our analysis to better understand how certain factors relating to knowledge and attitudes around cervical cancer may contribute to whether or not these women were getting screened. I also gained experience designing and writing up a manuscript for publication. My team was looking at how knowledge and attitudes about screening and cervical cancer in general may influence a woman’s willingness to utilize an HPV self-collection screening method.
I also gained a better understanding of how patients’ cultural beliefs about screening, or about healthcare in general, impact when and how they seek care. For example, many of the patients we saw in the hospital had sought out advice or therapy from traditional healers before coming to the hospital. What struck me the most was how inability to pay – as of 2013, less than 7% of the Tanzanian population had health insurance – affected every aspect of patient care. Diseases we had learned about in my medical school classes looked different in the Tanzanian patients I saw, since so many of them came in with such late presentations of disease. It was fascinating to see how financial considerations played into the conversation among physicians about management and treatment options, and how the role of the doctor was so different in such a low-resource setting. My abroad experience was beyond educational and enriching, and the lessons I learned from working in research, as well as in the clinical setting, at KCMC will be with me throughout my career in medicine.