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Opening Doors : A Veil Lifted

Spending six weeks in Tanzania working in the DarDar Project made a permanent impact on a Dartmouth medical student.

By Cara A. Mathews, M.D.

It took about two weeks before I was able to function comfortably in Dar es Salaam—ride the public buses, find food, and walk the streets. Around the same time, I began to refine my plans for a future in international health. But I had begun to appreciate the role of AIDS in Tanzanian society on my first day in the clinic—and I was still learning when I left for home six weeks later.

April 29, 2004
Patient after patient today with very low CD4 counts (interestingly, many Tanzanians are quite savvy about CD4 counts, much more so than Americans). They are often the last surviving members of their families who are able to care for children/nieces/nephews/ grandchildren. One woman started crying when asked whether she would be able to afford her baby's formula. Many, many tears, as the docs here are often the only confidants for the patients.

Death and illness touch the majority of Tanzanian lives and are not reserved for the elderly or the random, unlucky younger person. One 17-year-old-patient was orphaned when her parents and younger brother died in a farming accident. She traveled to Dar es Salaam from her rural village to seek employment and a new life. Instead, she was unable to find work, dated a man for a short time, and became HIV-positive. On her screening paperwork, she was able to list only one friend as a contact. No one else in Dar knew her well. Soon, her entire nuclear family will be gone—three from the farming accident and one (herself) from AIDS.

The effects of illness reach beyond the very poor, too. Among the middle-class employees of the Infectious Disease Clinic (IDC), there was a 27-yearold widow whose husband had died of appendicitis and a 30-year-old doctor who has been supporting her mother and young brother since the death of her physician father.

The DarDar Project's Infectious Disease Clinic, pictured above, is just across the street from the Dar es Salaam railway station, right. Monday is the clinic's busiest day; about 40 patients have appointments that day.

Above, a crowd of patients is waiting at the reception desk when the clinic opens at 8:00 a.m. on a Monday. Many are hoping to get their examination over with before they start work for the day.

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Mathews, a Dartmouth College '99 and DMS '05, was the first Dartmouth student to do a six-week elective in Tanzania with the DarDar Project. She divided her time there between seeing patients at the Infectious Disease Clinic, where the DarDar trial is being conducted, and participating in rounds at Muhimbili National Hospital. The dated passages in italics were drawn from a journal she kept while she was in Tanzania, and the other passages are reflections that she wrote in July of 2004, upon her return to the U.S. She is now a second-year resident in obstetrics and gynecology at Women and Infants Hospital in Providence, R.I.

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