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Opening Doors : A Veil Lifted

In Dar, I realized how much patients there appreciated my attempts to speak Swahili. I also recognized the efficiency of not using a translator. Now, a majority of my patients are Spanish-speaking. Before I started my residency, I traveled twice to Guatemala to learn Spanish and to work in the highlands—once with a traditional midwife and once in a free pediatric clinic.

My time in Dar and in Guatemala also exposed me to alternative medical beliefs. There is a difference between gaining an academic understanding of cultural differences and actually experiencing them. After watching a Mayan woman, surrounded by the female members of her family, breathe through labor pains in her midwife's courtyard, it was clear to me why my Guatemalan patient at Providence's Women and Infants Hospital had reservations about intravenous lines and epidural catheters for pain relief.

I am also much more aware of my own shortcomings and of gaps in my understanding. It is a common belief among many Liberian patients that a cesarean section causes permanent infertility, and many patients would choose a stillbirth over a c-section. As the Western physician standing in a labor room, watching and listening to the heart rate of a fetus who is not tolerating labor well, I find it nearly impossible to have a respectful conversation about cultural differences. Sometimes I just don't—just can't—get it. But at least I can see the differences in a way I couldn't have before.

Two years later, I still envision a career improving the lives of women with gynecological cancers in the United States and around the world. I am curious to see what further surprises the future will bring.

Dr. Kisali Pallangyo, above, is former dean and now principal and provost of MUCHS. He's fostered a collaborative relationship between the institutions despite challenges such as frequent power outages (the electricity failed twice while the photographer was in his office). The city's power comes from a hydroelectric dam on a river that is flowing at 25% of its capacity due to drought. At right is the MUCHS campus.

Above, MUCHS students relax on campus. Several Tanzanian students have visited DMS through the DarDar Project, including Isaac Maro, who is sitting on top of the table. "I believe prevention is the better option compared to cure," says Maro, who hopes to specialize in infectious diseases.

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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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