A medical student's journey from the classroom to the field

Caroline West shared her remarks at a luncheon event for Her Excellency Ambassador Liberata Mulamula of the Embassy of the United Republic of Tanzania.

By Caroline West

Hello and “Karibu Sani.” Jina langu ni Caroline West and I am a third-year medical student here at the Medical University of South Carolina (MUSC). It is an honor to speak to such a distinguished group of individuals today. Last July, I traveled to Dar es Salaam, Tanzania for three weeks as part of Dr. Michael Sweat's research project, called Ishi Huru or "Live Free". The subset of the research I am participating in aims at screening for type-II diabetes in the resource-poor setting of rural Tanzania, an area of the world with major obstacles to primary care. My time was spent between the urban setting of Dar es Salaam, where I went on rounds at the national hospital, Muhimbili University, and the rural district of Kisarawe.

At Muhimbili, I had the opportunity to go on clinical rounds in the new cardiology building with Dr. David Ploth, an MUSC nephrologist, and Dr. Janabi from Muhimbili. I participated in the care of patients with diagnoses I would not necessarily have seen here in the US, but have read about extensively- like Rheumatic Heart Disease. In Kisarawe, the rural district, I spent my time working with members of the Ishi Huru research team, as well as visiting the two villages where our research takes place and their respective health clinics where we refer patients. Specifically, I spent several days over several sessions holding discussions with the Nurse Coordinator, Mama Rosemary Ntibizi, and the Community Outreach Coordinator, Ishihaka.

I brought with me, the information I had studied in the first two years of medical school - the pathophysiology of diabetes, the risk factors, the signs and symptoms, and the procedures of how to screen for diabetes. They brought with them their years of experience working in the area, their sustainable relationships with the community, and their patience with me. It was an incredibly fulfilling experience to take the information I had learned while pouring over a book on the fourth floor of the library here in Charleston, fly across the world, and share that information with interested individuals who could take it and apply it to the context of their health system. I also got to meet with the Tanzania Diabetes Association, who are doing incredible work bringing education about diabetes to communities all around Tanzania, and who we would like to work with to bring their expertise to our research area.

Overall - I had a blast! I learned a tremendous amount in a short amount of time, because I had the opportunity to teach, discuss, and bring research theories I had been reading about in literature reviews into practice. As a side benefit, these experiences have made me a more grateful American medical student. I am more aware of the ample resources at my fingertips that are so easy to take for granted. It is much harder to complain about our electronic medical record system when all I have to do to find out if my patient has diabetes is to look through their past clinical notes or press one button to order an HbA1C.

If I catch myself complaining about a diabetic patient not tracking their sugars well, I think to myself- at least I know they have diabetes, and I can feel confident that I am doing something to prevent them from progressing into major complications. It is much harder for me to complain about having to work on a Saturday when I have experts all around me, willing to teach me how to take care of patients with the latest guidelines and to show me the latest procedures. It is hard to complain about reading and studying when I have a library of endless texts and journals, and a computer in my pocket to look up any medical question that pops into my brain.

I would also like to speak on the part of students like myself here at MUSC- students who crave medical experiences in international, developing country settings. As an active member, and past president, of the Global and Tropical Medicine Interest Group, I am very familiar with the growing subset of students who are eagerly trying to figure out how to work with the Dean's Office to schedule time participating in global medicine and to find funding for it. Students are actively searching for funding opportunities like the Center of Global Health Trainee Travel Grant, for which I am a very grateful recipient.

Without opportunities like this, I would never have been able to travel to Tanzania and I would have been missing this experience that reinforced my interest in global health and redefined my goals to participate in research as a clinician. As I move forward into choosing a residency, one of the key attractions I will be looking for is if they have global health opportunities- and I know that I am not just speaking for myself. I look forward to the day when I can go back to Tanzania and see again the kind and intelligent people I worked with in July, and to drink coconut water from a coconut off a tower of coconuts strapped to a bicycle. Asante Sana for the opportunity to speak today!"