Clara Fredy and Brendan Shayo, Tanzanian medical students from Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, spent six weeks at the Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, learning about clinical practices in Infectious Disease and Emergency Medicine. The senior students were selected through a competitive process at their university for the DarDar bilateral medical exchange program in which medical students from Dartmouth Geisel School of Medicine also travel to Tanzania to learn about patient care and healthcare delivery at Muhimbili National Hospital. Established in 2001, the DarDar partnership started as a TB and HIV research collaboration but has grown into a comprehensive program that includes bilateral medical exchanges, training, capacity building, and healthcare delivery for students and faculty. The Center for Global Health Equity Director, Dr. Lisa V. Adams MED'90, oversees DarDar and travels yearly to MUHAS as Principal Investigator (PI) of an NIH grant-funded HIV research training program.
Our Experience at Dartmouth Hitchcock Medical Center
By Clara Fredy and Brendan Shayo
As we reflect on our time in 2024, we both feel immense gratitude for the opportunity to travel to New Hampshire for our elective medical rotation in the Infectious Disease and Emergency Medicine departments at Dartmouth Hitchcock Medical Center (DHMC). This journey has truly broadened our horizons, enhancing both our medical knowledge and social interactions, and it has opened our eyes to the incredible possibilities that come from hard work and dedication. We're excited to share our experiences from our departmental rotations, along with some insights from our social interactions as well.
Emergency Medicine
Our two-week rotation in the Emergency Medicine Department was eye-opening. We actively participated in providing emergency care and learned the vital importance of timely identification of critical conditions to reduce morbidity and mortality. We observed the critical importance of a patient-centered approach, where patients actively participated in the decision-making process.
Teamwork stood out, with constant collaboration across specialties tailored to individual patient needs. The continuity of care was impressive; patients were consistently seen by specific specialists rather than receiving one-off consultations. We noted the high level of specialization, with dedicated IV teams and stoma nurses, which greatly improved care quality. The dynamics among residents, medical students, and attending physicians were refreshing—focused on collaborative discussions rather than straightforward question-and-answer sessions.
We polished our skills, particularly in point-of-care ultrasound and EKG interpretation. The didactic sessions were impressive, providing evidence-based approaches to care. One standout experience was Wilderness Medicine Day, where we learned to manage emergencies such as lightning strikes and hyperthermia outside of a hospital setting without fancy equipment. On Emergency Medicine Service (EMS) Day, we worked alongside paramedics, providing first aid and transferring critical patients to the hospital. These weeks solidified the idea that being a doctor is about continuous learning and being prepared to help, even without the tools we often consider essential.
Infectious Diseases
During our four-week rotation in the infectious disease unit, we gained valuable insights into the diverse epidemiology of various diseases and the evidence-based approaches for managing these infectious conditions. We also emphasized the importance of antimicrobial stewardship to combat antimicrobial resistance, a pressing global challenge that also affects our country. Particularly noteworthy were our observations of managing diseases less common in our country, such as babesiosis, non-atypical mycobacterial infections, Lyme disease, and prosthetic infections (including those related to cardiac valves, joints, and bone hardware).
The supportive learning environment fostered collaborative decision-making among residents, infectious disease fellows, and attending physicians. We had the opportunity to engage with patients both in the wards and clinical settings, further enriching our knowledge of infectious diseases. The tour of the Microbiology lab was equally impressive, as we witnessed the entire process of generating lab results—from sample collection to processing with advanced equipment, and finally to interpretation and reporting. We were particularly struck by the automation of certain machines, such as the culture processing system, which streamlined the work of lab technicians while ensuring accurate and reliable results.
Attending global health meetings was incredibly enlightening as we explored the current landscape of infectious diseases worldwide, particularly concerning epidemics like Marburg and Ebola hemorrhagic fevers. We delved into their epidemiology, incidence, case fatality rates, interventions undertaken, and recommendations for controlling these situations.
Social interactions
We were genuinely touched by the kindness and support we received from everyone around us. The warmth from neighbors in our co-living facilities, bus drivers, fellow passengers, Dartmouth staff, and Geisel students went a long way in making us feel at home. This experience was not just about academics; it was about building connections and fostering a sense of community.
Overall, our time at DHMC has been a significant step in our medical journey, shaping our perspectives and aspirations for the future. We look forward to applying what we've learned and sharing these experiences with our peers back home.
Acknowledgments
We are immensely thankful for the generous sponsorship from the Dartmouth Center for Global Health Equity, under Dr. Lisa V. Adams. Being our first experience outside the country, they ensured that our journey, accommodation, meals, and everything in between were seamlessly arranged, allowing us to fully focus on learning and personal growth.
We also extend our gratitude to the MUHAS Convocation and Internationalization unit for accepting our applications and selecting us for this amazing adventure. Our sincere appreciation goes to Ms. Tecla Colman, Ms. Kelly Burgess, Dr. Maryam Amour, and Mr. Rashid Gosse for their invaluable support and guidance during the application process. This experience has been liberating, pushing us to rethink our potential and aspirations as future doctors. From our interactions with DHMC staff, medical students, Global Health fellows, and the friends we made along the way, each day brought unique lessons that fueled our enthusiasm for this profession.
We extend our heartfelt thanks to Dr. Shankar Levine for organizing our experience in the Emergency Department and Dr. Zachary Soucy for facilitating access to the Point of Care Ultrasound (POCUS) 101 courses. We appreciate the support from all the physicians, residents, nurses, and technicians who greatly enriched our learning journey. We want to express our heartfelt gratitude to Dr. Colleen Kershaw for organizing our learning experience in infectious diseases and to the infectious disease specialists and fellows whose support greatly enhanced our education in the department.
We want to express our heartfelt gratitude to those who enriched our social life during our stay. We thoroughly enjoyed the Welcome Lunch and Farewell Lunch at the DICE office at Geisel School of Medicine, graciously organized by Firoj Gurung and his colleagues, as well as the Welcome Back BBQ and Student National Medical Association (SNMA) event. Additionally, dinners, and hikes at Gile Mountain with Dr. Jenny O'Flaherty's family, along with Geisel medical students India Burdon Dasbach and Paulita Lara Mejia, provided invaluable guidance and support. We are especially grateful for the memorable tour of New York City and Brendan's Birthday Party. Our thanks also extend to Dr. Frank Kussaga for his exceptional assistance in connecting us with Dr. James Koola and other Tanzanians in Derby, Connecticut. We appreciate Dr. Erick Mboya, Dr. Gaspard Habimana, and our neighbors at the co-living facility for their moral support, guidance, and the wonderful experiences we shared together.
