When Medicine Meets Culture - Reflections from a Global Health Elective in Tanzania
Muhimbili National Hospital/Muhimbili Orthopaedic Institute
Dar es Salaam, Tanzania – April 2025
Adina Harri, Geisel School of Medicine, Class of 2025
I wish there were a way to wrap up this experience in a neat bow. The reality is, my thoughts still feel like a jumbled collection of emotions and experiences without a clear through line, but one that has left me changed and humbled.
There have been moments where I have felt the highest highs – getting to connect with patients despite the significant language barrier; getting to meet and learn from amazing local colleagues and now friends in medicine; getting to feel like I was part of the team and contributed to improved patient care, despite health system resource and financial challenges.
One of the most powerful lessons I took from my elective at Muhimbili National Hospital in Tanzania came in the form of a Swahili phrase: "pole, pole," meaning "slowly, slowly." At first, this felt like a challenging contrast to the urgency with which I’ve trained. With time, it became a valuable reminder to slow down, be present, and observe with humility.
That theme extended into the hospital, where I encountered situations that challenged my assumptions about urgency and resource use. I witnessed patients with critical needs waiting on care due to system delays, and families required to prepay for services before treatment—something that felt jarring but also highlighted the price transparency and cost-awareness that is largely absent in the U.S. One case that has stayed with me involved a patient injured in a boda boda (motorcycle) accident whose family declined imaging due to cost. It compelled me to reflect on how financial barriers manifest in both visible and invisible ways, which are unique to each health system.
At times, I felt uneasy about my role. In the emergency department, language barriers and cultural differences around student involvement made it difficult to contribute meaningfully. I often questioned whether my presence added value or placed strain on already busy teams. These moments led me to grapple with my positionality as a visiting student—and to constantly check that I was pursuing this experience with humility, respect, and ethical integrity.
[Photos courtesy: Adina Harri, MED'25, Assisting with blood draws and a spica cast placement on the pediatric orthopaedic ward.]
During my rotation at Muhimbili Orthopaedic Institute, I felt more integrated into the team, thanks in large part to the supportive medical students and interns, to whom I am especially grateful. A highlight of my time was working on the pediatric orthopaedic ward, where I assisted with applying spica casts, performing blood draws, and changing dressings. I loved being hands-on, learning from skilled residents, and connecting with local medical students who generously helped me find my footing. Still, challenges remained: witnessing delayed surgeries due to cost, experiencing sexism, and observing stark differences in how I was treated compared to local learners.
Ultimately, this elective reshaped how I think about care, equity, and medical education. It reminded me that strong teams can rise above resource limitations, that consent and communication matter deeply, and that global health work is as much about self-reflection as it is about learning and relationships. I return home with new questions, a deeper sense of empathy, and a clearer commitment to practicing medicine with humility—pole, pole.
