"… we must review cases “as if we have no fingers”—without pointing blame."
Katie Hartnett, MED'26
DarDar Global Health Clinical Elective
November 2025
As a third-year medical student, I found myself yearning to learn more about solutions to common problems within the healthcare system. I wanted to broaden my perspective on health and healthcare, and I was thrilled to learn about the James Strickler Clinical Elective in Global Health. I applied because it offered a unique opportunity to participate in a longitudinal global health relationship—one rooted in cross- cultural collaboration and an intentional confrontation of white supremacy within the global health sphere. The inherent reciprocity of the bidirectional student exchange especially stood out to me. I hoped the skills I would gain would both reinvigorate my interest in working globally and translate to the rural healthcare settings where I intend to practice. Along the way, I aspired to learn creative solutions to the challenges of equitable healthcare delivery, improve my Kiswahili skills, and build lasting professional relationships and friendships.
My first day at the hospital began with a morning OB/GYN meeting reviewing the case of a patient with severe preeclampsia who, after a difficult hospitalization, required emergent surgery that sadly resulted in a stillbirth. In the U.S., we call these M&M (morbidity and mortality) meetings. The purpose is to review what happened, identify areas for improvement, and educate. What struck me most was the tone of the discussion—curiosity and nonjudgment rather than criticism. The team approached the review with a growth mindset. One senior physician remarked that we must review cases “as if we have no fingers”—without pointing blame. Another added, “Nobody comes to work here with the goal of harming patients.” That tone, set by the most senior and respected doctors in the room, left a lasting impression. It prompted me to reflect on my own training, much of which has been shaped by a culture of defensive medicine. It’s hard to build psychological safety in a system that normalizes blame and shame. It’s far easier to admit mistakes when you know you’ll be met with support and guidance on how to move forward. I left wondering how I could contribute to that kind of culture of safety in my future practice.
Later during my exchange, I rotated through the pediatric burn ward. The hospital didn’t have a specialized burn unit with advanced monitoring or sterile isolation rooms; instead, we did the best for our patients with the resources available. I noticed a resilience in this perspective that I aspire to carry into my own practice. I helped with dressing changes, wrote notes, presented patients on rounds, and even placed nasogastric tubes. I gained hands-on experience placing catheters in toddlers—a task that was humbling in every sense. The residents on my team pushed me to take more responsibility on the ward than I’d previously had at Muhimbili. As I became more involved, I also became more cautious. There is a long and troubling history of medical trainees from wealthier countries practicing in low-resource settings in ways that exceed their training, sometimes compromising patient safety and reinforcing “white savior” dynamics. I was mindful of this history, though navigating it was not straightforward. I tried to do only tasks I was trained for and only when invited by my Tanzanian colleagues. Still, I sometimes wrestled with whether my presence was more extractive than contributory, especially since my Swahili was still limited.
During my final weekend, I hiked through the Uluguru Mountains. The trail wound between small villages and terraced hillsides of corn, bananas, and berries. It was peaceful and grounding—a beautiful way to close my time in Tanzania. When it came time to leave, a local physician who collaborates with Dartmouth offered to drive me to the airport for my 3 a.m. flight—a gesture that spoke to the generosity I encountered throughout my stay. As we said goodbye, he smiled, patted my head, and said, “You must come back.” Oh, how I hope I will. My time in Tanzania felt less like an ending and more like an opening chapter one I hope to keep writing.
