Written by Kathleen Glass
This past summer I spent 2 months doing independent research on pain and palliative care in a rural region of Tanzania called Iringa. Now let me tell you how I ended up 8,000 miles away from home, feeling more alive and fulfilled than I ever have.
As a classic pre-med student, I didn’t think that there was time in my college career to study abroad, much less do international research so it was never something I pursued. In the spring of 2024, an opportunity fell in my lap, ultimately snowballing into the most impactful experiences in my life.
During the summer of 2024, I spent the first half working, earning minimum wage for the weeks that I was home, nestled in Upstate New York. On our nation’s birthday, July 4th, I left for a 6 week study abroad program through the University of Florida to Tanzania, a country I had to google when I first heard its name. Located on the Swahili coast between Kenya and
Zimbabwe, Tanzania hosts 71 million people and a variety of different climates and landscapes. A little larger than the size of Texas, Tanzania gained independence from England, secondary to its long history of German colonial rule in 1961. The first half of that trip was spent in the Southern Highlands at a private, Catholic, District Referral Hospital. The second half was spent in Dar es Salaam, a busting urban port city, at Ocean Road Cancer Institute, a government funded, national (and often international) referral hospital. These weeks gave me a peek into Tanzanian healthcare and medical anthropology, igniting a fire in me that would smolder until my visit this summer.
After getting hooked on the idea of returning to do research in Tanzania, I worked hard to make my dreams a reality. I wrote grant applications, budgets, and proposals to secure funding to take me to the other side of the world once again. Under the umbrella of my mentor’s NSF grant, my topic was somewhat preselected for me as pain and palliative care, but I was truly interested in this important facet of life, especially in another culture.
After a few close calls with government funding availability, I was able to get the NSF grant and additional funds from UF called the Summer Undergraduate International Research Program, joining a cohort of 6 other scholars. The 7 of us were scattered around the world in England, Scotland, Guam, Ecuador, Brazil and Tanzania. Joining me in my research would be my peer Lucy, another undergrad studying pain and palliative care under the same mentor. Because Lucy had also been to Tanzania on the study abroad program, we ventured over there together without a true authority figure, meaning our mentor would not be joining us.
For 8 weeks, Lucy and I figured out Tanzanian life and how to do research in another language we were less than mildly familiar with. We found places to stay, fed ourselves every day, fended off marriage proposals and used google translate to anchor us until we got a grip on Swahili.
Without a dedicated translator or research mentor to guide us, we fought our way through the first few weeks of research, flying by the seat of our pants and loving every minute.
Our research took place at the same hospital we visited last year in Iringa. Recently promoted, Tosamaganga was proud to serve Iringa as a private Regional Referral Hospital. This upgraded status meant that they had a minimum of 3 specialists to provide care. We later identified those specialists to be a neurologist from Hungry, an orthopedic surgeon, and a rotating internist. This summer, we would be rounding with the internal medicine doctors in the ICU, female and male wards, allowing us to see a variety of conditions and probe into the culture surrounding pain treatment.
Our day to day schedule usually included going to the morning meeting where the night shift would report major cases or admissions that occurred to properly inform the incoming day shift. This meeting happened at 7:50am and would last from 15 minutes to almost 2 hours depending on the agenda. Next, all doctors took a break for chai which meant going to the canteen on the perimeter of the hospital grounds to drink tea and have some light breakfast items such as chapati (a mix between a crepe and naan) or some mandazi (fried dough). After about 30 minutes to an hour, the doctors would reassemble for rounds, either major ward rounds or service ward rounds, depending on the day of the week. Starting around 9:15 am most days, they would begin in the ICU and move through the private wards and into the general male and female wards. All rounds would depend on the amount of patients which varied from day to day. Sometimes there were 6 patients in the male ward, and other times they were at full capacity of around 30 patients.
During rounds, we would follow around with the doctors, hoping the cases would be presented in English while taking extensive field notes of what we were seeing, whether we understood or not. We planned for a mixed methods ethnography technique that included fieldnotes and semistructured interviews, however we did encounter some problems that would come up later, causing us to add another method to our mixed bag!
Another aspect of rounds that we hadn’t accounted for when planning our research was that there was a rotating specialist every 2 weeks or so that would come to Tosamaganga from another city to serve as chief of the internal medicine department. The constant figures that remained with us throughout our time were the intern doctors, Edson, Ema, and Rachel, fresh out of med school and rotating through the different departments. These three interns were instrumental in our learning, often translating what we couldn’t hear or couldn’t understand. Because these interns were still treated as students in the Tanzanian medical system, the chiefs were inclined to educate them, often going on long kiswahili tangents about different diagnostic or treatment methods.
It took us about 2 weeks of acclimation time to adjust and attempt to gain trust from the doctors and nurses before we began to inquire about interviews. The majority of doctors and nurses we asked to interview about pain and end of life were adamantly against it, an attitude we had not prepared for when thinking about obstacles. Part of the deal was that the interview would be recorded and that was something that many people were not interested in agreeing to. In addition to this, another professor from UF was recently at Tosamaganga doing recorded interviews and so many providers didn’t see the difference between us and assumed they had already done an interview.
It was at this point that we were hitting a significant decline. The adrenaline of new adventure and novelty fizzled out and the reality of being 8000 miles away from familiarity without knowing the language and a challenging interview demographic slowly took hold of my perspective. As if we weren’t faced with enough battles, both Lucy and I fell sick with a viral infection of sorts, sapping us of energy and a new friend of ours got into a near-fatal accident, further darkening the already gloomy mood.
As we wallowed and looked around for someone to heal us, help us, or lift us, the only option we had was each other. So we picked ourselves up by the bootstraps, dusted off the dreary attitude, and did some problem solving. We shifted course in our research, creating anonymous questionnaires to hand out that nurses and doctors were more likely to fill out without “going on record” and were successful in circulating these questions. Our ailments resolved and a care package of goodies arrived, encouraging us to persevere. The last kick of confidence that we needed was the arrival of our research mentor, bringing a confident, fluent voice to advocate for us. With this, the final two weeks flew by with long days brimming with side quests and adventures with friends. We had reached a state of zen, finally being able to communicate adequately, advocate for ourselves to avoid “white people” prices, and celebrate our strides in research.
Ultimately, my time researching pain and palliative care in Tanzania was tumultuous, from the highs of successfully assimilation into Iringan society, to tumbling along the very lowest points of physical sickness and the reality of studying palliative care. As I continue to process my data and craft conclusions, I reflect on my time with admiration for my own resilience and know that my courage will carry me forward to become the best physician I can.
I would not trade this time in my life for anything in the world. I experienced more by reaching outside my comfort zone and saw incredible personal development as my confidence levels increased and my ability to communicate with others did the same. If life gives you a chance to do something ludicrous, please take it and enjoy every moment knowing that it will make you a better future doctor and a better human.
If you are curious about doing international research or have any questions for me, feel free to reach me at [email protected]. I also have a blog where I did weekly updates throughout my time over the summer (https://kathleenglass1.wixsite.com/kglass/blog) and an instagram account (@kg.inthewild) dedicated to this research! Feel free to reach me there and check out my pictures!