DAR ES SALAAM,TANZANIA

rriving in Dar es

Salaam last sum-

mer, I was full of

anticipation for the famil-

iar sights and smells of the

city and the start of an

undertaking laden with

challenges. I traveled to

Tanzania to oversee the pilot

version of a new public health

oriented exchange program for

undergraduates called Partners

in Research and Education in

Sub-Saharan Africa (PERSA).

Ten students – two from UNC,

three from Duke, and five from

Muhimbili University College of

Health Sciences – participated

in the eight-week program that

I devised last year in collabora-

tion with colleagues at Duke.

Ma

rce

Ab

are

Marce AbareClassHometown, State

My involvement in Tanzania’spublic health sector the previoussummer had opened floodgates tomy understanding of the unequalaccess to care and treatment thatcharacterizes current disparities inglobal health. Seeing firsthand theeffects and implications ofHIV/AIDS, TB, malaria, and otherdiseases that lie along the faultlines of our international order,forced me to consider myriad barri-ers to social development.

Partners in Research andEducation in Sub-Saharan Africa(PERSA) came into being through achance meeting of a Duke under-graduate in Dar es Salaam the sum-mer before PERSA’s pilot. Togetherwe recognized the need for stu-dents like ourselves to travel toAfrica and gain exposure to globalperspectives of health care, and weshared a growing frustration withthe limited opportunities for under-graduate students to engage inmeaningful work in health careabroad.

PERSA offers Tanzanian andAmerican students the opportunityto work in pairs to carry out com-munity-based medical researchprojects for eight-week sessions,first in Tanzania and later in NorthCarolina. The objectives of theprogram are multi-pronged: it pro-vides undergraduates experience inoperational research methodology

and an opportunity tobecome engaged inresearch analysis that couldinfluence Tanzanian healthpolicy; offers a uniqueopportunity for culturalexchange and developmentof lasting relationships withTanzanian students and pro-fessionals; facilitates anunderstanding of the infra-

structure, organization, bene-fits, limitations, and challenges

of the health care sector in adeveloping country; and inputsmonetary and educationalresources into Tanzania’s future

medical professionals. Participantsattend physician rounds at localhospitals of different sizes in vari-ous economic regions and conducttheir related research at thesediverse facilities in order to experi-ence a fuller breadth of theTanzanian health care system.Students also volunteer with localcommunity health organizationsand are encouraged to make theirown contacts and pursue areas ofspecific, related, interest.

When I finally landed inTanzania, after months of draftingproposals and searching for fund-ing, I discovered that things werenot likely go exactly as I planned.The dormitories I hadarranged for us tostay in were alreadyoccupied! A faultyinternet connectionhad prevented mybeing informed earli-er. So I settled into ahospital-owned flatabove Hindu MandalHospital in downtownDar es Salaam, andthen immediatelytook to wandering thedusty paths ofMuhimbili University, speakingwith students about the programand scheduling meetings withadministrators and faculty. I slowlyaccumulated allies for PERSA andmade new friends in the process.Thanks to the help of the Dean ofMedicine, Dr. Charles Mkony, I

found Dr. JulieMakani, a PhDstudent inter-ested in coor-dinating theprogram atMuhimbili. Ialso metAndreas

Nshala, president of the TanzanianMedical Students Association(TAMSA), who identified five med-ical student interested in participat-ing in the pilot program. Mycohort from Duke and the otherUS students arrived within twoweeks, and shortly thereafter wetook the ten participants out fordrinks and introductions.

While I was taking care of thelogistical aspects of the program,each of the pairs of students wasbusy formulating and conductingtheir research projects. FelixBundala and Gene Bain carried outsurveys to explore how healthinformation, including opportuni-

ties for care and education, is dis-seminated in the public sectorfrom policy makers to health careproviders to patients. AlanWoodruff and Emmanuel Balandyainvestigated correlations betweensocioeconomic factors (particularlyliving conditions and transport

options) to adherence to long-termtreatment. Catherine Kahabukaand Cyrus Yamin conducted abaseline screen for type 1 diabetesin children to assess the prevalenceor potential for misdiagnoses.Hayden Madry and AndreasNshala explored the affects of HIVon the productivity of workers andthe subsequent response of corpo-rations in the Dar es Salaam area.Salehe Juma and Richard Bouchardexplored the increasing use of bio-medical equipment and imagingtechniques, such as MRI and CTscans, as they relate to diagnosisand treatment options.

I thought that arranging logisticsand establishing administrativesupport for PERSA at the medicalschool was going to be the tough-est part of my job. More challeng-ing however, was working withparticipants to adjust to life inTanzania, establish research pro-jects, and settle into partnerships.

Looking back on the experience, Iam enormouslyimpressed by each indi-vidual’s ability to delveinto a new setting andwork continuously withsuch innovation andindependence. As a stu-dent, I see the enthusi-asm, curiosity, and capa-bility of the undergradu-ate population at UNCgoing untapped andunacknowledged. Findingan appropriate vehicle toutilize these characteris-

tics could revolutionize education atthis level – leading ultimately to amore informed, globally consciouscommunity. In the future, I wouldlike to see PERSA be incorporatedas just a small part of a larger move-ment to transform the undergradu-ate experience at UNC.

Continued

BURCH FELLOW 2004

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