Pratt Intern Finds Life-Changing Experience in Africa

Awakening as his plane landed in Tanzania, biomedical engineering student Sumit Shah looked out a dusty window and saw an acacia tree. It took a while before his sleepy mind conjured an explanation for the odd, flat-topped canopy of leaves on slanting, nut-brown tree limbs. He was finally in Africa.

Shah, whose ambition is to pursue HIV/AIDS research as a physician, decided to intern in Tanzania in part because Africa is struggling to survive the worst epidemic of AIDS in the world, and because his father was born and raised in the Tanzanian capital, Dar es Salaam. So, with help from Associate Dean Russell Holloway, Shah cobbled together funds to pay for the internship expenses.

Shah, a senior from Rose Hill, Kan., found a willing mentor in Dr. Ramaiya Kaushik, a slim, Tanzanian man of Indian descent with wisps of white hair at his temples. Chair of the Africa region of the International Diabetes Federation, and an expert on HIV/AIDS, Kaushik has his own connection to Duke, having done an internal medicine fellowship at Duke Medical Center in 1988.

For the first month, Shah shadowed Kaushik on patient rounds at the Shree Hindu Mundal (SHM) Hospital in Dar es Salaam to observe. For Shah, after an internship at Duke Medical Center surrounded by leading edge technology and gleaming, sterile cleanliness, his first impression was utter shock.

“I saw patients in such appalling states of health, with diseases and conditions that you would simply never see in the U.S.,” he said. More than 60 percent of the hospital’s patients had HIV/AIDS, and more than half of those patients suffered from secondary infections such as malaria, tuberculosis, and pneumococcal pneumonia.

Trained through his biomedical engineering curriculum to solve problems with technology, Shah assessed SHM’s resources. The hospital has no MRI; no CAT scans machines; no surgical teams. Tanzania, like other African nations, suffers from “surgical brain drain,” with most surgeons choosing to leave the country for higher pay and better living conditions abroad.

For Shah, the lack of technology and the abject state of the patient seemed both overwhelming and insurmountable. “I saw a side of health care I’ve never seen before. To study medicine in a third world country is an incredible experience,” he said.

So he followed Kaushik on rounds. Watched. And learned. The result: an understanding of the critical importance to healing of the spirit and personality of the doctor.

“I quickly noticed how Dr. Kaushik lights up the room when he enters,” Shah describes. “He has this deep, articulate voice that sounds so comforting and fatherly. He would sometimes crack jokes to make people feel more comfortable, but he was always very collected, very confident because his patients needed that. He always knew when to be a friend and when to be a physician.”

“I realized that although the available technology was limited, the way the doctors relate to their patients, their personal skills and bedside manner was much better than what I have seen in the U.S.,” said Shah. “They overcome what they don’t have with compassion.”

Shah also realized how profoundly, and even unthinkingly, doctors in industrial nations assume that basic services will be available to power their lifesaving, advanced technologies. “I was at the hospital once when a patient came in who desperately needed dialysis. We had the only dialysis machine in the country, but there was no running water that day,” Shah said. “That woman’s health crisis was worsened simply because there was no running water.”

In Tanzania, a country roughly the size of Alaska, nearly 10 percent of the population suffers from HIV/AIDS. The availability of health care services is complicated by the sheer challenge of travel. More than 40,000 kilometers of the country’s roads are unpaved and become virtually impassable during the rainy seasons.

AIDS patients who do get medical care temper their expectations against economic reality. The average annual income is about $250, and getting HIV/AIDS treatment is beyond the realm of possibility for everyone but the very rich. Antiretroviral drug “cocktails” routinely used in the U.S. cost more than $100 a month. Of course, doctors fight to keep secondary infections in check and try to help their patients stay as healthy and comfortable for as long as possible. However, slowing or halting the progression of the disease is impossible. Similarly the prohibitive cost of many other medicines makes highly treatable diseases such as tuberculosis an ongoing nationwide crisis.

For the first month, Shah shadowed Kaushik from 8 a.m. to 5 p.m. But later, when he was conducting his own research, he would sometimes work at the hospital until 1 a.m. “Dr. Kaushik was always there, no matter when I stopped by the hospital,” he said.

Only after he returned to the U.S. did Shah realize that in the entire time he spent in Dar es Salaam, he’d never seen Dr. Kaushik eat a meal.

During his clinical research rotation, Shah evaluated HIV/AIDS patient files to develop statistics on disease trends. Ultimately this information will be compiled into a report with recommendations for the Tanzanian Ministry of Health. Shah hopes the work will positively influence health funding and policymaking in Tanzania.

Rethinking his initial impressions about the hospital and the Tanzanian healthcare system, Shah says he realized that the care patients receive is much better than he ever expected. “They do as well as they possibly could under the conditions they face. Patients come first,” Shah said.

Also, as part of his work in Dar es Salaam, Shah taught HIV/AIDS awareness to children. “I actually taught in the very school my father attended as a child. Looking out into the upturned faces of those children, I felt amazement that my Dad had sat there as a little boy. It was a profound experience for me. A continent away, I felt more connected to my family than ever,” he said.

“This experience has changed me and the way I live my life,” Shah said. “I am grateful, so very grateful for the opportunities I have and I worry less about the smaller things. I truly gained an appreciation for the beauty of simplicity that I witnessed in everyday Tanzanian lifeÂ…living for each day.

“I feel that the wealthier nations should be taking a stronger role in fighting the HIV/AIDS epidemic in Africa,” Shah said. “It’s the largest, most widespread epidemic in the world, with thousands of people dying everyday–— yet it seems so little is being done. It will take a world wide effort to fight this”

Since Shah's return, he has become more conscious of the importance and implications of international policy, and is determined to make a difference on his own. “I want to give back to Dar es Salaam,” Shah said. “I don’t want to just do my ‘good deed’ and then move on.”

For example, he is collaborating with Holloway to establish the Dar es Salaam internship as a long-term, supported Pratt internship program, sending as many as four students a year to conduct clinical HIV/AIDS research, study health policy and to teach HIV/AIDS awareness through volunteer activities. This summer, Pratt student Chris Manz is in Tanzania continuing the clinical work that Shah began.

Shah plans to become a primary care physician, but before starting medical school, he is contemplating returning to Tanzania himself to help further the work with Dr. Kaushik, perhaps traveling to India to teach HIV/AIDS awareness, or possibly trying an internship at a biomedical company in the U.S.

“I’ve got plenty of time to study medicine, and I want to go into healthcare, to be a doctor, but Duke taught me the importance of pursuing my passions, and I want to spend some time exploring different ideas,” Shah said.

“I do think sometimes about practicing medicine in a third-world country someday,” Shah said, turning quiet for a few moments. “But following in Dr. Kaushik’s footsteps, the example he’s set, his compassion . . . such an inspiration . . ., I just don’t know,” he said softly. “He gave everything he had to his patients.”

Making eye contact again, Shah smiles gravely, and looks older than his 21 years. “If I could live up to the standard of commitment and dedication Dr. Kaushik has for his patients, I could call myself a successful man.”

“But you don’t have to go far away to help people,” Shah said, his face lighting up again with passion and determination. “There’s so much here to do locally in our own communities where HIV and AIDS are grave issuses.”

Sumit Shah will graduate with a bachelor’s in biomedical engineering in 2004.

This internship was funded with money from the Pratt School of Engineering, Duke Medical School, the Department of Public Policy and the Center for International Studies.