Jeffrey P. Levine, MD, MPH: Rutgers Robert Wood Johnson Medical School, Professor and Director of Reproductive & Gender Health Programs

Tanzania: August 2026

 I was immediately impressed by the facilities including Medical, Surgical, Pediatric, & Maternity Wards, an Emergency Room, two Surgical Suites, Laboratory and Pharmacy service, along with several ultrasound machines, X-rays, and even a CT scanner. They only have a few fully trained MDs at FAME - providers are Assistant Medical Officers (AMOs - like a Nurse Practitioner) or Clinical Officers (CO - like a Physician Assistant). They also had a handful of visiting Volunteer physician specialists, including a Neurologist from Germany, a Neonatologist and Adult Intensivist couple from Australia, and an Internist from Cameroon. Patients often wait an hour or more to be seen – many more if labs, radiology, and/or medications are needed. At least 75% of medical services provided here are subsidized by donations and grant support.

 I spent my first two days seeing patients in their Outpatient Clinic, one day of which was dedicated primarily to patients with Diabetes and Hypertension. One of the most striking things I noticed is how limited the Providers' history gathering is, and how rarely they even examined the patient. I asked permission to examine a few patients who were complaining of abdominal or joint pains. I tried to remain in preceptor mode, letting them lead in history gathering and assessment and plans, then contributing my thoughts and suggestions, and other questions for the patient only when asked.

 I spent my third day providing independent direct patient care at their Cervical Cancer Screening Clinic with a Nurse and/or Clinical Officer to help translate. Perhaps the greatest difference I made was helping improve their Cervical Cancer Screening Clinic protocol. They only provide Visual Inspection with Acetic Acid (VIA) along with a "See & Treat: single visit approach”. They spray vinegar on the cervix, and if they see anything turn white, they use either thermal ablation or LEEP, immediately to "treat it". This process is highly inefficient, inaccurate, and invasive. They had a digital Colposcope, left here by a prior Gyn, but they did not know how to use it. I was able to get it working, demonstrated the improved effect with applying acetic acid for 60 seconds, and how to use the digital colposcope to significantly improve identification of acetowhite lesions. My goal would be to help implement a sustainable "Self-Collect Vaginal HPV Cervical Cancer Community Outreach Program”.

 By my second week, word spread amongst staff and the surrounding community that a Women's Health Specialist was volunteering at FAME, and I became very busy providing Gyn Care and teaching. I was shocked and disappointed that FAME no longer stocked contraceptive devices, which are distributed by the government. There is currently a severe shortage due to U.S. funding cuts to organizations that provide food, medication (including antiretroviral therapy), and medical supplies to Tanzania. However, several patients came with "Black Market" copper IUDs or contraceptive implants in their bags, along with several babies in their arms, for me to insert. I also continued doing more Colposcopies and consultations for pelvic pain, abnormal uterine bleeding, and infertility.

 I gave two presentations to a packed room of health providers and staff. The first one was on "Cervical Cancer Screening Updates" - by far, the most common cause of cancer death of women of all ages in Tanzania (57 deaths/100,000 women vs The US 7/100,000). Since I had gained the trust and respect of the health providers, I took the opportunity to demonstrate step-by-step how to perform a more patient-centered, trauma-informed gynecologic exam. My second presentation was on Polyendocrine Metabolic Ovarian Syndrome - the most common cause of infertility among women in Tanzania.

 Overall, my time at FAME was a most rewarding and uplifting experience, paying it forward for the blessed life I live. However, witnessing the degree of poverty and despair felt overwhelming at times. Admittedly, I did not feel proud to be an American knowing that several of the HIV patients I saw were no longer receiving their antiretroviral medications, and others cannot receive LARCs. I made some more lifelong friends and colleagues at FAME and they have already sent me several emails and texts asking when I am coming back. I hope to be able to create a sustained relationship between Overlook, Rutgers RWJ, and the wonderful people at FAME.