It always seems that I do my best reflecting when I am over seven miles in the sky. There is just something about soaring effortlessly far above the earth towards a destination that has become so familiar to me, but had been so distant for most of my life. It has now been ten years since I had first traveled to that “dark continent” and it is now daily it seems that I have to pinch myself to be reassured that this isn’t just a dream. I don’t really believe in destiny as it is up to each of us to make the most of our lives, but somehow this just all seems like it was meant to be and I can’t escape that reality. So, as I travel east towards my first stop in Doha, Qatar, I reflect mostly upon the lives that I have touched during this journey – patients I have seen, the amazing Tanzanians who I have worked with, the friends I have made both here and there, and, perhaps most importantly, the residents and fellows from Penn who I have exposed to the wonderful world of international health and health equities.

Several days ago, we had a small gathering in advance of our coming trip of what Neena Cherayil has now coined “The Tanzanite Gems,” that group of residents who have accompanied me to Tanzania over the last several years along with several of those who will be traveling with me this visit. It is quite difficult for me to describe to you just how proud I am of these truly remarkable individuals and I am so grateful every day for the fact that I have had the opportunity to work with each and every one of them. The list has now become so long, but each of them have left an indelible mark and occupy a place in my heart – Danielle, Megan, Doug, Ali, Thu, Lindsay, Jess, Jackie, Kelley, Laurita, Chris, Jamie, Nan, Whitley, Sara, Neena, Johannes, Susanna, Susan, and Mindy.

And what began as merely a global health experience, traveling to East Africa to not only teach the doctors there by working side by side with them, but also to treat patients has now become a full-fledged program in health equities both in Africa and at home. This has been defined as the principle that everyone should have the opportunity to attain their full health potential and, conversely, that no one should be disadvantaged from achieving this potential. A few years ago, with the help of our residency program director, Ray Price, and the cooperation of the several other faculty along with our residents, we began to provide neurology services at Puentes de Salud, a non-profit health center in Philadelphia that provides medical care primarily to Hispanic patients who have no insurance or are undocumented. The interest by our residents in this program was so great that we began looking for other venues that would allow us to provide neurological care to those patients without access. We then approached the University of Pennsylvania Refugee Clinic to assist with those patients arriving here in need of neurological care and though we have assisted a few patients, the numbers have been small for the sole reason that there has been a drastically reduced number of refugees being granted asylum since 2016.

Still in search for additional sites, we were fortunate enough to have been introduced to an amazing clinic in West Chester, Pennsylvania, by one of our particularly incredible residents, Adys Mendizabal (who will be coming to Tanzania in March 2019), who had worked there during her medical school training. Community Volunteers in Medicine (CVIM) is a free clinic for uninsured and underinsured patients living in Chester County and provides not only medical and dental care, but also has a dispensary that is better stocked than most pharmacies and is able to provide several millions of dollars of medications to patients in need. Since August of this year, we have now provided a monthly neurology clinic to patients referred to us by other volunteer caregivers at the clinic. We are also able to obtain diagnostic studies through the generosity of two local hospitals who have realized the need to maintain the health of the community. Though our relationship is new, it is clear that there is a tremendous need for our services here and the opportunity to give back has been well received. It is also clear that the quality of the medical and dental care that is delivered at CVIM, all by volunteers such as ourselves, is of the highest quality and most desperately needed by this community.

And so it is that we now have developed, in a thoughtful and programmatic manner, a purely clinical program that allows neurologists in training the opportunity to develop their own skills and values while furthering the cause of health equity and allowing those we have served, both patients and other caregivers, a better chance of reaching their full potential of a healthy life both here and abroad. Some of those residents will go on to dedicate their careers to global and international medicine, but all will have developed a far greater appreciation for the basic right of health for all. And perhaps most importantly, a renewed confidence in humanity and why each of them has chosen this career and to serve.