Grant Smith currently works as a resident physician at the University of California, San Francisco. While he was in the Hart Fellows Program from 2008-09, he partnered with the Kilimanjaro Christian Medical Center (KCMC)-Duke University Women’s Health Collaboration in Moshi, Tanzania. His research examined the psychosocial factors that influence women’s ability to obtain services essential to lowering maternal mortality. Grant attended Harvard Medical School and has worked at UCSF since June 2014.
Follow Grant’s journey as a Hart Fellow.
Application: Becoming a Hart Fellow (February)
Prospective Hart Fellow candidates submit their applications in early February. This is a competitive process, where candidates are invited to make the case for why and how they are ready to take on the challenges of the fellowship. In his 2008 application Grant wrote:
“When I began researching a pediatric-to-adult care transition program for adolescents with sickle cell disease (SCD), I was nervous. I knew little about SCD and even less about conducting research. In addition, as a twenty year-old, white male, I felt like an outsider in the hematology clinic, where most of the staff are adult, African-American women. It was these and other challenges that made this community-based research (CBR) project essential to my intellectual, professional, and personal development. Because of my experience conducting CBR, I want to become a Hart Fellow to expand my understanding of global social justice issues, engage in meaningful relationships with community partners, and conduct research that will address community needs.”
Find the full application timeline for the 2017-2018 Hart Fellows Program here.
Preparation: Hart Fellows Retreat (May)
Before they hit the field, new Hart Fellows participate in an intensive, three-day training retreat in May where they learn about community-based research methods and ethics, leadership, and the practice of critical reflection. Grant attended the retreat along with the two other fellows in his year, Corey Sobel and Sam Swartz. Looking back on what he learned, Grant commented:
“The retreat was a great time to get to know the other fellows and learn from their previous experiences. Having not been abroad much, I was nervous about what it would be like. Sam and Corey helped calm some of my anxieties about living abroad for an extended period. They also had different ways of approaching their fellowships, and it was insightful talking with them about what we were expecting and hoping to experience during the year. It was also great to get to know them in person, since we emailed updates to each other throughout the fellowship. The retreat was also good because it showed me the support team I had back in Durham. It was reassuring to know that if something were to happen, I had a team of people who knew and cared about me and would do what they could to help.”
In the Field: Research Service-Learning (July – May)
Hart Fellows arrive in their new countries of residence in early July. Grant hit the ground running in Moshi, Tanzania, with the Kilimanjaro Christian Medical Center (KCMC). Living on the KCMC doctor’s compound with other medical students and practitioners from Duke and Tanzania, he immediately began carving out a role as a community member and researcher. In his Initial Impressions Assignment, Grant wrote:
“The two greatest challenges I think I will face are forming real relationships with locals and figuring out what my work with Dr. Wilkinson will be. As I mentioned above, the ex-pat community at KCMC is large, fun, and interesting. However, I would deeply regret spending ten months here without having a better understanding of Tanzanians’ daily lives, thoughts, beliefs, concerns, hopes, and fears. To accomplish this, I will have to make time to meet people, which will be difficult given the comfort zone and language barriers I will need to overcome. My work with Dr. Wilkinson will also be a great challenge because of how little is known about what the partnership between Dr. Wilkinson and KCMC will be… We have tossed around lots of ideas, all of which are broad, vague, and could take years to complete. In some ways, I love the fact that the door is wide open to go where we want, but I am also concerned that I have nothing on which to ground a project.”
a) Letters Home
One of the most important aspects of a Hart Fellow’s experience is the “letter home.” The fellows send these personal narrative essays to Hart Leadership home office once a month. The writing process gives fellows a chance to make sense of their experiences and to eventually share what they are learning with wider audiences.
“Postpartum hemorrhage, shoulder dystocia, vacuum extraction, and genital tract sepsis – these foreign topics have now become familiar to me as our team has taught Advanced Life Support in Obstetrics (ALSO) courses at KCMC and in Bukoba. A few weeks ago, our team was teaching the course at Mawenzi, the government-run regional hospital, located in the center of downtown Moshi. As a regional hospital, Mawenzi receives referrals from local health centers and the many dispensaries sprinkled throughout rural parts of the Kilimanjaro region. It was the middle of another hot and dusty day, and during a short break in the course, the head of the labor ward took us to see the hospital’s obstetrics and gynecology area…”
b) Critical Reflection
All Hart Fellows submit monthly Critical Reflection Addenda throughout the year, and more substantial reflections at the midpoint and end of their fellowship. At the time that Grant wrote his Midterm Reflections in January 2009, he had been living in Tanzania for six months and was heavily involved in his research project.
“For the first months of my fellowship, Dr. Wilkinson, Dr. Hayat, and I investigated possible roles we could assume at KCMC. During these months, I served as an extra set of eyes and ears as our team met hospital leaders, talked about potential projects, and learned about the complexities of our new environment. While I struggled to know how to contribute during these initial meetings, I felt privileged to be able to observe them. Seeing and hearing the initial conversations and actions that have grown into our current partnership have helped give meaning to concepts like “global health” and “women’s health.” Being able to see the process of forming a partnership like this has been one of the best parts of this fellowship.”
c) Community Based Research
The Hart Fellows Program experience is centered around Community-Based Research, or CBR. Together, the Fellow and the host organization design a research question that meets a need identified by the organization. Using a variety of quantitative and qualitative research methods, the Fellow carries out the research in collaboration with the partner organization and community members.
Grant’s CBR project investigated how psychosocial factors such as expenses, location of delivery/antenatal care, and family support influence where women deliver and whether women are able to attend 4 or more antenatal care visits.
Learn more about the different roles students, faculty mentors, and community partners play in community-based research here.
Home Again: Post-Fellowship Reflection
Hart Fellows come back home in May. Grant returned to the United States in May 2009, and attended Harvard Medical School.
“My experience in Tanzania opened up the possibility of living and working abroad long-term. While I cannot say if that is something that I will ultimately do in the future, it is something that is now within the realm of possibility. Regardless of where I end up working, I learned the importance of being devoted to a cause that you are absolutely passionate about. Seeing Dr. Wilkinson’s devotion to women’s health was incredibly inspiring to me. It was clear that he saw women’s health as a human rights issue, not just a medical problem. I hope that I also find a cause or field that inspires me to do whatever it takes to make a positive impact.”