Inside HRSA - November 2007
 
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Duke, Parham Hopson Represent Federal Women Leaders in Exchange Program with Tanzania

Two HRSA executives were among three women leaders in the Federal government selected to participate in an exchange program with their peers in the East African country of Tanzania.

HRSA Administrator Betty Duke and Associate Administrator for HIV/AIDS Deborah Parham Hopson made up two-thirds of the U.S. participants in a Ministerial Fellows Exchange Program directed by the Council of Women World Leaders through a grant from the U.S. Department of State. They were joined by Stephanie Monroe, assistant secretary for civil rights in the Department of Education.

The exchange program promotes and supports women’s leadership in government through cross-cultural exchanges. This year’s program with the Tanzanians was between women government leaders in the health, education and finance sectors.

  

In Tanzania, members of the U.S. delegation visited Bagamoyo District Hospital and met with nurses there.
In Tanzania, members of the U.S. delegation visited Bagamoyo District Hospital and met with nurses there. The U.S. Department of Education’s Monroe is in front center in the blue blouse; Dr. Duke and Dr. Parham Hopson are to her immediate left.

Two of the three Tanzanian participants – Mwantumu Mahiza, Tanzania’s deputy minister of education and vocational training, and Joyce Mapunjo, deputy minister of planning, economy and empowerment – recently visited the United States. The third member of the delegation was unable to travel due to illness.

The Tanzanians went to HRSA headquarters Oct. 25, where they were briefed on health professions issues as well as finance and budget topics. From there they left with their HRSA hosts for Shepherd University in Shepherdstown, W.Va., where they met with the dean of the nursing school and saw a state-of-the-art, speaking mannequin that is used to give students a simulated, hands-on treatment experience.

From Shepherdstown the group visited the nearby Shenandoah Valley Medical System in Martinsburg, W.Va., where staff at the HRSA-supported health center discussed the role of health centers in U.S. health care and answered questions.

The last stop was to the War Memorial Hospital in Berkeley Springs, W.Va., a HRSA-supported rural Critical Access Hospital with 19 patient beds and another 18 beds for nursing home residents. “We explained the circumstances in rural America that caused the emergence of critical access hospitals and their importance to rural residents,” Duke said.

Of the day-long trip to West Virginia, Duke said that “we wanted our visitors to get outside Washington and understand that HRSA has a significant responsibility in supporting the delivery of health care for millions of people living in rural areas.”

The next day the group toured the Total Health Care Inc. health center in Baltimore and discussed HIV/AIDS research and treatment with staff at the Johns Hopkins University Medical Complex.

Pictured are Dr. Duke; Sarah Parker from the Council of Women World Leaders; Mwantumu Mahiza; Joyce Mapunjo; and Dr. Parham Hopson.
Left to right: Dr. Duke; Sarah Parker from the Council of Women World Leaders; Mwantumu Mahiza; Joyce Mapunjo; and Dr. Parham Hopson.

 

Duke said she “was very proud of the way HRSA and its grantees took seriously the opportunity to show our work in America’s health care system. We had an urban and a rural focus and the teams really pulled together. The spirit of working together to make a difference among federal and state officials and local and community groups came across everywhere we went.”

The first stage of the exchange program began with the three American participants traveling to Tanzania in the spring for a five-day visit to Dar es Salaam, the country’s biggest city and former capital. While there, they toured hospitals, clinics, schools and other sites and saw a nation facing significant economic and health challenges.

Parham Hopson said Tanzania’s HIV infection rate is so high that it limits economic productivity. “They have lost – and are losing – many talented members of society to HIV/AIDS over the years,” she said. “Malaria and tuberculosis also are serious health problems.”

HIV’s impact is especially harsh in a country with weak infrastructure that Parham Hopson characterized as still struggling to make the transition to independence since the end of British colonial rule in 1961. Tanzania’s gross domestic product per capita was estimated to be $800 in 2006; U.S. GDP per capita the same year was $43,500, according to U.S. government estimates.

Tanzanians seeking medical care often face arduous circumstances, Parham Hopson said. “At one clinic we visited, mothers and children – many of whom were suffering from diarrhea – were waiting for hours to be seen with no food, no water, no diapers. That’s a challenge.”

Despite the tough conditions, Parham Hopson said she saw “beacons of hope” on the trip. “We visited a hospital that had some HIV medications, where doctors and nurses were treating patients. We saw a very dedicated staff that was doing the best they could with the resources they had.”

But the hospital’s 60 HIV patients had to share the 30 beds available to them, and more medications were still needed, she said. Tanzania is one of 15 countries that receives U.S. funds to fight HIV/AIDS through the President’s Emergency Plan for AIDS Relief, better known as PEPFAR.

Parham Hopson also recalled visiting a home in a low-income area of Dar es Salaam operated by nurses who took in teenagers living on the streets. The nurses taught sewing skills to the young people and, after a period of training, set them up in business with a sewing machine and supplies. “The nurses taught the teens a skill that helped them take care of themselves, gave them a chance to earn a living,” she said.

Duke agreed that Tanzanians confront daunting problems. Among them is the challenge of promoting public health in a country with significant gaps in primary education. Tanzania’s adult literacy rate in 2004 was 69 percent, according to UNICEF, the United Nations Children’s Fund.

“And just like here in the U.S., it’s difficult keeping scarce health care providers in rural areas as internal migrations into Dar es Salaam continue,” Duke noted. Of the country’s 38 million people, 2.5 million live in Dar es Salaam.

Duke called her trip to Tanzania “the completion of a life circle for me that I’d started long ago.” Decades earlier, Duke had just earned a master’s degree in sub-Saharan politics at Northwestern University when she followed her husband in a move to a new job on the East Coast. As a result, she interrupted her studies and never had the chance to go to Africa.

“So this program was a marvelous opportunity for me,” she said. “It was edifying to meet women leaders in Tanzania, and it was humbling to represent the United States as a woman leader in government.”

  

Mapunjo at Shepherd University’s School of Nursing.
Mapunjo at Shepherd University’s School of Nursing.

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