MIRROR 3.4.20
OPIOID CRISIS IN NH 3
Q&A WITH ANNE SOSIN 6
TTLG: BEING A TOUR GUIDE 7 GRACE QU/THE DARTMOUTH STAFF
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Editors’ Note
Q&A
DIVYA KOPALLE/THE DARTMOUTH SENIOR STAFF
Law and Order. Beyond being the title of a popular TV series — we know the familiar “dun dun” just played in your head — the concept is present in many facets of our daily lives. However, it is also subjective; each society has its own set of rules and regulations on par with its norms and expectations. We often believe that laws reflect what’s right and wrong — but with the variable constructions of what is good or bad, it may not be so black and white. In some countries, corporal punishment is a practical parenting method; in others, it is child abuse and illegal. In some parts of the world, marijuana can be bought and sold legally; in others, its possession can be punishable by death. In this week’s edition of the Mirror, we look at issues related to law and order. We investigate the opioid crisis in New Hampshire; we hear from the director of the Global Health Initiative Program at Dartmouth about the implications of coronovirus; and we ask our writers about their views on matters related to the law. Despite the differences in what societies deem lawful or illegal, all societies seem to share the belief that institutional regulations and prohibitions are necessary. As Aristotle so pointedly said, “Different men seek after happiness in different ways and by different means, and so make for themselves different modes of life and forms of government.”
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3.4.20 VOL. CLXXVI NO. 149 EDITOR-IN-CHIEF DEBORA HYEMIN HAN PUBLISHER AIDAN SHEINBERG MIRROR EDITORS KYLEE SIBILIA NOVI ZHUKOVSKY COPY EDITOR JULIAN NATHAN ISSUE LAYOUT GRANT PINKSTON
By The Mirror Staff
What does justice mean to you? Angelina Scarlotta ’23: Appropriate consequence, positive or negative, for action. Anne Johnakin ’23: I think justice is getting what is fair, right and just. It’s hard to define; I think it’s more of a gut thing. We, at our core, know what is right and wrong, and true justice is acting in accordance with that. Christina Baris ’22: I think that justice is really hard to define. To me, if something is just it is the right thing. However, it is often hard to know what the right thing is in certain situations. Elizabeth Whiting ’21: Justice means the right thing. That’s simple. But context can make the right thing so obscure that justice becomes an ideal. Charlie Ciporin ’23: Justice is everyone being treated fairly and equally. Caris White ’23: Justice is when laws are made and enforced fairly and when there is true equality and redemption for the oppressed. How does the law impact your day-to-day life? AS: There are not any huge effects on me personally, but it would be incorrect to say that I am unaffected by the law. It influences every little thing that we do or is done to us, from making impactful moral decisions to simply stopping for pedestrians at the crosswalk. AJ: Well, obviously, I have to follow the law. But generally, I don’t do things that would be illegal, so the law doesn’t cross my mind in regards to my own life. CB: It sets boundaries on my actions. Although I’d like to think that, on most days, I don’t consider doing things that would be against the law. EW: The law generally makes the world a safe place for me to exist within my bubble. CC: Most days, I’m not sure if it does; I think it’s so engrained in me and in society that I don’t notice myself following or
not following it. CW: I don’t interact with the law on a daily basis, but it implicitly shapes the way I view right and wrong, therefore impacting decisions I make every day. How have you experienced justice in Hanover? AS: This isn’t exactly justice-related, but I constantly see students actively getting involved in government — whether by exercising their right to vote, joining political clubs on campus or taking classes to learn more about the government. AJ: I don’t think I have, or at the very least, I can’t think of an example. CB: I honestly can’t say that I have. That is not to say that it doesn’t exist, I just don’t think I remove myself from Dartmouth enough to experience it. EW: I am not quite sure what it means to “experience justice.” I feel I am most often treated very fairly in Hanover with a few memorable instances of injustice. CC: Mostly by discussing it in a criminal justice class with professor Jennifer Sargent. CW: I haven’t interacted enough with law enforcement or the courts to experience legal justice (or the lack thereof) in Hanover. I think justice in Hanover can be present in other ways, like when people are held accountable for their actions, even in small ways. Do you ever feel the impacts of problems in the Upper Valley — like the opioid crisis — in Hanover? AS: Because Dartmouth is in its own sort of bubble, I don’t really feel the effects of any issues like the opioid crisis in my day-to-day life. I am, of course, aware of them, but it is not something that I am regularly witness to. AJ: I don’t interact with the outside community of the Upper Valley as much as I probably should, so I haven’t seen the effects of the opioid crisis. But we
can see evidence of other issues, such as ICE agents coming to the Upper Valley. CB: Again, it can be hard to feel the impacts of the “real world” while enclosed in the Dartmouth bubble. I think we should all strive to pop the bubble from time to time. EW: I personally do not feel the impact. I am aware of the impact because I have seen the effects a tiny bit in Hanover, but more overwhelmingly in areas surrounding Hanover. CC: I don’t think I do, but I try my best to be aware of these issues, and I would like to be more involved in the Upper Valley community moving forward in my Dartmouth career. CW: I don’t. Since I don’t have a car and I am not involved in volunteering, I rarely interact with our larger Upper Valley community. What is more important to you: equality or fairness? AS: I think that equality is fairness. It only makes sense that people — regardless of gender, ethnicity or culture — should be treated equally and fairly. AJ: I would say that more than either of those, I like the word “equity.” The definitions of equality and fairness get so muddled, it’s hard to tell exactly what they mean. CB: Fairness. Everyone is born into varying degrees of privilege. Although we cannot change this innate inequality, we should strive to be a more equalopportunity society. EW: Fairness. I think that equality ignores elements that complicate equality and whether equality can be considered just, making fairness more important. CC: Fairness. CW: I think they’re intertwined. True equality requires fair treatment of everyone, and the concept of “fairness” is based on the premise that the parties being judged impartially are coming from places of equal footing.
A Look Into the Opiod Epidemic in the Upper Valley STORY
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By Pierce Wilson
According to data from the Mara said that, while many people Drug Enforcement Administration, first try opioids as a prescription, Dartmouth-Hitchcock Pharmacy once opioids became more regulated, in Lebanon distributed 5,146,260 those same individuals began opioid pills to turn toward between 2006 illicit opioids to 2014, making “Back in 2012, we like heroin it the pharmacy started seeing in New and illegally which dispensed manufactured the most opioids Hampshire a lot of fentanyl. i n G r a f t o n pills, and we started County. While ccording to seeing property crimes AMara, the number most of of pills is not going up, particularly the heroin and i r r e g u l a r burglaries.” fentanyl entering considering the Upper Valley the size of the comes in through p o p u l a t i o n -DAVID MARA, ADVISOR Manchester via the phar macy drug routes from ON ADDICTION AND serves, the data Mexico. illustrates the BEHAVIORAL HEALTH TO “The opioid epidemic GOV. CHRIS SUNUNU Mexicans, they in the Upper saw a marketing Valley and New o p p o r t u n i t y, Hampshire, and they started which is changing with a rise in flooding the market with cheap, fentanyl use despite the best efforts potent heroin,” Mara said. of local organizations to combat the Illegally manufactured fentanyl is problem. stronger than heroin and cheap to Until recently, New Hampshire make and obtain. The availability has been the state with the second- and popularity of heroin caused a most opioid overdose deaths in shift in the market; according to the the nation behind West Virginia, same report from Sununu’s office, according to Gov. Chris Sununu’s there were no purely heroin related advisor on addiction and behavioral deaths in 2019, with all but 22 of the health David Mara. In 2019, New 295 opioid related deaths in 2019 Hampshire fell to third, with Ohio being attributable to fentanyl. now occupying second place. “By 2015, it was all fentanyl, and A report released by Sununu’s that was a marketing decision made office found that there were by the Mexican cartels, because 295 confirmed opioid deaths in [fentanyl] is a lot more potent, and the state of New Hampshire in they can use the same smuggling 2019. According to Mara, the routes,” Mara added. landscape surrounding opioids According to director of the in New Hampshire has changed Dartmouth Center for Technology drastically since 2012 due to state and Behavioral Health Lisa Marsch, and local policies, community-based Grafton County is not as affected initiatives and nonprofits. as many other counties in New “Back in 2012, we started seeing in Hampshire. The counties most New Hampshire a lot of pills, and we affected are closer to the Massachusetts started seeing property crimes going border and Manchester, so the center up, particularly burglaries,” Mara has yet to do research on Grafton said. “When we dug into it, what we County specifically. found was that people were stealing a “While it is the case that rural lot of pills. People were taking drugs communities were, early on, hit the from medicine cabinets.” hardest, there historically has been a
higher density of substance problems that much of the fentanyl entering According to Goodman, DHMC in certain communities that have the Upper Valley comes from towns provides “wraparound services” so less resources,” in Massachusetts that these mothers may have their Marsch said. like Lawrence psychiatric needs met, as women with “The Upper Valley F o r m e r and Lowell. He substance use disorders oftentimes suffers from a lack of member of the also said why the also have co-occurring psychiatric Addiction Policy resources, [and] the Upper Valley and needs. Goodman’s program provides Forum Kimberly sparse population New Hampshire, childcare services while mothers are Lohman Clapp like many rural in treatment and helps mothers apply said that the best allows isolation by communities, are for subsidized housing. ways to mitigate those using drugs.” According to Dr. Charles Brackett, more vulnerable addiction to to the opioid a general internal medicine doctor opioids or e p i d e m i c at DHMC, another significant any ad d ic ti ve -DOUG GRIFFIN, SENIOR because of their program is the New Hampshire substances are by DIRECTOR OF STATE isolation. Doorway program. The Doorway reducing trauma “ T h e program helps people struggling in a child’s life, CHAPTERS AT THE U p p e r Va l l ey with opioid use disorder access clean delaying onset ADDICTION POLICY suffers from a needles and also offers recovery of the first use lack of resources, services FORUM of any addictive [and] the sparse According to Brackett, the substance and p o p u l a t i o n program has expanded so that providing ample positive social allows isolation by those using individuals are never more than eight experiences for kids like sports, clubs drugs,” Griffin said. miles from a Doorway. and a sense of belonging. She added In the decades since the opioid Although opioid deaths in New that it is critical to teach children and crisis began, many individuals and Hampshire are currently trending adults that addiction is preventable o r g a n i z a t i o n s downward, and treatable, and that it is a brain around the state “We, as a community, Goodman said disease. have done work she feels that In her research, Clapp has to mitigate harm. need to wrap our arms there is much found that most of the illegally Fo r e x a m p l e, around families and more work manufactured opioids in the Upper recovery clinics left to be done Valley are coming in from Mexico like Recover in say, ‘What happened l o c a l l y, a n d and China. She noted the important Claremont and to you? What do looks forward to distinction between the prescription Project 439 in you need? How can the expansion fentanyl — which is tightly controlled L e b a n o n — of addiction by hospitals to manage pain during founded by four we help to develop disorder support surgery — and the fentanyl that Geisel alumni the services that are programs. accounts for most opioids death — offer needle “ W e statewide. e x c h a n g e s needed right here in need ethics as a “The fentanyl making its way and resources the Upper Valley for society and as a into street drugs is an illegally t o f a m i l i e s . community, as the our families?’” produced synthetic drug that is D a r t m o u t h Upper Valley,” cheaper to produce than heroin, H i t c h c o c k Goodman said. and 50 times more potent,” Clapp Medical Center -DAISY GOODMAN, “But think about said. “This fentanyl is also 100 times has also expanded this really as a more powerful than morphine. its programs to ADVANCE PRACTICE community issue. Oftentimes, the person using cocaine meet the growing ADDICTION NURSE AT It’s not about or heroin is unaware that the drug n e e d s o f t h e suicide. We, as a DHMC is cut with fentanyl.” community with community, need Senior director of state chapters respect to opioid to wrap our arms at APF Doug Griffin echoed many use. around families and say, ‘What of Clapp’s sentiments, and he added Advanced practice addiction happened to you? What do you that much of the fentanyl coming in nurse at DHMC Daisy Goodman need? How can we help to develop from China is available for purchase runs a program that helps pregnant the services that are needed right online and is delivered through U.S. mother s deal with addiction here in the Upper Valley for our Mail. Additionally, Griffin stated t h ro u g h o u t t h e i r p re g n a n c y. families?’”
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Dartmouth’s Response to the Opioid Epidemic STORY
By Caris White
ZOE CHEN/THE DARTMOUTH
Dartmouth is a bastion of wealth, privilege and education, but towns only minutes away are being ravaged by job instability, poverty and addiction. It’s all too easy for students to enjoy the natural beauty of our surroundings and ignore the rest because these problems feel far away from our climate-controlled classrooms. However, Dartmouth and the surrounding communities aren’t immune to epidemics like the opioid crisis sweeping across rural America. 68,557 people died from drug overdoses in the U.S. in 2018. Opioid addiction in particular is responsible for a large portion of these deaths, and it is especially prevalent in New
Hampshire, which is one of the top five states with the highest rate of opioid-involved deaths. The rate of overdose deaths involving opioids in New Hampshire is more than twice the national average rate. A small, but determined, group of students and professors have responded to the opioid crisis by conducting community outreach. Women, gender and sexuality studies professors Pati Hernández and Ivy Schweitzer coteach WGSS 66.05, “Telling Stories for Social Change,” in which students split time between hands-on interaction with people impacted by opioid use disorder and class time discussing the
root causes of these crises. “Pati’s program is really a program for working with people who are behind what we call ‘invisible walls,’” Schweitzer said. “When you’re in the Upper Valley, what we learned is that [the invisible wall] tends to be alcohol or drug use, and in 2013, it became clear that it was opioids.” Students have been receptive to this program, although it requires both an academic and an emotional time commitment, according to Emily Bjorkman ’21, who took Hernandez and Schweitzer’s class this past fall. Bjorkman said that she chose to take the class because it integrated social
justice with storytelling. There are substantial layers of privilege and life experience separating students from these community members, and Dartmouth students are often unprepared for the magnitude of the crisises their neighbors are facing, according to Schweitzer. “Dartmouth students tend to come at it from a privileged perspective of, there’s drug use at Dartmouth, and there’s drug use in their friend groups,” Schweitzer said. “But because there’s money, there’s affluence, there’s networks, there’s healthcare, and they start out with good health in the first place, it doesn’t rise to the level of
an issue. The people in White River Junction don’t have affluence, don’t have networks and don’t have health care — they’re starting with all these strikes against them.” From 2007 to 2019, the class worked with women at Valley Vista Rehabilitation Center, but this past fall, Dartmouth students worked with students at Ledyard High School, many of whose parents have been affected by opioid addiction, according to Schweitzer. Although the age difference was smaller, the communication gap widened, acccording to Bjorkman. “At the other programs, people
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The Geisel School of Medicine and Dartmouth-Hitchcock Medical Center are actively woking to combat the opioid crisis in the Upper Valley.
were only working because they really wanted to,” Bjorkman said. “With the students, it felt like sometimes they were doing it because they had nothing better to do. When you’re already dealing with all of the normal high school stuff, it’s hard to share about traumatic family backgrounds.” Schweitzer said that many of the Ledyard students had been expelled from other schools and were considered "difficult to teach." Although they weren’t always open about how the opioid epidemic had directly impacted their lives, Bjorkman found that putting their actions in context made a huge difference. “Seeing what else was factoring into their lives made it much easier to understand why these things happen, why these students lash out at the adult figures in their lives,” Bjorkman said. In addition to community outreach through classes, Dartmouth has allocated resources to conduct research on the opioid crisis. The Dartmouth Center for Technology and Behavioral Health, which is supported by the NIH,
and uses federal funds to research cutting-edge treatments for opioid use disorder, according to CTBH director Lisa Marsch. Marsch said that Geisel has piloted several new programs, forming partnerships with the New Hampshire state prison system, emergency rooms and even the Manchester Fire Department to give residents better access to treatment. Right now the CTBH is beginning a study on telecare, where 100 percent of medical care is remote, allowing providers to reach rural residents wherever they might be. Marsch said that access to resources like these is really important not just in New Hampshire, but in all of rural America. “We’ve been able to bring in federal resources to do research,” Marsch said. “We’ve worked so hard to not be perceived as this out-of-touch Ivy League school because we want to be in touch with the needs of the community. I have been so struck and excited by how engaged our clinical partners have been. Everyone is really ready and willing to be part of these solutions.”
COURTESY OF DARTMOUTH-HITCHCOK MEDICAL CENTER
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Q&A with Global Health Initiative Director Sosin STORY
By George Gerber
Anne Sosin ’02 is the director of the Global Health Initiative Program at the Dickey Center for International Understanding at Dartmouth. She has experience leading global health and international development partnerships on both the local and international levels. The Dartmouth sat down with Sosin to learn more about the novel coronavirus, or COVID-19, and the impacts the virus may have on people in the United States. W h a t a b o u t c o ro n a v i r u s concerns you the most? AS: I’m most concerned about how this epidemic will affect vulnerable populations, both in our country as well in low- and middle-income countries. We know there are significant questions of equity that arise in the conditions that influence disease as well as in the ability of systems and other settings to respond to them. We know that this disease is going to strain the capacity of health systems in this country, and we are currently worried about the capacity of our health system to respond to a high volume of severe cases of COVID-19. Such concerns are going to be heightened in countries with much weaker health systems. Also, the epidemic is expanding rapidly. The mortality rate is estimated at two percent right now,
but that number may change as more data becomes available. We also don’t know what will happen when the epidemic expands to settings with weaker health systems. I’m currently looking at a study from 12 sub-Saharan African countries that shows that only about 43 percent of these areas had uninterrupted access to oxygen, and many countries have a very limited supply of respirators. We can expect the mortality rate to be much higher in resource-constrained settings lacking the ability to provide supportive care to critically ill patients. What factors contributed to the spread of coronavirus? AS: Several factors can contribute to the emergence and spread of disease, including travel, migration, communication, commerce and any contact across the globe. The other thing we are seeing is that climate change is also contributing to the emergence and spread of novel infectious diseases, including Ebola and the coronavirus. What should governments do to protect citizens in the face of outbreaks like the novel coronavirus? AS: I would say the first thing governments should do is to prepare for epidemics. We’ve known for a
very long time that we would face a global pandemic, so the first step in response is preparedness. There are many steps governments can take first to contain infectious diseases, such as investing in public health infrastructure. However, when it’s not possible to contain them, governments must then turn to mitigate their impacts. What are common procedures that are put into place for controlling diseases in areas where there is increased human contact, such as college campuses? AS: Public health officials, as well as institutions, will likely institute social-distancing measures, and those measures might include quarantines. They also might consist of other measures to restrict mass gatherings, public events and other activities that bring large numbers of people together. As this epidemic unfolds, we may see some of these restrictions placed on a wide range of activities. What do you think is going to happen in the future, in light of similar outbreaks like the bird flu or Ebola? AS: I think policy measures really determine how the epidemic plays out. When the right policy measures are taken, it’s sometimes possible to contain and mitigate the impacts of epidemics, so we need our best minds and the best policies to respond to this epidemic. Good policy measures may include the imposition of quarantines. One thing that is especially important in epidemics is contact-tracing for all persons who are identified to have the disease. Another thing that I really want to emphasize is that good public health does not necessarily mean that human rights or civil rights need to be compromised. Sometimes, when human rights are violated in response to an epidemic, it drives people underground and can really impede disease control measures. One thing I do want to comment
COURTESY OF ANNE SOSIN
on a little bit more is that diseases or epidemics have what Dr. Paul Farmer calls a preferential option for the poor. We can expect the most vulnerable populations here in the U.S. and globally to be most affected by this epidemic. So, as we think about it on this campus and in this country, we should be mindful of how this will play out and what populations will bear the burden of it. What is the public perception
of coronavirus, and are people taking the matter too seriously or lightly? AS: I think there is a great deal of fear, in part because we are still learning about this disease. Coronavirus has an estimated two percent mortality rate, and that has the potential to cause significant death and illness at population level, so we need to be taking it seriously. This interview has been edited and condensed for clarity and length.
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TTLG: UnironicTakeontheIronyofBeingaTourGuide TTLG
By Rafael Rosas
T he insanity of writing a shortsighted and trivial. More than response to imposter syndrome reflection piece about being a tour that, though, it is that the position’s instead of a passion, and my guide is not lost on me. I truthfully purpose is to represent Dartmouth GPA and academic curiosity have cannot believe that, of all things to visitors from all over the world. suffered the consequences. The eligible for reflection and thought, I singlehandedly have encouraged closest I get to regularly speaking being a tour guide is what I chose. thousands of people to apply and, if my native language is when I am Maybe it is because being a tour admitted, to attend, this institution, teaching it as a drill instructor. I guide trainer the past two years knowing full-well what it has done had to miss both my older brother’s has dominated so much of my time to me. graduation from college and the that a part of my brain has been I have rarely felt as nervous, or birth of my niece because of the conditioned as guilty, as when pace of the quarter system and to think about reaching out to this administration’s bulls—t “I have rarely felt as guide-related q u e e r p e o p l e commitment to academic rigor. t h i n g s a t a l l nervous, or as guilty, of color to Quite truthfully, if I could go times. Or maybe as when reaching apply to be tour back in time, knowing what I know it’s because, as guides. I know today, I do not know what I would a s e n i o r, i t ’s out to queer people how drastically say to myself. I now know that time for me to of color to be tour d i f f e r e n t t h e on the surface, Dartmouth was admit that being D a r t m o u t h not the right school for me. But guides. I know how a tour guide e x p e r i e n c e i s because of that, being here forced has become an drastically different the for those folks me to grow and learn in ways that integral part of Dartmouth experience t h a n f o r t h e I could have at few, if any, other my Dartmouth “stereotypical” institutions. Now, at the end of my is for those folks than identity. D a r t m o u t h Dartmouth experience, I think this T h e t o u r for the ‘stereotypical’ s t u d e n t . T h e forced growth did make Dartmouth guide position types of visitors the right choice for me. Ultimately, Dartmouth student.” is professional who have the I still think Dartmouth has made and paid, but s o c i a l a n d me the very best version of myself. those two things alone could financial capital to visit an elite This school taught me to embrace never justify the amount of time school in rural New Hampshire change and to be proud of the and energy I have committed to with a single-digit acceptance rate growing pains caused by failure. I the program. Dartmouth is many are usually not the ones that I, as a learned to prioritize and to do so things, but it is nothing if not fast- gay brown NARP, can experientially unapologetically when necessary. I paced. The D-Plan taught me very relate to, and I don’t ever feel have become a better thinker and early on that time is the limiting conf licted about encouraging a more nuanced criticizer, but a resource in every aspect of life. In them to apply. They will likely love far-less skilled writer, as I now think an atmosphere where I feel guilty Dartmouth. It’s with those who are exclusively in equations. for doing a normal human thing more like me where my conflict lies. Dartmouth has also taught me like grabbing a meal with a friend This school to rely on others. instead of getting Collis pasta to-go has done things This school has to have a working dinner in Thayer, to my physical “This school taught some really there is simply no way I would have a n d m e n t a l me to embrace change sh—y people, invested as much time, energy and h e a l t h t h a t but it also has the effort into any group, position or high-school me and to be proud of the most incredible program if I did not truly enjoy what would never in growing pains caused people I have ever I do within it and feel rewarded by a million years anywhere in by failure. I learned to met it. h ave t h o u g h t the world, and Yet when I am around particular p o s s i bl e. T h e prioritize and to do so I d o n’t t h i n k subsets of the Dartmouth student r i g i d i t y o f unapologetically when I appreciate body, I feel ashamed about my f i n a n c i a l a i d enough that I involvement with the program, policy here has necessary.” am honest when and with the admissions office in caused me to I say my best general. To a certain degree this is take out nearly friends are my because being as passionate about $100,000 in loans (if that is not greatest inspirations. something as inconsequential as “demonstrated need,” I really don’t Reconciling these contradicting being a tour guide seems rather know what is). I chose a major in realities lies at the heart of why
COURTESY OF RAFAEL ROSAS
I would struggle to explain to 18-year-old me why choosing to come here, if I could do it again, would fundamentally be the right decision. Writing this is the first time I am putting words to the truth that being a tour guide gave me the tools necessary to arrive at this conclusion. Every time I have given a tour, I have actively been given the physical and mental space to reflect on this, both for myself on a personal level but also when trying to determine how best to honestly communicate these realities to visitors. At the end of the day, I am thankful for the FaceTime-y,
on-the-surface superficial job because it was my mechanism for reflection, contextualization and internalization during my brightest and darkest moments at Dartmouth. By better understanding how to communicate to visitors the realities of life here, I have come to better understand them myself. As a senior, I feel I am now more prepared than ever to explain to those whose experiences align more with mine what they should expect, and why it is worth it to be here in spite of that. Tour- guiding provided me with the infrastructure to optimize the intangible lessons and learnings of my Dartmouth experience.
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An Iron Fist PHOTO
By Naina Bhalla