Her Excellency Ambassador Liberata Mulamula of the Embassy of the United Republic of Tanzania made her inaugural visit to Charleston, SC and the Medical University of South Carolina (MUSC) on Thursday, February 5, 2015 where she took part in activities to highlight MUSC’s extensive involvement in the African Great Lakes region.
Ambassador Mulamula was accompanied by Tanzanian Economic Affairs Plenipotentiary, Paul Mwafongo in Charleston for a day’s worth of celebration to hallmark MUSC’s growing partnerships with institutions in Tanzania.
The MUSC Center for Global Health hosted a luncheon to celebrate MUSC’s long history with Tanzania and to share details about a developing multi-institutional collaboration between MUSC and Clemson University in the U.S. and Muhimbili University of Health and Allied Sciences and Arusha Technical College in Tanzania to develop appropriate health technologies.
Mark Sothmann, PhD, Vice President of Academic Affairs and Provost at MUSC, opened the luncheon by mentioning that the MUSC Center for Global Health was the product of the institution’s strategic plan to broaden MUSC’s involvement in programs abroad noting that “Tanzania has been the linchpin of that initiative.”
Kathleen Ellis, Director of Operations of the Center for Global Health, provided an overview of MUSC’s multiple partnerships with colleagues in Tanzania over the last two decades to develop and implement research and clinical programs to address HIV prevention and care, and scaling up the prevention and treatment of non-communicable diseases such as heart disease, chronic kidney disease, hypertension and diabetes.
An important contribution in advancing health care in Tanzania is the work Clemson University has been conducting with Arusha Technical College to address the serious challenges in identifying and diagnosing health issues due to lack of available technology in rural settings. This collaboration has focused on the recognition that low-resource settings require the innovation of low-cost, appropriate technologies that can withstand the often-difficult environmental conditions while remaining effective and culturally acceptable.
To better consolidate the mutual strengths and existing partnerships —the clinical expertise between MUSC and Muhimbili University, the bioengineering expertise between Clemson and Arusha Technical College, MUSC strong faculty ties to Tanzania and growing student interest—MUSC and Clemson held a retreat in Tanzania last fall with Muhimbili University and Arusha Techinical College to form an innovative consortium to develop appropriate health technologies.
The goals of this long term multi-institutional collaboration are to generate high-impact research, develop and test novel and appropriate health technologies, provide bi-lateral training opportunities, strengthen capacity-building and the local manufacturing and distribution of health technologies.
“Our vision is to have clinicians and engineers working together with public and private partners to develop solutions they can test in the field,” explained Ellis. “The way to these solutions is through high impact research which will allow us to expand bilateral training and service opportunities."
Ellis said the Ambassador’s visit to MUSC was symbolic of the growing need for cross-institutional collaboration, not just in the U.S., but across the world where appropriate technology is in increasing demand.
John DesJardins, PhD, Associate Professor in the Department of Bioengineering at Clemson University showcased the appropriate technologies—some with funding through a private and public partnership from investors—being developed by some of his students working with collaborators from Arusha Technical College.
“Some infants expire if they are not provided with oxygen 24 hours a day,” said DesJardins.
There is no question that adaptable technologies are needed in remote and low- and middle-income countries when childhood death comes by way of a treatable respiratory condition.
DesJardins continued, “we are working on an infant respirator system simply because they are expensive here: $40,000 to $50,000. We can make a system for $5, really.”
Clemson’s bioengineering team is also developing a printable glucose strip to test hemoglobin A1c. The test, Glucosense, is aimed at helping diabetics in developing countries and other resource-poor settings do the daily testing that can help them prevent potentially fatal complications. Glucosense is unique in that it can be printed for about a penny using an inkjet printer to infuse paper with enzymes rather than ink. This technology will be applied in rural areas in Tanzania resulting in data that was previously nonexistent. This data will be used to inform new interventions that will comprise HIV/AIDS and non-communicable disease screenings.
The overall consortium of U.S. and Tanzanian institutions was initially born by a growing need to better coordinate preventive health screenings with HIV/AIDS screenings. Michael Sweat, PhD, Director of MUSC Center for Global Health, has dedicated his career to rooting out HIV/AIDS stigma through community-based participatory research in Tanzania. His 20-year partnership with Muhimbili University and communities in the region buttressed the emerging multi-institutional collaboration with partners in the U.S. and in Tanzania.
Sweat has actively been involved in community-based participatory research projects in Tanzania addressing barriers to HIV/AIDS screenings. He has collaborated with health professionals at Muhimbili University and the Tanzanian government on a number of programs to increase HIV/AIDS screening uptake. The consortium being developed is mutually beneficial for both South Carolina and Tanzania. What is learned from intervening in one country is largely applicable to the other and Sweat acknowledges this fact.
“The research we conducted during the past decade in rural Tanzania has taught us a lot about to how to best approach HIV prevention in the U.S. The problem of reaching rural populations with care and prevention are virtually the same in Tanzania as they are in South Carolina,” Sweat said. “We used novel strategies to provide mobile care, and we can now translate them to U.S. settings.”
Conditions rarely seen in the western world keep researchers like DesJardin and Sweat busy, but an often overlooked public health threat has emerged in low- and middle income countries where infectious disease once held primacy: non-communicable diseases (NCDs).
In this together
Seven out of 10 leading causes of death in the U.S. are due to non-communicable diseases including, heart disease, stroke, diabetes, cancer and obesity. According to the Centers for Disease Control and Prevention (CDC), more than 75 percent of all deaths worldwide are due to non-communicable diseases, exceeding infectious disease deaths. If current trends continue, non-communicable diseases could cause a cumulative loss of output totaling $47 trillion between 2011 and 2030. Heart disease—the number one cause of death globally—cancer, chronic respiratory disease and diabetes are to blame for about 80 percent of global mortality. Most of these illnesses are preventable with the appropriate interventions and treatment.
Two veteran cardiologists from MUSC Heart and Vascular Center knew these trends were unsustainable not just in the U.S., but around the world. Peter Zwerner, MD, Vice Chair of Clinical Affairs and Associate Professor of Medicine and Eric Powers, MD, Director of the Acute Coronary Syndrome Center and Professor of Medicine developed an advanced training program at a cardiac care facility in Muhimbili National Hospital in Dar es Salaam, Tanzania. What is notable about the facility is that it is the first advanced cardiac and catheterization center in a country of 50 million inhabitants.
Non-communicable diseases can increase the likelihood of developing other morbidities, like heart disease and stroke. Chief among these NCDs is diabetes. Fifty percent of people with diabetes die of cardiovascular related conditions globally. Diabetes damages the heart, blood vessels, eyes, kidneys and nerves in patients who cannot afford exacerbation of existing health conditions.
Caroline West, third year medical student at MUSC, worked with Sweat and David Ploth, MD, Professor of Medicine in the Division of Nephrology at MUSC, on a study to determine the prevalence rate of diabetes, hypertension, and chronic kidney disease in Kisarawe District, Tanzania, a rural district just west of Dar es Salaam.
“We [were] keenly interested in the uptake of referrals for chronic diseases to the local health clinics, the demographics of those affected, as well as the comorbidities with HIV/AIDS infection,” West said.
Ploth’s project was seed funded by an MUSC Center for Global Health Faculty Pilot grant and was adjunct to Sweat’s overall project in the region. Prior to West and Ploth’s work in the region, little was known about the prevalence of chronic kidney disease and its impact on the health of Tanzanians in rural communities. Results will now inform the local community of best practices to reduce the overall disease burden in Kisarawe District, while expanding the growing body of literature on hypertension, diabetes and chronic kidney disease.
Prevention is arguably the most important component of healthcare and medicine. It has been recently mandated that health insurance plans cover vital preventive services in the U.S. The oft cited quote, “an ounce of prevention is worth a pound of care”, is resonant in that if patients are provided early treatment for non-communicable and communicable diseases, they are likely to live full, healthier lives. However, this accounts less for catastrophic events: motor vehicle crashes, occupational injuries and other spontaneous adverse health events. Prevention can be applied across borders, only less so in the more remote areas of the world.
Scott Reeves, MD, MBA, Chair of the Department of Anesthesia and Perioperative Medicine and Professor in the College of Medicine, knows full well the importance of prevention in low- and middle-income countries. Reeves developed an Accreditation Council for Graduate Medical Education (ACGME) anesthesiology residency rotation at Bugando Medical Center in Mwanza, near the shoreline of Lake Victoria to provide extensive learning and teaching opportunities for his residents, Tanzanian trainees and, even, patients at Bugando. He engineered the program so that it has “top talent, the trainees have the best medical apprenticeships available, and preventable deaths are hampered in a country where mortality is the norm.”
MUSC’s presence in Tanzania is expansive and continually growing through research and clinical partnerships with collaborators that have raised the health profile in the region. Rapport among government and healthcare professionals has been crucial in the huge strides MUSC has made across Tanzania. Testament to this fact are the relationships researchers and clinicians have established and maintained with top officials in the country including Tanzanian President Jakaya Kikwete, Ambassador Liberata Mulamula, Plenipotentiary Paul Mwafongo, and countless healthcare professionals.
Global health starts here
The political and financial capital expended on initiatives both in Tanzania and in the U.S., specifically in South Carolina, has yielded marked returns for all stakeholders involved.
South Carolina Representative Gilda Cobb-Hunter presented Ambassador Mulamula with a resolution from the South Carolina General Assembly to honor her visit to the State, but not before sharing her thoughts on ongoing projects and an increasing collaborative spirit among state institutions.
Other distinguished members of the South Carolina General Assembly in attendance at the luncheon were Representative Harold Mitchell, Jr. and the Executive Director of the South Carolina Black Caucus, Juanzena Johnson. The gravity of the visit and occasion championing MUSC’s involvement abroad was not lost on those in attendance. According to Rep. Cobb-Hunter, it was edifying to see institutions in South Carolina conducting research in Africa to inform medical practice and interventions in rural areas around the U.S.
“I want to say to Dr. David Cole and all of the staff here how enlightening this luncheon has been for me,” Rep. Cobb-Hunter began. “I came here expecting to be graced with the presence of the Ambassador and the Economic Affairs Plenipotentiary. Little did I know that I would learn, as a member of the higher-education subcommittee, that two major institutions, MUSC and Clemson University, have partnered in a way to make a difference in Tanzania. It is just impressive.”
MUSC President David Cole, MD presented Ambassador Mulamula with a Letter of Proclamation read on behalf of Charleston Mayor Joseph Riley and the City of Charleston, once again, welcoming the delegation to the area. President Cole took this opportunity to share the importance of MUSC’s involvement in projects in Tanzania and reemphasized the university’s growing commitment to global health.
“Seeing this sort of work having an impact is far more important than just talking about it—it is really a privilege to share this with colleagues,” stated Cole. “It’s meaningful work and very significant in terms of the far reaching impact it has.”
Receiving the Ambassador provided an opportunity for MUSC researchers and clinicians to tangibly have their efforts realized, not just through outcomes but an acknowledgement from a high-ranking official who has witnessed the impact of public health and medical interventions in her own life and country.
“I lost my mother to diabetes, which was not diagnosed,” Ambassador Mulamula said. “When she began losing her eyesight she saw the doctor, but they never knew she was diabetic. Then I was referred to an American doctor from Minnesota and was told that this American doctor is the only one who could save my mother. We drove 800 miles to see this doctor. The doctor diagnosed my mother and said it is very advanced, but I will try my best. She tried her best; my mother lived a few months longer. Since then, I’ve always wanted to associate myself with people who could save people like my mother—the signs seen today give me hope.”
Ambassador Mulamula was nearly moved to tears by the reception she received at MUSC and the work continually being done to enhance the lives of Americans and Tanzanians alike. MUSC successfully demonstrated its commitment to working in Tanzania across all disciplines. This commitment serves the needs mirrored in South Carolina and rural Africa.
“You don’t know what this means for Tanzanians,” remarked Ambassador Mulamula. “All of these interventions are saving many lives.”