Front entrance to Weill Bugando University College of Health Sciences in Mwanza, Tanzania.

MISSION
The mission of Weill Cornell Medical College (Weill Cornell) in Mwanza, Tanzania is to strengthen medical education at the Weill Bugando University College of Health Sciences (Weill Bugando) and at Bugando Medical Centre (BMC). Weill Cornell is committed to excellence in training to improve and expand Tanzania’s core of health-care providers. Weill Bugando is affiliated with Bugando Medical Centre, a 900-bed referral hospital dedicated to providing compassionate and equitable patient care to alleviate suffering in the Mwanza region. The partnership between Weill Cornell and Weill Bugando is of mutual benefit for both institutions; by training the next generation of Tanzanian physicians and by expanding the awareness and skills of Weill Cornell faculty, residents, and students as they work in a resource poor setting.

TANZANIA
Tanzania is located on the eastern coast of sub-Saharan Africa, with a population of approximately 38 million people (Fig. 1). Weill Bugando is located within the Bugando Medical Centre in Mwanza. Mwanza, the second largest city in Tanzania, is located on the shores of Lake Victoria and is the capital of the Lake and Western regions (Fig. 2).

Figure 1. MAP OF AFRICA
Tanzania is located on the eastern coast of Africa.

Figure 2. MAP OF TANZANIA
Mwanza is located on the shores of
Lake Victoria

"Tanganyika" was a German colony from the late 19th century until 1919, and then became a British mandate after World War I. Tanganyika became independent under the leadership of Prime Minister Julius Nyerere in 1961. In 1964, Tanganyika and the neighboring archipelago, Zanzibar, were united and officially renamed “Tanzania.”

Figure 3. WORLD MAP SCALED BY NUMBER OF PHYSICIANS WORKING AND POPULATION (Lancet, 2004)

Tanzania has 1 physician per 50,000 patients, the lowest ratio of physicians to patients in the world. Figure 3 shows a map of the world scaled to the ratio of physicians to the population of each country. This is compared to one physician per 390 patients in the United States. Sub-Saharan Africa carries 25 percent of the world's burden of disease, yet is home to only 2 percent of the world's health-care force. Of the nearly 40 million people living in Tanzania, approximately 34 million will never see a doctor in their lifetime. This lack of human health resources contributes to Tanzania's major health and development inequities (Table 1) and motivates Weill Cornell in its mission to deliver the best education possible to future Tanzanian physicians.

Table 1. TANZANIA: KEY HEALTH AND DEVELOPMENT INDICATORS. Adapted from the WHO Global Health Atlas (2002-2007).

HISTORY

Bugando Medical Centre serves as the tertiary referral hospital for the people of the Lake and Western regions of Tanzania (population, 13 million). BMC was built by the Catholic Church and was officially opened in December 1971. The hospital was nationalized and administered by the Tanzanian government from 1971 to 1985. Control returned to the Tanzania Episcopal Conference of the Catholic Bishops of Tanzania in 1985. Since its inception, BMC local doctors and staff have shown an unwavering commitment to their patients. For example Bugando Medical Centre was kept open despite the difficult conditions during the Ugandan-Tanzanian War from 1978 to 1979.
At present, Bugando Medical Centre is an 900-bed referral and teaching hospital employing approximately 950 people, serving approximately one-third of the country's total population of about 40 million. The hospital is led by General Director Dr. Charles Majinge. There are 18 clinical departments and six administrative departments (Figure 4).

Inauguration of Weill Bugando in Mwanza, Tanzania, February 2007.

The aspiration to build a medical college in Western Tanzania was put forth during the plenary Assembly of the Tanzania Episcopal Conference (TEC) in July 1994. After years of hard work, the Bugando University College of Health Sciences opened in September 2003. BUCHS was renamed in honor of benefactors Joan and Sandford Weill in February, 2007, becoming Weill Bugando University College of Health Sciences. The college, under the leadership of the Principal, Professor J.P. Mtabaji, offers an MD training programme, Masters in Medicine, and diplomas in the Allied Health Sciences (e.g., nursing, laboratory technician, radiology). The Tanzanian educational system is modeled after that of the British. Medical education is preceded by 14 years of primary, secondary, and high school. The medical education consists of a five year program. This is followed by a one-year rotating internship in medicine, pediatrics, surgery, and obstetrics and gynecology. Physicians may receive three years of additional specialized training (in anesthesiology, medicine, surgery, obstetrics and gynecology, and pediatrics) by pursuing a Masters of Medicine. This is equivalent to residency training in the Untied States.

Figure 4. Structure of Weill Bugando and Bugando Medical Centre.

There are 12 academic departments at Weill Bugando and approximately 50 full-time faculty members. The Institute of Allied Health Sciences offers diploma courses in 6 paramedical schools (Figure 4) . There are approximately 800 students enrolled in the MD, post-graduate and paramedical programs.

The relationship between Weill Cornell and Weill Bugando began over 20 years ago. Father Peter Le Jacq, M.D., an alumnus of Weill Cornell and also a Maryknoll priest, was an early force in the founding of the medical school.

Fater Peter Le Jacq

Dr. Le Jacq worked as a physician and a priest at Bugando Medical Centre between 1987 and 1997, providing medical care and pastoral services. He also developed a home care program for HIV patients and their families. As the medical school was being developed, he assisted with curricular development and helped to form important partnerships with institutions in the United States. The Weill Cornell Medical College and New York Presbyterian Hospital (NYPH) established their formal affiliation with Weill Bugando in 2006. A Weill Cornell faculty committee directed by Dr. Warren Johnson (Table 2), coordinates educational exchanges between multiple Weill Cornell and Weill Bugando departments. These exchanges are supported by Weill Cornell Dean Antonio Gotto, The Touch Foundation, the Pfizer Foundation, and private donors.

Table 2. WCMC Faculty Committee

Weill Cornell in TANZANIA

Two full-time Weill Cornell faculty members, Dr. Robert Peck and Dr. Beatrice Im, are based at Weill Bugando to coordinate teaching and training of Bugando and Weill Cornell students, interns, and residents.

Dr. Rob Peck teaching Tanzanian residents at Weill Bugando.

Dr. Rob Peck moved to Mwanza in 2007 to assist with the development of the clinical training programs for medical students and residents in the Departments of Internal Medicine and Pediatrics. Dr. Peck also coordinates the exchange of students, residents and faculty between Weill Cornell and Weill Bugando. As a medical student at Vanderbilt University, Dr. Peck worked with several Cornell faculty members in Haiti on a series of research projects related to HIV and anthrax. During this time he developed a profound appreciation for the mutual benefit of collaborative relationships between academic institutions in improving medical care and education as well as completing important research. Dr. Peck lives in Mwanza with his wife, a family nurse practioner, and their two young children.

Dr. Beatrice Im, Assistant Professor of Medicine,
Weill Cornell Medical College

Dr. Beatrice Im has been working with students, residents, and interns in the Obstetrics and Gynecology department at Weill Bugando since 2007. Dr. Im has played an important role in the mission to treat obstetric fistulae, a debilitating condition that causes urinary and fecal incontinence in women. Dr. Im's past experiences on a fistula repair team at the National Hospital in Niamey, Niger helped her develop the tools and interest to help improve health in resource-poor settings. Dr. Im is committed to reducing the high rates of maternal mortality in Tanzania (currently the 14 ^th highest rate in the world).

Dr. Peck and Dr. Im are leading the educational exchange between Weill Bugando and Weill Cornell. The goal of this exchange is to match Weill Cornell departments with Weill Bugando/BMC departments. Clinical residents from NYPH/Weill Cornell provide hands-on training on the wards for the Weill Bugando medical students, interns, and residents; senior faculty from both institutions work together on curriculum development. In 2008, approximately 30 NYPH/Weill Cornell clinical residents visited Bugando to teach on the wards and conduct tutorials in internal medicine, pediatrics, obstetrics and gynecology, ophthalmology, psychiatry, and surgery.

Weill Cornell students and residents, and Cornell University undergraduates at Weill Bugando in 2008. L-R: Kelvin Lee, MD (NYPH/Weill Cornell Resident in Pediatrics), Heather Player (Weill Cornell ‘11), Sarah Freeman (Weill Cornell‘11), Leeanne Stratton (Weill Cornell‘11), Ginger Golub (Cornell University ‘09), David James, MD - (NYPH/Weill Cornell Resident in Internal Medicine), Matthew Simon, MD (NYPH/Weill Cornell Resident in Internal Medicine), Monica Prieto (Weill Cornell‘11), Erin Byrt (Cornell University ‘09), Erica Miller (Weill Cornell’11)

DR. MATTHEW SIMON, RESIDENT IN MEDICINE, NYPH/WEIL CORNELL

Matt Simon, who completed his residency at Weill Cornell in 2009, spent 6 weeks at Weill Bugando during the summer of 2008 teaching residents and medical students, conducting research, and learning from senior physicians. Matt “…felt that the purpose of the trip was not to merely observe or be a tourist, but to have an actual role in teaching and sharing my medical knowledge and skills with Tanzanian residents and medical students.”

Matt reflects, “I was surprised by how limited the access is to basic hospital treatments that we take for granted in the US such as IV fluids, oxygen, ventilators, [or] dialysis. This was particularly challenging when patients became very sick… it was an unfamiliar feeling for me to be forced to make treatment decisions without knowing laboratory results or being able to look at imaging studies like CT scans or MRIs.”

Weill Cornell resident Matt Simon (center) with Tanzanian residents Andrew Luhanga (left) and Bahati Wajanga (right) in Mwanza, Tanzania.

In addition to learning from Tanzanian physicians, Matt contributed significantly to the education of Tanzanian students and residents. One of the biggest challenges Matt encountered while teaching was the tension between what students knew and the resources they had—he explains, “…the students often have knowledge of sophisticated and expensive tests and treatments that are not available at their institution. There is a tension between teaching students about the possibilities of modern medicine and what is locally practical.” In spite of this, the students were eager to learn. Matt recalls, “One day there was a power outage and a lecture was canceled because it wasn't possible to project the slides. For US medical students, I think this would be cause for celebration. At Bugando, the students were disappointed and wanted to re-schedule as soon as possible.”
Matt was recently awarded the prestigious David E. Rogers Memorial Research Award at Weill Cornell for a significant research project on cryptococcal meningitis that he conducted while in Mwanza. He studied the impact of a serum antigen test for diagnosing cryptococcal meningitis at Bugando Medical Centre. Matt found that cryptococcal meningitis was both common and lethal at Bugando. About 40 percent of meningitis cases were due to cryptococcus and the in-hospital mortality rate was 45 percent. “Our results showed that the serum antigen test was incredibly valuable. ” Based on these findings, Matt and a Tanzanian resident, Bahati Wajanga, developed a new protocol for the management of meningitis at BMC. Matt was assisted by Weill Cornell medical student Leanne Stratton and Cornell University undergraduate, Ginger Golub, in data collection and analysis.

Matt will begin an Infectious Disease Fellowship at NYPH/Weill Cornell in 2010. “I would encourage every resident to work at Bugando if they can. The experience helped me to appreciate the resources available in the US more than I previously had. More importantly, I think the opportunity to learn from Tanzanian physicians was extremely valuable for me."

Dr. Rodrick Kabangilla is a Tanzanian 3rd year resident at Weill Bugando. He trained under Dr. Peck and is planning to graduate and join the faculty of Bugando Medical Centre and Weill Bugando in 2009. On faculty, Dr. Kabangilla's responsibilities will include care of patients on the BMC wards as well as the teaching and training of future WBUCHS residents and students. His particular areas of interest include HIV and infectious diseases.

His resident thesis project entitled, "Opportunistic Infection Occurring in the First 3 Months after Initiation of ARVs," received high marks and Dr. Kabangilla hopes to pursue further clinical and operational research as a faculty member. Similar to all of the other senior Weill Bugando residents, Dr. Kabangilla has already visited Weill Cornell for 6 weeks of clinical rotations. Rodrick hopes to return to Weill Cornell for a Masters Degree in Clinical Epidemiology as well as further training in HIV and Infectious Diseases.

Weill Bugando and Weill Cornell residents at Bugando Medical Centre, Summer 2008: Back, L-R: Matt Simon (Weill Cornell), Bahati Wajanga (Weill Bugando), Roderick Kabangilla (Weill Bugando), David James (Weill Cornell), Ed Schenck (Weill Cornell); Front L-R: Hyasinta Jaka (Weill Bugando), Andrew Luhanga (Weill Cornell)

Cornell University student Erin Byrt ('09) (left) and Weill Cornell student Erica Miller ('11) (right) at Bugando Medical Centre, 2008.

I had the opportunity to study at Weill Bugando University College of Health Sciences and Bugando Medical Centre in Mwanza, Tanzania during the summer between my first and second years of medical school. I spent most of my time in the hospital's Department of Internal Medicine. We were welcomed to join the teams of Bugando residents, interns, and assistant medical officers (AMOs) at morning conferences and on the hospital wards for rounds. We participated in discussions about patient cases and were invited to ask and answer questions. We worked with patients suffering from diverse diseases, some common in the United States like hypertension and others practically unheard of at home like Schistosomiasis. It was exciting to problem-solve as a part of the housestaff team and exhilarating to learn about medicine through our patients rather than from our textbooks.

As a visiting medical student, I also worked with members of the faculty on quality improvement projects designed to evaluate the burden of diseases in the Bugando patient population and target future interventions. Using the records of the Histopathology Department, I compiled information about the frequency of different types of cancer diagnoses.

Erin Byrt, a Cornell University undergraduate, and I compared current results with data from seven years ago, and will use our data to communicate to members of the Bugando community which types of cancer are being diagnosed most frequently and which cancers are rare, possibly indicating a need for improved diagnostics or targeted interventions.

The Weill Cornell medical students also eagerly participated in Bugando student life. We shared meals with Tanzanian students in the medical student cafeteria, attended lectures and small group sessions, lived in the student dormitory on campus, and enjoyed the sights of Mwanza with residents as our guides. It was exciting to see what medical school is like in Tanzania and wonderful to connect with our peers studying in a different country. The students are friendly, welcoming, and as eager to learn about us and the United States as we are to learn about their lives and their country. The summer went by very quickly, and as the students at Bugando frequently asked me, I find myself wondering when I will be able to return to Mwanza. Whenever that may be, I am grateful now to have the lasting friendships, memories, and experiences from my wonderful summer in Tanzania.

- by Erica Miller