A 24-year partnership transforms health care in Tanzania
By Susan Kelley Noël Heaney
This is Part 1 of a five-part multimedia feature, Dispatches from Mwanza, detailing Weill Cornell Medicine’s partnership with Weill Bugando School of Medicine. The partnership improves health care in Tanzania, the U.S. and around the world.
The emergency room had a bed, a desk and a chair – and no ER doctor to serve it. Entire wards were filled with hundreds of children suffering from Burkitt lymphoma, a childhood cancer common in East and Central Africa, as well as tuberculosis, HIV and congenital heart defects.
“But there was not a single pediatrician in the hospital,” Dr. Dan Fitzgerald said.
The year was 2005, and Fitzgerald and his colleagues had been invited to Bugando Medical Centre in Mwanza, Tanzania, by the newly formed Weill Bugando School of Medicine, part of an institution that would become the Catholic University of Health and Allied Sciences (CUHAS), to assist with the school’s development.
Bugando Medical Centre, the university’s teaching hospital, serves more than 15 million people – a population the size of New York City, Los Angeles and Chicago combined. As the region’s referring hospital, it gets the sickest of the sick. Some patients travel two days by boat across Lake Victoria to get there.
“Even the director of the hospital at the time said, ‘We’re a big teaching hospital, but we’re staffed like we’re a small dispensary out in the village,’” said Fitzgerald, the B.H. Kean Professor in Tropical Medicine, a professor in medicine in microbiology and immunology, and director of the Center for Global Health at Weill Cornell Medicine.
That’s because Tanzania, famous for Mount Kilimanjaro and iconic nature reserves such as the Serengeti, had a dubious distinction: the fewest physicians of nearly any nation in the world. Just one doctor served every 50,000 people in 2002. In comparison, the U.S. had nearly 130 doctors per 50,000 people in 2000.
At center, Dr. Daniel Fitzgerald, director of Weill Cornell Medicine’s Center for Global Health, chats with Dr. Grace Ruselu, left, and Dr. Godfrey Kisigo, right, at Bugando Medical Centre in Mwanza, Tanzania.
Since then, a 24-year partnership between Weill Cornell Medicine and Weill Bugando School of Medicine has not only helped Weill Bugando to graduate more than 2,220 MDs since it was founded in 2003. The collaboration has also enabled both medical schools to improve their students’ education, boost health care in Tanzania with strategies applicable to the U.S., and conduct innovative research on diseases that affect people around the world.
“Fast forward 20 years: Now there is just an amazing group of physician educators in multiple departments – in pediatrics, surgery, obstetrics, gynecology,” Fitzgerald said. “And Weill Bugando School of Medicine is now recognized as really one of the best medical schools in East Africa.”
Although Weill Bugando is not part of Weill Cornell Medicine, they share a common philanthropist – Sanford I. “Sandy” Weill – and a memorandum of understanding to exchange faculty and students, and collaborate on education, research and patient care.
“The quality of care is improving, and this benefit goes now to the community here in Mwanza,” said Dr. Stephen Mshana, professor of clinical microbiology and infectious disease and deputy vice chancellor of planning, finance and administration at CUHAS.
Two decades of mutual benefits
The two institutions came together in the late 1990s, when Mwanza’s religious leaders wanted better health care for their city. Mwanza is Tanzania’s second-largest city, with a population of 1.1 million, a bit smaller than Dallas. Perched at the edge of Lake Victoria, the second-largest lake in the world, Mwanza is known for its delicious tilapia; fishing is a major occupation. Enormous rock formations dotting the landscape give Mwanza the nickname Rock City.
Before Weill Bugando was founded, “the medical care in that region was terrible,” said Dr. Estomih Mtui, a professor of anatomy in radiology at Weill Cornell Medicine from Tanzania who acts as a crucial bridge between the two schools. “People were dying of schistosomiasis, conditions you never see in the U.S., and malaria and malnutrition.”
Dr. Estomih Mtui, professor of anatomy in radiology at Weill Cornell Medicine, grew up in Tanzania and acts as a crucial bridge between Weill Bugando School of Medicine and Weill Cornell Medicine.
At the time, Dr. Peter Le Jacq, M.D. ’81, a Maryknoll priest, had been working at Bugando Medical Centre since 1987. City leaders asked him if any medical schools in the U.S. would share their curriculum. Then-Weill Cornell Medicine Dean Dr. Antonio Gotto obliged. And he pledged full support, with the backing of Sandy Weill ’55, who was then the chair of Weill Cornell Medicine’s board. LeJacq played a pivotal role in facilitating the partnership.
“It was a Tanzanian vision, and their confidence was infectious,” Fitzgerald said, “and it just helped us keep going, working with them and following their lead.”
The collaboration is one of several – in Brazil, Haiti and India – operating through Weill Cornell Medicine’s Center for Global Health. The programs aim to develop innovations and improve health among the world’s poor.
Over time, Weill Bugando and Weill Cornell Medicine collaborated to train faculty members, adapt the curriculum, and launch a residency program where Weill Bugando students can earn specialty certifications. Most recently, Weill Bugando created a Ph.D. program in which doctors conduct innovative research on the diseases they see in their clinics and affect millions around the world.
From the beginning, a steady stream of rotations and visits fueled the partnership.
Students at Weill Bugando School of Medicine walk to class. The school has a total enrollment of about 1,000 students.
Mshana spent four months in New York City in 2001 as one of the first 10 faculty members. They served as teaching assistants while working with Weill Cornell Medicine faculty to develop the curriculum and learn to teach basic sciences. Mshana was especially interested in the problem-based learning approach he saw there – in the classrooms and also on rounds. He subsequently integrated it at Weill Bugando.
“I found it very good, because it’s making the student think critically and connecting with the clinical practice early,” Mshana said. “It’s not like they are just given everything. They have to find the solution on their own.”
Dr. Benson Kidenya, professor and head of the Department of Biochemistry at Weill Bugando, spent several years going back and forth between the two institutions while earning a master of science degree in clinical epidemiology and health services research at Weill Cornell Medicine. He earned his Ph.D. at Weill Bugando in fields related to the epidemiology, genetic diversity and drug resistance of tuberculosis in northwestern Tanzania.
In New York City, he noted how students freely participated in class discussions – very different from the lectures-only model in Tanzania where students are mostly silent. He now uses the approach in his own classrooms. He is one of many Weill Bugando graduates now in faculty and leadership positions at their alma mater.
“I’m trying to make my students engaged, enjoy the session, and also be very interactive, ask questions, express their opinions,” he said. “Because for me, I say learning is fun. You have to enjoy the process of learning, and that’s what I also enjoyed as I was a student in Weill Cornell.”
Faculty members continue to do rotations at each institution – to both teach and learn.
Dr. Tanping Wong, associate professor of clinical medicine and an internist at Weill Cornell Medicine, spent two weeks at Weill Bugando to learn from her Tanzanian colleagues and demonstrate bedside ultrasound techniques..
Dr. Tanping Wong, associate professor of clinical medicine and an internist at Weill Cornell Medicine, spent two weeks at Weill Bugando in December to demonstrate how to use a hand-held bedside ultrasound device and observe how ultrasound is currently used. The intensive care unit has a cart-based device; the regular wards have none.
In a small exam room, she glided the ultrasound device over the abdomen of a medical student playing the role of a patient as other students observed.
Then she handed the device to another student. “Hand on the body – beautiful,” Wong said as the student got the hang of it. On a computer screen, a ghostly, pulsating image emerged. “And there’s the heart,” Wong said.
Later that day, Weill Bugando physicians asked her to scan a patient for fluid around his heart and lungs, to see if cardiac function was intact. “It’s really great for triaging,” she said. “This gives the physician quick information on how to take care of the patient.”
The visit not only gave her the opportunity to learn from her Tanzanian colleagues how to better use physical exams and patient histories as diagnostic tools. “It also helped me become a better teacher,” she said.
At left, Dr. Rob Peck, associate professor of medicine and pediatrics at Weill Cornell Medicine and adjunct associate professor at Weill Bugando in medicine and pediatrics, chats with Dr. Daniel Fitzgerald, center, director of the Center for Global Health at Weill Cornell Medicine, and Dr. Estomih Mtui, a professor of anatomy in radiology at Weill Cornell Medicine.
For students, the cross-pollination provides a medical education that is “transformational,” said Dr. Rob Peck, associate professor of medicine and pediatrics at Weill Cornell Medicine and an adjunct associate professor at Weill Bugando in medicine and pediatrics. He has been instrumental in the partnership for 18 years, establishing Weill Bugando’s standard operating procedures, co-coordinating student and faculty exchanges, and advising graduate students.
“For our Tanzanian students coming to New York, they’re observing the future of medical care in Tanzania,” Peck said. “They are really going to be the leaders of medicine and research, and so they’re able to think about what is available in the U.S. and how that could be implemented in places like Tanzania.
“For our New York students,” he said, “they’re getting to go to Tanzania and see what medicine is like in most other parts of the world.”
Mwanza is Tanzania’s second-largest city, with a population of 1.1 million, a bit smaller than Dallas. It is perched at the edge of Lake Victoria, the second-largest lake in the world.
“Prevention is my thing”
Dr. Gloria James Manyangu, director of community health at the hospital, climbed circular stairs to the hospital’s rooftop, where she goes to catch a breath of fresh air. In the distance are six outlying regions where the outreach programs she directs prevent communicable and noncommunicable diseases, improve nutrition, promote health, and prevent and treat schistosomiasis, a parasitic disease prevalent in the tropics and subtropics.
In this role, Manyangu is applying what she learned at a four-week residency in New York City as a Ph.D. candidate studying HIV treatment; she earned her medical degree at Weill Bugando in 2014.
Inspired by Weill Cornell Medicine’s primary care clinics, she’s planning a one-stop community health center in an outlying region. “When the patient comes, they get screening for maybe blood pressure and diabetes, and maybe get a lifestyle intervention from the psychologist, and then maybe go to another door for nutritional counseling,” she said.
In New York, she shadowed Dr. Mark Pecker, who directs Weill Cornell Medicine’s Hypertension Clinic. There, they take a patient’s blood pressure three times – not once, as they used to do at Bugando. “Since we have so many patients, sometimes it’s not easy,” she said. “So that’s the observation I made: despite the [number of] patients, I need to keep working on the standard.”
Manyangu also observed Weill Cornell Medicine’s diabetes prevention clinic, which prompted her to make changes at Bugando’s diabetes prevention program. Both clinics offer patients classes on lifestyle changes, like getting more exercise and starting healthy diets.
Now, based on the Weill Cornell Medicine model, Bugando also offers patients time to ask questions and talk about where they are struggling to meet the recommendations.
“A majority of them, they cannot afford to get quality health care, so we think the prevention part is important for them,” Manyangu said. “Prevention is my thing.”
More MDs for Tanzania
Over time, the Weill Bugando School of Medicine has graduated more than 2,220 medical doctors since 2008.
As part of her Ph.D., she collaborated with Nick Roberts, a fourth-year medical student at Weill Cornell Medicine who took off a year in 2023 to do seven months of research at Weill Bugando. Together they designed and implemented a questionnaire and measured blood pressure to screen patients for hypertension in the hospital’s busy HIV clinic, which sees hundreds of patients a day.
The first time Roberts took a patient’s blood pressure as part of the screening, he thought he had made a mistake. The reading, he thought, was impossibly high.
He adjusted the blood pressure machine and tried again. And again. “I even grabbed another machine, to make sure it was checking out,” he said, “because the number was such an outlier,” he said. He realized the reading was accurate.
Nick Roberts (left), a fourth-year medical student who spent seven months at Weill Bugando School of Medicine in 2023, consults with Dr. Rob Peck, associate professor of medicine and pediatrics at Weill Cornell Medicine and an adjunct associate professor at Weill Bugando in medicine and pediatrics.
“On the first day, we had four patients with a blood pressure of 200 over 120, which is sky high. Hypertension is 140 over 90,” he said. “In the U.S., I’ve seen maybe one or two patients with blood pressure that high, and they were in the emergency room.”
At Weill Bugando, he frequently saw what could happen to those patients. People in their 30s and 40s develop heart failure and stroke, wreaking financial havoc on them and their families. “It painted the other side of the story: how much prevention and early treatment are needed,” he said.
He also saw extremely advanced cases of cancer, HIV and tuberculosis and their consequences, which he had never seen in the U.S. “People in Tanzania, they tend to seek out traditional healers first. Or they tend to not come to the hospital until they really need to, because they have to pay for it, and they can’t necessarily afford it,” he said.
Families of patients line up for visiting hours at Bugando Medical Centre, in Mwanza, Tanzania. The hospital serves a population of 15 million.
And Roberts observed how Weill Bugando physicians make accurate diagnoses by taking extensive patient histories and doing repeated physical exams. (Weill Bugando does have CAT scan, MRIs and lab tests, but most patients can’t afford them.) The resident who oversaw his work was extremely skilled at doing procedures without ultrasound. “I definitely learned a lot from him,” Roberts said.
This past November, Roberts presented the screening project at the American Heart Association scientific sessions. And he and Salama Fadhil, a Weill Bugando research coordinator, are co-first authors on a paper in Kidney Medicine showing that HIV increases the risk of chronic kidney disease.
The Weill Bugando experience changed his perspective about practicing medicine in the U.S., Roberts said. “I was able to learn Swahili and talk to patients directly while I was there,” he said. “It just reinforced how much you learn from talking to patients, which I think is true in the United States, too.”
Weill Bugando MDs Practicing in Tanzania
From 2015-20, nearly 700 doctors and doctor specialists who graduated from Weill Bugando School of Medicine practiced medicine throughout Tanzania.
A sustainable, developing institution
In 2020, Mshana co-led a study asking a crucial question: Where had Weill Bugando medical doctors and specialists ended up practicing between 2015 and 2020?
The study found that 90% of Weill Bugando graduates were employed – the majority at Bugando. “The striking feature from that study is that we have really helped to concentrate medical doctors in the Mwanza region. We are proud of that,” Mshana said.
The study also shows other graduates dispersed throughout the country. As part of the curriculum, students now do rotations in rural and less-resourced areas outside Mwanza. “If they graduate and are posted there, it’s an environment they will be used to,” Mshana said.
Weill Bugando still faces challenges. It needs more funding for students with financial needs. It still lacks faculty members in core disciplines to expand educational programming.
Dr. Tanping Wong, associate professor of clinical medicine and an internist at Weill Cornell Medicine, demonstrates bedside ultrasound techniques to students at Weill Bugando School of Medicine.
Nonetheless, Weill Bugando School of Medicine now enrolls about 200 students every year, with a total annual enrollment of about 1,000. They include Mshana’s eldest daughter, Patricia Stephen Mshana, 21, a third-year MD student. She was born in 2003 – the same year Weill Bugando welcomed its first cohort of students.
“I have seen all this growth and I’m feeling happy that I have contributed something as a leader to the development of this institution,” Stephen Mshana said. “Really, my dream is to see Bugando transformed to a sustainable, developing institution, a situation which now will be there to stay.”
This story and videos were developed and produced with support from Matt Fondeur, Lindsay France, Eduardo Merchán and Ashley Osburn.
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