MUYU collaboration improving health education on two continents

BY COLLEEN SHADDOX

During the COVID-19 pandemic, doctors encountered enormous challenges, including a shortage of clinicians to treat the volume of sick patients and a lack of personal protective equipment (PPE) and other supplies.  Facing these problems in New Haven, Tracy Rabin, MD, SM, kept certain role models front of mind: the Ugandan colleagues she had met through the Makerere University-Yale University (MUYU) collaboration. Rabin, an associate professor of medicine at Yale, co-directs the collaboration with Harriet Mayanja-Kizza, MBChB, MMed, MSc, FACP, former dean of Makerere’s medical school. Students and faculty at Makerere routinely work with scant resources that Rabin has seen them combine with virtuoso clinical skills and thoughtfully deploy for maximum benefit. 

Mayanja-Kizza also recalled a day on the job that illustrated a similar point. An American physician in his sixties came to her office with his son, a doctor in his twenties. “He wanted to make sure that the son had the same quality of medical education that he’d benefitted from – and that had to include experience in Uganda,” she said.

Traditionally medical schools in high income countries have approached global health projects as a kind of export. Faculty expertise and other resources are shipped out and put to work in a lower income country. From the outset, the MUYU collaboration has been different – with both institutions shaping the program and both reaping benefits.

“This is truly a bidirectional partnership,” Rabin said.

The program launched in 2006, with an initial goal of improving patient care at Mulago National Referral Hospital in Kampala, which was beginning to set up specialty wards but did not have clinicians with formal subspecialty training.  The internal medicine departments at Makerere and Yale began setting up faculty, resident, and student exchanges, which they expected to improve medical education on both campuses. The partners initially concentrated on non-communicable diseases. Exchanges have broadened to include nursing, with an emphasis on diabetes management and midwifery, public health, and a much wider range of medical specialties. 

As of early 2024, 74 Yale School of Medicine faculty and associated physicians have spent time at Makerere, as have 182 Yale residents, and 159 students from the schools of Medicine, Nursing and Public Health. There have been two visits by Yale medical librarians.

Meanwhile 29 Makerere faculty and 43 medical students have travelled to Yale to experience a vastly different health care system and learn about technologies they will pioneer back in Uganda, as have two nurse educators and one medical librarian. During the COVID travel ban, medical students from each institution engaged in a joint, virtual elective where they learned about each other’s healthcare system and the spectrum of social determinants of health in both countries. Additionally, physicians who had planned to come to Yale for in-person observership experiences were given access to live and recorded virtual teaching conferences and adjusted their hours so that the seven-hour time difference did not prevent them from starting this portion of their training.

Erasmus Okello, MBChB, MMed, was in the first cohort of Makerere students to come to Yale for an elective and remembers that summer as “some of the best days of my life.” Today he is a lecturer at Makerere in anesthesiology and critical care. He is also head of anesthesiology and critical care medicine at TMR International Hospital in Kampala. The MUYU collaboration “really focused on the idea of making new leaders,” he said. He took on the role immediately after his time at Yale, even as a medical student interacting with patients at Mulago. “It helped us become their advocates, the experts around them,” he said.

For the past decade, Yale and Africa, an initiative to increase the university’s engagement with the continent, has encouraged programs of rich exchange like the MUYU collaboration. President Peter Salovey made his commitment to this work clear in his 2013 inaugural address: “With the growing influence of the African continent on the world economy, as well as increased migration to, from, and within Africa, this is the moment to bring scholarship and teaching about Africa at Yale into sharper focus,” he said. 

Throughout Salovey’s presidency, partnerships formed and grew.

“Thanks to the deep work of faculty on both sides of the exchange, Yale is breaking the old paradigm of a northern institution seeing itself as the benefactor of a southern one,” said Janette Yarwood, director for Africa and the Middle East in Yale’s Office of International Affairs. “Our partnerships do not start with ribbon cuttings and memoranda of understanding. Instead, they are conceived and driven by faculty interests and connections. Our office is here to help build those exchanges around a committed core of scholars in both countries who are already interested in collaborating. The bidirectional nature of these relationships is clear from the very start.”

Indeed, the MUYU collaboration began when Majid Sadigh, MD, then an associate professor of medicine at Yale, began doing HIV work in Kampala. Though the initial goal was to improve care at Mulago by creating educational opportunities for the doctors who would eventually practice there, the impact has been wider, as alumni of the program take leadership positions throughout Uganda and beyond. A key MUYU accomplishment, said Mayanja-Kizza, has been the partners’ willingness to extend collaboration to other schools and hospitals in the country.

U.S. law prevents doctors credentialed outside this country from taking a hands-on role in patient care, a policy around which Rabin strongly advocates for change on a national level. Because of this barrier, MUYU trainees may observe skills at Yale that they must go elsewhere to practice. These south-to-south exchanges, sending Ugandan physicians to places like India, Iran or South Africa, create a larger global community of expertise that she calls the “silver lining” of U.S. restrictions.

A range of programs are thriving under the MUYU umbrella:

What’s ahead for MUYU? There is a great emphasis now on training current and future physicians in pulmonology, a specialty for which there is not yet an existing formal training program in Uganda. Mayanja-Kizza and Rabin both said that they would like to scale up so that more students, residents and physicians can benefit from the transformative exchanges. This will include increased partnership with other universities in Uganda, which are not as well-resourced as Makerere. MUYU aims to strengthen connections between Yale and Ugandan colleagues over the paths of their careers. The co-directors have written and presented on the MUYU model, creating a valuable resource for other global health collaborations. While MUYU has focused more on clinical training than research, Mayanja-Kizza urges her Ugandan colleagues to enter into research partnerships with the people they meet at Yale. “To solve African problems, we need to ask African questions,” she said.

The potential is limitless, because everyone involved in the program spreads the skills and knowledge that they gain. “Every soul that is touched establishes a cascade,” reflected Erasmus Okello, whose career has been shaped by MUYU since medical school. The key, he said, is MUYU’s emphasis on both building confidence and pursuing lifetime learning. “You know that you belong among the best – and you can actually get better,” he said.