Mass General’s Adeline Boatin, MD, MPH (center), believes her presence in Mbarara encourages female colleagues there who are pursuing medical careers.
“When in distress, every man is our neighbor.”
Uganda did not exist as a nation when the founders of Massachusetts General Hospital penned that motto more than two centuries ago. Today, the African country provides a powerful reflection of just how global the hospital’s mission has become.
Focusing on the most vulnerable populations in dozens of countries, Mass General offers global leadership in clinical care, research, education and disaster response. Built on a strong humanitarian foundation, such efforts also produce skills, knowledge and innovation that benefit patients back home.
In Uganda, Mass General clinicians and researchers are working with their counterparts to address pediatric malaria, pneumonia and maternal health. In addition to providing health care—and hope—to an underserved population, these collaborations have generated pioneering research to fight HIV, cardiovascular disease and basic poverty.
Mass General is going one step further to strengthen and expand the training of Ugandan medical professionals to deliver these treatments and innovations in a sustainable manner. “We’re using the resources, energy and talent at Mass General to train a new generation of Ugandan doctors and nurses to deliver care,” says David Bangsberg, MD, MPH, director of Mass General’s Center for Global Health. “They will, in turn, train future generations of student physicians and nurses.”
The campus of Mbarara Regional Referral Hospital is the site of many of Mass General’s efforts in Uganda.
Building a Stronger Healthcare Future
This outcome is especially vital due to the problem of “brain drain.” Promising doctors and nurses frequently are recruited away from Uganda and other underserved countries to work elsewhere. By directly investing in these local clinicians through scholarship support to train and care for patients in the public sector, Dr. Bangsberg says, “We’re encouraging them to serve and adopt a public health mission. It becomes personal.”
A secondary goal is to train clinicians in sub-specialties to retain a long-term standard of care that goes beyond urgent issues like malaria. Mass General clinicians help train their Ugandan counterparts in crucial but sometimes overlooked specialties, like oncology, in order to be the first to provide cancer care to rural Uganda.
The effort faces challenges. In Uganda, very few clinicians can study and pay tuition at the same time, and many have families to support. To that end, Dr. Bangsberg’s program has raised funds for a master’s in medicine program, akin to residency training in the United States. Physicians also receive a small cost-of-living stipend so they can focus on their studies.
Most of Mass General’s efforts in Uganda center in and around Mbarara, a city of about 80,000 in the rural southwestern part of the country. It is home to both Mbarara Regional Referral Hospital and Mbarara University of Science and Technology (MUST), which trains health professionals to serve Uganda’s remote, under-resourced communities. Visiting Mass General staffers often stay in a guesthouse, which allows them to interact with their Ugandan peers in a personalized, immersive setting.
Moms Helping Moms
“It’s a beautiful place with profound health needs,” Dr. Bangsberg says. “But the spirit of the people is invigorating.”
In Uganda, the average woman has six or seven children. Mbarara’s small staff of obstetricians struggles to manage the many routine births. More complicated births tax their resources to the limit.
During one recent visit to Mbarara’s maternity unit, Mass General obstetrician Laura Riley, MD, saw 42 mothers and babies crowded into one room, sleeping on mattresses without sheets. “You don’t realize the impact of a lack of healthcare providers until you see it,” Dr. Riley says. “The staff does an incredible job under the circumstances, but they are stretched thin.”
Dr. Riley and another Mass General obstetrician, Blair Wylie, MD, MPH, have joined forces with some of their grateful U.S. patients, who were willing to make donations. Together, they started Moms Helping Moms. The program plans to fund resident obstetrical training at Mbarara Hospital rather than focus on supplies alone. Dr. Riley and several Mass General colleagues also aim to help the hospital expand a basic database to include obstetric patient outcomes in guiding patient care.
“At Mass General, data inform our priorities,” Dr. Riley explains. “We need to know the vulnerable areas at Mbarara Hospital and the risks women face there so we can develop protocols based on their resources and culture.”
David Bangsberg, MD, MPH (right), visits a Mbarara home to meet research study participants.
A Palpable Change
Adeline Boatin, MD, MPH, is a Mass General Global Health fellow who has spent months working in the maternity unit. She says the presence of women like her in Mbarara offers encouragement to female colleagues trying to pursue medical careers—and to female patients coming to the facility to seek care.
Dr. Boatin, who is from Ghana, also believes being on the ground continually has allowed her to gain the trust of Ugandan colleagues and forge longstanding relationships that have made a real difference. “Now I feel like I’m really getting into the system at Mbarara—and that change is palpable,” she explains.
Elsewhere, Mass General emergency medicine resident Nirma Bustamante, MD, recently spent several weeks at Mbarara Hospital teaching first aid techniques to potential first responders. Working with MUST and the Uganda Cancer Center, Mass General’s new Global Surgery Initiative is aiming to develop a national referral cancer center to serve Ugandans. And this summer, Mass General and MUST co-sponsored a Mbarara conference focused on the challenges facing nursing in Uganda. More than 100 nursing leaders from across the country attended.
“It’s a beautiful place with profound health needs,” Dr. Bangsberg says. “But the spirit of the people is invigorating.”
Bringing Technological Innovation to Uganda
Research and technology play a major role in the relationship between Mass General and Mbarara. Ryan Carroll, MD, MPH, studies both malaria and appropriate medical technology development. He divides his time between Mass General’s pediatric intensive care unit in Boston, and MUST, where he has been studying new treatments for pediatric cerebral malaria and helping build simple technologies to support children with respiratory illnesses.
Nirma Bustamante, MD, demonstrates techniques to potential first responders.
Much of Dr. Carroll’s work is enabled by the Center for Global Health’s Consortium for Affordable Medical Technologies (CAMTech) program. The worldwide network of academic, clinical, corporate and implementation partners strives to deliver high-quality, affordable medical technology development to low- and middle-income countries like Uganda.
Dr. Carroll was tapped for pediatric research in Uganda because of his strong background in malaria research in countries like Malawi, along with his experience in pediatric intensive care units and a special knack for diplomacy. As the program director for the Center for Global Health in Uganda, he oversees up to 15 research projects at a time in Mbarara, all deliberately aligned with the country’s healthcare needs. “We’re always asking the local medical community, ‘What are your top needs?’ And together we work to solve them,” he says.
“What’s most fulfilling,” Dr. Carroll adds, “is knowing there are young scientists and physicians here whose careers are being cultivated by this research, and they can pass it along to the next generation of Ugandan physicians.”
Acting As Village Health Workers
Geren Stone, MD, who also splits his time between Boston and Uganda, leads Mass General’s Global Primary Care program. The multifaceted initiative offers Boston physicians the chance to travel to Mbarara to teach and train alongside Ugandan clinicians.
MGH efforts in Uganda include studying new treatments for pediatric cerebral malaria and helping build simple technologies to support children with respiratory illnesses.
Through MUST, Dr. Stone is often stationed three hours northwest of Mbarara, at Bugoye Health Center, an area that his Ugandan counterparts identified as needing special attention. In this remote location, he helps treat a population coping with malaria, diarrhea, respiratory infections and other waterborne conditions. Many of these ailments afflict children under five years old, whose immune systems are especially susceptible to severe illness. “We’re going into villages and asking, ‘What do you need?’” Dr. Stone says. “And the best part is that Mass General is really listening.”
In addition to offering medicine (such as oral rehydration medications that can be mixed at home), Dr. Stone’s team focuses on health education for families who reside in the quiet mountain villages. For many, traveling to a hospital would be a long and arduous journey.
Dr. Stone’s team also collaborates with Ugandan clinicians to identify and combat longer-term and non-communicable illnesses, such as hypertension. “We’re focusing on how to help patients at a primary care level, before illnesses become a problem,” he says. “We’re thinking about how to innovate the entire system.”
Mass General’s Geren Stone, MD (left), at the Bugoye Health Center with Shem Bwambale, the clinical officer in charge.
Learning from One Another
Stateside, Dr. Stone serves as a primary care physician with the Boston Health Care for the Homeless Program (BHCHP). There, he similarly treats vulnerable and disenfranchised populations coping with illnesses specific to their circumstances, such as substance abuse and trauma. Through this relationship, he sees the Ugandan partnership come full circle.
Recently, Dr. Stone hosted three Ugandan counterparts in Boston. After they visited the BHCHP health site here in Chelsea, they talked about the similarities and the differences in caring for patients in Boston and Bugoye.
“At Mass General, we help our neighbor, and in modern times, we know our neighbor isn’t just in Boston,” Dr. Stone says. “We’re a truly global community, working as equals.”
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