Global change through education
A new program at Children's Memorial Hospital is offering residents the opportunity to complete a training rotation in international health in Tanzania, a country in eastern Africa. Sharon M. Unti, MD, director of the residency program at Children's Memorial, says the Tanzania program was resident-driven, and the result of nearly two years of research and planning, led by one of the current pediatric chief residents, Sabrina Wagner, MD .
Long-term impact
In designing the program for long-term impact on both patients and physicians, the residents selected Bugando Medical Centre, a referral hospital in Mwanza City, Tanzania, serving a region with 13 million people, and devised a schedule of consecutive coverage, with two physicians serving one-month rotations to attempt to ensure continuity throughout the year. There is one physician for every 40,000 people in Tanzania, compared to one per 400 in the U.S., and most have only one year of formal training. Despite a population of 37 million, Tanzania has just 800 physicians. By comparison, Children's Memorial alone has nearly 1,100 community and hospital-based physicians.
Wagner says that the dire state of health care in Tanzania, where one in seven children die before their fifth birthday, can feel overwhelming to those trying to improve it. She and the residents focused on where they could make a difference: education. “We had to accept that we couldn't change the impoverished conditions or lack of resources in Tanzania, but we could share medical knowledge and teach simple interventions that can save lives,” she says.
Partnership for enhanced care
Wagner emphasizes that the program, which she calls a “partnership,” is not about telling physicians in Tanzania how to practice medicine, because they are accomplished clinicians in their own right. Instead, it is intended to offer advanced training and share practices that can improve the delivery of care.
“Our education is a gift that we can share with our colleagues on the other side of the world to change outcomes for children,” says Dr. Wagner.
In Tanzania, where the majority of citizens live on $2 a day or less, medical facilities lag decades behind in technological capabilities. Most hospital rooms do not contain even the most basic electronic monitoring systems. With this in mind, the residents created a knowledge-based program focused on establishing systems, improving diagnosis and altering expectations. They also initiated the project that would become the cornerstone of the program's inaugural year – a comprehensive reference manual, based on World Health Organization guidelines, that outlines best practices and procedures for diagnosing and treating the most commonly seen conditions in the region, along with pocket-sized reference cards. Each pair of residents has expanded and enhanced the manual during their rotation.