Makerere University/Yale University (MUYU) Collaboration in Kampala, Uganda
Mulago HospitalMulago Hospital is the national referral and teaching hospital of Uganda and offers a unique opportunity to work with highly skilled clinicians who are faced with the task of managing a population with a heavy disease burden within the context of a resource-limited setting. Although the official bed capacity is 1500, the one hundred full-time physicians are often pushed to care for nearly double that number of patients.
The collaboration between Makerere University and Yale University, known as MUYU, was formalized in 2006 and has had a significant impact on medical education at both institutions. This collaboration was developed and directed by Dr. Majid Sadigh with strong support from the leadership at the Makerere University College of Health Sciences and the Mulago Hospital, and is now co-directed by Dr. Tracy Rabin and Reverend Professor Sam Luboga. (Please refer to the MUYU Five Year Report for more details.) It has provided opportunities for a two-way exchange of medical students, residents and attending/consultant physicians. A MUYU administrative office has been established at Makerere University, across the street from Mulago Hospital; it is the coordinating hub of activities for our partners.This group of physicians and administrators manage incoming MUYU participants, coordinate connections with physician mentors on different wards and throughout the Ugandan medical community, and organize a wealth of cultural and medical experiences (outlined below).
MUYU has helped to build capacity in a number of other ways, including improving access to the most current information at the Albert Cook Medical Library through a partnership with Yale Medical Library, enhancing the diagnostic and training capacity of Ward 4A's side laboratory, and supporting breast cancer screening efforts by facilitating the donation of two mobile mammography units. MUYU has supported the development of the Rainer Arnhold Senior House Officers' Teaching Support project to organize and enhance post-graduate medical education.
What started as a collaboration between two universities has grown to include participants from many institutions including the University of Vermont, Edinburgh University in Scotland, and Kazan State Medical University in Russia. The work at Makerere has mainly centered on the Department of Internal Medicine, but we continue to explore opportunities to collaborate with other departments.
Participants going to Uganda have found aspects of their experience to be challenging, particularly as they see the disparities in resources and their accompanying effects on health care delivery. Yet their involvement in the MUYU collaboration secures a community of colleagues and mentors with whom to discuss ideas and to formulate steps forward.
Rooted in mutual respect and trust, this collaboration continues to share its vision to enhance clinical care through medical education and research. Since its inception, more than 200 faculty, residents and students have rotated in Mulago Hospital through MUYU Office. In addition, one nurse and 12 faculty and physicians from Makerere College of Health Sciences and Mulago Hospital have spent 4-12 months at Yale and its affiliated hospitals, focusing on specific specialties with emphasis on the management of chronic diseases. We, in collaboration with the Yale School of Medicine’s Office of International Health, have also hosted 20 medical students from Makerere for a one month rotation at YSM. Most recently, we assisted one of the Makerere faculty, after returning from his year at Yale, in obtaining funding from the Mulago Foundation to oversee the training of internal medicine residents in Mulago Hospital.
Click here to see an example of the MUYU Office's weekly schedule.
Participants develop a keen eye for observation and couple it with enhanced skills in physical examination and patient history-taking. Other clinical sites are also available in Kampala for medical rotations, including private clinics, community hospitals, and home visits.
Clinical medicine opportunities also abound in northern Uganda at Lacor Hospital and in Kasensero, a small fishing town southwest of Kampala. Given its greater access to resources and focus on continuity of care, Lacor Hospital offers participants a different perspective on the health care system, in particular within the wider context of the post-LRA conflict. Kasensero illustrates how a far flung and neglected community can be ravaged by HIV yet still maintain hope.
To supplement their clinical medicine training, participants are also offered a series of lectures and courses to provide them with a more complex understanding of tropical medicine, along with the cultural, social and political landscape in which this training takes place. Tropical medicine presentations are given by faculty of the Department of Medicine in topics such as malaria, diarrheal diseases, endomyocardial fibrosis, and HIV/tuberculosis. Classes in the local language of Luganda are also offered by the MUYU office so that participants can build both a medical and a more day-to-day vocabulary. Participants also augment their laboratory skills with sessions devoted to tropical medicine microscopy. A political scientist at Makerere University leads weekly discussions on such pertinent and diverse topics such as the political backdrop of Africa, with an emphasis on East Africa and Uganda, the role played by women in Uganda, the history of the medical profession and the role of traditional healing. A weekly feedback session with MUYU faculty and staff provides a platform for participants to discuss their experiences on the wards and progress on their individual projects.Cultural tours of Kampala and its environs include one of the world’s seven Baha’i temples, the Namugongo martyrs shrine and the site of the Kasubi tombs. Many participants choose to travel to the National Genocide Museum and memorialized churches in Rwanda which provides further insight into conflicts of the region and the way in which forgiveness can pave a way forward amongst people who have experienced tragedy.
Ugandan faculty, residents and medical students who have taken part in the MUYU collaboration have similar opportunities. Junior faculty spend six to twelve months training in specialty areas at Yale and its affiliate hospitals, and return to Uganda to incorporate their knowledge into teaching and patient care. Often mentors from the United States travel to Uganda and continue to work with their Ugandan counterparts to assist in the establishment of new programs, such as breast cancer screening. Medical students enhance their clinical training by attending and taking part in morning reports, rounds and conferences. They learn not only to interpret investigative findings more readily, but they also learn about the health care system in the United States and the clinical findings common to its population. They also develop an increased awareness of the importance of patient ownership and advocacy.
- Impact of MUYU on education of trainees and patient care: An in-depth evaluation of the effect of the MUYU Program on education and patient care over the past five years.
- Treatment of Acute Kidney Injury with modified CAPD: A collaborative project with the Sustainable Kidney Foundation to assess efficacy and cost of using modified CAPD modality to treat acute renal failure.
- Impact of the in-hospital palliative care on treatment for dying patients in Mulago Hospital: A project to be done jointly with the University of Edinburgh's Global Health Academy led by Dr. Liz Grant.