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Makerere University/Yale University (MUYU) Collaboration in Kampala, Uganda 

Mulago Hospital Complex

Mulago National Specialsed Hospital
Kara Becker '18 took this photograph as a PA student performing clinical rotations.

Originally founded in 1913, and then expanded in 1962, the Mulago National Referral Hospital (MNRH) has been the primary public tertiary care hospital of Uganda, and the main teaching partner of the Makerere University College of Health Sciences (MakCHS). Over time, the clinical care, education, and research facilities on the Hospital and MakCHS campus expanded to include the Infectious Diseases Institute, the Uganda Cancer Institute, the Uganda Heart Institute, and two newly completed facilities – the Mulago Women’s Referral Hospital and the Mulago National Specialised Hospital. These locations, in addition to the smaller public partner hospitals located in other parts of Kampala - Kawempe Referral Hospital, Kiruddu Referral Hospital, and Naguru General Hospital - offer unique opportunities 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.

Organizational Structure

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 MakCHS and the MNRH, and is now co-directed by Dr. Tracy Rabin and Professor Harriet Mayanja-Kizza. 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 MakCHS, across the street from MNRH; 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 and Erlangen University in Germany. Although the work in Kampala had started as a collaboration between the Departments of Internal Medicine and a spectrum of subspecialty sections, the capacity building efforts have expanded to include a number of other YSM clinic department partnerships (Emergency Medicine, Endocrine Surgery, Neurology, Obstetrics & Gynecology, Pathology, Pediatrics Pediatric Surgery, Urology), as well as the Yale School of Nursing (Nurse-Midwifery) and the Yale School of Public Health.

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 400 faculty, residents and students have rotated at the MNRH(or one of its partner sites) through the MUYU Office. In addition, two nurses, one librarian and 28 faculty and physicians from MakCHS and MNRH 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 Global Health Education, have also hosted 39 senior medical students from MakCHS for a one month rotations at YSM.

Yale-Uganda collaboration improving health education, patient care

Twelve years ago, faculty and students from Yale and Uganda’s Makerere College of Health Sciences (MakCHS) began working and learning together with one goal: to improve patient care in Mulago National Referral Hospital (MNRH) in Kampala. During the course of this partnership, the goal — and the results — have become much broader.

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Clinical Opportunities

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.

Educational Opportunities

To supplement their clinical medicine training, participants are also offered a series of lectures and bedside teaching experiences to provide them with a more complex understanding of the unique aspects of providing care in this setting, along with the cultural, social and political landscape in which this training takes place. Presentations are given by faculty of the Department of Medicine on topics such as malaria, palliative care, diarrheal diseases, pre-hospital care, 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 from 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.

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 and advanced cardiac life support/advanced trauma life support training. 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.

Research Opportunities

The Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD) is a research partnership that is working to find better ways to address chronic diseases. UINCD came together in 2013 as a group of doctors, researchers, and government officials representing the Uganda Ministry of Health, Makerere University College of Health Sciences, and Mulago National Referral Hospital, joined by colleagues from Yale School of Medicine. The mission is to build capacity in the realms of prevention, care, training, and research to enable the provision of effective and integrated care along the NCD management spectrum.

Yale Faculty Lead: Jeremy Schwartz, MD

The Parikh lab focuses on translational studies of malaria in sub-Saharan Africa, with particular attention to vulnerable populations (children, pregnant women, and those with HIV). Dr. Parikh has been collaborating with colleagues at Makerere University, MSF Epicentre (Mbarara), and the Infectious Diseases Research Collaboration since the early 2000’s. Studies in Uganda have focused on optimizing current first-line drug regimens for the treatment of malaria with the ultimate goal of informing policy. Opportunities for pharmacokinetic, parasite dynamics, and host response sub-studies exist.

Yale Faculty Lead: Sunil Parikh, MD, MPH

The Uganda TB Implementation Research Consortium (U-TIRC) is a collaboration involving research scientists at Makerere University, Yale University, and other overseas institutions with public health officials at the Uganda Ministry of Health and the Uganda National TB and Leprosy Programme (NTLP). U-TIRC focuses on improving tuberculosis diagnosis, treatment, and prevention through high-quality clinical, epidemiological, and implementation research in clinic and community settings in Uganda.

Yale Faculty Lead: Luke Davis, MD

Walimu is a Uganda- and U.S.- registered non-governmental organization working to empower frontline health workers to improve the quality of care in Uganda through implementation science.

Yale Faculty Lead: Luke Davis, MD