The Office of Global Health in the Yale Department of Internal Medicine addresses global health disparities through education and research, in partnership with institutions serving resource-limited communities worldwide. One of their significant educational initiatives brings residents, fellows, physicians, and faculty from partner institutions to New Haven.
Recently, hematologist Christine Sekaggya-Wiltshire, MBChB, MMed, PhD, spent six months in New Haven, working alongside Robert Bona, MD, professor of medicine (hematology) and other faculty within the Section of Hematology. Sekaggya-Wiltshire heads the hematology section at the Mulago National Referral Hospital, in Kampala, Uganda.
Hematology resources in Kampala are constrained, so Sekaggya-Wiltshire was excited to learn more from Yale faculty.
“In my department, we do not have many people trained in hematology, especially benign hematology,” she said. "So our department leadership thought that one of the disciplines that needs additional support from Yale would be hematology.”
Inspiration to Pursue Hematology
Benign hematology, or classical hematology, focuses on non-cancerous blood diseases, such as sickle cell disease. Sekaggya-Wiltshire noted that sickle cell disease is a significant public health concern in Uganda.
“About 4,500 patients come to our hospital actively for sickle cell disease care, both children and adults,” she said. “The disease is common in Uganda, and we see it often at our hospital.”
Sekaggya-Wiltshire also cares for patients with hemophilia and other non-malignant hematological disorders. The limited number of specialists in Uganda in this area of medicine led her to care for these patients and lead research into these diseases to better understand them.
Experience at Yale School of Medicine
Before arriving at Yale School of Medicine (YSM) in May 2023, Sekaggya-Wiltshire had been learning virtually, through online tutorials, presentations, and case conferences.
At YSM, Sekaggya-Wiltshire observed patient care in the Smilow Cancer Hospital clinics and the hematology inpat. She also spent time as an observer with the Sickle Cell Program at Smilow Cancer Hospital, a 13-bed inpatient unit. In the outpatient clinic, she saw patients with clots, bleeding disorders, bone marrow suppression, and low platelets. She also attended learning sessions and case conferences.
“I've been practicing in this field for about 10 years now, so to come here and see the difference in practice—driven by differences in resources, approaches to patient care, and types of diseases and their spectrum—is an eye-opener,” said Sekaggya-Wiltshire.
Educational Opportunity
Upon acceptance into the bidirectional educational exchange program, under the umbrella of the Office of Global Health’s Makerere University-Yale University (MUYU) collaboration, Sekaggya-Wiltshire was connected with Robert Bona, MD, professor of medicine (hematology) and clinical director of the Classical Hematology Program. She also received additional funding from the HIV Research Trust to build capacity for evaluation of hematological disorders in people living with HIV.
“Prior to her arrival, we'd been talking by phone once a month or so to share stories and talk about some of the care she was delivering in Uganda,” Bona said. “She was doing amazing work, offering a service to a big university hospital in Uganda that doesn't have many people specifically trained in what she's doing. So we looked forward to the day she would come to Yale.”
Sekaggya-Wiltshire has learned much from Bona, and vice versa, accomplishing one of the goals of the program.
Sekaggya-Wiltshire noted the way Bona approaches his patients as a whole. “I like how he starts by catching up with his patients, having an easy conversation with them,” she said. “He explains things and empowers them to make choices. He might advise them or give evidence, but it's a joint decision.”
Sekaggya-Wiltshire’s care delivery and dedication to her patients inspire Bona.
“I've learned a lot about how medicine, particularly hematology, is practiced in Uganda, how excellent care can be delivered with limited resources, and how sometimes a lack of resources can limit what she can accomplish for her patients,” said Bona.
Bona shared examples of multiple platelet transfusion for patients with low platelet counts or an exchange transfusion used to treat sickle cell disease, as treatments that are much more difficult to access in Uganda.
“Where Christine is practicing, it's much harder to get a platelet transfusion to someone who's bleeding or exchange transfusion for sickle cell disease, which is standard of care in the U.S.,” Bona said. “Even some common medicines have been hard for her to obtain for her patients in Uganda.”
In addition to Bona, Sekaggya-Wiltshire has worked with Layla Van Doren, MD, MBA; Anish Sharda, MD, MPH; and Cece Calhoun, MD, MPHS, MBA; she looks forward to continuing to partner with Yale faculty on various mentoring and research projects.
Sekaggya-Wiltshire encourages others to participate in the Office of Global Health program, using the opportunity to learn, grow, and network as she did. “I plan to remain in touch with and do research with the people I met at Yale,” she said. “I will also be a mentor in sickle cell care and other non-malignant hematological diseases.”
The Office of Global Health in Internal Medicine offers many educational opportunities for residents, faculty, and colleagues through existing relationships with institutions around the world. Learn more by visiting their website.
The Department of Internal Medicine at Yale School of Medicine is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.