Pulmonary Learning Spans from Uganda to U.S.

Yale School of Medicine (YSM) and the Makerere University College of Health Sciences in Uganda have collaborated since 2006 to enhance medical education and research for improved clinical care, under the umbrella of the MUYU collaboration. Over the years, this collaboration has fostered a bidirectional exchange of medical personnel between the two institutions, and has been based in the Office of Global Health in Yale’s Department of Internal Medicine and the MUYU Office at Makerere University College of Health Sciences.

The current faculty participants include pulmonologists Akello Susan Adakun, MBChB, MMed, and Ivan Kimuli, MBChB, MMed, MPH. They arrived from Uganda in April 2024 and are now working with members of Yale’s pulmonary care team. Dr. Adakun studies interstitial lung diseases, while Dr. Kimuli specializes in sleep medicine.

Adakun and Kimuli were to begin their observerships at Yale New Haven Hospital in April 2020, but COVID halted formal exchanges between institutions for many months. They did, however, establish connections with Yale faculty and staff, beginning their observerships virtually in 2020 though participation in online tutorials, presentations, and case conferences.

Interstitial lung diseases (ILDs) are disorders that cause inflammation and progressive scarring of the lungs. Adakun became interested in these diseases because they are often mistaken for tuberculosis (TB) in her country.

“Since the burden of TB in Uganda is high, all patients with abnormal chest X-rays will be referred for tuberculosis treatment, even if the tests are negative,” says Adakun. Treatments for tuberculosis can take six months or longer, and many of the drugs have side effects. This often creates unnecessary stress and potential harm for patients who don’t even have the disease.

Adakun hopes her visit here will equip her with the knowledge to limit misdiagnosis. “If I can correctly diagnose interstitial lung diseases and refer patients for care early enough, I can improve their quality of life,” she said.

Kimuli’s experience treating pulmonary diseases led him down a different path than Adakun. After serving as the head of clinical services at the Lung Institute at Makerere University, he became passionate about establishing care for those suffering from sleep disorders.

Kimuli is particularly interested in obstructive sleep apnea, a breathing disorder characterized by partially or completely blocked airways while sleeping. He hopes his time at Yale will provide him with the skills needed to establish a sleep service in Uganda, a first for the country.

“From this collaboration, I plan to ensure that what I am offering in Uganda is up to standards and within what is acceptable by the American Academy of Sleep Medicine,” says Kimuli. “This is an opportunity to ground myself better in sleep medicine, and I welcome the opportunity with open arms.”

Since arriving at Yale for their clinical observerships, Adakun and Kimuli have had a variety of learning opportunities, rotating through the Medical Intensive Care Unit, pulmonary consult service, outpatient clinics (including pulmonology, rheumatology, and radiology), and attending the summer lecture series with Yale fellows.

They have been working closely with members of Yale’s Section of Pulmonary, Critical Care, and Sleep Medicine (Yale PCCSM), learning clinical skills necessary for their fields of interest. Adakun has been working alongside Jean Paul Higuero-Sevilla, MD, assistant professor of medicine (pulmonary, critical care, and sleep medicine), and Kimuli with Lauren Tobias, MD, assistant professor and program director for the Sleep Medicine Fellowship.

“It's very satisfying to involve someone in your field when they have the potential to make a significant impact back in their home country with what they've learned here at Yale,” says Dr. Tobias. “Everybody who meets Susan and Ivan senses their enthusiasm and is eager to spend more time with them.”

Drs. Higuero-Sevilla and Tobias learned much from Adakun and Kimuli, especially about caring for patients with limited resources. Resources are more constrained in Uganda than in the U.S. Physicians must carefully consider the costs of all medications and procedures before prioritizing their next steps.

“It's interesting being in a culture where we are used to just checking off boxes and ordering multiple tests, and now I am putting myself in a different framework of practice,” says Higuero-Sevilla. “If I can only order five tests, which tests would they be? I’ve been thinking a lot more about the essential things that we should have at a minimum for these patients.”

Adakun and Kimuli will return home in October after spending six months at Yale. “The team here is very supportive. Many people are interested in learning about Uganda and how to make our work easy when we return,” says Kimuli.

After the program, Adakun and Kimuli would like to establish new care services for patients with ILDs and sleep disorders, and eventually develop a pulmonology fellowship at the Mulago Hospital complex in Kampala.

They are also excited to continue collaborating with their mentors and other faculty at Yale and express gratitude for the network they’ve built through this program. “Everywhere we go, everyone is ready to help us, to ask us what we want to learn, and ready to support us in any way they can,” says Kimuli. “It's nothing that we take for granted.”

The Office of Global Health in the Department of Internal Medicine offers educational opportunities for residents, faculty, and colleagues through existing relationships with institutions around the world. Learn more by visiting their website.