Stanford University
Center for Innovation in
Global Health  

UPDATES 07.15.11

Novel Education Clinical Trainees and Researchers (NECTAR) Program in Zimbabwe

End of Year Updates

At the end of the 2013, MEPI had their annual meeting in Zimbabwe, and would like to share some of the successes of the last few years. Since the grant began, there has been a 152 percent increase in enrollment in medical school, from 92 students to 237, largely felt to be due to the excitement the MEPI project has generated. Prior to 2009, zero percentage of medical graduates went into internal medicine residency training, since the start of the grant, an average of 16 applicants a year seek internal medicine higher training. Zimbabwean students and faculty have had opportunities to come to both Stanford and the University of Colorado to learn specific skills and exchange knowledge. Over 75 faculty members from partner universities have rotated to Zimbabwe to teach and fill gaps in the curriculum.

Administrative activities focused on setting up the NECTAR organizational and operational structure

Drs. Michele Barry, Bonnie Maldonado, David Katzenstein, and Nancy Federspiel have participated in weekly conference calls with the teams from UC-Denver and UZ after the the grant was awarded in the fall of 2010.

Drs. Barry, Maldonado and Federspiel attended the NECTAR/CHRIS/IMHERZ Planning Workshop in Harare from Feb. 3-5, 2011, participating in all the sessions.

Prior to the workshop, Dr. Barry accompanied UZ faculty and students on medical rounds at Parirenyatwa Hospital and gave clinical lectures at the bedside. In addition, Dr. Federspiel and visitors from UCD were given a tour of the UZCHS undergraduate campus by Professors Jephat Chifamba and Lovemore Gwanzura, discussing the undergraduate (preclinical) curriculum as well as their teaching and equipment needs. 

Lastly, Drs. Barry and Federspiel accompanied Professor Lovemore and others on a visit to the outlying Howard Hospital and to a small district hospital as examples of rural attachment sites for the UZ medical students. Since the workshop, NECTAR/CHRIS/IMHERZ conference calls have continued on a monthly basis.

Establishment of a Zimbabwe Interest Group at Stanford

Under the auspices of the Stanford Center for Innovation in Global Health (CIGH), a Zimbabwe interest group was established to create communication and a community; currently 38 members are a part of this group.

Dr. Peter Mason from BRTI visited Stanford and attended the March 17, 2011 meeting, where he described the history of BRTI, its growing research portfolio, and his interest in building stronger ties and more collaborative research projects with investigators at Stanford.

The Zimbabwe interest group meets quarterly and has three sub-committees related to the NECTAR goals. Updates on each of these goals are provided below in detail.

  1. Medical curriculum and IT;
  2. The Visiting Professor program; and
  3. Research programs.

Curriculum

Dr. Maldonado is a member of the NECTAR Cross-Cutting Academic Committee (CCAC), charged with revising and updating the MMed curriculum in medicine and pediatrics. After the Harare workshop the CCAC has been meeting by conference call; they are developing a framework incorporating some of the concepts of team-based learning that will then be expanded to include other specialties.

In addition, medical students at Stanford, including Takudzwa Shumba who is from Zimbabwe, are working with Stanford’s Global Health Librarian, Lauren Maggio, and the Office of Medical Education to review the video-recorded Stanford Medical School curriculum for appropriate materials to transfer to UZCHS for the preclinical undergraduate medical students. Ms. Shumba, as part of her program in the Stanford Medical Scholars curriculum, will travel to Zimbabwe in July 2011 for 6 months to work with UZ medical students and faculty in coordinating the needs in Zimbabwe with the resources available at Stanford. The goal will be to supplement material available at UZCHS with lecture media and slides from the two pre-clinical years at Stanford, which uses an organ-based approach to cover anatomy, physiology, pharmacology, histology and microbiology. The plan currently is to use encrypted external hard drives to provide powerpoint presentations and other materials for faculty and students, until the IT infrastructure for UZCHS is upgraded.

Ms. Shumba was involved in organizing the Stanford Medical Leadership course, which she would like to adapt for incorporation in the UZCHS curriculum. The class introduced the fundamentals of effective leadership in health care, with a primary objective of providing students with a theoretical and functional knowledge of leadership. This was achieved through participation in skills workshops structured around activities of self-discovery and leadership immersion, as well as bi-weekly “fireside chats” where leaders from the medical school presented on their life journeys. Ms. Shumba will work on adapting this course for UZCHS, with input from former instructors and facilitators.

In the spring of 2011, Ms. Maggio participated in the FAIMER program in South Africa, where she helped to mentor the U of Z's two FAIMER fellows and taught hands-on information skills workshops. From there she visited UZCHS and collaborated with U of Z librarians and faculty to better understand the University's access to and use of information resources in the undergraduate medical curriculum and in the clinical setting. Based on these observations, Ms. Maggio will continue to work with U of Z faculty and librarians to foster information skills across the school.

Dr. David Katzenstien has developed a study design and data analysis course for burgeoning researchers, in addition to spearheading an e-learning module with faculty and staff from the Stanford Graduate School of Education, which is in its early stages.

Visiting Professors Program

Dr. Trevor Winter, a Stanford gastroenterologist and an alumnus of the Godfrey Huggins School of Medicine, University of Zimbabwe, is overseeing Stanford’s Visiting Professor program. He visited Zimbabwe from 4/22/11 – 5/7/11 to provide lectures and clinical expertise in his specialty and to help assess the needs at UZCHS so that the skills of visiting personnel from Stanford are well matched to the curriculum, calendar, and gaps in existing specialties.

Dr. Winter had extensive discussions with Professor Muguti in the Department of Surgery, where gastrointestinal endoscopy is currently being run regarding clinical, teaching, and equipment needs. They would like to organize a symposium to demonstrate esophageal banding and PEG placement. In addition, he met with other faculty and MMeds to discuss gaps in teaching and clinical expertise that could initially be addressed by Stanford faculty and fellows with the aim of developing a sustainable path for UZ faculty development in the future. In addition, Ms. Shumba will provide input from an on-the-ground perspective and help to coordinate visitors with the planned curriculum while she is in Zimbabwe from July – December 2011.

Dr. Nirali Vora, a Stanofrd fellow in Neurology, helped to launch UZCHS's first stroke unit, and Mike Ke, Chief Resident in Neurology reported on its success during his visit in the Fall of 2013. Recently, in the Winter of 2014, the Zimbabwean Minister of Health visited the unit.

Stroke Unit

Dr. Gift Ngwende (Doctor at UZHCS) outlines the operations of the Stroke Unit to the Minister of Health and Child Care, Dr. David Parirenyatwa, and his Deputy, Dr. Paul Chimedza. Looking on are Mr. Zigora (Hospital CEO), and other delegates.

In November 2013, Dr. Eduardo Corrales of ENT traveled to Harare to work with UZCHS ENT faculty and taught a temporal bone course. This grew out of a long relationship that ENT faculty, Dr. Anna Messner, has fostered with UZCHS faculty. During this same season, Dr. Andrew Connolly, also in the fall of 2013, worked with UZCHS faculty to determine their histopathology and anatomy educational needs, and taught a number of medial education classes.

As of Winter 2013, Stanford has sent faculty and fellows to Zimbabwe from Pediatrics, Internal Medicine, Infectious Disease, Nuerology, Anesthesia, Surgery, Otolaryngology (ENT), Gastroenterology, Pathology, and Emergency Medicine.

Bone Course

(Dr. Eduardo Corrales' Temporal Bone Course, taught fall 2013)

 

Research

Dr. Katzenstein has a long-term research relationship with Dr. Mason from BRTI, and Dr. Maldonado also has ongoing collaborative research projects with other investigators in Zimbabwe. Dr. Katzenstein is a member of the NECTAR Mentored Research Scholar Program and in conjunction with investigators at UZCHS, he is working to develop aspects of research projects that could be undertaken by medical students, MMeds, and other faculty. Topics include a) point of care detection of cryptococcal antigen to prevent cryptococcal meningitis in cases identified in ACTG studies, and b) a CD4-based medical laboratory information system with reflex testing for opportunistic infections (OIs) in Zimbabwe, among others. In the area of research training, Dr. Katzenstein hosted a planning meeting/conference call for training in research methods with participants from Stanford, Pangaea (Megan Dunbar and Barrot Lambdin), and the Elizabeth Glaser Pediatric AIDS Foundation (Rhoderick Machekano).

Dr. Lambdin has previously helped run a short course on Implementation Science in Peru and Mozambique and would be willing to help integrate this into the MEPI & ICOHRTA curriculum either in the fall, 2011 or early 2012. Stanford faculty who teach a bi-annual Intensive Course in Clinical Research to Stanford fellows and junior faculty have expressed interest in bringing the course to UZCHS in the next year, both to teach students and MMeds and to train the faculty so that subsequent editions of the course could be taught by UZCHS faculty.

Ms. Shumba will also work with Dr. Katzenstein to find research projects that would be of interest to UZ and Stanford students. The projects undertaken will ideally inform best practice and ultimately serve to strengthen the health system. In coming years, this research component can be expanded through peer to peer collaborations via Stanford (MedScholars funded research), and later when the infrastructure is in place, there will be opportunities for clinical student rotations and Johnson & Johnson scholar rotations in Zimbabwe.

Another new collaborative research effort has begun with Dr. Collen Masimirembwa from the African Institute of Biomedical Science & Technology (AiBST), who visited Stanford, gave a seminar and met with interested faculty and students in May, 2011. His pharmacogenetics research fits well with the Stanford SPARK program (a component of Dr. Barry’s NIH C-IDEA grant) that provides funding for the development of vaccines, diagnostics, and repurposed drugs. Three students from Zimbabwe will come to Stanford to work on a collaborative project with Drs. Katzenstein and Grimes supported by SPARK; the project will focus on developing a new method for drug resistance testing and will also involve Dr. Russ Altman’s group who have created the Pharmacogenomics & Pharmacogenetics Knowledge Base. In addition, another potential collaborative project is being discussed with Drs. Masimirembwa and Hakim from Zimbabwe, Dr. Havranek from UCD (the CHRIS project) and Drs. Assimes, Bustamante, and Snyder at Stanford, investigating the genetic determinants for the development of several cardiovascular disease states that are highly prevalent in sub-Saharan African populations.

An interest of the Research Programs sub-committee is to facilitate the publication of research from students and faculty at UZCHS, and an idea was conceived to start an electronic journal on a MEPI website for this purpose. Ms. Maggio has taken the lead in developing this concept in collaboration with MEPI coordinating center; she has convened a multidisciplinary team to work with the NIH to form an open access MEPI journal that will publish scholarship at the intersection of medical education and clinical research. In addition to providing a scholarly forum for MEPI participants, this journal will also be used as a demonstration journal providing a road map for journal formation for other groups. Ms. Maggio additionally coordinated the visit of UZCHS's medical librarian to Stanford, Masimba Muziringa, in the Summer of 2013.

Dr. Federspiel has also taught a grant writing workshop for faculty at UZCHS to assist in the development of their requests for funding.

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