University of Nebraska Medical Center

“If you want to go fast, go alone, if you want to go far, go together”. African Proverb – Martha Goedert

“If you want to go fast, go alone, if you want to go far, go together”. African Proverb

Three colleagues from the Dodoma Region, Tanzania visited the UNMC campus, hosted by the Center for Global Health and Development at the College of Public Health. Dean Ali Khan welcomed the visitors on their first work day with faculty and administrators gathering as colleagues with joint interests intersecting population-based maternal child health in Sub-Saharan Africa (SSA). Dr. Pinaki Panigrahi and Martha Goedert, Ph.D., arranged tours of the facilities, with an overview of interested UNMC key faculty, administrators and staff concerning the Tanzanian team’s work.

Major projects were envisioned from networking during the visit which will move forward this fall. One involves a forthcoming proposal to join forces with Innovation Campus along with an upcoming CoPH global initiative addressing disparities for children in the first 1000 days of life. Researchers across disciplines of agricultural, health care, engineering, veterinary medicine and child development will propose a project that joins forces across three University campuses: UNL, UNO and UNMC. Current researchers from UNL who are involved in ONE HEALTH projects in Tanzania, Liz VanWormer and Christopher Gustafson, joined the Tanzanian team’s visit to the Lincoln Innovation Campus. Engineering from the Durham School of Architecture, Engineering and Construction provided input through Professor James Goedert. Goedert has experience working with WaSH initiatives in the global south, and most recently as a Visiting Professor in Environmental Engineering at the University of Dodoma, Tanzania. Chris Neale (DWFI), provided an overview of projects that have been successful in SSA, concerning water and food security. The Tanzanian team, along with the Center for Global Health and Development has prioritized a joint programmatic approach to the almost 45% stunting and high sepsis deaths for children under five in the Dodoma Region. They recognize the need for cross-cutting public private partnerships that address capacity-building for sustainable ONE HEALTH and agricultural projects that loop in community-based leadership and empower local partners.

The Tanzanian team asked specifically to learn about new innovations and developments concerning UNMC’s capacity across classroom, clinical care, service and research settings. The educational ‘schooling’ included an overview of the Nebraska system’s work from Dr. Ward Peterson (Department of Health Services Research & Administration). The i-EXCEL (tour by Suzanne Torroni), the Sorrell Simulation Lab, Dinesh Chandel’s bench lab work with microbiome, and the Biocontainment Unit (Dr. Angela Hewlett, Medical Director of the unit and Infectious Disease specialist) were included in the tour. Contacts and references were  shared with the aim of promoting reciprocal affiliations with the University of Dodoma and the Ministry of Health.

Drs’ Charles, Nyundo and Ismail encouraged those within UNMC and the CoPH to consider ways to promote University-to-University collaborations that could promote excellence in education for the 1000 health care students entering the University of Dodoma system every year. They shared a vision of accommodating learning which is hampered by the tremendous shortfall in faculty members at the College of Health and the Dodoma Region. The Tanzanian team identified the ability of the Ministry of Health to access sites across the Dodoma Region that would provide opportunities for Nebraskan health care workers’ and students concerning clinical work, research and life-long learning. Each reminded us, before departure, ‘that together we go far’.

The visiting team represents health care professionals who have committed themselves to being a force for good within their own country, utilizing the enormous power of Tanzanians to meet the current health care challenges. (notice that Tanzania (URT), shows great improvement, and that statistics cover the 51% of facility cases, not the 49% still in village).

Dr. James Charles Kiologwe is the Tanzanian Ministry of Health’s Regional Medical Officer for Dodoma Region. He is a medical doctor, along with having an MPH. Dr. Charles is PI for the Harvard/MOH/UDOM study that is currently being conducted in Mvumi concerning facility and health care worker capacity along with viable life-saving skills and supply chain capacity in rural health centers. He has worked at all levels throughout the Tanzanian health care system and is aware of the acute needs of Tanzanians, especially those at the end of the road.

Dr. Azan Abubakar Nyundo is a consulting psychiatrist at the only Tanzanian National Psychiatric Hospital in Dodoma. In addition, he has a faculty position at UDOM College of Health Science teaching across the spectrum of medical education. His clinical research includes HAART and the HIV-associated neurocognitive disorders (HAND) effects for patients who are treated and those who choose to not take HAART. He is experienced with studies comparing performance of the International HIV dementia scale (IHDS) and Mini Mental Status Examination (MMSE) Scale in assessing HIV-associated neurocognitive disorders. Dr. Nyundo was a member for the planning committee for UDOM’s first International Public and Global Health Conference in March, 2016. He is most interested in developing preventive and health-promoting measures that create psychiatric and behavioral health in Tanzanians, especially for children.

Dr. Abbas Ismail Kihame is UDOM’s leading statistician in the Department of Mathematics and Statistics. He is one of the leads on the maternal-child research project in Mvumi which partners Harvard, UDOM and the Ministry of Health. Additionally, his research publications include risks factors and risk reduction among UDOM students concerning HIV infections. Abbas is coordinating maternal child health cohort studies concerning facility and health care worker capabilities for life-saving skills and survival in Dodoma Region.

Cooperative efforts had already come to fruition between UDOM and UNMC’s CoPH. Dr. Pinaki Panigrahi and Dean Ali Khan were invited as keynote speakers at the University of Dodoma’s First Annual Public and Global Health Conference (March, 2016). Both Panigrahi and Khan were well-received, presenting in unique entertaining styles the global and population health disparity topics from their respective research. Martha Goedert, working in her role as Visiting Professor at UDOM (Seed Global Health/Peace Corps) was able as conference co-chair to launch, a successful Regional dissemination of Helping Babies Breathe. Fifty HBB Master trainers from nine countries trained at a day-long workshop for experienced health care providers. With this launch, the MOH, encouraged by Dr. James Charles, became re-committed to expand life-saving, programs across three levels of training, to include the American Academy of Pediatrics’ program Essential Care for Every Baby (ECEB or Helping Babies Survive). In addition, the Integrated Management of Childhood Illnesses (IMCI) and the World Health Organization’s Handbook for Pediatrics were used for teaching these life-saving skills and protocols. http://www.who.int/maternal_child_adolescent/documents/child_hospital_care/en/ 

Master trainers were able to take the life-saving skills across facilities and universities, including UDOM, KCMC, CUHAS and Hurbert Kariuki Memorial University. Over 400 health care professionals were trained in HBB and an additional 50 trained in HBS. Peace Corps/Seed Global Health Service Partnership colleagues, Elisa Vandervort (University of Utah) and Hannah Bergbower (Partners in Health, Malawi) and UDOM faculty/students joined forces with the hub and spoke teaching method of ‘simulation in a suitcase’. Further dissemination was supported by Dr. James Charles, (RMO of Dodoma Region) to expand outreach to the Mpwapwa District, in coordination with the DMO (Said Mwaji). The training included a partnership with a faith-based community health outreach effort by Dodoma Christian Medical Center.

There was a concerted effort, partnering across institutions, across silos of health professions to create a viable plan to impact neonatal and maternal mortality. The Tanzanians are expert at using basic, responsive and responsible training in clinical settings to mediate the extremes of NMR and MMR. American health care students ‘benefit from African ‘missions’ as much as Africans benefit from American ‘exchanges’. This, simply put, is ‘reverse mission’. Each of us has had the experience of seeing one, doing one, teaching one. When we accompany others in their learning and they accompany us, there is no limit to the achievements both globally and at home. The greatest challenge of doing this across all boundaries is to work in partnership, listening and responding with great love.

The final activity involving the Tanzanian team was a presentation at the Tuesday Morning Rotary Club meeting in Omaha. This project will combine Rotary International funding with a Chikande, waiting home for pregnant women, in Dodoma Tanzania. This is a facility that reduces maternal mortality by enabling expectant mothers from distant locations in Tanzania to reside at the Chikande before labor begins.

The current center was built in 1992 by the Dodoma Municipal Council to accommodate 15 expectant ‘waiting’ mothers. Currently, the facility has a nightly occupancy of approximately 90 expectant mothers. The increased use of the Chikande Maternity Centre is due to a national campaign to reduce maternal deaths in the Dodoma Region, along with three districts sending high risk mothers to await delivery. In addition to Dodoma Municipality, three other districts (Manyoni, Bahi and Chamwino) are using the facility to house expectant mothers at risk for complications when laboring or delivering in their villages. The need for this updated facility has been expressed by local health care workers, and by Tanzanian families in response to the current high rates of maternal and newborn mortality, of which 90% are preventable.

One major gap in care for high risk expectant mothers is the transport to the Dodoma Regional Referral Hospital (DRRH) from the village at the time of labor. The influx of mothers late in their labor or after a fetus is dead, is seen as largely preventable. Housing provided near the Dodoma Regional Referral Hospital (DRRH), and free for expectant mothers from distant villages has been a viable solution that can address this critical gap for childbearing families. The project will link Rotary International, and the Big Results Now (BRN) with the Dodoma Julius Nyerere Rotary Club and interested American clubs. The Rotary project will be carried from the Dodoma Club to the Omaha Morning Rotary Chapter. James and Martha Goedert were regular attenders in Dodoma and now will continue to advocate for rebuilding a larger Chikande in presentations as invited speakers around the Midwest. The Tanzanian team was able to relate specifics about the Chikande to the Rotarians; they are able best to advocate from their positions of influence in the Dodoma Region.

As with all of the projects sketched out during the Tanzanian’s visit, the pivot foot centers on mothers and babies surviving and thriving. UNMC, UNL, and UNO are in unique cooperative positions to make a difference from our places of privilege and influence; our global partnerships can have an unimaginable impact, reflected in improved maternal and neonatal survival.

Martha Hoffman Goedert, CNM, FNP, PhD, FACNM

Assistant Professor, Department of Health Promotion Social and Behavioral Health

Center for Global Health and Development, College of Public Health,

University of Nebraska Medical College


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