Collaborating with health centres in Tanzania and Jamaica
20 August 2013
Professor Tim McHugh, Director of the UCL Centre for Clinical Microbiology, explains why working with and in resource-poor countries is so important, both for research and teaching.
My department has a long-standing collaboration with the Kilimanjaro Christian Medical Centre (KCMC) in Tanzania. We started off wanting to do clinical research projects in microbiology on malaria, tuberculosis and respiratory infections, but very quickly learned that the laboratory support for what we were doing wasn’t there; the people working in the labs had very low skill levels and knowledge bases – so we started thinking about how we could improve the situation.
We obtained funding from the Nuffield Foundation to run an MSc course from the Royal Free (when we were still part of it), with two terms of desk training in London and one term of practical work in Tanzania. The idea for the Tanzania-based term was for students to do service development-themed projects, focusing on improving the microbiological services onsite and gaining fantastic experience at the same time.
When we developed the MSc programme we wanted to teach Tanzanians as well as Europeans. The course ran for five years with around 40 students, but over that period we only taught four Tanzanians. There simply weren’t enough Tanzanians who were both interested and who had appropriate undergraduate degrees for a UCL MSc.
That led us to apply for funding to help colleagues at KCMC set up a diploma course for people aged over 18 to study healthcare sciences, leading to a BSc which in turn prepared them for a Master’s. Both the diploma and the BSc are now successfully run by KCMC. We provided training for the teachers but they do the actual teaching on the course themselves; they’re self-sustaining now, feeding their graduates into healthcare-related jobs throughout East Africa. So we achieved what we were trying to do: to create a sustainable model for healthcare science education in Tanzania. (We also funded two people to do part-time PhDs at UCL, one of whom worked here as an Associate Lecturer for eight years – she’s now fully qualified and is taking a leadership role in KCMC.)
I’m personally interested in Tanzania due to my research specialism in tuberculosis. While there are cases in London, the situation here is very different from rural East Africa, where the service is unlikely to be so good. Doing research that is relevant to the needs of the population in different settings is important, as is prioritising patient need. Collaborating with centres in Africa and elsewhere around the world means you can build capacity for healthcare in those settings and this reflects UCL’s global research agenda. Initiatives from UCL and the Institute for Global Health have changed the paradigm for UCL; we have gone from doing things that are central to our own aims to sharing our expertise and making an impact on a global scale.
While we are no longer running the split-site MSc, there are still opportunities for enthusiastic postgraduates to go over to Tanzania. We are open to conversations – students quite often come to see me and say that they’d like to get experience of working in Africa, and we’re now also working in Jamaica: last year I sent two of our scientists, one of whom is a UCL PhD student, to look at the clinical services at the University of the West Indies and in Kingston.
Working in resource-poor settings can be challenging so if a student does express interest in working in such an environment I set a series of tasks to make sure they’re up to it. As well as making them responsible for obtaining their own funding, I engage with them over several months, supporting them but setting quite a high barrier to make sure that when they go there they will get something out of it and not be too overwhelmed.
Biomedical students tend to theorise about disease in isolation but are unlikely ever to even be in the same building as, say, a TB patient while they’re studying, so actually going into an environment where you can see that sort of activity up close is a big lesson. The cultural aspect of mixing with different communities and societies is really important too: in some countries there are hierarchies and various other factors that affect your interactions with a patient. Some patients will tell you what they think you want to hear rather than the truth, and you also have to consider etiquette – orthodox Muslim women will not want to shake your hand, for example. It’s important to think about all of these things before operating in a different setting.
That said, if you travel during your studies or your career it gives you the opportunity to look at your work from a new perspective. If you’re in a different physical environment with people who are not part of your immediate cohort of friends or normal support network, you are more likely to challenge what you’re doing. I certainly think about this as a teacher because we’re all used to saying what we do but perhaps not explaining why. When someone from a different environment questions us it is a very valuable experience, especially as academics are meant to constantly question things. That’s what travelling to a different environment can do: it can lead you to ask questions that you wouldn’t think of in your cosy north London office.
Interview by Ele Cooper