October 23, 2015

Going global (again): How a Weatherhead education leads to an exploration of East African healthcare

J. Michael Tasse is a current student in Weatherhead's Global MBA program. The following is an excerpt from articles he has written on his blog.

Weatherhead’s Global MBA does more than just give its candidates the opportunity to learn and work in China, India and the United States. My Global MBA experience forced me to learn how to work with, better understand, and build trust between the different cultures, ages and languages of the world. As a result, University Hospital’s Department of Innovation selected me to travel to, and conduct research in, Kampala, Uganda. It was because Weatherhead's Global MBA gave me the opportunity to prove that I was able to work in cultures and settings different than mine and effectively build trust between heterogeneous groups, that I found myself on my fifth content over the course of this MBA program.

I was in Africa to document the untold relationship between Case Western Reserve University, its teaching institution University Hospitals in Cleveland and a string of medical institutions throughout Uganda. The focus of my work concerns answering the question:

Why has Case Western Reserve been so successful in Uganda, and why was building a case for dealing with Rheumatic Heart Disease (RHD) in Eastern Africa of extreme importance to the future of East African healthcare?

In short, RHD is a heart condition that results from multiple cases of untreated Streptococcal Throat Infection. It is easily treatable with benzene penicillin, but because it affects those living in extreme proximity without access to medical care, it is stereotyped as a disease of the poor. This brings with it a stigma by which parents may not seek medical attention for their young ones until the heart's valves (pipes that bring and expel blood from the heart) are too damaged for a child to live a long, healthy life. A simple series of low-cost, easily accessible penicillin injections can treat the disease.

Case Western Reserve and its teaching institution University Hospitals created a partnership in the 1980s to study HIV, Tuberculosis and Malaria in Kampala, Uganda, in partnership with the country's premier institution, Makerere University. Over the years, and as a result of the partnership, HIV, TB and Malaria outcomes have improved tremendously. HIV among children is now as low as 6% (down from 30%). Transmission of HIV from parents to children is almost 100% preventable, even in rural areas. TB is treatable, though not eradicated. Malaria takes under 25% of the lives it did 30 years ago, and is now thought to be commonly understood throughout the public. These diseases have less and less stigma associated with them every year.

So why is Rheumatic Heart Disease such an issue in Uganda?

We must understand what RHD is, why it is so prevalent in developing nations like Uganda, how people interact with healthcare, and why the improvement of HIV outcomes in Uganda has opened up a channel by which treating RHD can lead to a more sophisticated primary healthcare system in Uganda.

Educational posters and community awareness campaigns have been a direct result of Case Western Reserve’s partnership. Research between the university and Uganda’s Mulago Hospital has led to a better understanding of RHD, and also to understanding the importance of the Ugandan government investing in such community awareness. Consequently, I was able to meet with the Ministry of Health of Uganda with several doctors from Case Western Reserve and University Hospitals. The goal was to continue building relationships with government officials in order to improve the understanding of a disease like RHD, and direct funding accordingly. I never would have met the Ugandan Ministry of Health without Weatherhead’s Global MBA.

I was also able to learn more about Case Western Reserve’s contribution to echo-cardiogram machines, provided as the result of work with Case Western Reserve and several foundations. Echo-cardiograms use transducer wands to create ultrasound waves (like sonar) that effectively make an image of an organ. The magic lies in the equipment, which costs at minimum $65,000 (USD). The computer seen here receives the waves and constructs an image that can be viewed from multiple angles.The echo-cardiogram is the most reliable way to detect RHD. The power of the echo-cardiogram is that nurses trained in a basic skill set can use it.

Why is this so unique? Part of the reason is that Case Western Reserve's relationship goes far beyond the money supplied in the 1990s and 2000s, The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the HIV donations that came during that time. Many organizations moved in because strategically there were opportunities for money, and opportunities for infectious disease research in the developing worlda very important set of populations to study.

Case Western Reserve has been connected to Makerere University, Mulago Hospital and other institutions throughout the country since 1986 when Dr. Robert Salata began engaging with his colleague and mentor, the world-famous Dr. Fred Robbins who essentially pioneered the eradication of polio via medicine, cultural understanding, community organizing and most importantly, sustainable training of medical staff in Africa, specifically in Uganda.

Some of the earlier facilities from the 1990s still exist to this day. They run research programs on Malaria, Teburcelosis, HIV/AIDS, RHD and more. This photo is the first research collaboration building operating at the top of a small hill above Mulago Hospital. Once, Case Western Reserve was merely a name; now it is almost completely integrated with Makerere University Medical School's teaching programs, the Heart Institutes work procedures, guideline creation and in shaping the business processes that account and raise money for future operations.

It may all look simple, but inside these walls innovation is taking place out of both necessity, and out of passion for the future. I had the background in international project work, training and study from Weatherhead. But it was not just theory that was at work; I was able to apply the learning that comes with doing business and training in other cultures, to interacting with doctors, patients, government officials and many citizens throughout Uganda. The case study will be published in 2016.

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