Carolinas HealthCare System Physicians Help Shape Tanzania’s Future in Emergency Medicine

Locally and globally, Carolinas HealthCare System works to close gaps in care, helping patients everywhere receive the type of services they need: from cancer treatments to the most basic emergency medical care.

Since 2009, System physicians have helped providers in Tanzania develop a successful emergency medicine program in Dar es Salaam. Several faculty members of Carolinas Medical Center’s Department of Emergency Medicine, including Michael Runyon, MD; J.P. McBryde, MD; and Mark Bullard, MD; have played a significant role in the development of a new Emergency Department at Muhimbili National Hospital (MNH) and an affiliated emergency medicine residency program. Both are the first of their kind in Tanzania.

“It has been very rewarding to see our efforts come this far, and we could not be more proud of these Tanzanian doctors and nurses who have taken ownership of these programs and have shaped them into what they are today,” said Dr. Runyon, director of research and global emergency medicine at CMC.

“They are true pioneers in emergency medicine, a specialty that previously did not exist in their country. They have worked tirelessly to improve the quality of emergency care in Dar es Salaam and approximately 40,000 patients benefit from their considerable efforts each year,” he said. “We are honored to partner with them and appreciate the opportunity to continue help enhance these critical and much-needed programs and services throughout the country and continent.” 

According to estimates from the Disease Control Priorities in Developing Countries project, 45 percent of deaths in low- and middle-income countries can be addressed by the implementation of emergency care systems. But a number of barriers, including lack of coordinated advocacy for acute disease prevention and emergency care, have slowed the implementation of such services in Tanzania.  

Prior to Carolinas HealthCare System’s involvement in these projects, supported by the System’s International Medical Outreach Program, emergency medicine was not recognized as a medical specialty in Tanzania. Physicians and nurses dedicated to delivering emergency care were limited in number, training and resources. Today, the 12-bed Emergency Department in Dar es Salaam is fully staffed with clinicians who treat 100 to 130 patients every day. The department and residency program are supported by visiting faculty from a consortium of academic programs in South Africa, Canada and the United States and made possible by the financial backing of Abbott Fund Tanzania.

The residency program, a three-year Master of Medicine in Emergency Medicine at Muhimbili University of Health Allied Sciences, was created to support the long-term sustainability of emergency medicine in Tanzania by equipping local doctors with the knowledge, skill and credibility to be the leaders in this new specialty, ultimately eliminating their reliance on outside faculty support. The curriculum was developed and implemented in a coordinated effort between the MNH Head of Department and the U.S. emergency medicine faculty, and revised to a competency-based format.

The program will graduate its first class of residents in December 2013, officially creating the first eight Tanzanian emergency medicine specialists. Five of these residents visited Charlotte last year on an observational fellowship with CMC’s Department of Emergency Medicine. Several CMC emergency medicine residents also traveled to MNH in Dar es Salaam to do elective rotations, sharing their knowledge of emergency care with residents in Tanzania and learning from them in turn.

“The amount of collaboration involved in the development and sustainability of successful programs like these is truly breathtaking and something we anticipate will continue for a few more years,” said Dr. McBryde, emergency medicine physician at CMC. “To help ensure sustainability of the programs, however, we will increasingly rely on the involvement of these new graduates and their leadership to teach future residents and enhance the services they offer at the hospital in Dar es Salaam.”

One of the chief residents who will help lead the programs, Hendry Sawe, MD, recently won the “Best Resident Presentation” award at the 2013 Society for Academic Emergency Medicine Abstract Competition in Atlanta, Ga. His presentation focused on the clinical assessment of patients with severe anemia, one of many projects he completed during his residency. Dr. Sawe is the first recipient of the award, in its 30-year history, who represents a program outside of North America.

"Working with Dr. Runyon has truly transformed the way I take care of undifferentiated patients, developing and executing great research ideas and, most importantly, sharing the work we do in various high-profile scientific platforms,” Dr. Sawe said. “As a junior researcher and a clinician, I couldn't ask for better collaboration."

Dr. Sawe has also had the opportunity to present at emergency medicine conferences in South Africa, Canada and the United States and serves as a founding member, and president, of the Emergency Medicine Association of Tanzania.

“The ‘best resident’ award is among the most prestigious given to honor emergency medicine resident research,” Dr. Runyon said. “This recognition is an honor for Dr. Sawe and an important achievement for the field  of global emergency medicine. This goes to show the capabilities and medical professionalism of these residents, each bringing a unique perspective and background to the program.”

Tanzania resident physicians Michael Runyon, MD and Koka
Tanzanian resident physicians Upendo George, MD, (left) and Faith Ringo, MD, visited Carolinas Medical Center during Fall 2012 and will complete the global emergency medicine program in December 2013. Michael Runyon, MD (left), director of the Department of Emergency Medicine at Carolinas Medical Center, helped mentor Philip Koka, MD, Tanzanian resident physician, during his observational fellowship in Charlotte in early 2013.