By Rupal Ramesh Shah
“In low resource settings, the biggest challenge is to ensure not just that the healthcare needs are continuously met but to also develop long-term partnerships to ensure that future technologies and developments will reach the people who need it the most.“
Over the past 15 years, I have worked in the field of public health, and much of my experience has come from field work in South Africa, Tanzania, and Haiti. One of the key lessons I have learned is that large disparities continue to exist in terms of access to quality healthcare between high-income and low- or middle-income countries. And even after years of aid – both financial and in-kind – the gap remains wide. I believe that an essential element of success is local healthcare champions, who are the stewards of their country in terms of taking care of their people. One such champion is Stellah Mpagama.
Born, educated, and trained in Tanzania, Stellah Mpagama is a homegrown infectious disease expert. She graduated in 2005 from the University of Dar-es-Salaam (now known as Muhimbili University of Health and Allied Sciences), in Dar-es-Salaam, Tanzania. Soon after, she accepted a job with the Ministry of Health, and in 2007 was assigned to her first posting at Kibong’oto Infectious Diseases Hospital (KIDH),a national hospital that focuses on caring for patients with infectious diseases, especially tuberculosis (TB).
Mpagama wanted to continue working in her own country, and went on to earn a doctoral degree at Kilimanjaro Christian Medical University College (KIDH) in Moshi, Tanzania. She credits her success to mentors who supported and inspired her. “I have aligned myself with strong networks of mentors and collaborators,” she said.
In a country with a high TB burden, KIDH was built in 1926, during the time of British East Africa, as a sanatorium for TB patients. Located in the Tanzanian district of Siha, against the backdrop of the beautiful Mount Kilimanjaro, the hospital has served as a sanctuary for the villagers in Kibong’oto, and became the referral hospital for TB care during the development of the Tanzanian National Tuberculosis and Leprosy Program by the Ministry of Health in 1977. As drug-resistant TB cases increased and spread throughout East Africa, the work of the hospital became critical. Today, people travel from far and wide to obtain expert medical care for infectious diseases at KIDH.
According to Mpagama, who is the hospital’s senior research fellow, KIDH serves approximately 400 outpatients a week and about 70 inpatients, ages 7 to 78. The staff consist of approximately 20 physicians, 70 nurses, and 110 allied health professionals such as pharmacists, laboratory technicians, and administrative personnel. This strong team cares for patients 24 hours a day, 7 days a week.
“During my training, I was humbled by what I learned about TB, a disease that has afflicted the African continent for over 100 years. We continue to create an awareness for patients on topics of TB, poverty, and inadequate access to healthcare. At KIDH, we care for patients with all forms of TB, including susceptible and resistant strains. In my time, I have learned a lot about the implementation of care for patients with MDR-TB, a form of TB that is resistant to two first line, anti-TB drugs, isoniazid and rifampin,” said Mpagama.
According to the World Health Organization, on the African continent only about 50% of MDR-TB cases are detected. “That means many patients die from the disease before they are even diagnosed. In a study conducted at KIDH during my doctoral studies, we revealed that the time between sputum collection from TB patients to onset of treatment was approximately nine months. Now it has been reduced to less than one month. It is still not ideal, but there have been significant improvements,” she proudly explained.
According to Mpagama, another gap in the care of TB patients is the lack of awareness on the part of coordinators. “During interviews with the TB coordinators, we realized there were many knowledge gaps. The coordinators are supposed to empower others and that means they have to be very well-trained.” KIDH strives to ensure consistent training takes place to provide quality education. To that end, with support from the European and Developing Countries Clinical Trial Partnerships, Mpagama established a research capacity strengthening program for addressing emerging and re-emerging infectious diseases in Tanzania. In this program, she mentors a handful of students as they prepare to work in the field of infectious diseases. “I strongly believe in capacity building, as that is the number one way to address the gaps in access to quality healthcare for the citizens of this country. The more trained professionals we have in the field, the better equipped we are to care for our own people,” she said.
“In low resource settings, the biggest challenge is to ensure not just that the healthcare needs are continuously met but to also develop long-term partnerships to ensure that future technologies and developments will reach the people who need it the most.”
Mpagama attributes much of her success, as well as that of KIDH, as a whole, to strong partnerships and collaborations around the world. “Without the funding, we wouldn’t have been able to purchase supplies to do the work, and without the support of TB experts in the field, we wouldn’t have been able to discuss and address the key issues that affect our patients,” she said.
I worked with Mpagama in Tanzania in 2014 and was impressed by the way she uses her professional expertise to care for her own people, who have been disproportionately affected by infectious diseases, while also sharing the knowledge she has acquired with others in an effort to boost their growth. She is the quintessential example of someone moving forward and lifting everyone up along the way!
Rupal Ramesh Shah is a third-generation Tanzanian who grew up in an ethnically Indian family in the town of Moshi, at the foot of Mount Kilimanjaro. Her family immigrated to the U.S. when she was a teenager.