Global Health Program and Partnership in Tanzania
“You can’t do this work without having deep, trusting relationships with your partners ... It takes commitment over time, plus mutual trust and care, in order to learn and grow together through challenging times.”
Innovative Partnership Changes Lives in Tanzania and at Cornell
Story by Jonathan Miller for Global Cornell
It was 10 years ago, but Kathy Houng ‘10 still vividly remembers the bus ride to her Global Health Summer Program learning placement in rural northern Tanzania.
“It was really difficult to get to,” she recalls. “Very bumpy and uncomfortable.”
When she finally arrived, she met with a representative of an international nonprofit providing HIV/AIDS treatment and prevention services to the wives and children of men working in Dar es Salaam and Zanzibar, on Tanzania’s east coast.
“He told me that an entire truckload of vaccines had been unable to get there because of the road conditions,” she says. “The truck was stuck. Families in the village were expecting that their children would be vaccinated, but there was no knowing when the supplies would arrive.”
It was an object lesson in one of the fundamental principles of public health: context matters. Every patient is enmeshed in a complex web of family, community, culture, geography, infrastructure, economy and history. It is something Houng, who now works as a nurse practitioner with immigrant families in Philadelphia, is reminded of every day.
“As medical professionals, we’re trained to assess and diagnose, and while we do take into account the family and other factors, it’s really at a micro-scale,” she says. “When I see the issues that my patients are dealing with, it really reminds me of Tanzania.”
The Global Health Summer Program in Tanzania turned 10 years old last summer. It serves both Cornell undergraduates and fourth-year medical students at Kilimanjaro Christian Medical University College (KCMUCo) in the small northeastern city of Moshi, on the flanks of Mt. Kilimanjaro, Africa’s highest mountain. To date, 138 Cornell students and 140 KCMUCo students have participated.
For the Cornell students, the eight-week program fulfills the experiential learning requirement for the Global and Public Health Sciences major and the Global Health minor in the Division of Nutritional Sciences (College of Human Ecology and College of Agriculture and Life Sciences). Students also may enroll in programs in the Dominican Republic, India, or Zambia.
“To have students work in such an intense setting, from two different contexts, and two different academic institutions, it’s really unique,” says Global Health Program director George D. Levy Faculty Award for her leadership of the Tanzania summer program, which she helped create. “There are other institutions watching what we’re doing, and they think it’s really special.”
The Tanzania program grew out of a seed grant from the Mario Einaudi Center for International Studies. From the beginning, Moseley says, it has been built on the principles of openness, reciprocity, innovation, and critical self-reflection. Those principles are integral to the student experience; they also drive the evolution of the program itself.
“We try to make the students understand that they are key stakeholders in a partnership that represents a huge investment from the two institutions,” Moseley says. “This isn’t just for them, this is something they are co-creating with us.”
The program is divided into two segments. For the first four weeks, students from both universities work in small teams on a specific global health issue. They meet with stakeholders (health practitioners, policymakers, nonprofit representatives, others), debate the issues, and produce a case report complete with policy recommendations.
To date, 138 Cornell students and 140 KCMUCo students have participated in the Tanzania summer program.
Among the 60 topics investigated to date are childhood stunting, maternal mortality, mental health services, emergency care, blindness, HIV/AIDS, albinism, breastfeeding, teen pregnancy, geriatric care, and domestic violence.
The KCMUCo students then go back to their medical studies while the Cornell students spend the next four weeks doing hands-on work with local nongovernmental organizations. They live with host families and operate as much as possible in Kiswahili, the local language.
“You can’t do this work without having deep, trusting relationships with your partners,” Moseley observes. “And not just with our academic partner, but also with our homestay families and our different service placement organizations. It takes commitment over time, plus mutual trust and care, in order to learn and grow together through challenging times.”
“To me, the important thing is the mind change. This program is really changing attitudes.”
Rachel Manongi, MD and professor of community health at KCMUCo, helped conceive the program with Rebecca Stoltzfus, who was then a professor of nutrition at Cornell. (Stoltzfus is now president of Goshen College in Indiana.) Manongi says her students and fellow professors have benefited from the partnership. “To me, the important thing is the mind change,” she says. “This program is really changing attitudes.”
Honest Massawe, MD, was a classmate of Kathy Houng in the program's inaugural cohort in 2009. The following year, he spent a month at Cornell as a visiting scholar, interacting with faculty and students on campus. Today he is a pediatric surgeon and medical school professor.
“The Cornell collaboration introduced the world to me,” Massawe says. “It changed the way I see things, the way I judge things.” He credits the cross-cultural teamwork and critical reflection for influencing both his work and his teaching.
Recently, Massawe has been meeting with the Tanzanian Ministry of Health to share his ideas on how to address the overuse of antibiotics in the country. He says he never would have considered trying to affect change at such a scale if he hadn’t gone through the Global Health summer program.
“I realized that there was more to medicine than treating patients. It was also about making care equitable, affordable and accessible.”
Caleb Joel, MD, a KCMUCo graduate who participated in 2016, worked on a student team studying barriers to care and support for people with physical disabilities. The next year, he was invited to present the group’s findings at the annual conference of the Consortium of Universities for Global Health in Washington, D.C.—that was the first time he had traveled outside Tanzania. In 2018, he attended the consortium’s ninth annual conference in New York.
“The program made me see,” Joel says. “I realized that there was more to medicine than treating patients. It was also about making care equitable, affordable and accessible.”
Although he still plans to practice medicine, Joel has enrolled in a public health master’s program in Tanzania, and he is determined to continue working on disability issues. “It’s the Global Health program that started all this,” he declares.
Cornell student Jenny DiPietro ’17 was in Joel’s group. She says the program changed her life, too. Among the highlights, she cites: living with her Tanzanian host family where “the hospitality is unreal,” interviewing community stakeholders and spending time trailing nurses, doctors and midwives at a local hospital.
One particular moment stands out. “I was in the labor and delivery ward, and there was about to be a critical delivery, and everyone stopped and prayed,” DiPietro recalls. “One of the officers pulled me aside and explained that there weren’t any sterile scissors, so if the baby came out with its umbilical cord around its neck, they wouldn’t be able to cut it. I felt sick to my stomach, thinking about the sorts of things we take for granted.”
The delivery went well, and the baby and mother were fine. But DiPietro had found a calling. “I really credit that experience with pushing me toward maternal and child health, and especially reproductive health,” she says. She expects to attend medical school next year, ideally in a program that offers a supplementary degree in public or population health.
Many of the Cornell participants report the same sort of career recalibration. Psychology major Soumeeka Koneru ‘20 took part in the program in 2018 and did her service learning in a center for children with disabilities.
“I grew up thinking I’d be a pediatrician,” Koneru says. “The program experience actually made me more unsure of my career path, but it made me more sure about my interest in working with children. I realized that pediatrics isn’t the only option.”
When director Moseley looks back at the program’s first decade, she can’t help but take pride in the number of lives and careers it has influenced. But she also is struck by what the students have given back.
“There’s a thread of connection, where they’re building on what other students have done in the past,” she says. “The students are really key stakeholders in these programs, helping us to cultivate and maintain these partnerships.”