Before 2009, there were no full capacity emergency departments to provide emergency care in Tanzania.
Instead, hospitals had outpatient departments where patients could go for urgent care – but most outpatient departments closed at night and doctors were not always available after hours.
In 2010, Muhimbili National Hospital (MNH) opened the first full capacity emergency department in the country and needed doctors specifically trained in emergency medicine. In the same year, Muhimbili University of Health and Allied Sciences (MUHAS) launched a residency-training program in emergency medicine (EM).
This is when the fledgling field of emergency medicine in Tanzania crossed paths with former GloCal fellow, Hendry Sawe, a new Tanzanian doctor ready to launch into his career.
“I had never heard of EM before, I’d only seen it on ER series on TV,” said Sawe.
After his medical school training, he took a job as a junior physician at the MNH emergency department and soon realized it was his calling. Three years later, Sawe graduated from the MNH EM residency in the first class of eight emergency medicine specialists in Tanzania.
During the program, he traveled to the US to shadow emergency doctors and started developing research projects.
“My mentors in the US, and at home in Tanzania supported me as I developed my research interests. A few of them even personally funded my first research projects and for that I am very grateful,” he said.
One of his mentors, Dr. Teri Reynolds (UCSF faculty and scientist for the World Health Organization) encouraged him to apply for a GloCal Health Fellowship. He applied with a research project that examined the presentation and management of acute presentation of chronic illnesses with a specific focus on HIV and sickle cell disease, to inform guideline development for emergency departments in Tanzania and Sub-Saharan Africa.
He received the fellowship and joined the 2014-2015 GloCal cohort.
“We see patients who come in [for care] late because they’ve stayed at home for a long time, so our guidelines may not be a copy/paste of the guidelines we got from the US or Europe,” said Sawe.
Sawe’s GloCal project used clinical data to inform what modifications needed to be made to the guidelines to reflect the local context in Tanzania.
During his year as a GloCal fellow, Sawe cared for many patients with sickle cell disease and HIV and enrolled those who met the criteria into his study.
A child patient with sickle cell disease who he tried to enroll into the study stands out in his memory. The child’s guardian supported the idea, but the child ended up not meeting the study inclusion criteria. Sawe gave the guardian his phone number in case anything changed. About a month later Sawe got a call from the child’s guardian: the child was in the hospital again.
“He told me in Swahili, ‘I want you to enroll my child into your research because I strongly believe that what you’re doing will impact care and probably find a cure for this disease for my child and other children.’”
“It really meant a lot to me to have a patient acknowledge the value of the work we do,” said Sawe. “This is the reason I do research – to find solutions to problems that will impact the lives of patients today and tomorrow.”
While his patients are the inspiration for Sawe’s research, it was the GloCal program that made him the researcher he is today.
“The experience I had with GloCal really transformed me as a researcher,” said Sawe. From learning how to design a project, to managing the finances, developing a reporting structure and publishing, Sawe’s GloCal experience made him the researcher he is today.
At the GloCal orientatin in Bethesda, MD, Sawe made connections with junior and senior scientists also working in global health but in different contexts.
Additionally, “the mandate from GloCal that you must meet regularly with your mentors really propelled my career as a researcher,” said Sawe. He credits regular contact with his mentors, including Reynolds, Professor Lee Wallis (University of Cape Town) and Dr. Julie Makani (MUHAS) as the backbone of his research training.
Today Sawe manages three projects that are slightly larger than his GloCal project and is a senior lecturer and head of the Emergency Medicine Department at MUHAS. His goal is to continue doing research that affects people’s lives in low- and middle-income countries, particularly in Tanzania.
Sawe remains involved in the GloCal program. He serves on the steering committee, where he is involved in recruiting new fellows. He also mentors trainees, including 2017-2018 GloCal fellow Catherine Shari, emergency physician at MUHAS.
“I feel fortunate to have been able to support some subsequent fellows myself,” said Sawe. “I believe the extra support will change how they do research and continue to improve emergency medicine in Tanzania.”