Jerome Kabakyenga: prioritising rural health research in Uganda

Abstract

In the 20 years since Jerome Kabakyenga graduated from the Makarere School of Medicine, in Kampala, Uganda, his career has gone full circle. As a young doctor he worked as a medical officer treating patients at a rural hospital in the Bushenyi district of western Uganda. Now Kabakyenga wants to return to Uganda's rural communities to undertake research on the key health issues that affect these populations.After his early work practising medicine in western Uganda's rural, remote, and impoverished subsistence farming villages, Kabakyenga joined the faculty of medicine at Mbarara University of Science and Technology in 1992. This small university was created in 1989 to promote rural development and health in the west of Uganda. Here Kabakyenga built on his insights from rural medicine to push students from mostly urban, fairly affluent homes out of Mbarara and into the hinterland villages, where infant mortality is high, life expectancy short, food shortages a seasonal norm, and HIV/AIDS, malaria, cholera, tuberculosis, polio, and even Ebola are all part of a doctor's daily duties. After a decade of teaching, which focused on HIV/AIDS, child and maternal health, and malaria, Kabakyenga became Dean of Medicine at Mbarara University of Science and Technology. But now, after 8 years juggling teaching, administration, and research, he wants to get back to where he started: “It's time to ask someone else to take over as Dean”, he says. “The conditions are now ripe in Uganda for rural health research. And I want to go back to the villages to do that.”Uganda, says Kabakyenga, is on the road to recovery after two decades of civil war that sent “almost all of the top researchers in the country into exile”. Government support for education and health care is meagre, he notes, “but at least it's stable. The turbulent period has passed. We're now in post-recovery. And whereas our institutions were struggling in the 1990s and teaching was the dominant focus in medical education, there is now the stability required for research.”The funding picture for research is also brightening, says Kabakyenga, thanks to growing appreciation among researchers internationally that Uganda is a fertile place to forge collaborations. A flood of HIV/AIDS research collaborations in recent years has helped lay the foundation for new research themes driven by international concern about child and maternal survival. “There has been a boom in HIV/AIDS research in Uganda that left maternal and child health research at the side”, Kabakyenga explains. “Now, there is a growing belief that these areas need greater research support as well. I don't think research funding has switched from HIV/AIDS, but I do think child and maternal health has emerged as a second major theme. At this point, however, most of the funding for HIV/AIDS research is international, while most of the child and maternal research is internally funded. But HIV research helped build the capacity.”To illustrate this point, Kabakyenga takes me on a walking tour through the research laboratories at Mbarara University of Science and Technology. The first stop is the university's state of the art HIV/AIDS laboratory, which was kitted-out with funding from the Italian Government. The laboratory is a gleaming model of high-tech sophistication. By contrast, in the university's public health laboratories equipment is sparse and antiquated. The manager on duty explains that since the regional public hospital has no laboratory, the university's teaching laboratory doubles as the main regional diagnostic laboratory. “We can do rapid and comprehensive viral load analyses for HIV patients”, says Kabakyenga with careful impassivity, “but we can't always manage a timely malaria test”.For Ugandan researchers hoping to open up new fields of investigation aimed at tackling the country's biggest killers—malaria, pneumonia, and intestinal diseases—“the challenge is to get the prominence of child health and maternal health to reach the level that HIV has achieved”, says Kabakyenga. Recent efforts to pass national legislation aimed at bolstering maternal health suggest that the issue is gaining prominence in Uganda at a time when international health research funding is also growing. Over the past decade, Kabakyenga has benefited from a series of collaborations with Canadian and Swedish researchers investigating child and maternal survival.Jude Kimbowa, a paediatrician at the Mbarara Regional Referral Hospital, says the research gaps are numerous in child and maternal health. “I wouldn't say we're at the point of hopelessness”, he said during a recent shift on the malnutrition ward, “but there is a lot out there that we have not been able to look at. Take malnutrition. We did a small retrospective in 2008 and found that 80% of admissions had some degree of malnutrition, and 40% were severe. Almost no one is looking at other common childhood illnesses—diarrhoea, pneumonia, intestinal infestations.”Kabakyenga is now beginning studies of obstructed prolonged labour. This effort got a big boost last year when he was awarded a Teasdale-Corti Global Health Leadership Award from Canada's Global Health Research Initiative, which supports his research with about US$200 000 over 4 years. “It's a personal decision to make research the priority”, he explains, “but the international collaborations, and the Global Health Award, are pushing me”. In the 20 years since Jerome Kabakyenga graduated from the Makarere School of Medicine, in Kampala, Uganda, his career has gone full circle. As a young doctor he worked as a medical officer treating patients at a rural hospital in the Bushenyi district of western Uganda. Now Kabakyenga wants to return to Uganda's rural communities to undertake research on the key health issues that affect these populations. After his early work practising medicine in western Uganda's rural, remote, and impoverished subsistence farming villages, Kabakyenga joined the faculty of medicine at Mbarara University of Science and Technology in 1992. This small university was created in 1989 to promote rural development and health in the west of Uganda. Here Kabakyenga built on his insights from rural medicine to push students from mostly urban, fairly affluent homes out of Mbarara and into the hinterland villages, where infant mortality is high, life expectancy short, food shortages a seasonal norm, and HIV/AIDS, malaria, cholera, tuberculosis, polio, and even Ebola are all part of a doctor's daily duties. After a decade of teaching, which focused on HIV/AIDS, child and maternal health, and malaria, Kabakyenga became Dean of Medicine at Mbarara University of Science and Technology. But now, after 8 years juggling teaching, administration, and research, he wants to get back to where he started: “It's time to ask someone else to take over as Dean”, he says. “The conditions are now ripe in Uganda for rural health research. And I want to go back to the villages to do that.” Uganda, says Kabakyenga, is on the road to recovery after two decades of civil war that sent “almost all of the top researchers in the country into exile”. Government support for education and health care is meagre, he notes, “but at least it's stable. The turbulent period has passed. We're now in post-recovery. And whereas our institutions were struggling in the 1990s and teaching was the dominant focus in medical education, there is now the stability required for research.” The funding picture for research is also brightening, says Kabakyenga, thanks to growing appreciation among researchers internationally that Uganda is a fertile place to forge collaborations. A flood of HIV/AIDS research collaborations in recent years has helped lay the foundation for new research themes driven by international concern about child and maternal survival. “There has been a boom in HIV/AIDS research in Uganda that left maternal and child health research at the side”, Kabakyenga explains. “Now, there is a growing belief that these areas need greater research support as well. I don't think research funding has switched from HIV/AIDS, but I do think child and maternal health has emerged as a second major theme. At this point, however, most of the funding for HIV/AIDS research is international, while most of the child and maternal research is internally funded. But HIV research helped build the capacity.” To illustrate this point, Kabakyenga takes me on a walking tour through the research laboratories at Mbarara University of Science and Technology. The first stop is the university's state of the art HIV/AIDS laboratory, which was kitted-out with funding from the Italian Government. The laboratory is a gleaming model of high-tech sophistication. By contrast, in the university's public health laboratories equipment is sparse and antiquated. The manager on duty explains that since the regional public hospital has no laboratory, the university's teaching laboratory doubles as the main regional diagnostic laboratory. “We can do rapid and comprehensive viral load analyses for HIV patients”, says Kabakyenga with careful impassivity, “but we can't always manage a timely malaria test”. For Ugandan researchers hoping to open up new fields of investigation aimed at tackling the country's biggest killers—malaria, pneumonia, and intestinal diseases—“the challenge is to get the prominence of child health and maternal health to reach the level that HIV has achieved”, says Kabakyenga. Recent efforts to pass national legislation aimed at bolstering maternal health suggest that the issue is gaining prominence in Uganda at a time when international health research funding is also growing. Over the past decade, Kabakyenga has benefited from a series of collaborations with Canadian and Swedish researchers investigating child and maternal survival. Jude Kimbowa, a paediatrician at the Mbarara Regional Referral Hospital, says the research gaps are numerous in child and maternal health. “I wouldn't say we're at the point of hopelessness”, he said during a recent shift on the malnutrition ward, “but there is a lot out there that we have not been able to look at. Take malnutrition. We did a small retrospective in 2008 and found that 80% of admissions had some degree of malnutrition, and 40% were severe. Almost no one is looking at other common childhood illnesses—diarrhoea, pneumonia, intestinal infestations.” Kabakyenga is now beginning studies of obstructed prolonged labour. This effort got a big boost last year when he was awarded a Teasdale-Corti Global Health Leadership Award from Canada's Global Health Research Initiative, which supports his research with about US$200 000 over 4 years. “It's a personal decision to make research the priority”, he explains, “but the international collaborations, and the Global Health Award, are pushing me”. Uganda registers successes with child-health volunteersThanks to a small cadre of village volunteers, trained in basic health-care concepts, western Uganda is beginning to see some promising improvements in child health. Paul C Webster reports. Full-Text PDF