Global Outreach – Clinical & Training Programs in Tanzania with Eric Powers, MD

Eric R. Powers, M.D., FACC and other partners are assisting in the implementation of an advanced clinical and training program in cardiovascular disease at the Muhimbili National Hospital in Dar es Salaam, Tanzania—the first advanced cardiac and catheterization center in the country.

Dr. Eric Powers is a Professor of Medicine and the Peter C. Gazes M.D. Endowed Chair in Clinical Cardiology, is a board-certified physician of internal medicine, cardiovascular care, and interventional cardiology. He's a graduate of Harvard Medical School and completed his residency and fellowships at Massachusetts General Hospital in Boston. He has received numerous awards for his work as a clinician and scientist and has been named one of America's top doctors.

Read The Transcript

[00:00:07] Loretta Lynch-Reichert: Hello, everyone, and welcome to the Medical University of South Carolina Science Cafe Podcast Series Science Never Sleeps. I am your host, Loretta Lynch-Reichert. This month we welcome special guest from MUSC's renowned Heart and Vascular Center. In partnership with the Friends from the Heart Lecture Series, a program that seeks to educate the public about the latest advances in heart and vascular care at MUSC. Dr. Eric Powers, Professor of Medicine, and the Peter C. Gazes M.D. Endowed Chair in Clinical Cardiology, is a board-certified physician of internal medicine, cardiovascular care, and interventional cardiology. He's a graduate of Harvard Medical School and completed his residency and fellowships at Massachusetts General Hospital in Boston. He has received numerous awards for his work as a clinician and scientist and has been named one of America's top doctors. Thank you for joining us, Dr. Powers.

[00:01:06] Eric Powers, MD: Thank you for having me.

[00:01:08] Lynch-Reichert: We have all been discussing the coronavirus for months now, and one glaring highlight of that discussion is how global our relationship is to the rest of the world, especially in terms of the spread of disease. Your work on cardiovascular disease has taken you to far-reaching locations and is the topic of today's Science Café. The partnership between MUSC Heart and Vascular Center and Tanzania, a country in East Africa with over 56 million citizens. Tell us how you and MUSC became engaged in this very exciting endeavor.

[00:01:40] Powers: The program started with a neurosurgeon at MUSC named Dilan Ellegala, who had an idea to help bring medical care to underserved populations, particularly Tanzania. He was a neurosurgeon who developed a neurosurgical program, and the goal of the program has always been to train the trainers. That is, to build sustainable capacity where these programs are taking place. So, in 2010, he invited myself and my partner in this work, Peter Zwerner, who's also on the faculty at MUSC, invited us to come to Tanzania to kind of see what was going on in cardiology without a clear mission at that time. So, we made that trip to Tanzania, and what we observed was the population in Tanzania was very underserved in many ways medically, but in particular, in the management of cardiovascular disease. So, during that visit, we had a rare opportunity to meet with the president of the country, the Ministry of Health, and the leading cardiologist in the country, who has now become and remains a close friend, and we met with them to talk about cardiovascular disease.

And they, meaning the president, the Ministry of Health, the leading cardiologist, decided that they wanted to develop an advanced cardiovascular program, which, up until that time, did not exist in Tanzania, and, in fact, existed almost nowhere in Sub-Saharan Africa, and so that's what happened. So, they asked us to help develop the program. We have done this kind of work in the past in the United States, I myself have been a director of cardiac cath labs in the United States, and so, I have experience doing this kind of work. And so, we began to help them develop these advanced cardiac services. I should say we've had lots and lots of partners along the way as well.

[00:04:15] Lynch-Reichert: What I'm curious about, for those of us who've never been to Tanzania and not really that familiar with the environment and culture, what compelled the president to think that cardiovascular disease was an important disease to start working on right away, rather than, as you indicated earlier, other than neuroscience, maybe even infrastructure, maybe even diet? I'm very curious how they came about the idea that cardiovascular disease was an important medical issue to deal with.

[00:04:49] Powers: So, I can't tell you the complete answer. I can tell you what I've heard the president speak about, and what he has told us about the answer to that question, which is a great question. And there were at least two factors which led him to decide that developed and advanced cardiovascular care was important. The first has to do, I think, with prestige of the health care system in Tanzania. With cardiovascular disease becoming important everywhere in the world, including Tanzania, he felt that, to develop all of health care in Tanzania, this would be an important frontier to develop.

The second was a more practical reason, and that was financial, and that is that, in Tanzania, when there was no advanced cardiac care, if a patient in Tanzania needed advanced cardiac care, they would have to go elsewhere for that care. And typically, they would go to India, was the most common place they would go, and this cost the government quite a lot of money. So, they did the calculation that, in fact, it would be cost savings to build an advanced cardiac program, keep patients in Tanzania, and therefore, save the cost of transfer, and them getting their care in a different country.

[00:06:15] Lynch-Reichert: You have been working on this program for 10 years. You certainly have been dealing with cardiac issues in this country for a long time. Unfortunately, America is known for a diet that kind of encourages cardiac illness. When you went to Tanzania 10 years ago, and now, what are you seeing? What kind of difference is it making, what you're doing, training the trainers, and the health of the country?

[00:06:44] Powers: It's an interesting question. Before-- 10 years ago, before all this developed, there was very little information about what the burden of cardiovascular disease in Tanzania was. And so, as this program developed, and really the advanced cardiac services began being performed in 2014. The training had begun before that, by 2014, and now, those advanced services are actually quite mature and very sophisticated, so there's been a great success in developing these services.

And what's been found is there are lots of patients with advanced cardiac disease in Tanzania. And so, in fact there is a large population which is served by advanced cardiac care. In addition to that, and a worrisome trend, worrisome for the Tanzanians, is that Tanzania is becoming more westernized in many ways. And the regrettable parts of that, and an important regrettable part of that, is diet, it's obesity, it's more diabetes. So, it's risk factors for cardiovascular disease, so we see lots of disease there now, and the expectation is that will only continue to get worse and grow.

[00:08:13] Lynch-Reichert: Dr. Powers, I understand that your program is to assist the medical community in Tanzania to learn the latest in cardiovascular care, and then to be able to train others and care for their country. Are there other partnerships that you have developed there to not only help train the trainers, but to educate the country on good heart health?

[00:08:43] Powers: Remember that this program in developing advanced cardiac care was the priority of the Tanzanian government and health care system, and they decided that this was the place to start, rather than preventive care. You could certainly argue that that is a little backwards, that perhaps preventive care should've been the place to start, but that is not what they decided to do, and we're there to help. It's not our program, we're there to assist as we can. Of course, they are very concerned about prevention. It is a resource-limited country, and so lots of different programs really can't be occurring at the same time, but of course, they are extraordinarily interested in that. And the newest part of our program now, with other partners here now at MUSC, is to find ways to bring cardiac care to the whole population of Tanzania, not just those that need advanced cardiac care, but how do we help them provide cardiac care to the whole population? And not just advanced cardiac care, but even simple cardiac care. The treatment of blood pressure, for example. Treatment of cholesterol, for example. So, yes, all those are now becoming priorities.

[00:10:08] Lynch-Reichert: What are the barriers to trying to accomplish such a huge and ambitious goal?

[00:10:16] Powers: The barriers are some that you've already implied in your questions, and they include things like infrastructure, so that, for example, the system of roads in Tanzania is very incomplete. Things like clean water, and protection from infectious diseases remain challenges. And then, there are limited resources in money as well. The entire Tanzanian medical budget is a tiny, tiny, tiny fraction of the health care budget of a country like the United States.

[00:10:56] Lynch-Reichert: While working on this program, have you found any new innovative tools or ideas that have come out of this program that you can share with your American colleagues?

[00:11:10] Powers: There's a technology which has been around for a long time, which is handheld echocardiographies. So, this is a device which is the size of a cell phone, and which can take beautiful pictures of the heart and indicate all kinds of different cardiac diseases. So, this is a device which can be carried. People can easily be trained to use it. It's inexpensive. And so, the idea that we are now pursuing is using this device out in the rural areas to screen for and help manage cardiovascular disease. We have just completed a research project, which was primarily performed by an echocardiographer at MUSC named Rich Bayer and an echocardiographer in Tanzania, which has demonstrated the feasibility of training health care workers to use this technology to, in fact, identify significant cardiac disease. So, it's a device which has been around for a while. The innovation is to train non-M.D. health care workers to use it and help provide care to large populations.

[00:12:36] Lynch-Reichert: You've spoken about the barriers that you had to overcome. Now tell us about the great accomplishments that have occurred since you started working on this project.

[00:12:43] Powers: The government of Tanzania and the medical community decided they wanted to develop these advanced cardiac services. So, prior to 2014, there had never been a single cardiac catheter procedure or angiogram or treatment of a coronary artery with a stent in the country prior to 2014. So, since that time, with training, they have now developed an outstanding first-class program in cardiac catheterization, angiography, and treating coronary arteries. So, now they are working day and night treating patients with high quality, very high success. And, in fact, they have just recently been recognized as the predominant center in Sub-Saharan East Africa for these advanced cardiac services. So, in a consortium in Sub-Saharan East Africa looking at all different areas in health care, this particular program has been identified as the leader for advanced cardiac care.

[00:14:01] Lynch-Reichert: You are listening to MUSC's Science Cafe with Dr. Eric Powers, a cardiologist and researcher in partnership with our Heart and Vascular Center Friends from the Heart program. Dr. Powers, it comes to mind to me that when we are healthier, we are more productive, quality of life improves, the economy improves. Have you seen – to me it’s very exciting that Tanzania is at the heart, if you will, of this program that others can learn from, others can build from. What have you seen in terms of both quality of life and economic development in Tanzania because of this program?

[00:14:47] Powers: I think it's too early to answer that question. Although this program has been a tremendous success, it treats about-- or has resulted in the treatment of perhaps 1,000 to 2,000 patients a year, which is a great accomplishment going from zero. But, in a country of the population of Tanzania, it obviously is just a drop in the bucket, and so the long-term benefit,

I think, is a little hard to predict. The country is doing well economically, or had been doing well economically until the most recent crises, particularly around COVID. You know, so there's great optimism. The final overall benefit of the program, I think, is yet to be determined.

[00:15:44] Lynch-Reichert: One of the other issues that comes to mind to me is you train specialists there, and what keeps them in the country rather than taking their talent to other countries?

[00:15:58] Powers: That's a wonderful question, and that has been a problem with developing health care and other areas as well all around the world. And the answer is that the people who are in Tanzania, the Tanzanians who are now there are extraordinarily committed to health care in their country. So, I'm delighted to report that as we've been helping train the trainers over the last 10 years, there really has been no significant loss of the people we have trained, and, in fact, quite the contrary, that training the trainers has worked, so now there is a new generation of trainees being trained by the first people we did train, who are committed to developing these programs, as well as preventive care and other cardiovascular care. So, it was a concern starting that this might happen. I am very pleased to report that there is no sign that –

[00:17:05] Lynch-Reichert: That's quite an accomplishment. But what about bringing our own students to Tanzania to see what you've accomplished and what the citizens of Tanzania have accomplished? Because we're a global society, certainly they can learn a thing or two.

[00:17:21] Powers: So, we decided several years ago that our mission at MUSC is clinical care, research, and education. So, several years ago, we developed a medical student rotation, so every year we take two or three medical students with us. We also have a rotation for a cardiac fellow. A cardiac fellow being someone who is doing subspecialty training in cardiology just prior to finishing all their training. So, yes, so education is an important part of the program at the present time.

[00:17:56] Lynch-Reichert: And what do the students say to you when you come back?

[00:18:03] Powers: Well, the experience that everybody has who does this kind of work is that it's a life-changing experience, and it's something that you can't anticipate before you go, but you are definitely changed by it. And so, they come back. We choose students to go who are extraordinary people. They are all unbelievable people who will be leaders in American medicine. It may not be in global health it almost certainly won't be in cardiology, but they will be leaders in American medicine. And so, what they bring back is an appreciation for and insight concerning treatment of the underserved. And that is something which is, of course, critical in the United States, as every place else in the world. We certainly have large, large underserved populations. And so, the students who come back will be leaders, will have met treatment of the underserved as a priority, and I think will result in important improvements in care in the United States as well. At least, that's the model we have, and so far, it seems to be working.

[00:19:28] Lynch-Reichert: You know, necessity is the mother of invention and I can imagine these really smart, talented, compassionate and really dedicated students come back and start thinking of how they can make a difference, as you noted, in our own rural areas and I would expect out of all of this for them to come up with really great innovative ways to change medical care across the country. What is your hope for this program? Not just in Tanzania. Do you see it expanding elsewhere, or what would you like to see in the next 10 years?

[00:20:09] Powers: The next steps, I think, are some of the ones that you have identified. The developing advanced cardiac care really is well on the way in Tanzania, so now it's gonna be about delivering cardiovascular care to the larger populations in Tanzania and beyond. Can this be a model for care in other areas as well? And the answer is, "We hope so." I mean, there is nothing really special about what we are doing that could only apply to cardiovascular care. We think a lot of what we're doing could be applied to care in lots of other areas, which are important in Tanzania, but important all over the world.

[00:21:02] Lynch-Reichert: This is a laudable program, and it's one that needs support, and I think that one of the things we'd like to say today that we'd like our listeners to hear is how can they engage in this program? But before you answer that question, tell me why we should care. We, in this comfortable, rich country, who have fabulous physicians, such as yourself, taking care of us, why should I care about the citizen of Tanzania?

[00:21:31] Powers: Well, there are two reasons. One is because we care about everyone. And it's the right thing to do. But beyond that, if we are successful in this program as we have been, and particularly as we train our young, rising health care workers, particularly medical students I'm talking about, but it can be others as well, it's what we talked about before. They will come back educated in something which is critical in advancing health care in the United States. That is carrying forward the underserved. And that is a critical frontier for all of us, and we think that programs like this support these programs right here at home.

[00:22:32] Lynch-Reichert: I couldn't agree with you more, especially in this day and age and I think it is a powerful statement. And I think what it also says to our listeners – MUSC physicians and health care workers in general, when we have these podcasts, we bring not only the elite in their skillset, but the compassionate. So you bring a whole set to the table when you’re looking at an issue, it’s not just your skillset, it’s not just your education and expertise, it is the dedication and compassion of our faculty and I think that’s a highlight I’d really like to bring out to our audience. Our physicians, our health care workers, our faculty, our researchers – you bring more to the table and you do more because of your caring, and I want to thank you for that Dr. Powers. That is really extraordinary that you use your time so deliberately. What can our listeners do to support and engage in this program if they wish?

[00:23:32] Powers: Before I answer just let me thank you for those kind words, but I promise you it is a privilege to be able to do it, so thanks are not necessary. The answer is that this does cost money to do these programs. It's around travel, it's around training, and various things. We have been very fortunate through philanthropy and through the MUSC Foundation to have gotten financial support from some very generous donors. In addition, we do have grant support as well. So, any financial support that we can get is always helpful. And so, if any of our listeners are interested in providing that support, we would be extraordinarily grateful.

[00:24:27] Lynch-Reichert: And when we share this podcast with our listeners, we hope to send out a brochure that offers them information on what you are doing, what you've accomplished, and who to contact to support this very worthy endeavor. It has been a pleasure speaking with you today, Dr. Powers. Thank you so much for all you do to expand the health and well-being, not only of our state and region, but for all those you serve across the world. And thank you to our listeners for joining us on this journey today. Join us next month for our upcoming Science Cafe with Dr. Mike Yost, Professor of Surgery, on 3D printing and COVID-19. The future is now. Dr. Powers, our very best to you. We hope to have you back on the program again to tell us what you've accomplished in the years ahead.

[00:25:12] Powers: Thank you so much for this.

[00:25:14] Lynch-Reichert: You're very welcome. Until then, everyone, please stay safe and healthy.