2016 Update: A Lasting Solution for Healthcare in Mozambique

Mozambique highlighted on a map of Africa There is a critical shortage of practicing doctors and medical educators in Mozambique, where the life expectancy is less than 42 years and the rate of HIV infection in adults is 16%. UC San Diego is teaming with the nation’s flagship medical school to create a long-term solution.

Mozambique’s Universidade Eduardo Mondlane (UEM) and UCSD have won a five-year, $12.5-million award from the U.S. Medical Education Partnership Initiative (MEPI). The project will strengthen the nation’s medical education system by building infrastructure in several ways.


“We hope this will be a demonstration project for the rest of Africa.”
— Dr. Robert Schooley


Dr. Emilia Virginia Noormahomed, a co-investigator on the UCSD-UEM MEPI project.UEM’s principal investigator is Emilia Virginia Noormahomed, MD, PhD, a former dean of the UEM School of Medicine. Dr. Noormahomed (pictured at left) is now Assistant Professor of Parasitology at UEM and Assistant Professor of Medicine at UC San Diego.

Sam Patel, MD, Professor of Medicine at UEM and UC San Diego, is a co-investigator. In the photo below, he is pictured on the right.

View photo captions and credits

Dr. Bill Detmer, at left, demonstrates iPad mobile digital device preloaded with medical programs for doctors’ use in the hospital. Dr. Manuel Joaquim Tomás is at center and Dr. Sam Patel at right. Sam Patel, M.D., co-investigator on the MEPI project, is Professor of Medicine at UEM and UCSD. Bill Detmer, M.D., M.Sc., a MEPI project consultant, is Assistant Adjunct Professor of Clinical Informatics at the University of Virginia and President and Chief Executive Officer of Unbound Medicine.

MEPI is a joint initiative of the National Institutes of Health and the President’s Emergency Plan for AIDS Relief (PEPFAR). Under the MEPI program, UEM receives the bulk of the funding and uses it to build capacity in medical training, research, and technology.

A smaller amount of funding comes directly to UC San Diego, supporting time and travel for the partners and mentors who will help UEM meet its goals.

M. Wilson Tilghman, M.D., UCSD’s on-site faculty member in Mozambique, consults with a UEM internal medicine resident at a patient’s bedside. Instituting the use of wirelessly-accessed medical reference material in the hospital is one of the UCSD-UEM project goals.“This is an experiment in medical education for UEM and for the U.S. government,” said Robert “Chip” Schooley, MD, who is coordinating the UC San Diego side of the project. “It puts the funding into the hands of the African universities and allows them to invest it in ways that are beneficial to them.”

Dr. Schooley is Professor and Academic Affairs Vice Chair in the Department of Medicine and Chief of the Division of Infectious Diseases.

“I’m hopeful this will become a model for other kinds of aid,” he said.

Dr. Schooley and colleague Constance Benson, MD, have long experience in partnering with Mozambique and other African nations, and they have collaborated with Dr. Noormahomed in research projects for several years. Dr. Benson is Professor of Medicine, Director of the UC San Diego Antiviral Research Center, and Director of the Fellowship Program in Infectious Diseases.

The UEM-UCSD MEPI project expands some of the educational efforts that have been going on since July 2009 in the Internal Medicine Residency Program’s Global Medicine elective.

UC San Diego’s visiting faculty and residents have helped UEM adopt academic medical practices such as morning report and teaching conferences that strengthen the educational program.

MEPI biomedical informatics team members at October conference at UEM in Maputo.

MEPI biomedical informatics team members at October conference at UEM in Maputo.

The MEPI partnership relies heavily on biomedical informatics to accomplish its goals. This component of the program is led by Lucila Ohno-Machado, MD, PhD, Professor of Medicine and Chief of UC San Diego’s Division of Biomedical Informatics. The division will provide expertise for the partnership’s information technology projects.

Dr. Kathy Promer, a 2013 graduate of the UC San Diego Internal Medicine Program, is the current infectious diseases fellow at UC San Diego on rotation at UEM’s Maputo Central Hospital. In the photo below, she is standing, second from the right.

Dr. Kathy Promer (standing, second from the right), 2013 Graduate of the UCSD Internal Medicine Program and current infectious diseases fellow at UCSD on rotation at UEM’s Maputo Central Hospital.

Smartphones and iPad mobile digital devices have been deployed on the wards at Maputo Central Hospital, UEM’s primary teaching hospital and the only tertiary care center in Mozambique. With these devices, the Mozambican doctors are able for the first time to consult online medical literature at a patient’s bedside. Soon they will have immediate access to data generated by the hospital’s clinical laboratories.

“These efforts really have changed the character of the residency program at Maputo Central Hospital,” said Dr. Schooley.

Through training and partnership with UC San Diego, UEM will also increase its capacity to do operational, epidemiological, translational and clinical research. Another program goal calls for UEM to set up a biomedical informatics infrastructure and connect with SEACOM, the new fiber optic broadband internet service in South and East Africa.

Students in UEM medical school class.UEM will also take steps to enhance its support of two new medical schools recently established by the Mozambican government in Nampula and Tete. These two new medical schools were launched in the past 3 years to address the profound shortage of physicians in the country.

Another key UC San Diego figure in the project is Stephen Bickler, MD, who will work to improve the nation’s surgical capacity in rural areas via a linked MEPI project, “UEM-UCSD Surgery Partnership.” Dr. Bickler is Associate Professor of Surgery and Pediatrics.

A number of other UC San Diego faculty members will contribute to the MEPI effort as well.

Medical school class   UCSD internal medicine resident Dr. Bethany Karl

Above left, a medical school class at Universidade Eduardo Mondlane. Right, Dr. Bethany Karl on rotation at UEM’s Maputo Central Hospital. Dr. Karl graduated from the UC San Diego Internal Medicine Program in 2010 and is currently a nephrology attending. Photo courtesy of Robert T. Schooley, MD

Project leaders expect to double the number of graduating doctors in Mozambique in the next 10 years. They also hope to inspire more doctors to devote their careers to medical education.

With a greater number of highly-trained doctors and a better infrastructure to support them, Mozambique will increase its capacity to deliver health care to its citizens and to fill the faculties of two new medical schools in Nampula and Tete.

The doctors training today in Mozambique will be the specialists, medical school faculty members, and government Ministry of Health policymakers of the future.

“We hope this will be a demonstration project for the rest of Africa,” Dr. Schooley said.

Read the UC San Diego News press release about our MEPI project.

Read about the project in “The Great Beyond,” Nature magazine’s blog
for breaking news in the sciences.


Photo Captions and Credits:

Dr. Emilia Virginia Noormahomed, co-principal investigator on the UCSD-UEM MEPI project.Dr. Emilia Virginia Noormahomed, co-principal investigator on the UC San Diego-UEM MEPI project. Photo courtesy of William M. Detmer, MD, MSc.

Drs. Detmer, Tomás, and PatelDr. Bill Detmer, left, demonstrates iPad mobile digital device preloaded with medical programs for doctors’ use in the hospital. Dr. Manuel Joaquim Tomás is at center and Dr. Sam Patel at right. Sam Patel, MD, co-investigator on the MEPI project, is Professor of Medicine at UEM and UC San Diego. William M. Detmer, MD, MSc, a MEPI project consultant, is Assistant Adjunct Professor of Clinical Informatics at the University of Virginia and President and Chief Executive Officer of Unbound Medicine. Photo courtesy of Dr. Detmer.

Dr. Tilghman and Mozambican residentM. Wilson Tilghman, MD, UC San Diego’s on-site faculty member in Mozambique, consults with a UEM internal medicine resident at a patient’s bedside. Instituting the use of wirelessly-accessed medical reference material in the hospital is one of the UC San Diego-UEM project goals. Photo courtesy of Robert T. Schooley, MD.

MEPI biomedical informatics team members at October conference at UEM in Maputo. MEPI biomedical informatics team members at October conference at UEM in Maputo. From left: Lucila Ohno-Machado, MD, PhD; Eli Aronoff-Spencer, MD, senior postdoctoral fellow in infectious diseases at UC San Diego; Eng. David Bila, Network Director for the Informatics Center at UEM; Heimar de Fátima Marin, RN, PhD, Professor of Health Informatics at Universidade Federal de São Paulo; and Eng. Francisco Mabila, Director of the Informatics Center at UEM. Photo courtesy of William M. Detmer, MD, MSc.

Dr. Kathy Promer (standing, second from the right), is a 2013 graduate of the UC San Diego Internal Medicine Program and is the current infectious diseases fellow at UC San Diego on rotation at UEM’s Maputo Central Hospital.

Students in a medical school class at UEM.Students in a medical school class at UEM. Photo courtesy of William M. Detmer, MD, MSc.

A medical school class at UEM.A medical school class at UEM. Photo courtesy of William M. Detmer, MD, MSc.

UCSD internal medicine resident Dr. Bethany Karl on rotation at UEM’s Maputo Central Hospital.UC San Diego internal medicine resident Dr. Bethany Karl on rotation at UEM’s Maputo Central Hospital. Photo courtesy of Robert T. Schooley, MD.

Trademark Credit Notices:

iPad is a trademark of Apple Inc., registered in the U.S. and other countries.

$52M NIH Grant Advances Clinical and Translational Research at UC San Diego

Federal funding will help further on-going efforts to translate discoveries to clinic —

The Clinical and Translational Research Institute (CTRI) at University of California, San Diego has received a five-year Clinical and Translational Science Award (CTSA) for approximately $52 million from the National Center for Advancing Translational Science, part of the National Institutes of Health. … Read the full story from the UC San Diego News Center

At the Nexus of Substance Abuse and HIV

UC San Diego Researcher Wins Major Award to Study New Treatments and Preventions —

Dan Werb, PhD, an internationally noted epidemiologist at University of California, San Diego School of Medicine, has been named one of four inaugural recipients of the Avenir Award, a prestigious $1.5 million research grant from the U.S. National Institute on Drug Abuse, part of the National Institutes of Health (NIH). … Read the full story from the UC San Diego Newsroom

Big Data Sharing for Better Health

Researchers at University of California, San Diego School of Medicine have been awarded a $9.2 million grant to help modernize and transform how researchers share, use, find and cite biomedical datasets.

The 3-year project, in collaboration with The University of Texas Health Science Center at Houston, is part of a federal initiative to increase the utility of biomedical research data, launched this week by the National Institutes of Health (NIH) through its Big Data to Knowledge (BD2K) program. … Read the full story from the UC San Diego Newsroom


Dr. Lucila Ohno-MachadoLucila Ohno-Machado, MD, PhD, is lead investigator on the Biomedical and healthCAre Data Discovery and Indexing Ecosystem (BioCADDIE) project.

Dr. Ohno-Machado, professor of medicine, is founding chief of the Division of Biomedical Informatics.

Read the BioCADDIE project description on the NIH RePORTER

$5.6 Million Grant Renewal Expands Research in Kidney Failure

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) – part of the National Institutes of Health – has renewed a grant shared by the University of California, San Diego and the University of Alabama at Birmingham Schools of Medicine. The five-year, $5.64 million renewal will extend and expand research into acute kidney failure, or acute kidney injury, which kills 70 to 80 percent of patients in intensive care units who develop the disease.Read the full story from the UCSD Newsroom


Dr. Ravindra MehtaRavindra L. Mehta, MD, FACP, UC San Diego professor of clinical medicine and vice chair for clinical research in the Department of Medicine, is associate director of the UC San Diego – University of Alabama at Birmingham O’Brien Center for Acute Kidney Injury Research.

He directs the O’Brien Center’s clinical studies core with co-director Daniel O’Connor, MD. O’Connor is professor of medicine and pharmacology and co-director, UCSD Center for Human Genetics and Genomics.

UC San Diego nephrology faculty members Roland Blantz, MD, and Volker Vallon, MD, are co-directors of the pre-clinical studies core of the O’Brien Center. Blantz is distinguished professor of medicine emeritus and former chief of the Division of Nephrology-Hypertension; Vallon is professor of medicine and pharmacology.

UC San Diego nephrologist Satish RamachandraRao, PhD, assistant professor of medicine, is a co-director of the Bioanalytical Resource Core.

Ravindra L. Mehta is Director of Dialysis Programs and Clinical Nephrology for UC San Diego Health System. In the UC San Diego School of Medicine, Mehta directs the Clinical Research Enhancement through Supplemental Training (CREST) and Master’s Degree in Clinical Research programs.

In 2011, Mehta received the International Society of Nephrology (ISN) Shire Bywaters Award for his lifetime achievements in acute kidney injury.

More Information:

IDASH Projects: Protecting Privacy and Patient Rights in the Name of Scientific Progress

In the years since the best-selling book “The Immortal Life of Henrietta Lacks” made the issue of informed consent and patient privacy a national topic of conversation, scientists and clinicians have continued to struggle to develop a comprehensive methodology for collecting and sharing data from patients and research subjects without jeopardizing their rights.

The University of California, San Diego’s iDASH project aims to address some of these fundamental challenges to research progress with its most recent series of “Driving Biological Projects” (DBPs) … Read the full story from the UCSD Newsroom


Dr. Lucila Ohno-MachadoLead investigator in the iDASH project is Lucila Ohno-Machado, MD, MBA, PhD, professor of medicine, founding chief of the Division of Biomedical Informatics and associate dean for informatics and technology at UC San Diego.

Among other research and education projects directed by Dr. Ohno-Machado are the Biomedical Research Informatics for Global Health training program and the biomedical informatics component of the UC San Diego – Universidade Eduardo Mondlane Medical Education Partnership Initiative.  |  See all DBMI research projects

Dr. Ohno-Machado joined the UC San Diego faculty from Harvard Medical School in 2009. She was elected to the American Society for Clinical Investigation in 2010.

More Information:

Progress: the UC San Diego – Universidade Eduardo Mondlane Medical Education Partnership Initiative

In this official video, Dr. Emilia Noormahomed describes the goals and progress of the UC San Diego—Universidade Eduardo Mondlane (UEM) Medical Education Partnership Initiative (MEPI) program in Mozambique.

Map of Africa showing location of MozambiqueEmilia Noormahomed, MD, PhD, is UEM principal investigator of the MEPI project, which is intended to strengthen Mozambique’s medical education system by building infrastructure to support medical training, research and technology.

Noormahomed is associate professor in the Parasitology Section, Department of Microbiology, at UEM and associate professor of medicine at UC San Diego.

In their partnership, UEM receives the bulk of the grant funding and UC San Diego provides partners and mentors to help UEM meet its goals.  |  More about UC San Diego’s role

The UC San Diego Internal Medicine Residency Training Program offers a global medicine elective in which residents rotate to the UEM’s Maputo Central Hospital in Mozambique for a four-week period.  |  More about the elective

MEPI is a joint initiative of the United States National Institutes of Health and the President’s Emergency Plan for AIDS Relief (PEPFAR).

More Information:

Internal Medicine Residency Training Program

Medical Education Partnership Initiative

Fate of the Heart: Researchers Track Cellular Events Leading to Cardiac Regeneration

Studies in zebrafish reveal abundant potential source for repair of injured heart muscle

In a study published in the June 19 online edition of the journal Nature, a scientific team led by researchers from the University of California, San Diego School of Medicine visually monitored the dynamic cellular events that take place when cardiac regeneration occurs in zebrafish after cardiac ventricular injury. Their findings provide evidence that various cell lines in the heart are more plastic, or capable of transformation into new cell types, than previously thought. … Read the full story from the UCSD Newsroom


Dr. Neil Chi

Dr. Neil Chi

Principal investigator of the study is Neil Chi, MD, PhD, assistant professor of medicine in the Division of Cardiology and member of the Institute for Genomic Medicine.

Chi directs the UC San Diego Cardiovascular Genetics Clinic and Cardiac Tissue Harvest and Biorepository Core.

In 2010, he received an NIH Director’s New Innovator Award for his study of cardiac regeneration in zebrafish. He is currently the principal investigator on that project and two R01 grant projects for research in cardiac morphogenesis and cardiac conduction development and disease.

Citation for the report: Zhang R, Han P, Yang H, Ouyang K, Lee D et al. In vivo cardiac reprogramming contributes to zebrafish heart regeneration. Nature (2013) doi:10.1038/nature12322.  |  Read the full text (UCSD only)

More Information About Dr. Chi:

No Sons Linked to Lower Contraception Use in Nepal

While poverty and under-education continue to dampen contraception use in Nepal, exacerbating the country’s efforts to reduce maternal and child mortality rates, researchers say another, more surprising factor may be more intractable: Deeply held cultural preferences for sons over daughters. … Read the full story from the UCSD Newsroom


Dr. Anita RajFirst author Anita Raj, PhD, is a professor of medicine in the Division of Global Public Health and a Senior Fellow in the UC San Diego Center on Global Justice.

She focuses her global public health research on sexual and reproductive health, gender-based violence and substance misuse and abuse.

Funds from the Lucile and David Packard Foundation’s Population and Reproductive Health program support Dr. Raj’s study, Assessment of Girl Child Marriage and Adolescent Motherhood and Its Public Health Impact in South Asia.

The coauthors of the Nepal study report are three Division of Global Public Health colleagues: medical student Rohan J. Vilms, postdoctoral researcher Lotus McDougal and professor Jay G. Silverman, PhD.

Raj and Silverman are faculty members and Lotus McDougal is a graduate of the Global Health track of the UC San Diego – San Diego State University Joint Doctoral Program in Public Health.

Vilms is a second-year medical student who had the opportunity to take part in the Nepal study via a summer internship supported by UC San Diego’s National Institutes of Health Short-Term Research Training Grant for medical students.

His undergraduate degree is from the Global Health and Development track of the Human Biology program at Stanford University.

Rohan J. Vilms

Medical student Rohan J. Vilms

Vilms was born in the United States and spent his childhood years from age 3 to age 12 in India. Living in the two nations shaped his perceptions of disparities in standard of living and health outcomes because of social circumstances, he said.

He has particular concern for reproductive health.

“I think working for reproductive health is extremely important,” he said. “The standard of what we can do is not what we are doing. There are preventable deaths — infant and maternal mortality. That these still occur is a travesty.”

The Nepal project also attracted him because it gave him a chance to work with data from the Demographic and Health Surveys (DHS), a respected source of information from United States-conducted fieldwork around the world. The DHS database includes reproductive health information.

In working with the DHS data, he said, postdoctoral researcher Lotus McDougal gave him invaluable coaching and expert help.

Vilms makes the most of every opportunity to work and study in global public health. “I have had a lot of mentors,” he said. “I’m learning a lot.”

He has taken Dr. Richard Garfein’s San Quintin Field Course (FPM 244/MED248) three times, the maximum possible in the first two years of medical school.

Dr. Richard Garfein

Dr. Richard Garfein, professor in the Division of Global Public Health.

The San Quintin Field Course is associated with project VIIDAI: Viaje Interinstitucional de Integracion, Docente, Asistencia y de Investigacion (Retreat for Educational Integration, Assistance and Investigation), first conducted by Tijuana’s Universidad Autonoma de Baja California School of Medicine in 1981.

UCSD’s San Quintin Field Course is a School of Medicine elective built around VIIDAI’s academic and research field trips to rural regions in Baja California and Sonora. Students have the opportunity for hands-on clinical experience as well as public health research and practice. The course includes a required 3-day trip to the town of San Quintin on the west coast of Baja California.

Vilms hopes to arrange a global public health research year between his third and fourth years of medical school. Beyond that, his aspiration is to work in a setting where he can make a difference in health and in social justice.

In February, he presented data from the Nepal study as lead author of a poster presentation at the multidisciplinary Consortium of Universities for Global Health (CUGH) annual meeting in Washington, DC.

He said he couldn’t speak highly enough about the Global Public Health division faculty members and graduate students he has worked with.

Of Vilms and his contributions, Anita Raj said, “He worked incredibly hard and did a terrific job.”

More About Dr. Raj and Her Work

Earlier this month, Raj and Ulrike Boehmer, PhD, of the Boston University School of Public Health reported that rates of maternal and infant mortality are significantly higher in nations in which it is common for girls to be married before the age of 18.  |  Read the UCSD press release

At UC San Diego’s International Women’s Day event March 8, 2013, Raj spoke on “The Movement to End Rape Post-Delhi – Public Health Perspectives and Solutions.”

She was an online panelist on Public Radio International’s program The World February 25. The topic: whether there is a global movement for women’s safety in the wake of the Delhi rape protests.  |  Watch the video

In May 2012, Raj and her colleagues published a report in the Journal of the American Medical Association on the results of two decades of efforts to eliminate the practice of girl-child marriage in South Asia.  |  Read the UCSD press release  |  Read the report

Anita Raj is also affiliated with the Section of General Internal Medicine, Clinical Addiction Research and Education in the Department of Medicine at Boston University School of Medicine/Boston Medical Center.

Citation for the Nepal study report:  Anita Raj, Rohan J. Vilms, Lotus McDougal, Jay G. Silverman. Association between having no sons and using no contraception among a nationally representative sample of young wives in Nepal. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics – May 2013 (Vol. 121, Issue 2, Pages 162-165, DOI: 10.1016/j.ijgo.2012.12.011)  |  Read article abstract

Seema Sharma Aceves MD, PhD, Elected to American Society for Clinical Investigation

Dr. Seema S. AcevesUC San Diego pediatric allergy/immunology physician-scientist Seema Sharma Aceves, MD, PhD, has been elected to the American Society for Clinical Investigation (ASCI).

She was formally inducted into the Society in a ceremony at the ASCI annual meeting in Chicago on April 26.

“It is a true honor to be included in this distinguished group of translational research leaders,” Aceves said.

“Seema represents the best and the brightest among clinical investigators today,” said Gary S. Firestein, MD, who nominated her for the honor.

“Her remarkable progress understanding the causes of an unusual and very debilitating disease in children made a significant impact on their quality of life.”

Firestein is professor of medicine in the Division of Rheumatology, Allergy & Immunology, Dean of Translational Medicine, Associate Vice Chancellor of Translational Medicine and director of the Clinical and Translational Research Institute.

Aceves, a specialist in pediatric eosinophilic esophagitis (EoE), is associate professor of clinical medicine in the Division of Rheumatology, Allergy & Immunology and associate professor of pediatrics in the Division of Allergy-Immunology-Rheumatology.

In her research, she investigates the mechanisms of tissue remodeling in EoE, exploring the role of pro-inflammatory and pro-fibrotic molecules. Major support for her work comes from a National Institutes of Health R01 research grant and funding from the Department of Defense.  |  Read NIH grant abstract

Her clinical specialty is pediatric allergy (Rady Children’s Specialists of San Diego). She practices at Rady Children’s Hospital – San Diego, where she directs the Eosinophilic Gastrointestinal Disorders Clinic.

Aceves received all of her medical training at UC San Diego. After she earned her MD and PhD in the Medical Scientist Training Program, she completed her internship and residency in the Department of Pediatrics and her fellowship training in allergy and immunology in the Department of Medicine.

She is board certified in allergy/immunology and pediatric allergy/immunology.

She was named a Physician of Exceptional Excellence in the 2012-2013 “San Diego’s Top Doctors” survey from the San Diego County Medical Society and San Diego Magazine and listed as one of the nation’s top doctors on the 2012-2013 U.S.News & World Report “Top Doctors” List.