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:

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Leading Metabolics Researcher Joins UC San Diego School of Medicine

Alan Saltiel will head unified effort to create comprehensive diabetes center —

Alan R. Saltiel, PhD, whose studies of the hormone insulin have helped drive research of obesity, diabetes and other metabolic disorders across the nation, is joining University of California, San Diego School of Medicine as professor and director of a new Comprehensive Diabetes Center.

Saltiel, who most recently served as director of the Life Sciences Institute at University of Michigan, will bring together and expand UC San Diego’s diverse programs to better understand and treat diabetes and other metabolic disorders. … Read the full story from the UC San Diego Newsroom


Dr. Saltiel joins the Department of Medicine as professor in the Division of Endocrinology and Metabolism.

New Biomarkers Might Help Personalize Metastatic Colorectal Cancer Treatment

Low levels of two genes predicts positive response to chemotherapy and longer survival times —

Metastatic colorectal cancer patients tend to live longer when they respond to the first line of chemotherapy their doctors recommend. To better predict how patients will respond to chemotherapy drugs before they begin treatment, researchers at University of California, San Diego School of Medicine conducted a proof-of-principle study with a small group of metastatic colorectal cancer patients. The results, published June 17 in PLOS ONE, revealed two genes that could help physicians make more informed treatment decisions for patients with this disease. …Read the full story from the UC San Diego Newsroom

Paul Fanta, MD, MS

Paul Fanta, MD, MS

Senior author of the study is Department of Medicine oncologist Paul Fanta, MD, MS, Health Sciences associate clinical professor in the Division of Hematology-Oncology. Dr. Fanta is a researcher in the Solid Tumor Therapeutics Program at the UC San Diego Moores Cancer Center.

Read the article in PLOS ONE (Open Access)

Medicine 401 Teaching Award Winners Announced

The winners of the 2015 Medicine 401 Teaching Awards were announced at an awards ceremony on May 27. Granted by the third-year medical students each year, the awards go to residents and attending physicians for their excellence in teaching on the wards at the Veterans Administration San Diego Healthcare System and the UC San Diego Medical Center in Hillcrest.

The winners:

VA Wards Resident Award: Dr. Tyler Woodell
Hillcrest Wards Resident Award: Dr. Michelle Pearlman

VA Wards Attending Award: Dr. Mara Zulauf
Hillcrest Wards Attending Award: Dr. Darcy Wooten

“There were many kind words of praise and admiration in the comments from the students who worked with Drs. Pearlman and Woodell,” said residency program director Simerjot Jassal, MD. “Congratulations to these outstanding doctors!”

The medical students’ comments included the following.

Dr. Michelle Pearlman

Dr. Michelle Pearlman

Of Michelle Pearlman, MD: … Really focused on teaching … worked hard during the rotation to make sure we were achieving our own goals and learning as much as possible … gave excellent feedback … made great teaching points during rounds … great example of professionalism … will make an excellent teacher … great role model … clear and detailed expectations … we knew exactly what to work on and how to succeed … one of the best residents with whom I have worked … gave frequent feedback enabling me to improve daily … strong leadership skills, a positive attitude, and a great work ethic … will make an amazing GI fellow and attending.

Dr. Pearlman has matched to a fellowship program in gastroenterology at University of Texas Southwestern Medical Center in Dallas.

Dr. Tyler Woodell

Dr. Tyler Woodell

Of Tyler Woodell, MD: Always made it a priority to have a teaching point every day … always willing to make sure all of our questions were answered and that we were engaged in patient care … went out of his way to make sure we had a good learning experience … an exceptional model physician who I would recommend to any student as a preceptor and any patient as a doctor … focused on making sure that we learned as much as possible … carved out time to talk through our assessment and plans with us … took time on rounds to talk through key issues with us …both a fantastic role model for compassionate patient care and bedside manner as well as an engaging teacher … clearly loved to teach … not only an outstanding teacher, but also very compassionate with patients.

Dr. Woodell has matched to a fellowship program in nephrology at Oregon Health & Science University.

Binational Police Program in Tijuana Targets HIV Reduction

Effort also aims to improve safety of officers —

Research consistently shows that policing practices, such as confiscating or breaking needles, are key factors in the HIV epidemic among persons who inject drugs. Police officers themselves are also at risk of acquiring HIV or viral hepatitis if they experience needle-stick injuries on the job — a significant source of anxiety and staff turn-over.

A binational team from the University of California, San Diego School of Medicine and the U.S.-Mexico Border Health Commission, Mexico Section has launched a new research project aimed at promoting prevention of HIV and other blood-borne infections. The effort is led by Steffanie Strathdee, PhD, professor and director of the UC San Diego Global Health Initiative, Leo Beletsky, JD, MPH, associate professor, and Gudelia Rangel, PhD, deputy general director for migrant health and executive secretary of the Mexico Section of the Mexico-United States Border Health Commission, in partnership with the Tijuana Police Department and Police Academy. The binational team will offer and evaluate Proyecto ESCUDO (Project SHIELD), a police education program designed to align law enforcement and HIV prevention in Tijuana. … Read the full story from the UC San Diego Newsroom


Dr. Tyler Woodell and Dr. Lawrence Ma Receive Arnold P. Gold Foundation’s Humanism and Excellence in Teaching Resident Awards

Dr. Tyler Woodell

Tyler Woodell, MD

Tyler Woodell, MD, left, a senior categorical internal medicine resident, and Lawrence Ma, MD, a fourth-year medicine-pediatrics resident, will receive the Arnold P. Gold Foundation’s Humanism and Excellence in Teaching Resident Award in a ceremony at the UC San Diego School of Medicine on May 15.

The award recognizes Dr. Woodell and Dr. Ma as role models for others in their compassion, dedication and humanism in their approach to patient care.

Dr. Lawrence Ma

Lawrence Ma, MD

“The Gold Humanism and Excellence in Teaching Resident Award is one of the greatest honors that can be bestowed upon a resident,” said internal medicine residency program director Dr. Simerjot Jassal. “Tyler is a beacon of professionalism. I think this is the most important quality a physician can possess.”

Simerjot K. Jassal, MD, MAS, FACP, is clinical professor in the Department of Medicine.

“This is a great honor that is given to only a handful of UC San Diego housestaff each year. Congratulations to both Lawrence and Tyler!” said Lori Wan, MD, director of the Combined Medicine/Pediatrics Residency Program. She is clinical professor of medicine and pediatrics.

Drs. Woodell and Ma were selected in a vote by third-year medical students and each is one of six recipients this year.

After graduating from the UC San Diego Internal Medicine Residency Training Program in June, Dr. Woodell will begin fellowship training in nephrology at Oregon Health and Science University.

Dr. Ma will start a fellowship in geriatrics at Stanford University in July, with the ultimate goal of practicing primary care across the age spectrum.

As award recipients, Dr. Woodell and Dr. Ma become lifetime members of the UC San Diego Gold Humanism Honor Society. One of their first actions as awardees is to speak to the rising third-year medical students at UC San Diego during Clinical Transition Week.

UC San Diego Health System, Scripps Health Partner in Hospice Care, Training and Research

UC San Diego Health System and Scripps Health are partnering to provide improved continuity of patient care, fellowship training and research in hospice and palliative medicine. Under a new five-year agreement, Scripps will work with UC San Diego to provide outpatient and inpatient hospice care for UC San Diego patients, allowing UC San Diego physicians to better coordinate post-acute care for patients with chronic illness. The joint fellowship program is the only physician training program of its kind in San Diego County …

… The hospice and palliative medicine training program is an extension of a fellowship that was previously offered through San Diego Hospice. Gary Buckholz, MD, UC San Diego, and Holly Yang, MD, Scripps Health, co-direct the joint fellowship program, which will be housed at UC San Diego beginning in July 2015. The program will engage faculty from both organizations, exemplifying the teamwork required to meet the physical, emotional, social and spiritual needs of palliative care and hospice patients and their families. … Read the full story from the UC San Diego Newsroom


Some Atrial Fibrillation Patients Receive Unnecessary Blood Thinners

Researchers believe cardiology specialists may be unaware of risk —

About one quarter of all atrial fibrillation patients at the lowest risk for stroke receive unnecessary blood thinners from cardiology specialists, according to a new study by researchers at University of California, San Diego School of Medicine and University of California, San Francisco, and these health care providers must be made aware of the resulting potential health risks. The findings are published online April 13 by JAMA Internal Medicine.

“Clinicians who prescribe blood thinners need to be diligent about weighing the risks and benefits of these medications,” said lead author Jonathan C. Hsu, MD, cardiologist and assistant clinical professor of medicine at UC San Diego … Read the full story from the UC San Diego Newsroom


Dr. Jonathan C. Hsu

Dr. Jonathan C. Hsu

The lead author of the study report is Jonathan C. Hsu, MD, MAS, assistant clinical professor in the Division of Cardiovascular Medicine.
See Full Text of Article (PDF) (UCSD only)

Kevin Shah, MD, Named 2015 House Officer of the Year

Dr. Kevin ShahSenior internal medicine resident Kevin Shah, MD, has been selected from all UC San Diego Health System house staff in all specialties as the 2015 House Officer of the Year. The honor was announced on March 30, National Doctor’s Day.

Also honored was Tyson Ikeda, MD, 2015 Physician of the Year. Dr. Ikeda is a Health Sciences clinical professor in the Department of Family Medicine and Public Health.

Read more about Kevin in the full story from the UC San Diego Health System Newsroom here.

Researchers Find Link Between Inflammation, Tissue Regeneration and Wound Repair Response

Discovery has implications for potential new treatments of some cancers and inflammatory bowel disease —

Almost all injuries, even minor skin scratches, trigger an inflammatory response, which provides protection against invading microbes but also turns on regenerative signals needed for healing and injury repair – a process that is generally understood but remains mysterious in its particulars.

Writing in the February 25 online issue of Nature, an international team of scientists, headed by researchers at the University of California, San Diego School of Medicine, report finding new links between inflammation and regeneration: signaling pathways that are activated by a receptor protein called gp130.. … Read the full story from the UC San Diego Newsroom


Dr. William SandbornStudy coinvestigators included Division of Gastroenterology division chief William Sandborn, MD, and Inflammatory Disease Center researchers Brigid S. Boland and John T. Chang.

Other Department of Medicine coauthors included Petrus R. de Jong; and Samuel B. Ho, professor of medicine in the Division of Gastroenterology and Section Chief, Gastroenterology, at the VA San Diego Healthcare System.

Full text of the article (UC San Diego only)