A collaborative effort

In fall 2024, Peck wrote two questions on a whiteboard in Lasdon House at Weill Cornell: “What?” and “So what?”

The questions keep his Tanzanian Ph.D. students focused on the key points in their research papers. What have they found in their clinical research? And what are the implications?

“What I found personally is that I have so many results, but now I’m figuring out which one to present, because you can’t present everything,” said Dr. Gloria James Manyangu, a Ph.D. candidate who is conducting research on how to improve the cardiovascular health of people living with HIV; cardiovascular disease is the No. 1 killer of people with HIV. “Our mentors help us structure that, so that we have a clear story.”

Credit: Noël Heaney/Cornell University

She and five other Ph.D. candidates spent three weeks at the Center for Global Health for a “writing boot camp.” There they learn how to produce an academic research paper, from analysis to drafting a manuscript, finalizing it, submitting it to academic journals and publishing. It’s one of the most important things the M.D./Ph.D. program does, Peck said.

He has mentored a dozen Ph.D. students, and says the needs of his American and Tanzanian students are largely the same. But the Tanzanians often need language support, because English is their second or third language. “They’ve just had to work that much harder to get good at this,” Peck said. “For them to learn how to do this in a second language is very impressive.”

The program also helps students build a network of senior researchers in their fields. Ph.D. candidate Dr. Tullah Masoza had run into roadblocks in her work on cardiovascular disease in adolescents. “But in Tanzania, there’s no one in the entire country who does that,” Peck said. He set her up to spend a month shadowing a leading specialist, Dr. Elaine Urbina at Cincinnati Children’s Hospital, to learn about preventive cardiology for teens. “It was very productive,” Masoza said.

Credit: Noël Heaney/Cornell University

Kisigo spent a month in 2022 at Weill Cornell’s Center for Sleep Medicine. There he saw a CPAP machine for the first time, and observed overnight polysomnography, a gold standard test for assessing sleep. The test is also extremely expensive, so he also learned how to use an ActiGraph, a watch-like device that detects movement and measures many components of a wearer’s sleep, at a much lower cost.

In turn, the Tanzanians contribute to the professional development of Weill Cornell faculty and students. They share their expertise in tropical diseases and other illnesses rarely see in the U.S., and present their research to the faculty and students during their visit.

They also model leadership. In her early 30s, Manyangu became the head of public health at Bugando Medical Centre, Weill Bugando’s teaching hospital and the referral hospital for more than 15 million people – a population the size of New York City, Los Angeles and Chicago combined. Masoza has been assistant head of pediatrics there for five years. “That’s the kind of position which, in the U.S., would be very rare for a young pediatrician to have,” Peck said.

Credit: Noël Heaney/Cornell University

Unlike U.S. mentees, they often have prior research experience.

So far Manyangu has found that five years after diagnosis and the start of treatment, people with HIV have better cardiovascular health than those who don’t have HIV – perhaps because they pay more attention to their overall health. She hopes to integrate her findings into the primary health care program at Bugando Medical Centre’s HIV clinic.

“Coming here and having the support of the mentors, I find that it’s a collaborative effort that we’re presenting to the world, making sure that we’re improving the quality of the health of the people and health outcomes generally,” she said.

‘A more equitable picture’

Lazaro Ng’Habi sat under a mango tree in Mwanza and demonstrated a specialized lung test available nowhere else in East Africa.

Ng’Habi took a huge breath, filling his lungs to capacity. Then he blew as hard as he could into a tube attached to a small box-like device, and inhaled again to capacity, as his colleague, Anthony Kaji, coached him. “Blow, blow, blow,” Kaji said.

They were demonstrating a spirometry test, which measures lung capacity and can diagnose a range of lung diseases.

As research assistants, they administer the test to study participants at Bugando Medical Centre with Dr. Jonah Kreniske, a pulmonologist and instructor in medicine at Weill Cornell.

“In my research, what we’re interested in is what drives lung disease in parts of the world that have been underexamined,” Kreniske said.

In the past, smoking was thought to be the main risk factor for lung disease. But those studies were done in Europe and the U.S., where tobacco use was common. Now many other risk factors are thought to drive lung disease – but it is unclear which ones, especially outside of the U.S. and Europe, Kreniske said. “And so the two risk factors we’re looking at most closely are HIV and tuberculosis.”

Ng’Habi and Kaji administer the tests to study participants to screen for chronic obstructive pulmonary disease (COPD). “These guys are currently the only team in northern Tanzania with the capacity to do this test,” Kreniske said.

Credit: Noël Heaney/Cornell University

So far they’ve found COPD in 9% of study participants with HIV and 2% in those without – and none are smokers.

“Folks in sub-Saharan Africa and many other parts of the world have been underrepresented in the evaluation of lung disease,” he said. “What we do is one very small part of bringing a more equitable picture of lung function to pulmonary medicine, and to medicine in general.”

They’re also helping to build research capacity at Weill Bugando, he said. They offer the use of the spirometer to their colleagues at Weill Bugando’s pulmonary clinic and have arranged collaborations with pulmonary radiology specialists at Weill Cornell, for example.

“One of the most important aspects of what we do here is helping support the next generation of physicians, researchers, leaders in public health,” Kreniske said. “It’s about making sure that we’re able to move forward in a really collaborative way.”

Credit: Noël Heaney/Cornell University

Those collaborations have informed significant policy changes from Tanzania’s Ministry of Health, Peck said.

“A lot of the research that’s been conducted by Weill Bugando’s Ph.D. trainees has been instrumental in completely rewriting the guidelines around antimicrobial resistance,” he said. Weill Bugando research has also contributed to national guidelines on rubella vaccination and HIV.

Ph.D. candidate Emmanuella Ambrose did research on the use of an old drug, hydroxyurea, to treat sickle cell disease in Tanzania. When she began her studies, hydroxyurea was unavailable in Tanzania, Peck said. “Because of her research, it’s now being given to thousands of children across the country, and really transforming the lives of kids with sickle cell disease.”

Dr. Emmanuel Kimaro, a Ph.D. student, recently published research that showed bread in Tanzania contained dangerously high levels of a known carcinogen, potassium bromate, which led to a government investigation in Tanzania.

“Those are a few examples,” Peck said, “but there are so many.”

Credit: Noël Heaney/Cornell University

Kisigo may soon add another.

In his research, he measures study participants’ sleep for seven consecutive days. Participants also keep a photo diary of the things in their homes that help and hurt their sleep, so the team can understand how to help them get good sleep.

That’s important, because people with HIV are more likely to have disrupted sleep, due to side effects from medication, the chronic inflammation the virus causes, and many other reasons. But poor sleep can make it hard for them to maintain their health regimens, Kisigo said.

“You can imagine if someone has excessive daytime sleepiness, they might forget to take medication,” he said. “The disease will advance, and it’s likely that we stand no chance of helping them to survive.”

A sleep research center could help the researchers understand more about sleep architecture, he said, but there are only a few in the entire continent of Africa, and none in Tanzania, East Africa’s largest country.

Kisgo wants to change that.

“In East Africa, I feel like we could be among the first groups that have really looked into sleep and HIV,” he said. “It’s my hope that with this collaboration we have right now, who knows – we might even be the first site to have a sleep center in East Africa.”

This story and videos were developed and produced with support from Matt Fondeur, Lindsay France, Eduardo Merchán and Ashley Osburn.