AFRICA: New medical schools seek strength in numbers

New medical schools in Africa have formed an unusual consortium in partnership with well-established medical schools in the United States and Finland, as they strive to avoid re-inventing the wheel and instead focus on strengthening teaching, learning and research.

The initiative is unusual because "where similar arrangements have been set up, collaboration has often been between well-established schools," Professor Peter Nyarango, founding dean of the school of medicine at the University of Namibia, told University World News.

It arises out of an understanding among universities around the world that collaboration is necessary to succeed in research and to attract grants for research that tackles pressing issues.

The consortium brings together the University of Vanderbilt in the US and Oulu University in Finland as northern partners, and in Africa the medical schools of the universities of Namibia, Copperbelt in Zambia, Lurio in Mozambique, and Masinde Mulioro and Moi in Kenya.

"We have also invited the University of Botswana to be part of the consortium," Nyarango revealed.

"We needed institutions in the region which are almost at the same level of development as our own school of medicine in terms of establishment, to use as a sounding-board or benchmark so that we know how they are progressing and also how we are progressing."

He said the University of Namibia medical school had established links with the University of Vanderbilt to work on curriculum and staff development. "We are going to be doing some activities with the University of Oulu, which requires that we work with universities in Africa."

Nyarango said senior faculty members of some emerging medical schools in Africa recently held meeting in Ndola, Zambia, and mooted the idea of a Consortium of New Schools of Medicine. His medical school had been holding discussions with various public universities that it felt shared its vision and could complement its capacity.

The new University of Namibia medical school had exemplary facilities for research, Nyarango said, that are currently underutilised.

"These are facilities that can attract high-level research done anywhere in the world, but at the moment we do not have either postgraduate students or established research. So we see this as a great opportunity to work with other institutions that may lack the facilities as well as one important thing that we have in this country: the research materials."

He cited the example of HIV-Aids and its associated morbidity and mortality, as well as conditions like tuberculosis, where research is at a molecular level. Rather than examine sputum to decide whether a patient has TB, using a specimen of blood and biomedical markers, a diagnosis can be made and the patient put on the right drugs within 24 hours.

"The people who have developed this kind of technology don't have access to patients. We have easy access to patients and pathogens. So by attracting researchers of that calibre, and equipment and clinical materials at that level, we can utilise fully the research potential that we have here. We can also start developing people who want to become researchers."

Nyarango said the University of Oulu would be a key partner in the consortium. It was instrumental in setting up the medical school in Namibia, which has a grant financed by Finland's government of some EUR600,000 (US$808,000) over two years.

"We intend to motivate to extend it so that it covers student exchange and faculty exchange and we plan to buy two vehicles with part of that grant. These are very good friends we have with whom we share not just training and medicine, but also health care delivery."

Governing instruments have been developed and a framework for cooperation will be forged for the new consortium. Namibia's medical school has tentatively agreed to assist the University of the Copperbelt with the teaching of basic sciences, once a memorandum of understanding between the two institutions has been signed.

"It is envisaged that our cooperation will help them overcome the serious problems that they are facing with basic science teaching. The consortium will preoccupy itself with research and writing grants as well as monitoring our progress in establishing schools of medicine on the continent," Nyarango said.

Officials at the Copperbelt school described the consortium as a "godsend", he added.

Other schools of medicine involved in the consortium are at varying levels of development and expectations are that the new arrangement will give them opportunities to influence the future of medical education.

Nyarango said these days medical education was concerned with efficiency, relevance and effectiveness in learning.

"Efficiency in learning means that the learner is assisted to acquire vast amounts knowledge in a short period of time. Today the problem is not about acquiring information from their teacher because information is readily available: it is literally in the air. The problem for the medical student is making sense of this information and developing skills to manage it. So it has nothing to do with the students accumulating knowledge in their heads, but applying it."

He said one way of making learning efficient and relevant was to enable students to learn in the context of action (clinical and community settings). "If you can link the clinical and basic science settings, you will assist the student to sift through the vast amount of basic science that s/he has to learn and link it to a specific problem at hand." This would produce better doctors.

"We also believe that to make learning effective, there is need for medical students to learn in small groups characterised by intense discussion. Learning by discussion and elaboration of knowledge is very important. Small groups make learning more participatory. This is also in line with the team approach to managing health problems."

Nyarango is convinced that poor health starts in the household or village. For that reason, today's medical student has to understand factors and interaction between the individual who is sick and the environment in which s/he lives.

"This involves the social, physical and economic environment so that patients are able to manipulate their environment to their advantage. We want to see a lot of teaching happening in the community. These are the major trends in medical education."

It is this thinking that has led the University of Namibia's medical school to train doctors who are not just packed with scientific knowledge but also know how disease and the patient interact so that they are able to communicate and manage resources and systems of health care at the micro and macro levels.

"This is the hallmark of evidence-based medical practice," Nyarango said.