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.

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Hello, everyone, and welcome

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to the Medical University

of South Carolina

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Science Café Podcast Series

Science Never Sleeps.

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I am your host,

Loretta Lynch-Reichert.

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This month we welcome

a special guest

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from MUSC's renowned

Heart and Vascular Center.

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In partnership with the Friends

from the Heart Lecture Series,

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a program that seeks

to educate the public

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about the latest advances

in heart and vascular care

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at MUSC.

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Dr. Eric Powers,

Professor of Medicine,

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and the Peter C. Gazes M.D.

Endowed Chair

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in Clinical Cardiology,

is a board-certified physician

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of internal medicine,

cardiovascular care,

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and interventional cardiology.

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He's a graduate

of Harvard Medical School,

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and completed

his residency and fellowships

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at Massachusetts

General Hospital in Boston.

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He has received

numerous awards for his work

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as a clinician and scientist,

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and has been named

one of America's top doctors.

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Thank you for joining us,

Dr. Powers.

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Thank you for having me.

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We have all been discussing

the coronavirus for months now,

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and one glaring highlight

of that discussion

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is how global our relationship

is to the rest of the world,

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especially in terms

of the spread of disease.

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Your work on

cardiovascular disease

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has taken you

to far-reaching locations,

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and is the topic

of today's Science Café.

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The partnership between MUSC

Heart and Vascular Center

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and Tanzania,

a country in East Africa

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with over 56 million citizens.

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Tell us how you

and MUSC became engaged

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in this very exciting endeavor.

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The program started

with a neurosurgeon at MUSC

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named Dilan Ellegala,

who had an idea

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to help bring medical care

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to underserved populations,

particularly Tanzania.

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He was a neurosurgeon

who developed

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a neurosurgical program,

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and the goal of the program

has always been

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to train the trainers.

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That is, to build

sustainable capacity

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where these programs

are taking place.

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So, in 2010,

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he invited myself

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and my partner in this work,

Peter Zwerner,

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who's also

on the faculty at MUSC,

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invited us to come to Tanzania

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to kind of see

what was going on in cardiology

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without a clear mission

at that time.

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So, we made that trip

to Tanzania,

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and what we observed was

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the population in Tanzania

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was very underserved

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in many ways medically,

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but in particular,

in the management

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of cardiovascular disease.

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So, during that visit,

we had a rare opportunity

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to meet with

the president of the country,

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the Ministry of Health,

and the leading cardiologist

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in the country,

who has now become

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and remains a close friend,

and we met with them

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to talk about

cardiovascular disease.

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And they, meaning the president,

the Ministry of Health,

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the leading cardiologist,

decided that they wanted

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to develop an advanced

cardiovascular program,

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which, up until that time,

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did not exist in Tanzania,

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and, in fact,

existed almost nowhere

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in Sub-Saharan Africa,

and so that's what happened.

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So, they asked us to help

develop the program.

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We have done this kind

of work in the past

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in the United States,

I myself have been

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a director of cardiac cath labs

in the United States,

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and so, I have experience

doing this kind of work.

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And so, we began

to help them develop

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these advanced cardiac services.

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I should say we've had

lots and lots of partners

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along the way as well.

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What I'm curious about,

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for those of us

who've never been to Tanzania

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and not really that familiar

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with the environment

and culture,

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what compelled the president

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to think that

cardiovascular disease

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was an important disease

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to start working on right away,

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rather than,

as you indicated earlier,

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other than neuroscience,

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maybe even infrastructure,

maybe even diet?

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I'm very curious

how they came about the idea

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that cardiovascular disease

was an important medical issue

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to deal with.

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So, I can't tell you

the complete answer.

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I can tell you what I've heard

the president speak about,

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and what he has told us

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about the answer

to that question,

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which is a great question.

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And there were

at least two factors

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which led him to decide

that developed and advanced

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cardiovascular care

was important.

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The first has to do,

I think, with prestige

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of the health care system

in Tanzania.

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With cardiovascular disease

becoming important everywhere

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in the world,

including Tanzania,

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he felt that,

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to develop all of health care

in Tanzania,

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this would be an important

frontier to develop.

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The second was

a more practical reason,

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and that was financial,

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and that is that, in Tanzania,

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when there was

no advanced cardiac care,

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if a patient in Tanzania

needed advanced cardiac care,

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they would have to go elsewhere

for that care.

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And typically,

they would go to India,

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was the most common place

they would go,

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and this cost the government

quite a lot of money.

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So, they did the calculation

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that, in fact,

it would be cost savings

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to build

an advanced cardiac program,

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keep patients in Tanzania,

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and therefore, save the cost

of transfer,

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and them getting their care

in a different country.

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You have been working on

this program for 10 years.

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You certainly have been dealing

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with cardiac issues

in this country for a long time.

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Unfortunately,

America is known for a diet

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that kind of encourages

cardiac illness.

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When you went to Tanzania

10 years ago,

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and now, what are you seeing?

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What kind of difference

is it making,

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what you're doing,

training the trainers,

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and the health of the country?

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It's an interesting question.

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Before--10 years ago,

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before all this developed,

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there was

very little information

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about what the burden

of cardiovascular disease

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in Tanzania was.

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And so,

as this program developed,

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and really

the advanced cardiac services

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began being performed in 2014.

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The training had begun

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and now, those advanced services

are actually quite mature

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and very sophisticated,

so there's been a great success

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in developing these services.

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And what's been found is

there are lots of patients

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with advanced cardiac disease

in Tanzania.

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And so, in fact,

there is a large population

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which is served

by advanced cardiac care.

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In addition to that,

and a worrisome trend,

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worrisome for the Tanzanians,

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is that Tanzania

is becoming more westernized

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in many ways.

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And the regrettable

parts of that,

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and an important

regrettable part of that,

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is diet, it's obesity,

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it's more diabetes.

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So, it's risk factors

for cardiovascular disease,

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so we see

lots of disease there now,

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and the expectation

is that will only continue

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to get worse and grow.

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Dr. Powers, I understand

that your program

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is to assist

the medical community

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in Tanzania to learn the latest

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in cardiovascular care,

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and then to be able

to train others

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and care for their country.

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Are there other partnerships

that you have developed there

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to not only

help train the trainers,

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but to educate the country

on good heart health?

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Remember that this program

in developing

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advanced cardiac care

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was the priority

of the Tanzanian government

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and health care system,

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and they decided that

this was the place to start,

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rather than preventive care.

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You could certainly argue that

that is a little backwards,

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that perhaps preventive care

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should've been

the place to start,

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but that is not

what they decided to do,

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and we're there to help.

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It's not our program,

we're there to assist as we can.

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Of course, they are

very concerned about prevention.

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It is

a resource-limited country,

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and so lots

of different programs

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really can't be occurring

at the same time,

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but of course, they are

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extraordinarily interested

in that.

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And the newest part

of our program now,

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with other partners

here now at MUSC,

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is to find ways

to bring cardiac care

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to the whole population

of Tanzania,

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not just those that need

advanced cardiac care,

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but how do we help them

provide cardiac care

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to the whole population?

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And not just

advanced cardiac care,

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but even simple cardiac care.

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The treatment of blood pressure,

for example.

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Treatment of cholesterol,

for example.

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So, yes, all those

are now becoming priorities.

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What are the barriers

to trying to accomplish

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such a huge and ambitious goal?

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The barriers are some

that you've already implied

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in your questions,

and they include

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things like infrastructure,

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so that, for example,

the system of roads in Tanzania

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is very incomplete.

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Things like clean water,

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and protection

from infectious diseases

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remain challenges.

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And then, there are limited

resources in money as well.

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The entire Tanzanian

medical budget

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is a tiny, tiny, tiny fraction

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of the health care budget

of a country

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like the United States.

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While working on this program,

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have you found

any new innovative tools

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or ideas that have

come out of this program

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that you can share

with your American colleagues?

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There's a technology which has

been around for a long time,

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which is

handheld echocardiographies.

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So, this is a device

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which is the size

of a cell phone

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and which can take

beautiful pictures of the heart

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and indicate all kinds

of different cardiac diseases.

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So, this is a device

which can be carried.

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People can easily

be trained to use it.

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It's inexpensive.

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And so, the idea

that we are now pursuing

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is using this device

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out in the rural areas

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to screen for and help manage

cardiovascular disease.

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We have just completed

a research project,

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which was primarily performed by

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an echocardiographer at MUSC

named Rich Bayer

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and an echocardiographer

in Tanzania,

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which has demonstrated

the feasibility of training

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health care workers

to use this technology

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to, in fact, identify

significant cardiac disease.

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So, it's a device which has

been around for a while.

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The innovation is to train

non-M.D. health care workers

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to use it and help provide care

to large populations.

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You've spoken about the barriers

that you had to overcome.

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Now tell us about

the great accomplishments

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-that have occurred.

-The government of Tanzania

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and the medical community

decided they wanted

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to develop these advanced

cardiac services.

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So, prior to 2014,

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there had never been a single

cardiac catheter procedure

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or angiogram

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or treatment of

a coronary artery with a stent

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in the country prior to 2014.

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So, since that time,

with training,

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they have now developed

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an outstanding

first-class program

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in cardiac catheterization,

angiography,

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and treating coronary arteries.

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So, now they are working

day and night

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treating patients

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with high quality,

very high success.

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And, in fact, they have

just recently been recognized

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as the predominant center

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in Sub-Saharan East Africa

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for these advanced

cardiac services.

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So, in a consortium

in Sub-Saharan East Africa

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looking at all different areas

in health care,

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this particular program

has been identified

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as the leader

for advanced cardiac care.

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You are listening

to MUSC's Science Café

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with Dr. Eric Powers,

a cardiologist and researcher

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in partnership with

our Heart and Vascular Center

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Friends from the Heart program.

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Dr. Powers, what have you seen

in terms of both quality of life

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and economic development

in Tanzania

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because of this program?

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I think it's too early

to answer that question.

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Although this program

has been a tremendous success,

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it treats about--

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or has resulted in the treatment

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of perhaps 1,000

to 2,000 patients a year,

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which is a great accomplishment

going from zero.

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But, in a country

of the population of Tanzania,

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it obviously

is just a drop in the bucket,

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and so the long-term benefit,

I think,

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is a little hard to predict.

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The country

is doing well economically,

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or had been doing

well economically

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until the most recent crises,

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particularly around COVID.

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You know,

so there's great optimism.

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The final overall benefit

of the program, I think,

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is yet to be determined.

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One of the other issues

that comes to mind to me is

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you train specialists there,

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and what keeps them

in the country

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rather than taking their talent

to other countries?

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That's a wonderful question,

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and that has been a problem

with developing health care

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and other areas as well

all around the world.

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And the answer is that

the people who are in Tanzania,

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the Tanzanians who are now there

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are extraordinarily committed

to health care in their country.

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So, I'm delighted to report

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that as we've been helping

train the trainers

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over the last 10 years,

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there really has been

no significant loss

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of the people we have trained,

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and, in fact,

quite the contrary,

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that training

the trainers has worked,

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so now there is

a new generation of trainees

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being trained

by the first people

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we did train,

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who are committed

to developing these programs,

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as well as preventive care

and other cardiovascular care.

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So, it was a concern starting

that this might happen.

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I am very pleased to report

that there is no sign that--

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That's quite an accomplishment.

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But what about bringing

our own students to Tanzania

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to see what you've accomplished

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and what the citizens

of Tanzania have accomplished?

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Because we're a global society,

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certainly they can learn

a thing or two.

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So, we decided several years ago

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that our mission at MUSC

is clinical care,

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research, and education.

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So, several years ago,

we developed

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a medical student rotation,

so every year we take two

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or three medical students

with us.

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We also have a rotation

for a cardiac fellow.

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A cardiac fellow being

someone who is doing

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subspecialty training

in cardiology

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just prior to finishing

all their training.

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So, yes, so education

is an important part

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of the program

at the present time.

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And what do the students

say to you when you come back?

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Well, the experience

that everybody has

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who does this kind of work

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is that it's

a life-changing experience,

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and it's something

that you can't anticipate

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before you go,

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but you are

definitely changed by it.

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And so, they come back.

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We choose students to go

who are extraordinary people.

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They are all

unbelievable people

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who will be leaders

in American medicine.

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It may not be in global health,

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it almost certainly

won't be in cardiology,

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but they will be leaders

in American medicine.

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And so, what they bring back

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is an appreciation for

and insight concerning

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treatment of the underserved.

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And that is something

which is, of course,

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critical in the United States,

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as every place else

in the world.

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We certainly have large, large

underserved populations.

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And so, the students

who come back will be leaders,

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will have met treatment of

the underserved as a priority,

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and I think will result

in important improvements

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in care

in the United States as well.

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At least,

that's the model we have,

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and so far,

it seems to be working.

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You know, necessity

is the mother of invention.

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What is your hope

for this program?

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Not just in Tanzania.

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Do you see it

expanding elsewhere,

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or what would you like to see

in the next 10 years?

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The next steps, I think,

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are some of the ones

that you have identified.

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The developing

advanced cardiac care

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really is well on the way

in Tanzania,

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so now it's gonna be about

delivering cardiovascular care

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to the larger populations

in Tanzania and beyond.

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Can this be a model for care

in other areas as well?

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And the answer is, "We hope so."

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We think a lot

of what we're doing

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could be applied to care

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in lots of other areas,

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which are important in Tanzania,

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but important

all over the world.

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This is a laudable program,

and it's one that needs support,

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and I think that

one of the things

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we'd like to say today that

we'd like our listeners to hear

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is how can they engage

in this program?

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But before you answer

that question,

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tell me why we should care.

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We, in this comfortable,

rich country,

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who have fabulous physicians,

such as yourself,

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taking care of us,

why should I care about

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the citizen of Tanzania?

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Well, there are two reasons.

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One is because

we care about everyone.

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And it's the right thing to do.

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But beyond that,

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if we are successful

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in this program as we have been,

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and particularly as we train

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our young,

rising health care workers,

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particularly medical students

I'm talking about,

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but it can be others as well,

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it's what

we talked about before.

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They will come back educated

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in something which is critical

in advancing health care

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in the United States.

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That is carrying forward

the underserved.

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And that is a critical frontier

for all of us,

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and we think

that programs like this

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support these programs

right here at home.

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I couldn't agree with you more,

especially in this day and age.

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What can our listeners do

to support and engage

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in this program if they wish?

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The answer is that

this does cost money

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to do these programs.

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It's around travel,

it's around training,

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and various things.

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We have been very fortunate

through philanthropy

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and through the MUSC Foundation

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to have gotten financial support

from some very generous donors.

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In addition, we do have

grant support as well.

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So, any financial support

that we can get

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is always helpful.

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And so, if any of our listeners

are interested

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in providing that support,

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we would be

extraordinarily grateful.

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And when we share this podcast

with our listeners,

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we hope to send out a brochure

that offers them information

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on what you are doing,

what you've accomplished,

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and who to contact

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to support

this very worthy endeavor.

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It has been a pleasure speaking

with you today, Dr. Powers.

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Thank you so much for all you do

to expand the health

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and well-being, not only

of our state and region,

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but for all those you serve

across the world.

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And thank you to our listeners

for joining us

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on this journey today.

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Join us next month

for our upcoming Science Café

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with Dr. Mike Yost,

Professor of Surgery,

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on 3D printing and COVID-19.

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The future is now.

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Dr. Powers,

our very best to you.

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We hope to have you

back on the program again

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to tell us

what you've accomplished

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in the years ahead.

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-Thank you so much for this.

-You're very welcome.

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Until then, everyone,

please stay safe and healthy.

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