DGHI20 Reflections: Blandina Mmbaga

Blandina Mmbaga, M.D., Ph.D., is the force behind DGHI’s longstanding partnership with the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. And “force” may be the only word that lives up to Mmbaga’s  tireless work ethic and can-do spirit. A pediatrician by training, Mmbaga oversees every aspect of DGHI’s largest and most complex global collaboration, from directing clinical trials to managing research budgets to mentoring dozens of students and early-career researchers. 

“Blandina is probably the hardest-working person I know,” says DGHI professor emeritus John Bartlett, M.D., who has worked with Mmbaga for more than two decades. “She is a natural-born leader and never, ever says no to anyone who needs her help. She is a force in the very best sense of the word.”

Originally from the Kilimanjaro region in northeastern Tanzania, Mmbaga grew up in Mwanza before moving to Russia for medical school. She joined KCMC in 2003, where she helped establish a pediatric HIV clinic and became active in research, earning aPh.D. in public health and epidemiology at the University of Bergen in Norway. Since 2015, she has served as director of the Kilimanjaro Clinical Research Institute (KCRI), while also still teaching and seeing patients in the hospital.

We spoke with Mmbaga, who is also an associate adjunct professor with DGHI, about the early days of DGHI’s collaborations in Moshi, and how a Duke course helped ignite her passion for clinical research. The conversation has been condensed and edited for clarity. 

How did you become interestedin medicine?

My mother always wanted to become a nurse, and she was very brighten school, but her parents thought that a girl should be married, and so she had to drop out. Later on, she decided to get training from a traditional midwife,  and she used that skill to support other women. She often treated us at home, She could give us injections of chloroquine if we had malaria or penicillin if we had an infection. 

When I started to show an interest in medicine, she decided to teach me. I became her supporter when she was traveling. She was excited for one of her children to be interested, but even then, she thought I would be a nurse. It was not believed that a female could be a medical doctor. But I knew when I was 12 years old I wanted to be a children’s doctor. 

How did you end up in Russia for medical school?

It was not going to be easy for my family, because we were not even middle class. But I had a head mistress in school who took an interest in me, and she said, “I will make sure you become a medical doctor.” At that time, Tanzania had only one medical school, but her father had been an ambassador in Russia, and her cousin was there. And so I got a scholarship and went to Russia. 

While doing my medical school, I met my husband. We got married, and I had my first two children. Who are both medical doctors today. I was offered a year off to take care of my children, but I told them, I was not sent here to take a leave. I was sent here to study.” My other sisters did not go further in studies so that they could work with my mom and help raise school fees. They sacrificed their education for me, and that has always made me want to work hard for my family. 

What was your first interaction with Duke?

It had to be in 2003, when I was doing my internship at KCMC. [Duke professors] John Bartlett and John Crump were building a small office at KCMC. Then, I met [former Duke pediatrics professor] Coleen Cunningham when I was doing my master’s thesis. She started to become my mentor and guided my research. In 2006, Coleen told me they were starting IMPAACT (the International Maternal, Pediatric and Adolescent Clinical Trials), and because I had spearheaded the establishment of the youth HIV clinic in Moshi, she wanted me to be involved. I was one of the first members of the vaccine immunology scientific committee. 

Coleen and John Bartlett arranged for me to take a course at Duke on comprehensive research methodology, and so I spent three months at Duke in 2006. And at the end of that course, I had my abstracts accepted at the annual CROI conference, and so that became something that really motivated my research. 

How has your role changed as the partnership has grown?

The partnership has allowed me to learn and grow as a researcher, but also as a leader. My leadership has been made stronger by the succession plan John Bartlett put into place for the Socio-Behavioral Sciences D43 grant, which transitioned the principal investigator role to me. This prepared me well overtime. 

I  remember in 2015, when I was invited to attend the interview for the position as director of KCRI. I’d never thought of the position and at first, I didn’t think I was capable. I was at an IMPAACT meeting then visited Duke around that time, and I told [DGHI professor] Nathan Thielman, I don’t think I am able to do it. But he said, “Yes, you are. You are already running the collaboration.” Everyone at Duke told me I shouldn’t worry, and that they would be there to support me. 

So I have had to learn how to be multitasking. We are doing a lot of different things, and it may be that I am working late, not leaving the office until 10 or 11 p.m. But I am never alone. There are always other researchers and students here, looking for mentorship or advice on projects. 

In 2021, you and [DGHI professor] Catherine Staton launched the TRECK program, which is the first NIH-funded training program led directly by KCMC. How important is it to see programs in the partnership transitioning to local leadership?

It’s very important, With trauma and injury, we now have a registry and so we have a lot of data. But we don’t have a lot of people to analyze it, and so building capacity in data science is critical. We need people who can take leadership. And I really feel very proud, because the TRECK team are working very hard. Some of them are now the project leaders, and we are slowly transitioning the principal investigator role to them. 

It’s like with James Ngocho, [a lecturer at KCMC who graduated from one of the DGHI-KCMC partnership’s training programs] who did a master’s degree with me and later went on to get his Ph.D. He is now leading a K43 award and is overseeing a lot of clinical trials at KCMC. He has become like my second hand with managing clinical trials. And so it shows the value of building up others, because it makes my work easier.  

It must be gratifying to see your mentees step into roles as leaders.

It really is.  Some of them have become senior lecturers and associate professors, and it kind of drives why I keep mentoring, to see this growth even in our institution. I really enjoy it when my mentee becomes successful. I feel I am paying back to my mentees by building trust and capacity for them to lead grants and be part of institutional leadership. And I tell them, “Don’t just sit there and expect to move forward. You have to show how hard you’re willing to work, and how much you want to contribute.” It’s about taking responsibility, because that is how we grow. 

You’ve also been really influential as a mentor to Duke students who come to Tanzania to participate in experiential learning and research. What do you try to impart to those students?

The most important thing is communication. We have a lot of communication with students before they arrive to help them know who they are going to meet and what is here. We also have weekly meetings, which the trainees are always attending, and this helps them to know what is going on, not only in the area that they know, but other research activities. These meetings are times when we can talk about problems they are having or changes they can make. We try to be close with them and be always available to them, because that makes them feel safe. 

I always enjoy meeting with the students, because we are learning, too. Each student comes with a new idea, maybe a different way of implementing things. I remember we had some students coming to work on a mental health project, and they used pictoral diagrams to help assess youth, and that was something new to me. And so we have been able to explore this, because we are also taking time to learn. 

As you look to the next 20 years of working with DGHI, what are your goals? How do you think the partnership will change in the years ahead?

Well, my first goal is to make sure the partnership is maintained. But it is important that we continue to expand and tackle other areas that are emerging. The landscape of disease is changing, and we need to be building together to take on things like non-communicable diseases and the health impacts of climate change. I also want to see us extend mentorship more to local leaders and communities. 

I see the impact of our current interventions, but how are we extending those impacts out into the community? I love the way we are moving forward with [Catherine Staton’s] alcohol intervention studies, where we are going outside of KCMC and into the peripheral hospitals. It’s similar to the work we are doing with [DGHI associate professor] Julian Hertz on hypertension and myocardial infarctions and [DGHI associate professor] Dorothy Dow on youth mental health, looking at scaling up our Sauti ya Vijana (SYV) intervention. We have seen that this works at KCMC, but how best are we now bridging the gap and supporting health systems around the country? So that’s how I’m looking forward, to see how best we provide the good lessons we have learned through this partnership to reach many more people.