Orientation guide

The Medical Education Partnership Initiative (MEPI) is an NIH program to transform medical education in 11 sub-Saharan African countries. Stanford University's Center for Innovation in Global Health (CIGH) has partnered with the University of Zimbabwe College of Health Sciences (UZCHS) and the University of Colorado, Denver in receiving a $10 million dollar grant to establish the Novel Education Clinical Trainees and Researchers (NECTAR) Program in Zimbabwe, a $2.5 million dollar pilot grant dedicated to cardiology and another $2.5 million dollar grant dedicated to mental health.

The two teaching hospitals of UZCHS are the Parirenyatwa Hospital (2000 beds) and Harare Central Hospital (1200 beds). These hospitals also serve as community hospitals for the City of Harare (population 3 million) and will provide trainees with a broad diversity of patients with illnesses that are representative of the Zimbabwe health care priorities. All major medical and surgical subspecialties are represented in these hospitals and there is a rich environment for interactive bedside teaching. The Parirenyatwa hospital is immediately adjacent to the Medical School building and is easily accessible via connecting hallways. Harare Central Hospital is approximately 10 km from the Medical School. Trainees can travel to and from Harare hospital via a shuttle bus (for medical students), by car or taxi. Each hospital also has outpatient clinic facilities with consulting rooms. All inpatient and outpatient facilities at both hospitals would be available to trainees in this program.

UZCHS has laboratory capacity for teaching of medical and postgraduate students and for the conduct of basic science and clinical research. Basic science laboratories are located in the pre-clinical departments. Clinical side room laboratories are located in 5 medical wards for teaching medical students basic clinical laboratory techniques. These laboratories are available to faculty and students for training and for research capacity development.

If you are being funded through MEPI, you are most likely going to Zimbabwe for 2-4 weeks. The minimum required duration for funding under MEPI is two weeks.

If you are a resident traveling to Zimbabwe as part of an independent rotation through Stanford’s Center for Innovation in Global Health, you will be visiting for 4-6 weeks. The minimum required duration for this type of rotation is 4-weeks.

If you are a resident traveling as part of Johnson & Johnson, you will be visiting for four weeks. The minimum and maximum required duration for funding under Johnson & Johnson is four weeks.

Interested applicants need to complete the appropriate application form found on the MEPI/NECTAR section of the CIGH website. Your application will be reviewed and you will be contacted within two weeks after submission.

All those traveling to Zimbabwe are required to complete the web-based ethical challenges course, which can be found at http://ethicsandglobalhealth.org. You are required to complete all surveys following each case.

If you are a resident or a fellow traveling to Zimbabwe, you are required to complete the Away Rotation Form and submit this to GME directly at least 60 days prior to departure. Please check “yes” for malpractice. This is a GME requirement. To this form, you should attach the competency-based goals and objectives but do not need to attach a letter of acceptance from the host program and do not need to attach a program letter of agreement (PLA). Contact the Program Manage for the core-competency goals and objectives.

The Host Program details are below.
Name of Host Program: University of Zimbabwe College of Health Science (UZCHS) as part of the Stanford MEPI Grant with the Stanford University Center for Innovation in Global Health (CIGH)

Name of Host Program Director: James Hakim, MD

Name of Facility: Parirenyatwa Hospital

Address: See Tenday Chisvo’s address below

Contact Person: Tendayi Chisvo (phone number is below)
If you are a faculty member, you are required to complete a Certificate of Insurance (COI) Malpractice Insurance Coverage Request Form and submit it to Risk Management, specifically to Janet Sencenbaugh (sencenbaugh@stanfordmed.org). A copy of the form can be provided to you by the Director of Educational Programs in Global Health.
Registration Requirements

Once you are accepted via application process described above, you will need to submit the following paperwork to the NECTAR Office in Zimbabwe for registration through the Medical and Dental Council in Zimbabwe. This should be done at least 8 weeks prior to departure. See the list below.

• 
  Letter of Good Standing from the California Medical Board ($10), an example can be found here.
  
• 
  Copy of updated CV.
  
• 
  *2 copies of passport photos (each needs to be stamp notarized on the back). Some notaries will not provide a stamp on the back of the photos. If this is the case, please have them staple the photos to a blank piece of paper and instead notarize the paper.
  
• 
  *Signed short-term philanthropic form (for physicians who plan to lecture, do demonstrations, surgeries or procedures). This form can be found here. Please leave “Coordinator” signature area blank. This is for Tendayi Chisvo to sign when she receives the paperwork.
  
• 
  *Ensure you meet the requirements to take a Stanford laptop abroad. Submit all required documentation. This is a Stanford requirement prior to taking your laptop overseas.
  

The Letter of Good Standing, copies of passport photos, copy of CV, and the signed Short-term Philanthropic Policy form should be mailed at least four weeks prior to arrival. All of these documents should be sent to Tendayi Chisvo by FEDEX to the following address:

Tendayi Chisvo

NECTAR Programme

Department of Medicine

Parirenyatwa Hospital Complex

University of Zimbabwe – College of Health Science

Harare, Zimbabwe

Tel: 263-773-524493 or 00263-772 629131

Single-entry: $30

Double-entry: $60

Multiple-entry: $55

If you are not a US, Canadian or British passport holder, it is highly advisable to get your VISA prior to departure. You should apply for a Tourist Visa (unless you will be going to work in Zimbabwe for more than six weeks). To do this, contact the Embassy of Zimbabwe at least 4 weeks prior to departure. It is recommended that all visiting professors obtain their VISA prior to departure to save time upon arrival to Zimbabwe.

You are required to schedule your mandatory Travel Clinic appointment (at least 6 weeks prior to departure). To do this, follow these directions:

Call the Travel Clinic at 650.736.5700 to make an appointment. You should let the scheduler know that you are traveling as part of the Stanford Center for Innovation in Global Health. Once your appointment has been made, you will need to complete the 2-Page Pre-Travel Risk Assessment on the Travel Medicine Clinic Website and fax this in at least one-week prior to appointment. Please note these appointments will most likely take place on Thursday mornings (8 AM–11 AM).

Travel Arrangements

This program is funded by the NIH, which means that you must adhere to the Fly America Act if you will be funded under the NIH grant. If you are unsure of your funding source, please contact the Director of Educational Programs in Global Health to confirm. If you are funded by NIH funds, you are REQUIRED to book your ticket through the CASTO travel agency on a US Carrier. You can contact this grant’s dedicated travel agent, Eileen Young, by phone at 408.553.4708/888.852.6499 or by email at eileen.young@casto.com. Please let Eileen know that you are traveling as part of the Zimbabwe group with Stanford’s CIGH.

Please note that NIH requires all visitors to fly on US carriers from the US and that as part of an effort to best utilize these funds we require that the cheapest airfare be issued. All ticket itineraries will be sent to the Director of Educational Programs in Global Health for approval before they are issued to ensure the ticket is within NIH guidelines. For any questions about these requirements, you should contact the Director of Educational Programs in Global Health.

Keep in mind that it will take about two days to travel from the United States to Zimbabwe, including air travel time and layover time. Take this into account when arranging travel.

Please note that the CASTO travel agency is not to be used for Visa processing. This is not allowed due to the high cost of this service by the agency.

If you are traveling as a resident with funding through CIGH, you do not need to follow these guidelines and can book your own ticket.

Once your ticket has been booked, please forward this directly to Tendayi so that she may arrange for a driver to pick you up from airport. Please ask that she confirm receipt of your email. You should let her know which B&B you will be staying at so she informs the driver of where he should drop you.

Evacuation and Repatriation Insurance

If you are a Johnson & Johnson scholar, you are covered under MEDEX and you should refer to the Johnson & Johnson intranet for information on this program. For any questions about this, please contact Laura Crawford (laura.crawford@yale.edu)

Expenses are not to exceed $5,000 for a 4-week rotation. Please contact the Director of Educational Programs in Global Health re: expenses.

Payments will be made in the form of reimbursements. Please contact Ryan Oden (roden@stanford.edu) prior to departure regarding any questions pertaining to what is required for reimbursement to ensure a smooth reimbursement process once back in the US. Submit all receipts and forms for reimbursement to Ryan upon return.

Travel Warnings and Country Specific Information

Due to political instability in Zimbabwe, we recommend that all visitors frequently check the travel alerts prior to travel. This can be done on the State Travel Alerts Website. Also, general information on Zimbabwe such as travel guidelines, regulations and general country-specific information can be found on the Travel State Website. The CDC also offers information about needed vaccinations and health information regarding Zimbabwe. Additionally, the Zimbabwe Demographic and Health Survey offers valuable information and should be reviewed.

Medshare is a non-profit organization dedicated to improving healthcare and the environment through the efficient recovery and redistribution of the surplus medical supplies and equipment to those who need it most. We highly encourage you to participate in taking over the supplies that are most needed during your trip. You should consult with the Zimbabwe contact (depending on which department you are in) on which supplies are needed.

The process is quite simple and detailed below.

1. Complete the application on the Medshare website: http://www.medshare.org/services/medical-mission-teams then send an e-mail to Shannon Kuehnel to arrange an appointment for your product pickup. Medshare is open Monday-Friday from 8:30 am to 3:30 p.m. **Tuesday and Thursdays are best – as Medshare has special volunteers to assist you on those days, so please plan on those days. Only medical professionals may pick up supplies. This is a self-service program where you will be hand-selecting the supplies that you desire.

2. As a charity, Medshare asks for a $75 donation for the first 50 pounds of supplies then $2 for every pound over the initial 50 pounds.

3. Upon your return, Medshare asks that you share your medical experience with them. Send them a short summary of your mission accomplishments, with an emphasis on individual patient stories with pictures, so we can know how the supplies were used and how it impacted those served.

• 
  Hand Sanitizer
  
• 
  Adapter (costs about $30 and can be found at the Stanford Bookstore to convert electricity from 220V to 110V. You can also buy an adapter at the airport. If you leave it in Zimbabwe with Tendayi, you can be reimbursed for it). The adapter works very well for charging laptops, iPhones, etc. but NOT blow dryers.
  
• 
  Snacks (for airport, when you arrive, office time)
  
• 
  Toilet paper/tissues (these can be hard to find in bathrooms and offices)
  
• 
  Laptop with power source
  
• 
  Flashlight with batteries
  
• 
  Umbrella (during rainy season: November – April)
  
• 
  Travel clock with alarm
  
• 
  Ziploc bags in a few sizes and larger plastic bags (plastic bags are typically sold in Zimbabwe for 10 cents)
  
• 
  Personal medications (Cipro for GI discomfort)
  
• 
  Camera
  
• 
  Bubble wrap (in case you buy something fragile)
  
• 
  Stethoscope
  
• 
  Ophthalmoscope/otoscope with batteries
  

The airport is about 45 minutes away from Harare, where you will be staying and working. Transportation is arranged for each visitor from airport, to airport and from/to apartment and work. You do not need to pay the driver designated to you for the rides.

Often the electricity does go off in Zimbabwe. This is less an issue in the NECTAR Office and UZCHS because of the generators but it is common for houses and apartments so be aware of this.

We have identified a few housing options for you. For $60/night, you can rent a room in a comfortable B&B, near to the hospital. The house has two bedrooms, each with a bathroom and is located in Avondale, close to shopping centers and restaurants. The house has a large garden, a water tank of clean water and an inverter so electricity is not an issue. The room includes breakfast. You can learn more about the B&B and see more photos here.

Milton Park B&B ($85/night. If staying for more than 2 weeks, the negotiated rate is $65/night). More information and photos can be found here. The Milton Park B&B is available for faculty. Faculty are welcome to stay at the Avondale B&B is there is no availability at the Milton Park B&B.

Avondale B&B ($65/night). Photos below and more information here. The Avondale B&B is available for residents and fellows. Residents and fellows are able to stay at the Milton Park B&B only if there is not availability at the Avondale B&B.

Travelers are responsible for managing their accommodation bookings.

You will receive a phone when you arrive to Harare. The phone will either be given to you at the airport during pick-up or will be left for you in the apartment you will be staying in. The phone should have some “air-time” (minutes) left by previous visitor. The phone will be handed to you with instructions on how to add minutes and a pin, if applicable.

When your minutes expire, you can add more by visiting a local supermarket and purchasing them from the cashier. You can use this phone to text and call anywhere in the World and can recharge minutes as needed.

Money

The USD is the official currency of Zimbabwe. Be prepared to bring a lot of change with you (coins and $1 and $5 bills), as change for larger denominations is rare. Getting change when in the supermarket or restaurants is quite difficult. We suggest you have at least $100 in $1 bills (for 2 weeks) and about $10 in coins (for 2 weeks).

Most ATMs do not work so do not rely on getting money from them when you are in Zimbabwe. Try your best to bring enough cash for your stay. Always keep your money secure.

You will find that locals in Zimbabwe are very fond of new dollar bills and will often try to exchange older bills for newer bills, if you have them. Also, be prepared that most bills there are extremely used so try to bring hand sanitizer with you (see “what to bring with you” section in this orientation guide).

Internet is spotty in Zimbabwe. However, a dongle can be used to help access WiFi. Tendayi will have a dongle with instructions either at the NECTAR flat or with the driver upon arrival. You may also choose to purchase a dongle (~$50). Tickets to use the internet cost about $9 for a half day. Both the dongle and tickets can be purchased at the Avendale Shopping Center near UZCHS.

It is important to dress in a presentable manner at all times while at work in Zimbabwe. Prepare to wear business clothes, i.e. slack, button-down shirt and tie for males and at-the-knee or below-the-knee skirts and button down shirt for females. The dress code in Zimbabwe is fairly conservative and formal relative to the west coast American dress code. Sleeveless shirts and shorts are not common in business settings. Walking shoes are useful and helpful during work hours.

For social outings, more casual yet conservative clothing will suffice.

In the work setting, you will find that white coats are only worn by medical students, residents and house officers (those who have completed residency and have not yet completed subspecialty training).

As with any country, you should avoid complacency. Overall, Harare is a safe city but it is not recommended that you walk alone at night or walk alone in isolated areas. It is better to be driven at all times by either a driver designated to you or a taxi that is referred to you by someone in the NECTAR office.

Keep it to an absolute minimum. Wear a wedding band but do not wear any diamonds or flashy jewelry. It is best to keep it safe at home in the U.S. and avoid losing it or getting it stolen.

Do not talk about them. Often people will bring this up in casual conversation but you should refrain from discussing your opinion when it comes to politics.

The official religion in Zimbabwe is Christianity. Religion is discussed in casual conversations as well and you should refrain from speaking in-depth about your religious views. Homosexuality is also very frowned upon and can fringe upon the safety of people so please refrain from discussing your personal lifestyle choices and views on this subject. For more information on cultural dilemmas, refer to the web-based ethical challenges course found in SECTION I of this guide.

It is very important to address all faculty with their official titles. You should ask each faculty member you speak with how s/he would like to be addressed. For example in surgery a doctor who has passed boards is called a “mister” while a surgeon who has fulfilled certain research requirements is referred to as a “professor”. If you are a faculty member, you should address yourself as “professor so-and-so” and do expect that you will have to address another professor, of similar training and age, with their official title.

All stipend processing and reimbursements are handled by Ryan Oden (roden@stanford.edu). The per diem amount for meals and incidentals is $30/day. All expenses will be reimbursed after travel has been completed. Please keep your boarding passes upon return as reimbursements for other aspects of your trip cannot be handled without this piece of documentation.

As part of this grant, the University of Colorado-Denver and their Evaluation team have been working on evaluating the visits by staff, residents, fellows and faculty. Prior to your trip, please reach out to Jeffrey Proctor (jeffrey.proctor@ucdenver.edu) to provide you with the following two evaluation forms: 1) post-trip report and 2) participant feedback survey. The first evaluation is one that should be used for your overall trip. The second evaluation should be handed out to those who attended your lectures, demonstrations, workshops, etc. while you were in Zimbabwe. Please plan to take a copy with you during your trip. Tendayi will be able to make copies for you depending on how many you need.

You are required to submit a 2-5 page trip summary to the Director of Educational Programs in Global Health. Please also include 2-4 photos that could be posted to the CIGH website in a .jpeg format.

• 
  Tendayi Chisvo (tmaunganidze@gmail.com), NECTAR Coordinator. Tendayi is the point of contact for arranging airport pick-up/drop-off, meetings while in Zimbabwe and any other coordination questions/situations can be answered/handled by her
  
• 
  Jackson Mwepetha, the NECTAR driver who will be responsible for airport pick-up/drop-off and also will help with driving you to and from NECTAR office during your visit
  
• 
  Professor Jonathan Matenga (jonmatenga99@hotmail.com) is the NECTAR coordinator and should meet with each visitor upon arrival and before departure