John Stanifer: To Tanzania and back

Sunday, January 31, 2016
John Stanifer, MD in Tanzania

By Scott Huler

John Stanifer, MD, MS, once gave a wedding toast in Tanzania in the Chagga language.

“I practiced for about a month,” he says, shaking his head.

As for the response?

“The people just laughed and laughed,” he says. Not because his Chagga was poor – because “most of the young generation Tanzanians don’t even speak Chagga, so to hear a mzungu – a white person – speak Swahili is funny enough, but to hear them speak chagga….”

Well, once you’re delving further into the culture than even the native children, you’re saying something about how you do things.

So before you even get to his current role as trainee in the Duke Nephrology Fellowship Training Program, and his role as Clinical Scientist in Nephrology Fellow with the American Kidney Fund, before you get to the many publications he already has about his work in Tanzania, before you get to his current work with the Lumbee people of southeastern North Carolina, before you get to his commitment to mentoring those who come behind him while he is himself barely coming up, just absorb that.

When he went to Tanzania, Stanifer learned a language that not even the native children learn.

Which is to say, you can try to keep up with Dr. Stanifer, but it’s not recommended. A better approach is to just watch, listen, be amazed – and maybe try to catch the slipstream. Wherever he’s headed is probably worth following along.

Having strong partners who are actually interested in the research and not just their name on the project helps.

John Stanifer, MD, MS

Stanifer graduated from the University of Tennessee College of Medicine in 2010 and came to Duke as a resident in internal medicine. He expected to do cardiology, but he became interested in nephrology and turned to kidney disease. When he decided to get his Masters of Science in Global Health, he knew it would require extra commitment.

“It required us moving to Tanzania and taking an extra year of training and doing a master’s degree on top of it,” he recalls discussing with his wife, Molly.

It also required him to venture into the wilds of the University of North Carolina for training in Swahili, where he sat in class next to undergraduates.

“I’m sitting there thinking about all this clinical work, and they’re talking about how they just went to prom three months ago,” he says.

For Stanifer, Swahili was essential.

“In Tanzania, you have to be able to speak Swahili in order to do much of anything. It’s an important connection and an important bond you can form with people.”

He used that bond to connect to local leaders and befriend people so he could test their renal health for his study. That study, according to Stanifer, says a lot about how Duke does global health.

“The idea is to bring a research focus to do global health,” he says.

That is, a group like Doctors Without Borders intervenes to help – that’s what they do. “Whereas here we say, that’s what we want to do, but we also want to go and answer questions and do some research on top of that,” Stanifer says. “You can do broad-scale interventions that have a large impact, but do it in a way that is scientifically sound, valid, and academically rigorous and studied.”

Stanifer and Molly moved to Tanzania in 2013, and he’s already had resulting work published in journals like PLoS One, The American Journal of Kidney Disease, and The Lancet Global Health.

“The neat thing about the program was that I got a lot of independent research experience early on, which is unusual for a resident or someone early in training, which I was.

“I got to be involved in the research from conceptualizing a question, writing a grant, getting funding, designing a study, writing the protocol, administering funds, hiring and managing the team, doing data collection and management, and finally data analysis and publication.”

Stanifer and his team found a high rate of kidney disease that had not been noted before in sub-Saharan Africa. He’s still writing up and working on the data from that work, but he’s back home now.

You can expect that doesn't mean he’s sitting still, catching up on his Netflix queue.

(See more photos of the Stanifers in Tanzania and watch a video of their trek to the top of Kilimanjaro.)

Back in North Carolina

Along with the work he does in his nephrology fellowship at Duke University Medical Center, Stanifer is now doing a similar study among the Lumbee.

“We said, you know it would be neat and helpful and it would serve the Global Health Institute mission to come back and then do something in eastern North Carolina. We said, ‘Can we address disparities in kidney disease there, and can we do it while drawing parallels to what we’re doing in Tanzania?’”

Though people might initially doubt the similarities between the two populations, Stanifer found a lot of similarities.” In both places you’re dealing with a population that is disenfranchised and has limited access to health care, and suffers significant disease from poor lifestyle choices, he says.

“There is poor social support. There’s stress. People using spirituality and religion as coping skills to address chronic disease. That’s very common in both Robeson County, N.C. and Tanzania.”

Stanifer has a five-to-ten-year vision for his program.

“That’s kind of a common thread. We’re beginning to understand the differences, but can we draw parallels between the two and answer broader questions about kidney disease globally?”

Not coincidentally, if you want to be funded by NIH, you need to be helping American public health. The process of bringing things learned through foreign research back home – reverse innovation – is a current global health buzzword, he says.

“I think this is a neat way to do it. We have a population in Tanzania that we’ve learned a lot about. Now let’s take this population in North Carolina and learn a lot about North Carolina.”

Working with the Lumbee requires the same kind of trust-building, but he can’t learn Swahili to gain their trust. What’s more, the epidemiology in Robeson County is largely known – people have kidney disease because they have diabetes and hypertension.

But what are people’s knowledge, attitude, and practice surrounding chronic disease in Robeson County? Stanifer wondered. He's found that among the Lumbee a top-down approach is vital: you have to work through tribal, political, and cultural leadership.

“And having strong partners who are actually interested in the research and not just their name on the project helps.”

He’s working in the study with Ronny Bell, PhD, professor of epidemiology and prevention at Wake Forest University School of Medicine, who is himself Lumbee, and with Cherry Beasley, PhD, MS, FNP, RN, CNE, nursing researcher and professor at UNC-Pembroke. They were important in this, says Stanifer, because they have cultural insider status.”

That kind of collaboration works both beyond Duke and within – in fact, Stanifer is part of a team that just received a Duke University-wide Bass Connections Grant for this research, supporting the project’s focus on spirituality and self-management, and the Duke Clinical Research Institute awarded Stanifer and Blake Cameron, MD a supplemental funding grant that will help them leverage the power of the electronic health records in the Robeson County work.

Mentoring others

Enough? Nope. He worked with Joseph Lunyera, a Master’s of Science in Global Health grad who was a year behind Stanifer. “He was able to write his thesis on our Tanzania work; he carved out a piece of what we did in traditional medicine and wrote his thesis on that. He now has a publication off of that.

“I hope to do the exact same thing with another student this year, except she’ll be doing it off the Robeson County project. She’ll be involved, doing a lot of the study groundwork, with Duke undergrad students in the Student Research Training Program (SRTP). So we’re engaging Duke students and bringing them into these projects and then sending them in and getting research skills.”

It works out for Stanifer, of course, too.

“It’s the right way to do it on a shoestring budget,” he says, with a smile. “Because I get free labor.”

His urge towards helping those behind him extends to his fellow trainees as well. He’s working with internal medicine resident Dinushika Mohottige, MD, who’s looking into similar renal issues in Sri Lanka. This too plays into the way Duke wants things to work.

“Even though I’m still very junior – junior doesn’t even describe it, I’m not even faculty, I’m a fellow. The idea of me kind of becoming a mentor, which again is kind of accelerating career development. It’s a product of the pathway Duke has built,” he says.

It’s Duke, for sure, but there may be a little more pure Stanifer there than he wants to let on – at least according to one of his mentors, Ralph Corey, MD, vice chair for education and global health. Dr. Corey has seen Stanifer’s fierce focus from the start.

“He’s a master tactician,” says Corey, who got to know Stanifer when Stanifer was an intern. During rounds with Corey, Stanifer would ask questions that only he knew the answer to, Corey recalls. “He would stay up half the night finding out something I didn’t know and then he would ask me a question.”

That’s that kind of fire you want – on a hospital floor, in a lab, in Tanzania, or in Robeson County.

“He’s an amazing guy,” says Corey. “He’s a driven guy. He just does a whole lot. A lot more. I love this guy.”

Well, nice enough. But can you say that in Chagga?

Read more about Dr. Stanifer's Tanzaniza work as a Fogarty fellow.