Kenya - Eldoret

Jessica Burness (Brown Medical student Class of 2001), patient, & Dr. Jane Carter in Eldoret Kenya

The continent of Africa is in desperate need of help as HIV/AIDS decimates its population. Brown Medical School, with the support of its physician-in-chief, Dr. Edward Wing, has significantly increased its commitment over the last year to the program in Kenya to help the people in that country fight their battle with HIV/AIDS and TB. The foundation of this program is built on the resolution of our students, residents, fellows and faculty to share their expertise in Infectious Diseases with their counterparts in Kenya.

Dr. Jonathan Cohen, T32 fellow conducting a training session in Kenya

The HIV Care Clinic was opened at Moi University Faculty of Health Sciences in December 2001 with an ancillary clinic site opening at Mosoriot Rural Health Center four months later. During the winter of 2002-2003, Dr. Jonathon Cohen, supported by the NIH T32 grant and CFAR, worked on site in both clinics for 6 months, providing care to patients and training for the Kenyan faculty, clinical officers, and nursing staff of both clinics. Dr. Cohen's work has led to the AMPATH Clinical Care Training program, a didactic module to be combined with a mentored on-site training module to address the educational needs of supplying HIV care now that low cost antiretrovirals (ARV) are available. The first training course occurred in September 2003 with 28 participants. These two small clinics today supply care to 1600 patients, 753 on ARVs. The AMPATH (Academic Model for the Prevention and Treatment of HIV/AIDS) program is now the recipient of a Gates Prevention grant, a site for MTCT plus as well as a recipient of philanthropic dollars to support ARV supplies. Innovative initiatives accompanying the treatment clinics include HAART and Harvest, a food security program that not only supplies food to HIV patients in the rural area, but also supplies high yield, low cost agricultural training combined with HIV prevention training for these HIV patients. The goal of this program is self-sufficiency in both ARV procurement and food security for HIV patients locally. A similar urban program of microeconomic initiatives, the Family Preservation Project, has also begun. Ground has broken for the HIV Care Building to be open in May 2004 with a goal to supply care for 6000 HIV patients within one year of opening. In less than 24 months, the situation has gone from no HIV care to a model HIV care site, with some of the largest numbers of patients maintained on ARVs in Eastern Africa.

Jane Carter, M.D., Assistant Professor of Medicine at Brown University and Director of the RISE Tuberculosis Clinic and the Brown/Kenya Collaboration spearheads this effort in Kenya. Below are reflections from her frequent visits to Kenya.

Having just returned from a month with the Brown Moi medical exchange program in Eldoret, Kenya, I have been asked how my time away went. I invariably answer “great” or “wonderful”, but always with the hope that I will be asked to elaborate as these single words cannot convey the depth of my experience.

The major diagnoses on the ward are TB, malaria, pneumonia, diarrheal illnesses, and end stage rheumatic heart disease. Malnutrition is the norm. There will be a small number of diagnoses that we see regularly at home, DKA, hypertensive crisis, DVT, cancer. Average age on the adult ward is 24 years – this is considered middle aged. 60% of the ward admissions are HIV positive; at least half of these have clinically obvious AIDS with oral thrush and profound wasting. HIV seroprevalence in Kenya is reported at 17% of the general population. HIV is clearly a heterosexually transmitted disease here. Blood transfusions are a high risk procedure. Because we could not rely on the accuracy of HIV testing of blood, we stopped giving transfusions. Newspaper stories and TV cannot convey the tragedy – it is unrelenting and almost unbearable to contemplate as you stand in the middle of the wards.

So why do I describe this experience as “great” and “wonderful”? My paradigm for a physician has always been a combination clinician and teacher. The clinician takes care of the here and now, diagnosing and prescribing for what has already occurred. The teacher is making the investment for the future. It is that investment for the future, that collaborative effort for the better, that seems distilled in the experience at Moi.

Dr. Carter in collaboration with Dr. Timothy Flanigan were awarded a Fogarty International Research Collaboration Award (FIRCA) for their work in Eldoret Kenya. They are collaborating with Dr. Lameck Diero of Moi University to study the feasibility of combining Directly Observed Therapy (DOT) for the treatment of TB and HIV in Eldoret. Several oral presentations were given at the 13th International Conference on STI’s and AIDS in Africa by CFAR faculty in collaboration with our Kenyan colleagues. Topics addressed included characteristics of HIV/AIDS patients cared for at Moi Teaching Hospital, addressing the educational void, and academic model for the prevention and treatment of HIV/AIDS, equitable treatment for participants in HIV/AIDS clinical trials and establishing an electronic medical records system for outpatient care of HIV infected patients in Eldoret, Kenya.