Brater

ELDORET, Kenya—I think that most are aware that we have a program in Kenya – a collaborative effort with Moi University’s School of Medicine and with the Moi Teaching and Referral Hospital. This program began about 15 years ago through the efforts of a small group of committed faculty including Joe Mamlin, Bob Einterz, Charlie Kelley and others. The motivation for its birth was to create an opportunity for students, residents and faculty to experience medicine in the developing world and thereby reinforce the altruistic spirit of medicine.

It has been my privilege to visit our Kenya program on several occasions. Rather than take a full-fledged sabbatical every seventh year, I have elected to take about six weeks every few years (mini-sabbaticals) to devote to the Kenya program. As a result, I have spent time here in 1995, 1997, 1999 and this summer. On these visits I spend time rounding and participate in addressing the innumerable issues that arise. The reality is that I learn far more than I teach, and people go out of their way to not embarrass me too much!

In the five-year hiatus since I was last here, I have witnessed remarkable changes that I wish to relay to all of you, because you should be proud of what your colleagues have accomplished. To jump ahead to the bottom line, we have established the most successful HIV/AIDS prevention and treatment program in all of sub-Saharan Africa and likely the entire developing world. We have more patients receiving treatment than any other program – sadly that is only about 3,000 patients among the millions that are afflicted. We are in the process of ramping up that number to 30,000. You can imagine the humanitarian impact of this, as well as its potential for education and research.

During my last visit in 1999, there was an inexorable increase in the level of death and despair. Since treatment for AIDS was not available here, with the increasing prevalence of the disease, we were surrounded by death and dying. Rounds on any clinical service were one patient after another with obvious AIDS, often presenting as primary TB. We could discuss their illness in the abstract, offer them little, if anything and send them home to die. Since there was no chance of treatment, people would not be tested and potentially bear the stigma of the disease that at that time could manifest as being cast out of the home and into the streets.

There also seemed no hope of addressing the cultural issues that contributed to this pandemic. As you can imagine, the staff in the hospitals and clinics were dispirited; all those who came from IU and elsewhere to work here were shocked if not downright depressed, and we literally gave serious consideration to pulling out. After all, if this program’s primary motivation was to reinforce the altruistic sprit of medicine, how could we possibly do that if all we did was bear witness to this carnage and do nothing?

We feared that there was a substantial risk that what we might reinforce was man’s inhumanity to his fellow man. By displaying to our learners the stark contrast of how we attack this disease in the United States with a veritable armamentarium in contrast to shrugging our shoulders in Kenya, we ran the risk of a form of institutional role modeling that said in effect that it is okay to sit on the sidelines and watch one of humankinds greatest tragedies and do nothing. As Bono of U2 fame stated when he visited Indianapolis a few years ago: fully knowing the ravages of HIV in Africa, what would we be able to tell our children and grandchildren 10 and 20 years from now when they looked us in the eye and said, "What did you do?" Those leading this program decided that we could not stay here unless we tried our very best to implement meaningful prevention and treatment programs.

A series of efforts then ensued to raise funds to obtain anti-retroviral agents. Joe Wheat and many others were instrumental in getting this started. A lot of heavy lifting was done by the usual suspects who have had long-term commitments to the program—Joe Mamlin, Bob Einterz, Bill Tierney and many more. Clinics were established, donations were found from individuals, churches, corporations and foundations. Grants were obtained.

In Kenya, as the possibility of treatment became known, individuals who cared about their communities as well as themselves became willing to stand in front of their colleagues and tell them, "Yes, I am infected, as are many of you. We must bring HIV out into the open and lay it in front of ourselves and do something about it."

As people were treated, our team here discovered yet another problem that was pervasive among these patients – malnutrition and outright starvation. I saw an adult patient this visit who had a CD4 count of 1, meaning she had virtually no immune system left, and weighed 66 pounds. The antiretrovirals got her CD4 count up to the point that opportunistic infections could be stopped. This patient was still debilitated until she got calories – which she got through your colleagues. She now weighs 132 pounds, is taking care of her family and is an outspoken public advocate for addressing the HIV problem in her community.

Making a very long story short, we now couple our prevention and treatment program with a series of farms where our patients are able to not only obtain nutrients but they can learn subsistence farming techniques and become self-sufficient.

Yes, your fellow faculty members in collaboration with their Kenyan colleagues are in the process of preventing and treating HIV/AIDS, organizing support groups and community education, providing nutritional support and training, and also developing skills training so that patients can support themselves.

The result of this is that despair has transformed to hope. Because of the commitment of our faculty, students and residents, we are able to offer legitimate hope and a future to people who were doomed. The spirits and commitment of staff in the hospitals and clinics are palpable as they see an opportunity to exercise their clinical training and improve the health of people as they intended when they sought careers in medicine, nursing, medical technology, etc. This, of course, is the way it must be because, in the long run, Kenya’s health issues can only be solved by Kenyans. We are, at best, a catalyst.

The programs that have been developed here have now attracted the attention of many: USAID, WHO, CDC, NIH, UNAIDS, numerous foundations, and the core of a number of individuals and groups whose philanthropy has been instrumental. This includes many of our fellow faculty members, Clarian Health Partners, churches in Indianapolis, etc. The extent of this support is such that the program currently sustains itself, though as you would imagine, the margin is always thin.

I can think of no better example of professionalism and altruism than this program. This statement is not to diminish the numerous other examples of altruism that occur at IUSM, such as our work at Wishard Memorial Hospital and the Roudebush VA Medical Center, and our Service Learning programs. All these activities are a form of individual and institutional role modeling that is unsurpassed. Our School and all that have been involved are enriched by all these programs.

Even if you have had no personal involvement in the Kenya program, it is important that you know that your medical school has made such an important contribution to both individuals and society, and to share in the pride of its occurrence. I personally could not be more pleased, and I hope that you feel the same.

For additional information on the IU-Kenya program, contact Ron Pettigrew, program manager, at 317-630-8695, or rpettigr@iupui.edu, or visit the Web site:http://medicine.iupui.edu/kenya/introduction.html