Beryl Maritim - Population Health Delivery Pilot in Turbo

On February 28th, 2018, the population health screening team was in Jua Kali town, Turbo Sub-county offering screening services in groups like they do every Wednesday. The team offers integrated screening for diabetes, hypertension, HIV and soon will include mental health and cancer. We visited Angaza group, a community GISHE group that meets within the market in a small temporary structure that offers the group some level of privacy and protection from weather elements. Angaza group has 22 members. On this sunny midmorning the health team prepared their equipments and booths ready to offer services to the group members and the droves of people turning up as news had spread of the arrival of AMPATH health providers. Having completed the main agenda of savings and loaning, the group settled down to receive health education and be sensitized about the national Insurance, NHIF.


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Lillian, a health Liaison officer employed by AMPATH, took the crowd through the benefits of NHIF and the steps to enrollment. Judging from the questions that followed her session, it was clear that a lot needs to be done to increase information about NHIF and increase uptake - a task AMPATH has taken up working with NHIF. A quick assessment of the enrollment within the group revealed a less than 2% membership amongst the people present in the gathering.


Miriam aged 39 with three children is one of the 3 people who were still active members of NHIF. She has been a member of NHIF since 2013. Neither she nor any of her family members have been hospitalized for illness. Miriam still pays her premiums faithfully despite the fact that neither she nor any of her family members have had to use the service. She understands the benefits of health insurance and fears losing her hard earned investments to cover the high cost of treatment in case of illness or accidents. "I know many people who have had to sell their property or businesses to pay hospital bills. I work hard in my grain and miller business and I would not want to risk." Miriam is also part of a GISHE group where she and 21 other men and women save and loan to each other.

Miriam was later screened for hypertension, diabetes and HIV and while her blood pressure and RBS reading was normal, she was informed that her BMI and age puts her at a greater risk of developing hypertension or diabetes. She was counseled on how to stay healthy and reduce her risks.


Seated next to her was Selly. Selly doesn't have NHIF insurance and hopes to enroll after the sensitization she received. She believes that her small vegetable stand can give her the returns that would enable her to enroll for NHIF. She has been a member of the GISHE group since 2017 and has seen the importance of savings. A single mother herself, she is able to put her three kids through school and provide for them. Health insurance would give her added security of knowing she is covered in the case of illness in the family. She already borrows from the group to restock her stall and plans to take a loan to pay for her NHIF premiums soon. Sheila, who runs a small salon next to Selly's vegetable stand also hopes to sign up for NHIF and is a member of the same group.


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The group and community members were happy to have health services and teaching brought close to them and they all benefitted from the questions other members asked in the marathon. 14 out of the 38 screened were Angaza group members. 11 people had elevated pressures and sugars and were referred to Cheramei dispensary for further investigation and treatment. AMPATH supports a monthly diabetes and hypertension clinic in Cheramei dispensary, a small level II dispensary within Jua Kali town. On that clinic day, a team of care providers from Turbo Sub County Hospital joined the nurse and clinical officer in Cheramei to offer hypertensive and diabetes care to the clients booked on that day. The facility is manned by nurses and clinical officers trained and mentored to offer chronic disease care. When the team encounters difficult cases they tele-consult with the clinical team in Turbo Sub-county Hospital. A mini revolving fund pharmacy within the facility pharmacy has been equipped with medication to manage diabetes and hypertension offering a back up to the facility pharmacy that also stocks the medication.


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Difficult cases are referred up to the next level health facility, Turbo Sub County Hospital to be seen by clinical officers or physicians who visit the clinic from MTRH from time to time in the reverse referral system.




Posted at 07:53

Jo Taylor - Remain vulnerable to a dream . . . Celebrate!

For more than 15 years physicians working at the AMPATH Centre have been treating patients with HIV.  They have developed education, treatment protocols, and drug regimens for pregnant women to reduce the likelihood of HIV transmission during childbirth.  And, based on the data, enormous progress has been made decreasing the odds from 45% to an astonishingly low 3% likelihood of transmission. 

In the context of so much progress, it would be understandable if both healthcare workers and women themselves would simply assume that in 2018 there is a new norm - an unborn child would no longer be at risk of transmission. 

When experience matches expectations, it is possible that we miss the opportunity to be amazed. 

What was intended to be a quick stop at the Turbo AMPATH Comprehensive Care Clinic on the morning of February 2nd defied this. We arrived in the midst of a glorious celebration.  They called it a Graduation - more than 100 babies born to HIV+ mothers since 2015 have been declared HIV-Free.  These toddlers were dressed in caps and gowns.  Tents were set up to protect the revelers from midday heat.  There was face-painting, balloons, cake, and speeches.  Everyone was singing and dancing . . . the mothers, the children, the healthcare workers, the guests. 




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Earlier in the week Joe Mamlin challenged our group of visitors to 'remain vulnerable to a dream'.  As we remain vulnerable to new dreams, let us stay vulnerable to old dreams.  The dream of eliminating transmission of the HIV virus to a baby during birth. 

What a great example we can take from the dedicated staff at Turbo's Clinic . . . may we never become so accustomed to new standards of care that we miss the opportunity to celebrate with every mother when tests reveal that her baby is HIV-free.  




Posted at 03:52

Odep - Growing up with HIV in Kenya

My name is Odep. I am a heartfelt individual with a keen desire to help others. My desire and passion lies with children and adolescents who have experienced hardship throughout their lives. As an individual born with HIV, who has lost many loved ones and experienced firsthand living on the streets of Eldoret, Kenya, I feel a distinct connection with what many children and adolescents are going through. I have positioned myself within the Eldoret community as a spokesperson for young adolescents living with HIV and advocate for the health and well-being of street children. I love sharing my story to anyone, anyplace, and anytime.

Currently, I am working as a volunteer peer navigator with the AMPATH-Kenya prevention department. My volunteer experiences consist of me visiting various institutions; prisons, schools, companies and streets (road shows), to share my personal story and advocate on HIV/AIDS in my hometown. Through my work as a volunteer, I have noticed a positive change in the mindset and attitude of people regarding HIV and I am very grateful and humbled that I've been fortunate enough to contribute to this.

In my mentorship work with the street children of Eldoret, I share my personal story of what it was like living on the streets as an adolescent. Personally, I feel that by sharing my story with these children they will be inspired to have more hope in their lives and try to live healthier lifestyles.

In addition to peer mentorship, I also coach the street children football club called SC FC. I am proud to say that we have participated in a numerous tournaments and finished particularly well in each of them. Not only has the team performed well, focusing on the essential tenets of teamwork and goal attainment, but also they have had so much fun competing together and this fills them with hope and laughter. It is great to see children who have experienced so much hardship enjoy themselves. This inspires me to try and give more children similar opportunities. I first handedly know what it's like to be in their position, and I want to provide something positive for them.

Many of my peers look to my fun and outgoing personality for cheering up. Through my rapping and comedic alter-ego, named Fat Prince, I perform artistic and comedic expressive words of encouragement to my peers. Fat Prince represents an outgoing adolescent in western Kenya who brings light to social issues found in our society with a comedic twist. I have found my performances as Fat Prince not only bring laughter to the group of my peers, but also instill hope through my encouragement to stay healthy, despite various social and medical challenges that we all face.

I hope that my combined efforts, as a peer mentor with AMPATH and my experience working with the street children of Eldoret, will one day break the stigma barriers and hardship associated with poverty and HIV for children and youth living in Eldoret. It is my goal to bring together my town of Eldoret and build a welcoming and understanding community. My experiences with conquering my own hardships and coming to accept my HIV status have shaped me into the young man I am today. I am proud of who I am and of what I have overcome. It is my dream to be a role model for those living with HIV and those living on the streets and provide a beacon of hope signifying that they too, can live healthy and fulfilling lives.

My future plans are to attend college and study clinical psychology or a related discipline. This education will give me the necessary knowledge to fulfill my dream of contributing to the betterment of the community that I grew up in.  I plan to do so by continuing to establish relationships with the street children of Eldoret and set an example of what they can achieve. It is my hope that I can encourage the children to pursue education and be successful and contributing persons in our community.

Odep blog

Kenyan school children.



Posted at 03:58

Mary* - Living in Kenya with diabetes

At age 3, I was admitted to the local hospital and after staying for almost a month without anybody having any idea of why I was having problems, someone finally requested a glucose test and I was diagnosed with diabetes. To many people this was strange. In the village I come from, people thought diabetes was a disease for the elderly.  Some people also said those with diabetes do not live long-I even remember someone telling me that I wouldn't live to see my 18th birthday.

Every morning I would cry because of the insulin shots I got from my parents as part of my daily routine.  I frequently tried to run away because of the needles and pain of these injections (thin insulin needles weren't available at the time).  Little did I know that I needed these insulin injections in order to live.

Growing up with diabetes was not easy- taking insulin every morning, eating a different diet from my siblings, and having everyone look down at me and referring to me as a sick one. All these brought sorrow to me. Sometimes I would ask my parents "why me?"  "When will I get well?"  

My school life started well, but it did not continue well because of the many challenges diabetes brought. I had stunted growth and a big belly. My classmates would laugh and make fun of me, largely because I could not explain why I was so different.  I never really understood what I was ailing from; all I knew was that I was sick.

At the age of 10, my dad was advised to take me to Moi Teaching and Referral Hospital to attend the educational clinics. It was there that I met a nurse named Jane Gitahi (Diabetic Educator) who taught me about the disease and the many unanswered questions I've had over the years. She educated me and the other patients on what diabetes does to your body, how to manage it, how to store and administer insulin, and the appropriate diet to follow. We booked for the next clinic visit, but I went home and immediately started applying the strategies she had taught me.  My parents started doing everything that we had been taught, and in the next clinic visit I looked much better. Jane never stopped caring for me and consistently took her time to educate me and made sure I learned more about diabetes. She advised my parents to get me a glucometer so that I could do my blood sugars at home. MTRH also hired peer diabetes educators who advised me to attend trainings on diabetes and follow all the steps needed to improve my diabetes. These trainings really helped me and after completing them I became very comfortable with taking care of myself away from home and from my parents.

The time came for me to join high school and I was eager to go to boarding school where I knew I would get a better education.  My parents were very hesitant to allow me to leave home but eventually allowed me to go after seeing how far I had come in managing my own diabetes.  I did not have many problems because I had learned about diabetes and how to manage it. I was getting insulin from the hospital every time I went for checkups and I never missed insulin. I successfully completed high school and was able to gain admission to university.

I faced several challenges during my university training. Sometimes lectures could come at a time when I needed to eat or I needed to take my insulin.  I also had trouble eating with the stress of school and therefore I had problems managing my diabetes; but quickly realized my eating habits were prevented me from getting my blood sugars under control. 

The medical care that I was getting from the personnel at Moi Teaching and Referral Hospital and the many partners that supported this clinic gave me hope of living my life with diabetes. After benefitting from this clinic, I was excited about the opportunity to join this team and help other patients the way they helped me. I worked in the home glucose monitoring program for 2 years and after my graduation I got another job with the AMPATH-Kenya Program to serve as their lead Business Manager and coordinate their many projects including diabetes related programs. Through my employment with Moi Teaching and Referral Hospital, I have also been able to see how the Lilly insulin product donation has improved my life and the hundreds of other patients who are now able to better control their diabetes. 

* Though Mary's name is a psuedonym, her story is real.


Posted at 03:11

Sonak Pastakia - What Lilly means to us

As I was walking through the new Chandaria Cancer and Chronic Diseases Centre at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, I was reminded of the early days of diabetes mellitus (DM) care in western Kenya.

When I first arrived here almost a decade ago, a diagnosis of Type 1 DM was essentially a death sentence.  With ~ 75% of the population in Sub-Saharan Africa not having access to reliable stocks of insulin, many patients faced an especially harrowing situation. This is further compounded by the lack of access to even basic monitoring supplies. Patients previously relied on facilities like MTRH to provide all diabetes monitoring during their irregular visits to the facility every 3-6 months. This visit typically included only a point-of-care random blood sugar whenever the frequently stocked out strips were available, which forced providers to make the vast majority of decisions based on nothing more than a series of educated guesses.

This unfortunate reality for diabetes patients has been completely reversed through the efforts of the Lilly-AMPATH partnership. We now are able to provide early detection through home-based screening which prevents the many complications seen with the late stage diagnosis. In addition, we have also created one of the largest home glucose monitoring programs in the Sub-Saharan Africa public sector with over 800 patients enrolled in this highly impactful service.           

However, one of the biggest developments in improving care and outcomes has been the continual supply of insulin through the life-saving product support from Lilly. This partnership has been able to transform the <25% availability of insulin seen in most Sub-Saharan African settings to ~98% at MTRH.  Lilly's support has helped improve thousands of lives throughout western Kenya as they now have the confidence that insulin supplies will be available to help them avoid life threatening complications they would inevitably face in the absence of insulin.  As we continue to distribute Lilly insulin to patients, we are consistently reminded of how Lilly's singular act of kindness donating insulin to our program has spawned the creation of all the advancements in diabetes we have seen throughout western Kenya.

Sonak Pastakia, PharmD, MPH, BCPS
Associate Professor, Purdue University College of Pharmacy

What Lilly means to us

Posted at 06:35


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