Ken Cornetta - Dow Jones Exceeds Expectations!!!

Jambo!

Hello from Eldoret. As usual, the past three weeks have flown. It has been a wonderful visit. As to the title "Dow Jones Exceeds Expectations", let me explain. Two outstanding physicians made their first visit to Eldoret, Drs. Dow and Jones.

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Lyndsay Dow is a remarkable palliative care physician from Mount Sinai Medical School in New York. In addition to her clinical expertise, she specializes in teaching health care workers to navigate difficult conversations. For this trip, she developed a teaching program "Communicating Bad News and Responding with Empathy". She trained the palliative care team in this two-hour interactive seminar. By the time we left, the team was doing an excellent job training physicians, nurses, and trainees. It was very exciting to see Dr. Korir, the lead palliative care physician in Eldoret, do an outstanding job teaching this program. It was also encouraging to see the interest by health care workers throughout the hospital in improving their communication skills.

Ti Jones is an oncologist and palliative physician from Lafayette Indiana. His expertise in oncology really contributed to our work in assessing patients and balancing the tough decisions that many cancer patients face. He spent time with the palliative care team and with the local oncologists. That certainly helped communication between both teams. He is also a natural teacher and his prior work in Uganda made the transition to Eldoret seamless.

An exciting outcome from our visit is the decision by both physicians to continue an ongoing relationship with the Eldoret palliative care team. Now that they know the lay of the land, they are looking forward to returning and working independently. The two of these physicians, along with myself and the ongoing commitment by Colleen Brown from St. Vincent Hospital in Indianapolis and Peter Kussin from Duke University, will work to support the team throughout much of the year.

Finally, to put the icing on the cake, several leaders at the hospital in Eldoret are ready to proceed with development of a palliative care certificate program for nurses, physician assistants, and physicians. This is a topic we have discussed in the past, but there is now clear movement. It will be a lot of work, but I believe we can play an important supportive role in curriculum development. We hope to work side by side with our Kenyan colleagues to bring new specialty training to Western Kenya.

As always,

Your support is greatly appreciated. Asante Sana (thanks so much). 

Ken

Posted at 03:51

Chris Khamasi - KIBISI COOPERATIVE: Fighting poverty and illiteracy

Kibisi Investment group in Bungoma County have been working with AMPATH for the last four years. The group started in late 2014 and aimed to improve the living standards of farmers in the community and eradicate illiteracy though empowerment. Then, it had just 20 members, growing now to 98! The group is still growing and have helped approximately 220 community members via their activities.  

 

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Kibisi chairman Mr. Omoit (standing) and the secretary, Mr. Wamocha (seated)

 

Kibisi have been working with AMPATH since 2015 and feel that they have gained substantially from this relationship. "We used to waste a lot of our harvest but since we started engaging with them (AMPATH), taught us post-harvest control." AMPATH have been working closely with Kibisi on several key areas including post-harvest management, storage and training across several areas.

Previously members of the Kibisi group used to lose a lot of income because they did not have an organized way of storing their produce, mainly maize. Training session conducted by AMPATH have shared best practices with the members preventing post-harvest and therefore income loses. One of the key components of good post-harvest management is access to a clean, dry, secure store. The group's major milestone so far can be said to be the construction of their store which they started building in 2016, with a completion date of 2018. The store's capacity is 10,000 bags of maize. Kibisi plan to rent out the store to farmers who wish to store their maize, generating a source of income for their members.

 

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Kibisi's store under construction 

 

Being able to store grain for periods and not sell immediately is essential for farmers who are wishing to obtain the best price for their produce. The Kibisi secretary shared with AMPATH that they have had many challenges with prices. Their work with AMPATH has opened up access to reliable buyers such as the World Food Program (WFP), removing the need to work with brokers or middle men. They are constantly receiving good prices for their maize now, an average of 3200KSH per 90kg bag. AMPATH have also helped Kibisi access superior quality seed which has been crucial in boosting productivity, strengthening yield, improving food security and increasing income.

In addition to the training on post-harvest management and maize production, Kibisi have been the recipients of training on risk management, health insurance and income protection. AMPATH have shown them the importance of building resilience and awareness with all members registering for National Hospital Insurance Fund (NHIF) cover to protect them from expensive health expenditure.

The chairman, Mr. Omoit, had much praise for what they have been able to achieve, "Ampath have great men and women who have helped us," He said the group is ready to embrace dairy extensively apart from maize farming.

Kibisi cooperative is building success upon success. The goals of eradicating poverty and fighting illiteracy in Kibisi are being realized because of the initiative that these farmers took to push their cooperative forward. One of the reasons they are making steps forward is they were open to receive fresh ideas, they accepted to be trained and they were keen to learn when they were linked to Ampath. They have developed their cooperative on their own terms while applying the effective farming methods they have been trained on. Their success story is defined by willingness to learn and determination to succeed. 

Posted at 01:41

Joe Mamlin - A Tribute to Dr. Jim Greene, AMPATH Social Science Researcher

At its core, AMPATH is a partnership that creates opportunities for people to help people. To lift each other up. To inspire each other to do more. And to walk farther together. 

On March 3, 2018, the world lost Dr. Jim Greene, one of AMPATH's inspiring people who touched the lives of many. In the early 2000s, Jim served as a consultant with AMPATH, applying his Ph.D. in cultural anthropology to help AMPATH's HIV care work respond more effectively within the social and cultural fabric of communities.

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With Kenyan colleagues, Jim formed AMPATH's Social Behavioral Team, working to answer questions like: How can we assess the home-based HIV counseling and testing? Why are pregnant women not getting linked to care? Will local patients with diabetes be willing to come for care in our current AMPATH buildings? What do locals think of community health workers?

Perhaps more importantly, Jim mentored young Kenyan researchers who continue to make breakthroughs in behavioral sciences that help AMPATH better treat patients and communities. Jim's work lives on in Kenya, particularly carried on by AMPATH researchers Violet Naanyu, Ph.D., Associate Professor of Moi University School of Medicine, Rose Ayikukwei Ph.D., Researcher at Elizabeth Glaser Pediatric AIDS Foundation Kenya and Juddy Wachira Ph.D., Lecturer at Ondiga University of Science and Technology.

Dr. Joe Mamlin writes:

"In 2000, Sarah Ellen and I went to Kenya to help with a second medical school for the country that some of us at IU had helped start ten years earlier. We encountered something unexpected---we were now in the epicenter of the worst pandemic in human history. Hundreds of thousands of young Kenyans were dying from HIV. We turned to Jim Greene, a cultural anthropologist who had contributed so effectively to the growth of Wishard Hospital. I asked if he could give us a hand in our work here in Kenya. As AMPATH began to grow, Jim began training young Kenyans in demonstrating the key role of behavioral sciences in guiding the evolution of a responsive care system. His three protégés, Violet, Juddy and Rose each ended up with a PhD in medical sociology and continue to carry Jim's gifts in every facet of this growing Kenyan medical center.

In early 2016, I woke up to the reality that our long journey had created components of a health system that could go far beyond HIV. Why not do it all? I attempted to put that dream down on paper and once again asked Jim if he would give me a hand and look it over. Jim painstakingly poured over every word. He re-wrote, re-arranged and clarified that dream into a document that has given birth to Population Health with Universal Health Insurance.  This is now the cornerstone of AMPATH's next journey in Kenya."

Dad &Jim Greene

 

Posted at 06:22

Tony Wiederhold - Beauty in Bungoma County

As we rolled into Kanduyi, "beautiful" was not a word that came to mind, but now whenever I think of the place, it is the first. The bucolic sugar cane fields we passed on the way from Webuye gave way to a dusty town: wooden snack shacks selling mangoes, bananas, and soda, tin-roofed butchers, patches of grass, and semis - so many semis - headed this way and that way, clogging the main intersection of town. They were parked on the shoulder of the two-lane highway and akimbo in dirt lots. It was late morning, nearly lunchtime, and snack shacks were bustling with people doing business and living daily life. The Ugandan border lay 35 km ahead on A104. It's a busy highway, part of the great ring road that covers 2,300 kg (1,430 miles, or roughly the distance between Chicago, IL and Miami, FL) connecting the countries around Lake Victoria - Kenya, Uganda, Rwanda, Burundi, and Tanzania - to each other. It is also part of the main land route between the Indian Ocean port of Mombasa and Uganda, Rwanda, South Sudan, and perhaps points beyond.

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The meeting was outside on a grassy patch between buildings set up with white plastic chairs. The six of us from Lilly and the two AMPATH workers, Mercy and Elizabeth, who invited us as guests, sat facing the women of GroupWasupu.They were there to promote the free cervical cancer screening and treatment available at the Webuye clinic to the women in this remote support group and listen to their questions and stories to understand the barriers to care. The seventeen women were tidy and dressed in bright, colorful patterns, as if in defiance of their drab and disheveled surroundings. They welcomed each other, and us, with handshakes, smiles, and warm embraces. Elizabeth, a psychological counselor based in Webuye, told us "Wasupu means 'Beautiful Ones' in their language." A few men peeked towards us from the street, but kept their distance. A rooster in the yard did the same.

Elizabeth stood tall in her black leather jacket, smiled effusively, and started the introductions. She exuded a relaxed, easy joy. After each of us visitors introduced ourselves, she revealed herself in a matter-of-fact manner to be HIV-positive for the last 18 years and the mother of three HIV-negative children. She spoke of her experience with cervical cancer screening and her compliance with her medication. I didn't see a reaction in any of the faces. She could have been talking about her hair color. One by one, the women stood up, introduced themselves by giving their name and, with similar placidity, how long they have been infected with HIV, their viral load, if and when they had been screened for cervical cancer, and in some cases, a personal story about how they have been affected by cancer. A baby boy bounced on his grandmother's knee.

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Mercy, a patient outreach leader for AMPATH, told us that she visits thirty two groups like this one in Bungoma County. "We are here to sensitize (get women to understand risks to their health and what they can do) and encourage screening. When I sensitize, I talk to women woman-to-woman." Dispelling myths is an important part of the job. It saves lives. Some of the myths the women mentioned included a variety of things rumored to cause cervical cancer, from cooking oil to contraceptives to screening itself. One woman, who lost her mother to cancer, talked about how her attitude to screening has changed over time: "Before, when (AMPATH personnel) talked to us, we hid. Now, I am happy to be screened and know the results so that I know how I can live."  

There was plenty of beauty in that dusty lot. Friendship. Knowledge. Support. Healing. Health. Hope. With the continued work of AMPATH workers like Mercy and Elizabeth and the growth of programs like outreach screenings that bring care to the people and bring down the barriers to community health, more women like The Beautiful Ones can lead longer, healthy lives and lift up their families and their communities. 

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Tony Wiederhold has been an employee at Eli Lilly and Company since 2004. He has traveled to Kenya in November 2016 and March 2018 as part of Lilly's Connecting Hearts Abroad (CHA) program. Through CHA, since 2010, Lilly has sponsored two-week global health volunteer assignments for 100-200 employees each year. The volunteers staff projects in areas of need around the world. Lilly's CHA program in Kenya, new in 2016, is an expansion of the company's longstanding partnership with AMPATH to improve population health in Kenya. Cervical cancer and breast cancer early detection and treatment are current areas of focus of this partnership, through which Lilly provides funding, medicine, and CHA volunteers.

Posted at 03:35

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.

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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.

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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

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