People of AMPATH: Laura Ruhl, MD, MPH, and Matt Turissini, MD

AMPATH colleagues Laura Ruhl, MD, MPH, and Matt Turissini, MD, took very different paths to Kenya. Along the way those paths converged to create a partnership that thrives on working to create an accessible health system in western Kenya while raising their young daughters to be global citizens.

Laura currently serves as the Field Director for Population Health with the AMPATH Consortium working to create an accessible and financially-sustainable primary health system for the people in western Kenya. She began the position in July of 2017.

Matt is the AMPATH Consortium Medicine Team Leader as well as a co-coordinator of AMPATH's population health work focused on creating an accessible health care system. He also began July 2017.

What is your background in global health?

Matt: I was a sociology and English major in college and lived in Bloomington for six or seven years after undergrad while working for some local non-profits. At one point when I was 27 or 28, I said “I’m going to be a doctor” which was both one of the least-informed and better decisions of my life. I wanted a career where I could do both systems planning and interact with people, and medicine seemed to fit the bill. Of course, I hadn’t had a science class since high school, so I had to do two years of pre-requisites first.

I was a Slemenda scholar and went to Kenya for the first time after my first year of medical school. Then I did pediatric HIV research for a year with Dr. Rachel Vreeman between my third and fourth year of medical school which is when I met Laura. In total, I spent about 20 months or so in Kenya during med school. I became AMPATH’s Medicine Team Leader after my residency in Med-Peds (combined internal medicine and pediatrics) residency at Duke.

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Laura: I, on the other hand, am a child of AMPATH. I went to Kenya for the first time in 2000 as an undergrad in a study abroad program, and I fell in love with it. I deferred medical school for a year and went to Uganda to work on a USAID maternal-child health project. I chose IU for medical school because of the IU-Kenya program. I immediately reached out to Bob Einterz and was a Slemenda scholar as a first-year medical student.

Shortly after I arrived in Kenya, all flights to and from Kenya were suspended for two months. There were three Slemenda scholars, Joe Mamlin and basically no one else. Joe took the three of us all around the country on weekend trips. It was a blast. We had a great experience and got to know Joe really well. I then came back as a 4th year, as a resident, as Pediatric Team Leader for two years and a pediatric field director for two years. I’ve now spent about six years total in Kenya.

What excites you about the work you are doing?

Laura: We are improving the quality of services and improving lives for the poorer population in Kenya. We are truly building toward a sustainable health system that will have the resources to exist without AMPATH. I’ve worked on many projects where I didn’t feel they would continue once my involvement ended, but in AMPATH you know that the system we are helping to build will continue to serve Kenyans for decades to come.

Matt: Two areas I’m most excited about are training next generation of Kenyan doctors and providers and population health which is developing a health system that actually allows people to get care.

Fifteen years ago on the wards of Moi Teaching and Referral Hospital, we largely saw HIV and affiliated conditions. Now most patients are affected by chronic diseases including cancer, heart failure and strokes and they are developing these diseases when they are still income earners and have children and grandchildren dependent on them. By the time patients present with late stage cancer or advanced heart failure we are limited what we can do anywhere in the world and we are more limited in Kenya due to resources. Primary prevention and early detection are far better avenues. Population health is the response to the increasing burden of chronic diseases.

What makes AMPATH special?

Laura: We work with a great team. In both Kenya and North America, we have really great people at AMPATH.

AMPATH is built on the idea of purposeful collaboration. Everyone who joins AMPATH is focused on the same mission. We may all have different goals or roles to meet that mission, but we all work together. We are deliberate about building partnerships in Kenya and any other area where we might replicate a similar program.

By working together, the framework for what we need to achieve is focused on the needs of the population, not the needs of the institution. Many times in global health, the university is pushing their needs and the needs of the population are not being met.

Matt: AMPATH is a long-term partnership that’s dedicated to always having medical professionals on the ground in Kenya. There are many projects where people fly in, look at a problem and then leave, but that often doesn’t benefit patients or the community.

This commitment of departments at Indiana University to fund staff in Kenya since 1989 is really impressive in terms of commitment to that partnership. Dividends from that commitment in terms of research and education are amazing. More than 1,400 medical students and residents have traveled to Kenya and more than 400 Kenyans have visited North American medical institutions during that time. Without long-term people on the ground, really none of that would have happened.

What advice do you have for people who want to enter the global health field?

Matt: If you aspire to a career in global health, then go and spend time in the area where you want to work to decide if it’s really what you want to do. While so much of the medicine and other things are similar, the hard part is learning how to partner and work cooperatively within a different culture and system. It is a big skill set and it is not something you can just show up and know how to do.

Laura: It’s so easy to get pulled in different directions based on academic positions, so you have to keep it a priority. Although you can’t live and breathe global health during your training, you need to keep it as a focus for your future. It’s also okay to go in a different path. Global health work is not always a good fit for every family.

What is it like to raise your family in Kenya?

Laura: We knew we would love the work, but we wondered if this would be a good choice for our children. We feel so lucky to be raising our kids in Kenya, it is not a sacrifice at all. Our kids are outside all day. We have good childcare and good preschool and our children are becoming global citizens. They don’t understand that other kids don’t have a Kenya home and an Indiana home. It’s been lovely. Of course, there is stress related to travelling back and forth and keeping up two lives, but we have a great community of Kenyan friends and their children.

Matt: We love having a family in Kenya. Our daughter goes to a Montessori pre-school with Kenyan kids and we have 8-10 other children most of the time at IU house so there is always someone to play with. Our children will grow up learning about other cultures and languages which is wonderful!

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