“Can we do better?” - Slemenda Scholar Journeys

Photo of Diane, Maddy, and I on our first day at the AMPATH clinic

Photo of Diane, Maddy, and I on our first day at the AMPATH clinic

Hello! Jambo!

Wow, it has already been a month in Kenya and there has been a lot going on for us Slemenda Scholars and AMPATH. The focus for this first half of the trip was to learn all we can about AMPATH and the programs that they are involved in. And we have spent a good amount of time doing just that. I have rounded in medical, surgical, and pediatric wards. I have visited a local school that takes in street children. I have spent time in an HIV resistance clinic. I have visited a mother’s group focused on antenatal care for pregnant women. I have played with children in the child life center. I have gone to an insurance enrollment and health screening day. I have visited a small local clinic which was one of the first to begin treating HIV. And I have begun aiding in some research projects for with a maternal/child health team.

Photo of a weekend trip to Umbrella falls

Photo of a weekend trip to Umbrella falls

These programs have been amazing to see. But their impact took time to set in for me. There are popular goals and buzzwords for global health currently such as “sustainability”, “partnerships”, and buildings systems instead on fixing acute problems. AMPATH seems to be a model of how to do a sustainable global health partnership well and I am very grateful to see and learn from it. The intentionality with the choices they make to empower Kenyans and build up long-term systems is amazing. As I learn about the programs AMPATH has currently or the goals it has for the future I am constantly impressed.

But as crucial and important as the big picture system is, none of it matters unless the result is caring for hurting people. For the first two weeks, I was impressed and amazed by the size of the programs and the thought put into them, but I wasn’t having my heart captured for those we were trying to serve.

Things changed at the HIV resistance clinic. I sat with Dr. Adrian Garner who is an infectious disease physician. The clinic is for referrals of patients that have HIV and are on retroviral but are not getting better either due to lack of adherence to the medication or a drug resistant mutation in the virus. A woman came in with two friends, or possibly sisters. Dr. Adrian told me a year ago she was a dead man walking. Less than 12 months ago, her CD4 count was 1, her viral load was 1.3 million, and she weighed 75 pounds. Now she came in with a CD4 count of 633, an undetectable viral load, and weighed over 155 pounds. She was bubbly, full of smiles, and gave Dr. Adrian a hug when she came in.

As Dr. Adrian was sharing her story, he showed me a photo of her 11 months ago when she was skin and bones. She saw the photo and began to cry. They weren’t tears of sadness but of joy. Joy in a chance at life. Joy in new beginning. She was surely dead within the year if not for an antiretroviral treatment. This big system that has taken years to develop was changing lives like hers. I almost wept for joy with her as she thanked me and hugged goodbye.

Photo from our time visiting a pregnant mothers health education and financial empowerment group

Photo from our time visiting a pregnant mothers health education and financial empowerment group

There is a popular story about pulling children out of a river that are drowning. The point of the story is that we can’t keep pulling out children forever. Eventually we must go look upstream to see why kids are falling in the river at all and work to fix that. The message is true and good. But what I have been challenged with and what I challenge others who work in global health or a health system in the states is this: we have to keep our motives in mind. All the big things we do are for caring for individuals. It takes active intentionality to keep compassion for those we are caring for. If we don’t work to let our hearts break for the hurting then our board meetings about sustainability and bilateral exchange will be less informed, less motivated, and less effective.

The leaders here at AMPATH do this well. I have heard the way they talk about their patients that they see on the wards. One of my favorite days so far has been visiting a clinic with Joe Mamlin, one of the AMPATH founders. In sharing some of the history of AMPATH he said their decisions to do more always came from somebody saying, “This is great… but can we do better?”

They had a medical school partnership but decided to treat HIV. They treated HIV but then realized people were going home hungry so they began a food initiatives. And the tale went on…

“Can we do better?”

As I move into the second half of the trip I hope to continue to learn from attitudes like that.

Asante (Thank You),
Ryan Smith



Ryan Smith is a second year medical student at the IU School of Medicine and a 2018 Slemenda Scholar spending two months in Eldoret, Kenya with AMPATH. Ryan is from Kokomo Indiana and is studying at the Indianapolis campus. He loves volunteering and has spent time investing in a refugee camp in Athens, Greece. This is his first time to sub-Saharan Africa.