AMPATH & Kenya: Modeling Global Health for Dell Med

Clapping and singing in welcome, the women of Chama cha MamaToto, or “Group Mother-Baby,” began to tell their story. After garlanding and seating the late-arriving visitors to their rural community outside of Eldoret, Kenya, they presented mini-dramas depicting the challenges and learnings of real Kenyan women.

Women who sought help from traditional healers during pregnancy, gave birth at home and could not stop their bleeding. Women who advised their peers to go to trusted hospitals. Women health care professionals and partners who helped their patients and explained the importance of long-term family planning and preventative health care. Women and men in their local chama — a Swahili term for local peer support group — socially and economically empowered by health, family communication and microfinance activities, who encouraged others to become members, too.

Though the members were of all ages, did not all speak English and some cuddled babies in their laps, they followed orderly rules and expected the visitors to do the same. They gently insisted on a latecomers’ fine of 100 shillings — about $1 — to the day’s table banking collection, facilitated a review of lessons learned from the maternal health skits and encouraged quieter women in the group to speak.

The visitors — leadership, faculty and staff from Dell Medical School and The University of Texas at Austin’s International Office — had come on a weeklong visit led by Tim Mercer, M.D., director of Global Health at Dell Med, whose background includes extensive work in Eldoret.

Through visits alongside academic and local leadership to regional teaching and referral hospitals, rural clinics, pharmacies and more, they aimed to understand the far-reaching impact of AMPATH, or the Academic Model Providing Access to Healthcare.

Created as a long-term academic partnership model between medical schools at Indiana University and Moi University with its Teaching and Referral Hospital in Eldoret, AMPATH’s cross-cultural and cross-disciplinary commitment to sustainably improving population health spans three decades. By linking and empowering physicians and nurses, faculty and students, government agencies and real people like those in this chama, AMPATH’s trifold mission to improve health care training, provide community care and lead impactful research later blossomed to include a consortium of participating North American universities. Now, Dell Med is part of it all.

Clay Johnston, M.D., dean of Dell Med, noted the unique opportunity that collaboration with Kenya would bring to improving health in Central Texas and vice versa.

“The partnership should allow us to open our minds to an array of possible solutions at the health systems level,” Johnston said. “They can teach us a lot about how to think creatively with limited resources. We can bring in some of the background skills in design, population health and value, while also providing expertise in specialties areas that aren’t represented there.”

His first trip to the country — and his impressions of Chama cha MamaToto — emphasized more similarities than differences between people and systems in Kenya and the United States.

He noted how learning new models for addressing resource constraints meet Dell Med’s mandate to elevate positive health outcomes and serve people where they are.

“We all deal with tremendous inequities and too great a focus on acute care,” Johnston said. “We all have disjointed systems. We are all under-resourced for the poor. I’m particularly excited about how the learnings from each place are useful to the others.”

Clarissa Johnston, M.D., associate professor at Dell Med, had the opportunity during the trip to round on wards with internal medicine and palliative care teams at the Moi Teaching and Referral Hospital. She described striking parallels between American and Kenyan patients and the deep-rooted pride her Kenyan counterparts have in building their health programs.

“Clearly there has been a huge amount of behind-the-scenes work that has gone on,” she said. “The creative and innovative programs AMPATH has started in partnership with Moi Teaching and Referral Hospital and the Eldoret Public Health team really are aspirational for us at Dell Med. They demonstrate the highest level of community engagement.”

For the Global Health Division in Dell Med’s Department of Population Health, joining AMPATH means a mutual exchange of physicians, residents, students, research and programs. But it won’t stop there. Dell Med, as part of a wider UT Austin initiative, is currently embarking on a México-based adaptation. This includes seeking like-minded institutional partners, securing long-term funding and understanding the overall Mexican health context. A step in this direction was proudly receiving the President’s Award for Global Learning, funds given to interdisciplinary teams of UT undergraduate students. In June, Mercer will co-lead a student group conducting a health and infrastructure needs assessment in Puebla.

Puebla native Adriana Pacheco Roldan, chair of the International Board of Advisors to UT President Greg Fenves, saw this trip to Kenya as a humbling boost of energy in launching similar efforts in México.

“I never realized the big scope AMPATH has and its great influence on the national health conversation, its role in the supply of medicines or its support of the public and private health systems,” Pacheco said. “México might be more developed in infrastructure and might have more homogeneous communities in terms of language, traditions and culture, but about problems regarding medical services, medicine distribution, chronic diseases and data collection, México has similar needs to Kenya.”

Besides the upcoming President’s Award project in México, the Global Health team kicked off a global health elective rotation, sending three residents and a supervising faculty member to Eldoret in mid-March. The next goal is to receive Kenyan counterparts. Other new collaborations between UT and Dell Med departments, practitioners and trainees, students and communities in Kenya and México are under development.

Soon — like the women of the chama in Eldoret — we can add our stories to a new global narrative in sustainable health.

To learn more about Dell Med’s global health work with AMPATH, contact Tim Mercer.

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