A letter from from Joe Mamlin
Pause a moment and ponder the depth and breath of the IU-Kenya Partnership. It has already become so large yet admittedly remains in its infancy. Be assured that it is not the size of the effort or the level of funding that makes all of us proud.
This entire effort remains responsive above all to each solitary patient like Salina. And along with the patients come our Kenyan colleagues prepared to give their careers to this effort. Right behind them are the many wonderful US students and residents, house staff and visitors who add so much to the energy needed to make AMPATH come of age.
About Joe: Dr. Joe Mamlin had worked in Kenya in the early 1990s and returned in 2000 to head up the university partnership program in Eldoret. His detour into farming began after he noticed patients who were so malnourished that their HIV medications were ineffective.
"I remember the very first patient I admitted to the women's
medicine ward... she was nearly my age. However, age was just about
all we had in common. She was a young Kalenjin woman, married with
five children. Her husband was gone quite a bit and she was
essentially raising her children alone. She had been feeling sick
for about a year, losing weight and always catching cold. Her two
youngest children had also been sick, and one had died of an
infection. I knew before the ELISA came back positive that she had
AIDS. I knew that her husband would not come to visit, and that she
would die alone in the hospital. I knew that her children would
share the same sad fate as so many other orphans in Kenya. I think
she knew all these things, too, and that this knowledge was more
painful than her esophagitis or her pneumonia. She didn't speak
English. She understood a bit of Swahili, and that's about all I
could speak anyway. Thankfully, we both spoke pretty well with our
hands ... she told me about her children; I told her about my
parents. She taught me how to wrap a kanga; I taught her some
English... she came to the hospital because it was time for her to
die. And I really believe that she came to teach me something I
won't find in the medical texts..."
- IU Senior Medical Student
"Work at the hospital continues to be very demanding, rewarding,
frustrating, draining. We are remodeling the nursery and the work
is proceeding well. The plumbing drains empty to the outside for
the first time. The nurses and other staff are very
excited...help(ing) morale...is very important for many of the
wonderful staffers who are working for the long haul..."
- Nurse/Spouse of IU Faculty Physician
"Without a ventilator and an endotracheal tube, there was
no way to save this child. The medical officer and I regarded each
other, and he reached over and clasped my arm. 'These are always
difficult,' was all I remember him saying. I looked at this doctor,
a man I respect as a colleague and as my teacher, and I saw in his
eyes the same anger and frustration that I felt...of knowing what
to do without having the tools with which to do it. For that brief
moment, despite our cultural differences, we truly understood each
-Resident, IU School of Medicine
...And there, in my own little corner of a tattered schoolhouse
thousands of miles from Indiana, I ran my first true clinic. I saw
patient after patient, most speaking only their tribal tongue, and
I treated them. We struggled with the language barrier and somehow
we managed to overcome it. We did the best with the supplies and
medicines that were available. In a few short hours I learned how
to recognize malaria, typhoid fever and kwashiorkor. I learned how
to dose Fansidar and Mebendazole. More importantly, I learned about
the Kalenjin people and their customs. Four hours and four hundred
patients later, I remember the wave of true satisfaction that swept
over the schoolhouse."
- IU Medical Student
"...I was impressed by the fund of knowledge of the Kenyan students, interns and attending physicians. Coming from the 'best healthcare system in the world,' I thought the Americans would be teaching our Kenyan counterparts a great deal. Instead, I found myself learning more than I had expected from students two to three years my junior. I was ashamed by my lack of physical exam skills, at which my Kenyan counterparts were so adept..."
"Caught in a pay-as-you-go system, and with an average income of two dollars a day, the typical Kenyan patient would sometimes find it a challenge to pay for a four dollar chest x-ray that could make a difference in diagnosis and treatment..."