Cardiology Care at Moi Teaching and Referral Hospital (MTRH)

Chronic non-communicable cardiovascular disease is rapidly becoming one of the major causes of death and disability in the developing world. At present, there are no adult Kenyan cardiologists in western Kenya and limited technology to take care of the myriad of patients presenting at MTRH.

Duke helps build the cardiac program at MTRH.

In 2009, the National Heart, Lung, and Blood Institute (NHLBI) awarded Moi and its AMPATH partners a grant to establish a Cardiovascular and Pulmonary Diseases Center of Excellence (CVPD COE). Although primarily established as a clinical research training program, it provided a platform for Duke University to also take a lead role in developing the clinical cardiology program at MTRH. Duke was fortunate to identify a senior cardiologist (a former Duke resident who spent 35 years in private practice at one of the largest cardiology practices in western North Carolina) who was willing to lead Duke’s effort “on the ground” to build the cardiac program at MTRH. Captivated as a boy by the life and work of Albert Schweitzer taking care of the “sickest of the sick” in Africa, Dr. John Lawrence always knew he wanted to serve in a similar capacity. Yet he observed that cardiologists rarely had the chance to apply their “technology-heavy” skills in resource-constrained environments. In October 2010, Dr. Lawrence and his wife had their “Albert Schweitzer opportunity” and Dr. Lawrence began a two year commitment in Eldoret focusing on clinical service and teaching.

Since then, new space for a cardiology clinic has been secured and the number of patients seen in clinic each week has doubled. Teaching ward rounds with young Kenyan fellows and a consult service have been established and MTRH administration has created a CV Unit, appointing Dr. Myra Maghasi Koech as its Director. Duke has procured equipment for the echocardiography lab and has enlisted the support of a Duke sonographer and nurse practitioner willing to spend time overseas training local staff. However, diagnostic equipment at MTRH is still severely lacking and much more is needed to allow MTRH to adequately treat its patient population. This past summer we began training hospital staff on core competencies in cardiovascular care and basic and advanced life support skills.

Duke has donated a mobile catheterization lab to MTRH to combat severe cardiac sequelae secondary to rheumatic valvular disease in young adults. This new cath lab will eventually be attached to the new primary care and chronic diseases building which AMPATH leadership is currently fundraising for. However, before initiating any efforts to deliver the equipment, we must first ensure that staff can deliver safe and competent care, that the equipment can be operated and maintained adequately and sustainably, and that patients who need treatment, even those without adequate resources, have access to care. We have begun a major initiative that includes hiring a business consultant to develop a financial model for AMPATH “Specialty Care” that will sustain cardiac services and develop a new monitored cardiac care unit.