There are fewer than 200 radiologists in Kenya---a country of 43 million people. There are still many places in Kenya where exploratory laparotomy is performed for women with positive pregnancy tests and abdominal pain because of lack of access to ultrasound and a competent radiologist.
Kenya has two teaching hospitals: Kenyatta National Hospital in Nairobi and Moi Teaching and Referral Hospital (MTRH) in Eldoret. Since 1990, Moi University School of Medicine (MUSM) has partnered with MTRH to educate medical students as well as residents in internal medicine, pediatrics and family practice. The partnership between Indiana University School of Medicine (IUSM) and MUSM dates to the inception of MUSM. Led by its primary care division of General Internal Medicine, IUSM has had permanent faculty on-site at MUSM for two decades. Those faculty physicians develop and support partnerships between multiple IU and MU schools and departments. Counterpart relationships between individual faculty members and departments are the keystone of this partnership and support clinical care, teaching, and research.
In order to have a wider impact on health care in sub-Saharan Africa, in 1997 IUSM formed the AMPATH consortium which consists of nine North American academic medical institutions led by Indiana University. The partnership has had a major impact on delivery of health services, education, and research in Kenya. It developed and implemented sub-Saharan Africa's first electronic health record (EHR) in a rural health center in Nandi North District; trained numerous health workers and leaders, including two former Deans of MUSPH; helped develop MUSM's residency training programs in Medicine, Pediatrics, and Family Medicine; developed a core of clinical and health services researchers and a research infrastructure to manage grants and assure ethical research; bolstered the health services capacity of several hospitals and health centers; and enhanced community-based services (including Kenya's immunization program) in northern and western Kenya.
While the strongest AMPATH consortium presence has historically been in the Department of Medicine, participation by members from other departments, notably the Departments of Pediatrics and of Obstetrics/Gynecology, has grown substantially. In 2003 the relationship between IU and Moi Teaching and Referral Hospital (MTRH) radiology departments began with an IUSM representative initially spending two months in Kenya. That first visit firmly established the idea of cross-Atlantic collaboration within both the MTRH and IU radiology departments. In 2004, the IU Department of Radiology hosted one of the MTRH radiologists at IU for 6 weeks. Past visitors have read studies (primarily plain film and ultrasound with a small amount of CT), given lectures and instruction to medical students and house officers (residents), and installed the first (very rudimentary) MTRH PACS, using a digital camera to capture images of chest radiographs and ultrasounds from a light-box. Since then, further enhancement of the technology available at MRTH occurred, including ultrasound and CT machines to the hospital. The radiology department provides much needed support as MRTH moves toward improving oncology services.
The fall of 2010 brought an important change to the MTRH radiology department as they added a registrar (similar to medical school residents in the U.S.) program. The presence of trainees has dramatically increased interest from U.S. radiologists in rotating to MTRH. The following year Dr. Kohli began a mobile X-ray truck project with the hope of bringing radiology services to the rural villages where many people do not have access to transportation to Eldoret to receive these services. With funding from the National Library of Medicine, two digital CR readers as well as two X-ray generators were purchased and transported to Kenya. The mobile X-ray truck has been a work in progress and in October 2013, the truck made its first visit to the rural village of Turbo.
The core principle of the project has been bi-directional exchange. The plan is to expand on the exchange program now that Moi University has a dedicated radiology residency with the hope for an endowment that would support a bi-directional resident exchange yearly.