Sustainable health care systems and how they evolve

Karibu! Asante! Mbogatarian!

Welcome! Thank you! Vegetarian!

(Me, after 5 Swahili lessons, showing off my newfound language skills-guess which one of those I use the most?)

For a long time, I have been very, very interested (read: obsessed) with the concept of sustainability, especially in the context of global health. I would be remiss if I didn't discuss an extremely important conversation I observed one of my fellow Slemendas have with Sonak Pastakia, a Purdue PharmD-PhD-MPH (expert on everything). During the conversation, they were debating whether AMPATH is replicable in other countries that need similar healthcare services. Some background information: one of AMPATH's current goals is to encourage patients to sign up for NHIF, which is the National Hospital Insurance Fund. Through this insurance, treatment for patients is covered, and AMPATH receives payment for services through the government. This is necessary to sustain AMPATH services in the long-term. Currently, a great deal of AMPATH's funding comes from USAID. Before USAID, AMPATH relied on small grants and private donors. (Recap: Stage 1: small grants to Stage 2: USAID to hopefully Stage 3: NHIF.)

This chronology is important to understand because it is absolutely correct that the current AMPATH model and variety of services is not replicable in its current form, because it took time, vision, demand for services, and so many other factors to get to this point in time. Demand for services really drove what AMPATH offers now, and this factor was what really changed my thoughts on sustainability. In the beginning, HIV was a death sentence, with no available treatment. Treating patients in sub-Saharan Africa was considered to be impossible. It really was a humanitarian emergency. To test the idea of treating patients, Joe Mamlin used personal funds, donations, and very, very small grants to buy medications-certainly not "sustainable." Stage 1. He proved the concept, so larger grants came along, and AMPATH could treat more patients. Stage 2. HIV became treatable-the initial emergency was beginning to pass. Now, AMPATH is looking to encourage the growth of NHIF, to be less reliant on external funding. Stage 3. It suddenly became so, so clear to me that emergencies must be treated as just that-as emergencies. In an emergency, whatever is necessary to help the situation must be done. Only after the initial situation is resolved can sustainability come into play. Sonak really drove this point home by emphasizing that what is sustainable also changes-mind-blowing. He gave the example that NHIF can only work if enough people enroll. So, if NHIF fails, Sonak will be there with the next long-term solution.

Whew! If you made it through that (and all my previous musings on this topic), please let me know what you are thinking. This concept has bothered me for such a long time and I am so happy with this new understanding.

I continue to love all the supplemental lectures and activities planned for us on a weekly basis. The latest Slemenda initiative has been to screen movies/cartoons on the pediatrics ward on Thursday nights. The first Thursday, we watched Sing and last week we watched Tom & Jerry. With the nurses strike still going on, fewer patients are being admitted, so those who are in the hospital are extremely sick. Just like other children, they love crude humor and mild violence, so it is really fun to sit with them and watch them laugh. 

Watching Sing at Shoe4Africa, the children's hospital-over 60 attendees!

We also have great lectures and workshops from and with the visiting faculty from universities within the AMPATH consortium. I've gotten to learn how diabetes in sub-saharan Africa is drastically different from diabetes in the US, pretend to be a trauma patient with a GCS of 5, and try to redesign the Kenyan healthcare system. This morning, we had a great lecture on biostatistics (8 AM, with over 40 attendees, if that tells you anything about how engaged everyone here is!), with two more later this week on global surgery and population health.

Wednesdays are also a special day at IU House because of fireside chats followed by catered dinners. Fireside chat topics range from post-election violence to palliative care (although we did play Jeopardy! last week). It seems like every restaurant in Eldoret serves at least one Indian dish, though I have yet to find any as good as my mom's cooking...

This weekend, we did two extremely fun day trips. On Saturday, we went to Kruger Farm, where we climbed a mountain and tried to follow giraffes around stealthily (and failed), followed by Kerio View, where we ate lunch overlooking the Great Rift Valley. On Sunday, we went to Torok Falls, a 10 mile, 6 hour hike/rock climb up a mountain to the base of a waterfall. For someone who really does not like hiking (and took a pretty impressive tumble during the rock climbing and have a fierce knee bruise to prove it), I find myself doing a lot of hiking this summer… 

Giraffes, just 50 feet away!

Torok Falls (when you travel with med students, they warn you about bare feet and schisto, which you ignore anyway)