The Mosoriot Clinic: A story of quiet generosity

The AMPATH HIV program began around 2000-2001 following a donation from an IU physician to treat one young man dying on the wards at Moi Teaching and Referral Hospital (MTRH). That young man was Daniel, one of the fifth-year medical students at Moi University. The same donor then gave us enough money to treat 40 people. That may not sound like much now, but at that time, we felt rich being able to treat 40 people when everyone was dying.

We divided the donation into 25 slots for MTRH and 15 for a village clinic. We thought we could show what can be done in the villages as well as in town. I was familiar with the village of Mosoriot from the 1992-93 time I spent in Kenya. I had lived there for three weeks with ten Moi University medical students. Now the Mosoriot clinic matron gave me one room to start an HIV clinic. We were also given one room at MTRH.

We started both clinics the very same week. I spent one half day in the Mosoriot clinic and one half day at MTRH in Eldoret. The amount of stigma was enormous. When I met with the Mosoriot village elders and the chiefs and told them I was starting an HIV clinic, they said, “No.” They didn’t want the clinic because “there was no HIV in their community”---even though they were going to funerals every week.

“OK,” I said, “We have this one room. Send me anyone with hypertension and diabetes and let's just see what happens.” In no time, I had people lying everywhere and probably had the largest village HIV clinic in Kenya--with one room, 15 spots and loads of patients. That was how we started.

Then, PEPFAR funding arrived, and the number of patients exploded! Like most Ministry of Health (MOH) rural health centers in Kenya, the Mosoriot clinic was built in the 1960s. At that time no one could have imagined the space that would be needed to respond to one of the world’s most devastating pandemics. Our crisis was no longer absence of drugs, but absence of space.

In 2003, I returned to Indiana for a few weeks to see family and check in at the IU Medical School. A woman we had known since the early 60s called my wife Sarah Ellen and asked if she would meet her at the Lafayette Square food court. She just reached in her pocket and handed Sarah Ellen a check and said, “Joe needs a clinic.” And she said, “No one can ever know.” Her husband was not to know. No one was to know about this gift but the two of us. We pledged to never tell anyone.

We built the clinic which probably became the first MOH facility dedicated to the treatment of HIV in all of East Africa. Certainly it was the first in Kenya. Daring to declare that “This building is for the care of HIV,” took some courage. Empowered by having this new building, we were determined to get right into the face of stigma.

Our new AMPATH clinic at Mosoriot was dedicated in 2005.

Having an actual MOH clinic for HIV was so unusual, the dedication attracted the presence of the US Ambassador and the Kenyan Minister of Health. After the formal speeches the dignitaries drove off with their police escorts. But the community was not satisfied.

The community said, “Let us show you how to dedicate a building.” They dressed me up in blue monkey fur and they gave me an old Nandi fly whisk. By this time I had been made a Nandi tribal elder, so I was to march with the elders. We marched through town accompanied by members of the tribe carrying shields and spears. Members of the community dropped in line, and like the Pied Piper, we led the community back to its new HIV clinic.

All eyes turned to the elders to make the first move to dedicate the building and a little old man next to me knew just what to do. He spit on the building! I had read that the precious way for the Nandi tribe to put a blessing on something was to spit on it. So we all followed his lead and spat on the building. The next step was to bless every room in the building by spitting. I’ve often thought that the poor US Ambassador had no idea how to really dedicate a building.

For the next 15 years, there was not a week that I did not guide students and other visitors through the Mosoriot AMPATH clinic and tell them this story. What a powerful model the clinic had become. But I always kept the secret. This was the first AMPATH building. Since that time, we have built buildings across western Kenya, but I always said, “I like where this one came from.”

The Mosoriot AMPATH clinic grew so fast, it became the innovative model for all of AMPATH.

It was where we launched our first HIV mother-to-child prevention program. It was also where we demonstrated that one could safely task shift care away from doctors to serve large numbers of patients and where we started Kenya’s first door-to-door HIV testing program in an effort to Find, Link, Treat and Retain (FLTR) everyone. It was where we first developed the electronic medical record system that morphed into OpenMRS and spread across the world. The AMPATH clinic at Mosoriot has become a powerful symbol of where we are headed, but I was still unable to tell anyone who helped us start it all.

Each time we returned for an AMPATH gala or celebration, the donor would be there. Before we could even say hello, she would put her finger up to her lips to tell us to be quiet. Just a couple of those quick little gestures that we knew meant, “Keep your mouth closed! Don’t tell!”

Then this week, I was giving a speech for IU School of Medicine emeritus faculty and learned that the wife of the former chair of the Department of Medicine and dean of the school, Walter Daly, had passed away. And I said to myself, “My God, that’s Joan Daly.” Walter and no one else had known, but for the first time I felt free to look out among friends, many of whom knew Joan, and tell them the story of what Joan had done in her own quiet way.

It felt right to be able to finally share that story and then call Walter, not just to share words of sympathy with him as a friend who had lost his wife, but to tell him this story. I’m sure he was surprised, just like everyone else.

I think it is important to tell the story of Joan Daly. Not every gift is a big showy thing. Not every gift is from somebody who thinks that they are going to move the Earth with that gift. This was a very quiet, private gift, but it gave birth and momentum to what has become one of the largest HIV treatment programs in the world.

It all goes back to Joan Daly. For me that's the Joan Daly building, but it is so much more than a building. What I’ll remember about Joan Daly was just a quiet determination to make a difference in her own way, and what a difference it continues to make for so many in East Africa.