People of AMPATH: Dr. Benjamin Elly, Gynecologic Oncologist
In 2008, Kenya had just one recognized gynecologic oncologist. Dr. Benjamin Elly is on a mission to change this scarcity in specialized care for women with reproductive tract cancers. He was one of the first graduates of the AMPATH-developed fellowship training program in gynecologic oncology, the first program of its kind in East Africa.
Tell us about your medical training prior to your fellowship in gynecologic oncology?
I am an obstetrician/gynecologist and gynecologic oncologist with over 20 years of experience in clinical practice and programmatic leadership of public health initiatives. Prior to joining the fellowship program, I was technical lead of prevention of mother-to-child transmission (PMTCT) of HIV/maternal and child health at the U.S. Centers for Disease Control and Prevention in Kenya.
What training did you undertake during the fellowship?
I joined the Moi University School of Medicine for a clinical fellowship in gynecologic oncology in September of 2016 and completed the training in September of 2019.
The program involved management of patients with reproductive tract cancers, often through surgery or chemotherapy. It also included integration of data collection on all patients. This provided opportunities to do clinical research and develop manuscripts.
The fellowship took three years instead of two as planned because of strikes and action that delayed our exams. However, my training still continued, which was really a blessing in disguise. During this period, I was privileged to be a mentee of the International Gynecologic Cancer Society (IGCS) global mentorship program. Through IGCS, I got an opportunity to be exposed to more surgical cases and collaborate with colleagues around the world.
Dr. Benjamin Elly
I also had an opportunity to travel to University of Toronto for a period of six weeks for rotations in radiation oncology, gynecological pathology and palliative care.
Why was the Gynecologic Oncology fellowship needed?
In 2008, Kenya had just one recognized gynecologic oncologist. With the rising cancer burden there was a huge need to train more physicians and surgeons specialized to meet the needs of so many women with these types of cancer.
For example, cervical cancer is the second most common cancer in women in Kenya and the most common cancer in Kenyan women ages 15-44.
How was the gynecologic oncology fellowship developed?
The fellowship was developed as a collaboration between Kenyan and North American physicians who worked together to develop a gynecologic oncology training in Kenya. Dr. Barry Rosen from the University of Toronto really led the effort beginning in 2008 and continues to work with us weekly.
In 2008, a gynecologist from MTRH visited the University of Toronto as an observer and the following year a gynecologic oncologist visited MTRH with the objective to teach the gynecologists how to do a LEEP excision on women with cervical abnormalities. It was soon identified that there was neither a coordinated approach nor strategy to manage patients with reproductive tract malignancies. This led to a recommendation that a specific gynecologic oncology clinic should be started.
The two Kenyan gynecologists working in the oncology clinic wanted to learn how to do a radical hysterectomy so that they could treat the women identified with early stage disease. Teaching modules were developed by The Society of Gynecologic Oncology of Canada to address every step of the surgery including management of complications.
At the same time, through direction and leadership from AMPATH, clinical algorithms for all gynecologic malignancies in Kenya were developed. The starting position was to use protocols established in North America and modify them to the Kenyan context.
With the support from the Department of Reproductive Health at Moi University, the clinical fellowship curriculum was developed and went through many steps required by Moi University including a stakeholders meetings with deans, gynecologists from MTRH and Nairobi, and colleagues from radiation oncology, pathology, radiology and others.
Approval for this training program was required from the post-graduate education committee which supervises all residency programs, from the Dean of Medicine, from the Moi University Dean's committee and finally from the Moi University Senate. Once all the approvals were obtained, this program officially became the first medical postgraduate subspecialty-training program at Moi University and the first official university gynecologic oncology-training program in sub-Saharan Africa outside of South Africa. This was a very valuable step to developing a sustainable training program. The program is recognized by the Kenya Medical Practitioners’ and Dentists Council.
How many fellows have graduated from the fellowship training program?
So far, eight fellows have graduated and we have an additional five fellows currently in the program.
Tell us about your current role and why you are passionate about the fellowship?
I now serve as the Head of Gynecologic Oncology at Moi Teaching and Referral Hospital (MTRH).
In addition to clinical and management duties at MTRH, my additional role with the fellowship program is as an honorary lecturer in the Department of Reproductive Health at Moi University. I not only participate in teaching, but also supervision and mentorship of postgraduate students and fellows in gynecologic oncology.
The subspecialty training has empowered me to provide advice that will shape health care policy and provide sustainable expertise for women diagnosed with a gynecologic cancer.