Pediatric Registrar Fulfills Her Destiny with Rotation at Indiana

AMPATH co-founder Dr. Joe Mamlin calls Irene Kalamai the “mother of AMPATH.” Kalamai, now a retired nurse, was the matron in-charge of the rural Mosoriot Clinic when AMPATH’s first HIV care and treatment efforts began in the early 90s.

Dr. Joe Mamlin and Irene Kalamai in Kenya

She became an HIV prevention advocate, not only going door-to-door for testing in Nandi County, but also passing out wisdom and condoms to fellow bus passengers while travelling around the county with her young niece in tow.

That niece, Brenda, inspired by her aunt’s devotion to her patients, grew up wanting to be a doctor. Aunt Irene began to dream about Brenda being part of the AMPATH educational exchanges and one day coming to Indiana University for a clinical rotation and being mentored by Dr. Mamlin and other IU faculty members that she had worked with for decades through the AMPATH partnership.

But it seemed that Brenda was destined to miss that opportunity. She didn’t attend Moi University for medical school and when she joined the university as a pediatric registrar there had not been a pediatric rotation to IU for several years. Resigned to the fact that a rotation at IU was not in her future, Brenda—now Dr. Chepkoech—told her faculty mentor that she wanted to do her away rotation in a place where she could see “big and crazy” things. They discussed opportunities in India or maybe at Kenya’s Aga Khan University.

But then, “I think God heard my aunt’s prayers,” and suddenly things fell in place for the opportunity to complete a rotation at IU. “Nobody in the department knew that I was related to her, because it has never come up,” said Dr. Chepkoech. “So, I think it was just luck or fate.” Whatever it was, Dr. Chepkoech spent 8 weeks in Indianapolis this summer and got to see plenty of “big and crazy” things, spend time with Joe and Sarah Ellen Mamlin and fulfill her aunt’s greatest hope and dream for her.

Dr. Brenda Chepkoech in front of Riley Hospital for Children in Indianapolis

During her time in Indianapolis, she completed rotations in nephrology, pulmonology and in the pediatric intensive care unit (PICU) as well as travelling to California for a training about PICU procedures and pediatric critical care medicine. She hopes to be part of the team that is slated to set up a PICU in Eldoret in the near future.

Reflecting on the need for a PICU, Dr. Chepkoech said, “I was telling the residents (at Riley Hospital for Children in Indianapolis) that all of the patients on the cardiac ICU, if they were back home, they would have died.” Advanced surgeries for critical congenital heart disease, ECMO machines that oxygenate the blood in place of lungs, and continuous renal replacement therapy are not currently available at Moi Teaching and Referral Hospital (MTRH).

She hopes to be able to bring back many of the things that she saw during her time in Indianapolis back to Eldoret and MTRH. Among these are advanced spirometry (a breathing test to measure pulmonary function) and family-centered rounds that incorporate the child’s caregivers in decision-making.

“I want to be a part of the bridge that connects where we are back home with where Riley is at as of the year 2023. The gap is so big, literally ages apart! I want to contribute in providing options for the children back home who would have survived had they been cared for at Riley,” said Dr. Chepkoech.

Dr. Chepkoech will complete her pediatric residency in Kenya in September 2024 and served as chief resident during the past year. She aspires to be a “leader who makes you want to do what is right” rather than being too directive.

She reflected on the teaching and mentoring styles of the IU faculty members she met during her time in Indianapolis and what she will take from each of them. Dr. Adnan Bhutta, division chief for pediatric critical care medicine at IU School of Medicine, has visited Kenya and made a point to provide training that would be applicable in the Kenyan context. “He would say, ‘Brenda, you are going back to start a PICU, this is important to you so pay attention,’” said Dr. Chepkoech. “He knew our needs in Kenya so he would be sure to bring out the most important parts.”

Dr. Mamlin and Dr. Chepkoech finally meet in Indianapolis.

“Dr. Castaneda loves science and she made me want to be like her,” added Dr. Chepkoech. “She’s very smart and I liked the way she explained things. She would say ‘It’s just science, don’t make it difficult.’”

Overall, the multi-disciplinary approach, teamwork and efficiency made a lasting impression on Dr. Chepkoech and are areas that she hopes to implement during her career. An example was a clinic that provided pulmonary care specifically for children with sickle cell disease that was started by Dr. Evans Machogu, a pulmonologist at Riley Children’s Hospital. Children with the condition are prone to developing pulmonary complications. Dr. Chepkoech said that in Kenya children with pulmonary symptoms might be prescribed antibiotics even though it is not an infection because there is no pulmonology equipment for testing or pulmonology clinic for follow-up.

During her free time, Dr. Chepkoech explored sites such as the Indianapolis Motor Speedway (home of the Indy 500 auto race), Indianapolis Zoo, State Fair, Children’s Museum, and even took a day trip to Chicago. She liked trying a variety of cuisines including Mexican, Vietnamese, Ethiopian and Italian. She enjoyed spending time outside of the hospital with Dr. Bobbi Byrne, Dr. Megan McHenry and Dr. Palka Patel.

Dr. Chepkoech now understands why her Aunt Irene was so insistent that she find a way to get to IU for her rotation. “She had seen how Prof. Mamlin was working—the commitment, the dedication. I have seen that here. So many people who came to Kenya as students or residents for the exchange from IU now have something going on to make things better—Dr. McHenry, Dr. Baenziger, Dr. Palka (Patel), Dr. Adrian (Gardner).”

“Even Dean Songok (of the Moi University School of Medicine) came here (to IU) as a resident and now she’s bringing change both in academics and student mentorship. Dr. Audrey Chepkemoi came here and has transformed our newborn unit. Dr. Njuguna came and has transformed the hematology-oncology service.”

“I feel like this is now a responsibility. It’s like passing a baton—like this is now your turn to make things better. I feel like it’s my time to change something for the better,” reflected Dr. Chepkoech.

Hear more about Dr. Brenda Chepkoech’s story during her Tusker Tales presentation.