Looking Back at 2022 and Forward to a New Year of Possibilities
Happy 2023! As many of you know, people and relationships are what make AMPATH special. I’m delighted you are part of the AMPATH family.
I’m thrilled to be back in Eldoret for a few weeks--joining new and old friends around the table at IU House. It is great to see Joe and Sarah Ellen Mamlin in their favorite element again for the month of February, check in with Dunia, John and others at the IU house office, and reunite with Prof. Kimaiyo and so many other colleagues and friends at MTRH and Moi University.
It has been a busy start to the new year, but I wanted to take a moment to reflect with you on the many accomplishments of our AMPATH Kenya partnership over the last year. The COVID pandemic has reached a level of stability, but the work of addressing global health disparities that have been more prominently brought to light over the last few years is far from over.
AMPATH partnered with a youth group in Webuye to support a GISHE group to build the poultry value chain.
Additionally, the war in Ukraine, avian flu, droughts, climate change and other factors have led to global inflation, economic stagnation and food insecurity globally. These forces are posing serious challenges for the individuals and communities that AMPATH serves. AMPATH has always taken a holistic approach to addressing the health and well-being of the population—strengthening health systems, but also creatively addressing the social determinants of health by improving access to food, transportation and health insurance and by implementing income-generating activities.
AMPATH’s response to these challenges once again illustrates the power of our long-term institutional partnerships. While there are many impactful departmental initiatives and activities, more than I can possibly describe here, I want to highlight a few for you:
Leading with Care
The Rafiki Center of Excellence in Adolescent Health is a model program.
AMPATH Kenya partners in the delivery of high-quality HIV services with ongoing support from the government of Kenya and USAID/PEPFAR. Led by AMPATH partners Moi University and Moi Teaching and Referral Hospital (MTRH), USAID AMPATH Uzima, USAID Dumisha Afya and USAID 4theChild continue to assist the Kenyan Ministry of Health in nine counties to surpass impact targets such as linkage to care, HIV viral suppression and number of orphans and vulnerable children served. This month, MTRH Rafiki Center of Excellence in Adolescent Health was lauded as an innovative model of comprehensive adolescent care by USAID/PEPFAR and all implementers of HIV services in Kenya were invited to Eldoret to learn about the model.
At MTRH, a second linear accelerator was installed to meet the growing demand for radiotherapy services (over 60 cancer patients per day!). Facility and community-based efforts to screen women for breast and cervical cancer have now reached over 200,000 people.
The AMPATH mental health team continues to offer important and innovative services at the MTRH Nawiri Recovery and Skills Centre and expand access to mental health and substance use services in communities in western Kenya, partnering specifically with schools and youth organizations to support adolescents and youth.
In addition to the long-standing partnership in general surgery, collaborations in plastic surgery, orthopedics, neurosurgery, cardiothoracic surgery and ENT all continue to grow in significant ways.
The AMPATH universal health coverage (UHC) team continues to work closely with the Busia County government and the National Health Insurance Fund (NHIF) to pilot an innovative strategy specifically designed to ensure access to all and prevent families in the informal sector from defaulting on premium payments. It has been endorsed by the top national leadership of NHIF and holds promise as a strategy for the long-term sustainability of health systems investments by PEPFAR and other donors. AMPATH also continues to implement innovative elements of a comprehensive population health approach in Bungoma, Uasin Gishu and Elgeyo Marakwet Counties.
Expanding the global health workforce
One of the highlights of the year was the restart of our bidirectional education exchange and welcoming Moi University medical students and registrars to AMPATH Consortium schools for their rotations.
A new team of full-time faculty members from the AMPATH Consortium arrived in Eldoret and is doing a fabulous job of contributing to the care services at MTRH and also assisting with the education of Moi University trainees and supporting visiting trainees and faculty. Their efforts have allowed us to resume our robust, bilateral, trainee exchange program and offer meaningful clinical global health experiences with increased emphasis on self-reflection and global power imbalances. We are grateful to the Consortium institutions that hosted 21 Kenyan trainees this year and to Indiana University’s Department of Surgery who hosted the first Moi University surgery registrar for a clinical rotation in Indiana this year!
AMPATH faculty and staff have also established more robust programs in a number of disciplines using Project ECHO, a tele-education and mentoring platform. They have also supported clinical officer and nursing training courses in palliative care and echocardiography, and neurologic care training experiences for MTRH nurses. The first cohort of palliative care clinical officers will soon graduate from Moi Teaching and Referral Hospital Training College!
Moi University fellowships in gynecology-oncology, maternal-fetal medicine, cardiology, pediatric oncology and now medical oncology are training the next generation of providers in Kenya.
Generating research to inform policy and practice
The AMPATH Research program had another record-breaking year with AMPATH investigators receiving more than $16 million in awards and publishing 132 articles in 2022. Moi University also became the first university in Kenya to establish a Research Integrity Office to oversee research integrity and misconduct policies and procedures across all schools, faculties and departments. The establishment of the office was supported by an NIH grant to Professor Edwin Were at Moi University and AMPATH collaborators.
Participants gather at the PIC4C dissemination meeting last summer.
Support from the Fogarty International Center continues to provide young investigators in AMPATH the opportunity to build their research career and contribute to policy and practice for HIV, mental health, pediatric cancer and more.
Last summer, a three-day dissemination meeting and policy dialogue attended by national and international policymakers showcased the Primary Health Integrated Care Project for Chronic Conditions (PIC4C) project, led by Dr. Jemima Kamano of Moi University. The project, funded by the World Bank and Access Accelerated through the Kenyan Ministry of Health, supported County governments to develop and pilot models of integrated care for non-communicable diseases at community and primary care levels in Busia and Trans Nzoia counties.The findings are expected to inform implementation and scale up of integrated primary care approaches in Kenya and other low- and middle-income countries.
AMPATH going Global
In February 2022, we joined new partners around the world to announce AMPATH Global which now includes partnerships in Ghana, Mexico and Nepal based on the successful AMPATH Kenya model. In October, the AMPATH Global Gathering provided the opportunity to join together in person to strategize about universal health coverage, cardiovascular disease, mental health, oncology, medical and nursing education, public health, informatics, and other disciplines. It was an absolute privilege to host our colleagues from Kenya in Indianapolis, and the presence of institutional leaders from partner sites brought AMPATH Global efforts to life. Our new AMPATH partnerships in Ghana, Mexico and Nepal are all growing rapidly and already having a major impact!
Dr. Paula Braitstein was a friend and mentor to many.
In memory
Sadly, this year we lost our dear friend and colleague, Dr. Paula Braitstein. Paula was an outspoken champion of the underserved and her contributions to our partnership are beyond what can be captured in words. Her absence leaves a hole in our hearts, but efforts to memorialize her work and passions at Moi University/AMPATH and the University of Toronto are ongoing.
Looking ahead
AMPATH teamwork will continue to bring great things to Kenya in the coming year. The AMPATH Biobank will officially open its doors in mid-2023 under the leadership of Professor Kirtika Patel from Moi University. The biobank currently houses almost 150,000 samples in the Chandaria Cancer and Chronic Diseases Centre at MTRH and represents a unique resource in Kenya to support research activities in cardiovascular genomics, viral resistance, HIV/AIDS and cancer pharmacogenomics, among others.
MTRH will add new, cutting-edge imaging equipment and facilities for cardiac catheterization which will enable expansion of the partnership with the AMPATH Consortium in radiology and cardiovascular disease care. Investments in infrastructure and training will expand the capacity of MTRH orthopedic and neurosurgeons to address spinal trauma.
We are also thrilled that AMPATH’s efforts to care for children with disabilities and neurodevelopmental delays will be bolstered by significant investments, laying the foundation for improved service delivery, education and research.
Growing partnerships in emergency medicine, dermatology, microbiology and antimicrobial stewardship and multidisciplinary wound care will have a great impact in the year ahead.
Our successes in 2022 and plans for 2023 are only possible through the support of people like you, sharing your time, talent and treasure to grow our partnership. No brief summary could ever fully capture the depth and breadth of the work that happens every day to improve the lives of people in western Kenya, but I hope this letter gives you a glimpse into the many people and initiatives that bring our AMPATH mission to life.
We are grateful that you are part of the AMPATH family and wish you health and happiness in the year ahead.
Asante Sana,
Adrian
PS- Professor Jim Kelly published a new book this year about AMPATH filled with the stories of many people like you who make AMPATH special.