Partnership with Nepal Improves Care for Mothers and Babies

AMPATH Kenya hosted the first AMPATH Global educational exchange by inviting Dr. Sumisti Shakya, an OB/GYN and second-year fellow in high-risk pregnancy at Dhulikhel Hospital in Nepal, to rotate with the Moi University maternal-fetal medicine (MFM) fellows at Moi Teaching and Referral Hospital. Dr. Sumisti shared about her experience completing a 4-week rotation in Eldoret, Kenya.

Dr. Sumisti with the MTRH maternal fetal medicine team

Dr. Sumisti’s main goal during the elective was to gain experience in managing a broad range of high-risk obstetric cases. "I wanted to develop my skills in handling complex pregnancies and apply what I learn to my practice back home in Nepal," she noted. The elective provided her with a diverse array of cases that expanded her understanding of global maternal health.

Reflecting on her experiences in both countries, Dr. Sumisti pointed out similarities between the healthcare systems in Kenya and Nepal. "Both hospitals have limited resources, but despite this, they manage and treat patients with full effort," she remarked. She also observed that the number and severity of cases were high in Eldoret. “I have seen some of them (in Nepal), but it’s in very small quantity. But over here, I see them quite often,” said Dr. Sumisti. Some of the cases she saw during the month-long rotation included severe preeclampsia, HELLP syndrome, acute kidney injury, cardiac issues, sickle cell disease and cancer in pregnancy.

During her time in Kenya, she rounded in the wards, completed ultrasound training, spent time in the operating theater and in the clinics. Dr. Sumisti said she had a short time to absorb everything, “but in that short period, I’ve learned a lot from here.”

She enjoyed the camaraderie with the Maternal Fetal Medicine (MFM) fellows at the hospital. “When they see the patients, they're very serious and they're into the zone of learning and teaching. But they also laugh around and joke around, which is very enjoyable,” she said. She appreciated when the fellows shared about their own challenges. “We all have certain boundaries on us, but we are treating the patients in the best way possible,” she said.

Dr. Mogeni and Dr. Sumisti

“I felt lucky that it was Dr. Sumisti who came for this first AMPATH reproductive health educational exchange experience because she was very open-minded and she integrated into the MFM team really well,” said Dr. Wan-Ju Wu, Icahn School of Medicine at Mount Sinai OB/GYN faculty and adolescent health team leader for AMPATH Kenya. “The MFM team registrars and fellows also had an opportunity to learn from her as well. I think it was truly a bilateral educational and learning experience.”

This was echoed by, Dr. Bett Kipchumba, an MFM specialist at MTRH, “We had the opportunity to have Dr. Sumisti rotate in our high-risk antepartum wards. She is very hard-working and a critical thinker. Overall, I strongly support these partnerships, and we should continue to build them. Through this exchange we learned from each other on differences in disease morbidity in different parts of the world. For example, we learned from Dr. Sumisti the differences in PET (preeclampsia) presentation between Nepal and Kenya. We look forward to having one of our gynecologists travel to Nepal.”

Dr. Sumisti also appreciated the experience of staying at IU House with other AMPATH Consortium members. “IU House itself is a very good environment because we get to meet different people from different countries. So we have a cultural exchange over there,” Dr. Sumisti admits that she and her husband were nervous before she travelled to Kenya. “After coming here, actually, I feel very secure. The people are very warm, welcoming. It's very humble, friendly. I enjoyed it a lot.”

Planning for this educational exchange started during the AMPATH Global Gathering in January 2024 when the AMPATH sites met together in Eldoret. “The different sites all agreed that there would be a lot of potential for future collaboration,” said Dr. Wu. “We have Dr. Sumisti here for MFM. Dr. Richard Mogeni, an MTRH gynecologist, will be traveling to Dhulikhel Hospital, for a one-month minimal invasive surgery rotation in November 2024. Hopefully, this will be the start of collaborations between the AMPATH Global sites so that each site can capitalize on their strengths and educational opportunities and be able to have more fellows and more trainees travel between the sites,” said Dr. Wu.

Dr. Sumisti plans to apply the knowledge and skills she gained in Kenya to her work in Nepal. "The ultrasound skills I developed will be very useful in diagnosing and managing high-risk pregnancies back home," she said. She also intends to utilize the strategies she learned for managing conditions with limited resources, helping to improve care for women with high-risk pregnancies in Nepal.