Fogarty Fellowship Aims to Improve Care After a Stroke
Medical interventions do not have to be dramatic to be lifesaving. For people who have had a stroke, relatively simple and low-cost interventions, such as checking if a patient can swallow properly and elevating the head to prevent choking, can dramatically increase survival rates.
Ishmail Sillah, DNP, AGACNP-BC, RN, MPH, is on a mission to improve care for people who have had strokes in resource-limited settings. He was selected as a 2024-25 Fogarty LAUNCH Fellow through the Northern Pacific Global Health Leadership, Education and Development for Early-Career Researchers (NPGH LEADERs) and will spend the next year working to improve post-stroke care at Moi Teaching and Referral Hospital (MTRH). His project is entitled, “Adapting an Evidence Based Oropharyngeal Dysphagia Screening Tool for patients with Stroke in a Low- and Middle-Income Setting.”
“Oropharyngeal dysphagia (OD) which commonly happens in stroke, can impair a patient’s ability to swallow properly,” Dr. Sillah explained. “This swallowing impairment can lead to adverse outcomes including pneumonia, malnutrition, dehydration, depression and premature death. Common signs of dysphagia include facial droop, drooling, or coughing when eating. A relatively simple screening can identify patients at risk for OD. Once this risk is identified, it can be communicated to the patient, their family and the healthcare team. This early OD recognition and early risk communication is necessary to help initiate early interventions such as speech therapy support, dietary modification, and feeding tube insertion to prevent OD adverse outcomes mentioned earlier.”
“I tell my patients and their families that most strokes don’t really kill people unless they are very severe. It's the things that we don't address after the stroke that gets people,” said Dr. Sillah.
In most healthcare facilities across Kenya, including MTRH, there are no formal dysphagia screening, diagnosis, assessment or management tools or protocols for people with acute stroke. Working with the nurses and other healthcare professionals at MTRH, Dr. Sillah’s Fogarty project aims to assess, develop, and reevaluate strategies to sustainably reduce dysphagia complication among patients with stroke in a resource-limited environment.
Each year more than 12.2 million people experience a stroke which occurs when the flow of oxygenated blood to the brain is impaired. Strokes are the second leading cause of death globally with approximately 6.5 million people succumbing each year. The impact of deaths and disability caused by strokes each year is greater than HIV and COVID-19 combined. People in low- and middle-income countries are disproportionately impacted by strokes with 86% of stroke deaths occurring in these countries.
“Following AMPATH’s mission to ‘Lead with care, then do more’ we are building local technical expertise and evidence-based interventions to meet the needs of all patients who present with stroke at MTRH despite resource limitations,” said Dr. Sillah. “Our work will set the standard for sustainable evidence-based stroke care in Kenya and possibly other low- and middle-income countries.”
“I'm a bedside clinician. I look at things from the perspective of what can I do for the patient right now and right there. However, this Fogarty fellowship is challenging me to have a global perspective. This global perspective pushes me to first understand health systems challenges and opportunities. Once this is understood, then I can develop clearer perspective of how resources can be aligned to not only address the needs of the patient in front of me but also systematically create structures to meet multiple patients’ needs across multiple settings.” added Dr. Sillah.
The NPGH LEADERs Program is a 12-month mentored clinical research training sponsored by the National Institutes of Health’s Fogarty International Center in partnership with several NIH Institutes and Offices. Fellows represent academic institutions from the U.S. including Indiana University, as well as 31 partner institutions including Moi University in nine low and middle-income countries. The Fogarty LAUNCH fellowship includes a week of onsite research training at the National Institutes of Health in Washington, DC, and ongoing virtual research training throughout the fellowship year.
Another key component of the Fogarty Fellowship is guidance provided by the fellow’s mentorship team including experts from both the host institution and U.S. institutions. Dr. Sillah’s mentor team includes:
· Local Senior Fogarty Mentor: Chrispine Oduor, MBchB, M.MED, Chair of Department of Medicine, Moi University, Eldoret
· US-Senior Fogarty Mentor: Megan McHenry MD, MS, FAAP, Indiana University School of Medicine
· Nursing Mentor: Jane von Gaudecker, PhD, MScN, AGCNS, IU School of Nursing
· Titus Ngeno MD, MSc-GH, Duke University, Junior Fogarty Mentor
· Carmen Graffaginino, MD, Duke University, Neurology Mentor
“As a physician working with stroke patients and a mentor to Dr. Sillah, I strongly support his work on post stroke dysphagia/aspiration,” said Dr. Oduor. “A patient who can feed is regarded as doing well, so the relatives go out of their way to ensure that such a patient takes something orally oblivious of the inherent risk of aspiration especially in patients with dysphagia from stroke or other neurologic disorders. This puts these patients at risk of aspiration pneumonia/choking with increased mortality. Dr. Sillah's work will investigate the barriers and facilitators of implementing and using an evidence-based dysphagia screening tool and eventually validating the tool for local use. This will have a huge impact on dysphagia screening and prevention of post stroke aspiration pneumonia with resultant improved outcome in patient survival rates,” he explained.
“Dr. Sillah is a very dedicated healthcare practitioner who is very self-driven and empathetic to patients. He also likes to share his skills and knowledge with other healthcare workers particularly the nurses whom he intends to train in dysphagia screening. He is obviously the right person for this work,” added Dr. Oduor.
Dr. McHenry is providing mentorship in the area of implementation science which is a research methodology used to study how evidenced-based interventions can be integrated into clinical care and policy. "Implementation science gives us the information we need to close the gap between what we know would work and what actually happens in real life,” she explained.
Typically, Fogarty Fellows from the U.S. relocate for their fellowship year, but Dr. Sillah is already living and working in Kenya. His spouse, Dr. Rachel Ogumbo, is the AMPATH Pharmacy Team Lead and their family moved to Kenya in early 2023. Dr. Sillah has been the Nursing Stroke Care Quality Improvement Specialist at MTRH since March 2023. With the support of several nurses who are “stroke champions” they are making changes to post-stroke care and seeing declines in stroke mortality due to aspiration pneumonia.
Dr. Sillah said the connections that the stroke champions make with the patients and seeing the impact that small changes can make in care and outcomes is motivating additional nurses to become interested in learning more about post-stroke care.
Dr. Sillah is grateful for the AMPATH partnership and the ways it has supported his work as well as the upcoming Fogarty Fellowship. “At AMPATH, we have a community of people that are passionate not only about addressing current healthcare needs, but also driven to mentor early career researchers like me despite resource limitations. I hoped for so many years to find a place like this,” said Dr. Sillah who spent his early childhood in Sierra Leone and relocated to the U.S. where he completed high school and university studies. After spending a decade working in multiple acute care settings in the U.S., Dr. Sillah is excited to share his skills via multiple teaching engagements at Moi University and MTRH in Eldoret. He is especially excited that the Fogarty Fellowship has provided him with an opportunity to further develop his global health research experience using implementation science to address stroke care needs in resource limited settings.
“Personally, I believe AMPATH has the tools that we need to address healthcare problems despite resource limitations. The idea of serving by first providing quality care then doing more through education and research pushes us to always seek innovations to provide better healthcare regardless of where we find ourselves. Working with AMPATH and becoming a Fogarty Fellow, I feel blessed to be in the company of mentors who are deeply committed to building early career global health researchers to meet rising healthcare needs,” he added.
Applications for the 2025-26 cohort of Fogarty LAUNCH Fellows are currently open and the deadline to apply is September 13.