Dr. Mamlin and his wife, Sarah Ellen, are central to the story of all that has been accomplished since Indiana University first established a relationship with Moi University & its Kenyan physicians in 1989. At some point thereafter, the AIDS pandemic swept through Eldoret. To hear Dr. Mamlin speak of the experience is moving. He gives a tour to the students who accompany him each week to Mosoriot, pointing out the tiny room where AMPATH first set up shop. Starting with funding to treat just 15 HIV+ patients (the existence of whom village elders once denied), AMPATH today cares for upwards of 120,000 HIV+ Kenyans.
The AMPATH map with a map of Kenya below. Find Eldoret just below the "K" in Kenya.
I find that number staggering.. in a good way. Even moreso when followed by Dr. Mamlin's ambitious plans for the next few years. Two years ago, on the same strip of road back from the clinic & in the same car, Dr. Mamlin described his vision of a home-based HIV testing program. Those words are today a reality with a vast expansion planned in the near future. There is reason to take Dr. Mamlin at his word, it seems.
But for as much as I find big numbers and "never been done before" plans exciting, it all pales by comparison to meeting just one Kenyan patient who would have died years ago were it not for these efforts. One woman called Dr. Mamlin "her father". She had lost sight in one eye due to a zoster infection but described Dr. Mamlin's care bringing her back from blindness. An elderly man lit up each time Dr. Mamlin passed through the waiting area. This man has Parkinson's disease and is able to walk only because the Mamlins' imported a year's worth of PD medication. As we departed from introductions made to the Outreach team, Dr. Mamlin described meeting its leader years prior as she was carried in to the clinic, oxygen saturation of 70% with a P. jiroveci pneumonia... an opportunistic infection and an AIDS-defining illness.
One very sad young woman had been rejected by her parents, had her home sold out from under her by a husband who disappeared and was having trouble finding school fees let alone a roof for her child. A terribly difficult time in what has probably been a very difficult life. It's possible that the medical care, mental health services, social worker, food program and job training will help get her through it. I shudder to imagine the alternative. Sadly, that alternative is still more the rule than the exception. Eighteen clinics with more by the year care for many like her each & every day. In conclusion, yet another memorable experience at Mosoriot. I have the good fortune of working with Dr. Mamlin next week on the inpatient wards as well.
I presented the case of a 33-year-old father of four this morning at AM Report. Hepatitis B & hepatocellular carcinoma, and a discharge with hospice. I do hope that is what it sounds like though my definition of end-of-life care is surely quite America-centric. Neither do family meetings have the same place in the decision-making process here. My registrar was away this AM so I led rounds from start to finish. Both the presentation & rounds went fairly well. I briefly had thoughts of an attempt at humor in my presentation but gave up as the hour got late last night. I did save this fine picture and would like to share it. Tom, I'm sure you remember this gem of a movie. Meet Turbo & Ozone.
We travel tomorrow evening to an area called Mount Elgon, located near the Kenya-Uganda border (see map above). There will be plenty of hiking, hopefully a good deal of cooking and perhaps some spelunking. Surely, Anne will fill in the details on Sunday. As we head into "the bush" for the weekend, I'll make a wish for continued GI stability. The toilet paper here is named "TENA", or "Again" in Kiswahili, which I find ironic.
And finally, Philip & I were handed our IREC approval letter today. Four weeks after our arrival but infinitely earlier than some might have predicted, we will commence interviewing outright tomorrow.
Tutaonana baadai,
Joe
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