Our vision is for Moi Teaching and Referral Hospital’s radiology department to be a leader in East Africa in clinical care, education, and research. Below you will find a brief summary of the history of our program representing Indiana University School of Medicine (IUSM) in Eldoret, Kenya, as well as an outline of our plan for fulfilling our tripartite mission.

File Room in Moi Teaching and Referral Hospital

Kenya has two teaching hospitals: Kenyatta National Hospital in Nairobi and Moi Teaching and Referral Hospital (MTRH) in Eldoret. Since 1990, Moi University School of Medicine (MUSM) has partnered with MTRH to educate medical students as well as residents in internal medicine, pediatrics and family practice. The partnership between IUSM and MUSM dates to the inception of MUSM. Led by its primary care Division of General Internal Medicine, IUSM has had permanent faculty on-site at MUSM for almost two decades. Those faculty physicians develop and support partnerships between multiple IU and MU schools and departments. Counterpart relationships between individual faculty members and departments are the keystone of this partnership and support clinical care, teaching, and research. To make a wider impact on health care in sub-Saharan Africa, in 1997 IUSM formed the “ASANTE” consortium, which currently includes Brown University, Duke University, George Washington University, and the Universities of Toronto and Utah. The partnership has had a major impact on delivery of health services, education, and research in Kenya (Einterz, Kimaiyo et al. 2007). It developed and implemented sub-Saharan Africa’s first electronic health record (EHR) in a rural health center in Nandi North District; trained numerous health workers and leaders, including two former Deans of MUSPH; helped develop MUSM’s residency training programs in Medicine, Pediatrics, and Family Medicine; developed a core of clinical and health services researchers and a research infrastructure to manage grants and assure ethical research; bolstered the health services capacity of several hospitals and health centers; and enhanced community-based services (including Kenya’s immunization program) in northern and western Kenya. According to a special emphasis panel at the National Institutes of Health, the partnership “serves as a model for how collaboration between US institutions and those in developing countries can be established, nourished, maintained, evaluated and enhanced…This linkage has been developed in such way that the interests of Moi University and the people of Kenya have been kept uppermost.”

The partnership’s population perspective and focus on primary care and institution building throughout the 1990s gave birth in 2001 to its HIV-control program, the Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH). AMPATH’s systems-based approach links comprehensive clinical care, prevention, health promotion, research, and training across multiple sectors in a population of nearly 2 million people in western Kenya. AMPATH prevents new infections, improves the quality of life of persons infected with and affected by HIV/AIDS, and strives to mitigate the social and economic impact of both HIV/AIDS and TB. While the strongest ASANTE presence has been in the Department of Medicine, participation by members from other departments, notably the Departments of Pediatrics and of Obstetrics/Gynecology, has grown substantially. The ASANTE presence in Radiology to date has been relatively weak, consisting of Marc’s and my bi-annual visits, with shorter single visits by 2 other radiologists. We’ve moved forward, but we haven’t reached kindling temperature. We need others to help us in our mission. Here is what we’ve accomplished to date:

In 2003, I visited for two months. That first visit served as a relationship-building effort. It was successful in that regard. The idea of cross-Atlantic collaboration was embraced by both Departments of Radiology (MTRH and IU). In 2004, the IU Department of Radiology hosted one of the MTRH radiologists at IU for 6 weeks. My second (and Marc’s first) visit in 2005, was, however, another relationship-building effort, because the previous MTRH radiologists (including the one we’d hosted), had left MTRH. A new radiologist, Joseph Abuya, now HOD (head of department), had joined the hospital. Dr. Livingstone Wanene, who continues to work with Dr. Abuya at MTRH, was hired a few days before Marc and I left Eldoret. Marc and I read studies (plain film and ultrasound) with them, and installed the first (very rudimentary) MTRH PACS, using a digital camera to capture images of chest radiographs and ultrasounds from a light-box. Our last visit, in 2007, built upon that visit, and upon the two intervening visits by two of our partners, each of whom stayed for three weeks. They, Don Hawes and Ken Kopecky, were primarily responsible for our faculty’s donations of ultrasound and CT machines to the hospital. A used 4 detector non-helical CT was installed a few months before our 2007 visit, replacing the barely-functioning single detector CT that had become permanently inoperable some time in 2004. During that last visit, I worked at length with Drs. Abuya and Wanene and their technologists on CT imaging protocols and interpretation, in addition to standardization of CXR readings and data input into the second generation, web based RIS/PACS system Marc (who is a computer wizard) created. I also continued to do scattered IR procedures, mostly percutaneous biopsies, and to show Dr. Wanene how to do them. I am proud that he now performs several such procedures each week.

The last trans-Atlantic visit by a member of our all-too-small consortium was made by Dr. Abuya, who spent 6 weeks with us at IU in April and May, 2007. He spent his days primarily in abdominal, neuro, chest, peds, and ER areas. He didn’t spend much time in IR with me, as there is very little IR in Kenya. As I noted above, in the several months that I’ve spent in Eldoret, I’ve done lots of biopsies, a few PICCs, a few abscess drainages, a single biliary drain placement. And read lots of CXRs and OB ultrasounds… which I hadn’t thought about for about 11 years prior to going to Eldoret. Those are, however, what’re needed in Kenya, where HIV and TB are everywhere, and the birthrate is among the highest in the world.

We have accomplished some of our goals. All partnerships depend on strong interpersonal relationships. Marc and I have built a strong relationship with our Kenyan counterparts. We respect each other, and have learned from each other. We’ve improved clinical care by increasing access to image and report data and bolstering report quality. Our department has provided financial support for much needed equipment. IR, although in its infancy, exists. Each of these accomplishments however, is merely a step along the way, and requires constant attention, which we haven’t been able to give. We want to fulfill our vision by supporting faculty retention and recruitment, integration of our RIS/PACS into the AMPATH Medical Record System (AMRS), input of 100% of patients’ information and images into the RIS/PACS, and, eventually, the creation of a Radiology Residency at MTRH. Eastern Africa has a severe shortage of trained radiologists: There are fewer than 100 Kenyan radiologists, far too few for a country of over 30 million people. What good is a CXR to a patient with TB if it can’t be interpreted?

The End

Written by Matt Johnson, M.D. with assistance from Marc Kohli, M.D.

Einterz, R. M., S. Kimaiyo, et al. (2007). “Responding to the HIV pandemic: the power of an academic medical partnership.” Acad Med 82(8): 812-8.