Walking Together, Walking Far: How a U.S. and African Medical School Partnership Is Winning the Fight against HIV/AIDS

8. AMPATH in Action

106 walking together, walking far 106 walking together, walking far 8 AMPATH in Action On the days when Dr. Caroline Kosgei sees patients at one of the three AMPATH clinics in the Mt. Elgon area, she wakes before dawn, kisses her eighteen-month-old son Jonathan good-bye while he sleeps, and heads out the door. If Kosgei is fortunate, it is a two-hour drive northwest from Eldoret to Mt. Elgon. But in the rainy season, when the dirt roads turn to mud and collapsed bridges slow progress and force detours through the mountain villages, she can expect to spend at least three hours in the jeep. Kosgei has to pass through three police barricades en route to the Cheptais clinic, which is so close to the Ugandan border that her cell phone display changes to “Welcome to Uganda.” A graduate of Moi University School of Medicine and a native of Eldoret, Kosgei, who is twenty-eight years old, is the medical officer in charge of these remote clinics. She grew up in a Kenyan middle-class household; her father works as an accountant for Moi University and her mother teaches at the university’s nursing school. But their relative prosperity has not kept AIDS from hitting the family hard. Kosgei’s uncle died from AIDS in 2001 in Nakuru, before AMPATH’s treatment program had begun to grow. Six months later, the uncle’s wife died too. While Kosgei was a medical student making rounds on the wards of Moi Teaching and Referral Hospital, she came across a neighbor in one of the hospital beds. He died of AIDS a few weeks later. AMPATH in Action 107 “Before AMPATH, the wards were just horrible,” she says. “There was no specific way to care for the HIV patients.” After emotionally wrenching days in the hospital, Kosgei and her friend and fellow student Rose Koskei would talk into the night, trying to help each other deal with the frustration of working with patients whom they could not treat. Together, they questioned the point of becoming doctors at all if they were powerless to stop such immense suffering. Even their fellow student Daniel Ochieng fell ill, and they watched him waste away like all the others before him. Caroline and Rose cried over Ochieng, and awaited his inevitable death. But, miraculously, Ochieng began to gain weight and strength. After seeing the effects of the antiretrovirals on her friend, Kosgei rediscovered her hunger to be a physician. A post-internship year at a hospital in Nairobi, where there was limited and uncoordinated HIV testing and care, inspired her to return to Eldoret and work for AMPATH. Finally, she would get the chance to treat patients for the illness that had killed so many in her community. Rose Koskei joined AMPATH as well, and became medical officer in charge of the equally remote Port Victoria clinic. But even with miracle drugs on hand, providing medical care in the developing world can be an enormous challenge. Kosgei discovered that truth in Mt. Elgon, where a long-running land dispute between two clans, the agricultural Soy and the huntergatherer Ndorobo, has led to clashes that have cost hundreds of lives and displaced thousands of people. On a Friday morning in January 2007, Kosgei’s efforts to care for HIV patients became caught up in the violent feud. “When I arrived at the clinic that morning, at about 8 am, there were already eighty patients waiting,” she says. “Friday is market day for the village of Cheptais, and all kinds of tribes— Tesos, Elgon Masai, and Ugandans—go to market that day. About thirty minutes after I started seeing patients, I heard loud noises and ran out of the clinic to see what was going on. There were people running through the clinic yard, carrying pangas [machetes ] and screaming that people were being killed. “Soon, people began carrying dead bodies into the clinic. Some were beheaded and some of those heads had even been crushed after they had been severed. The conflict was moving 108 walking together, walking far 108 walking together, walking far toward the clinic, so police came into the building and told us that we all had to pack up and go. “I started packing up my things, but then I noticed something . All of my patients were still sitting there—they hadn’t left even with all that was going...