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

9. Moving Upstream

Moving Upstream 123 9 Moving Upstream It is an early summer Saturday morning in 2007, and the rainy season has arrived in western Kenya. The people who begin filing into the expandable conference room of the AMPATH Centre have hopped the puddles in Eldoret and forded the sudden roadside streams on the way in from the villages. Sixty-five people, a dozen Americans sprinkled among the Kenyans, track brick-red mud across the white linoleum floor. Dr. Sylvester Kimaiyo stands at the front of the room, looks out over the leadership of the AMPATH team, and smiles. “Today marks a great milestone for AMPATH,” he announces. Kimaiyo turns on a PowerPoint program, and reviews the accomplishments of AMPATH to date. One of the first slides shows the number of patients enrolled, featuring a graph with a sharply upturned arrow. Since Patient #1, Daniel Ochieng, began receiving antiretroviral medication in the fall of 2000, AMPATH has grown to the point where the program recently enrolled its 50,000th HIV-positive patient. Eighteen urban and rural clinical sites have been opened across western Kenya, where nearly two thousand new patients are added each month. Those patients are recovering at a remarkable and demonstrable rate; studies show AMPATH patients consistently gaining weight and increasing their CD4 cell counts well into the third year of follow-up. 124 walking together, walking far 124 walking together, walking far By this time, Kimaiyo has fully assumed the reins of Kenyan leadership of AMPATH. When Joe Mamlin made presentations in the United States about AMPATH, he would show a PowerPoint photo of Kimaiyo, the manager of the program, immaculate in a green suit and tie, pushing an AMPATH vehicle that had been stalled in the mud of a rural road. Sometimes Mamlin would also tell a story he says epitomizes Kimaiyo’s leadership style. Kimaiyo heard a rumor that a respected leader in one of the rural communities AMPATH serves was criticizing the program, leading some of the people in the area to decline AMPATH services. Kimaiyo could not confirm the rumor, so instead of confronting this person, he visited her and implored her to help in AMPATH outreach. Happy to have her importance in the community affirmed , the woman ended up traveling the countryside promoting HIV testing. “I’m so impressed by his problem solving, his patience , and his reluctance to condemn,” Mamlin says of Kimaiyo. “You add that to how bright he is and how hard he works, it is a dynamite combination.” Kimaiyo finishes his presentation and yields the floor to Mamlin , who points out that only a few years ago it was widely believed that African HIV patients would not be able to comply with strict antiretroviral therapy. He then announces that less than 4 percent of AMPATH patients have had their initial prescription fail and that many of those failures were attributable to factors unrelated to patient compliance. This, Mamlin points out, is a tribute not only to the conscientious AMPATH patients but also to the clinical officers and outreach workers who fill this room. Mamlinticksofftheprogram’schiefaccomplishments:50,000plus HIV patients, 30,000 people fed each week, nearly 170,000 people tested for HIV each year. Indiana–Moi’s electronic medical records system, the first of its kind in sub-Saharan Africa, is thriving . Where AMPATH once offered HIV/AIDS screening and felt lucky if four or five people showed up, the community mobilization team now holds rallies and running races and tests nearly a thousand people in a day. Thousands of orphans are cared for, rape victims are sheltered, and abandoned babies are taken in. The meeting room itself reflects success: This Saturday’s gathering is being held in the AMPATH Centre of Excellence for HIV Moving Upstream 125 Care, Kenya’s first facility dedicated solely to HIV care, training, and research. This morning’s crowd is dominated by Kenyans, as scholarships for Kenyan medical students and financial security for faculty members are stemming the dreaded medical “brain drain” from this corner of Africa. The group also includes medical school professors from Indiana and Brown universities. The University of Utah has sent physician-professors and students to Eldoret for years, and the University of Toronto and Duke University are adding ob-gyn specialties to the ASANTE (America/ sub-Saharan Network for Training and Education in Medicine) Consortium, which includes Lehigh Valley Hospital and Health Network and Providence Portland Medical...