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

7. The Power of the Academic Health Center

The Power of the Academic Health Center 97 7 The Power of the Academic Health Center Even foreign aid critics concede that health initiatives in developing countries are worthy efforts, and aid supporters admit that far too many well-intentioned programs have failed miserably. The next question is what type of global health program can succeed. The “What Works” group of the Center for Global Development identified elements shared by successful large-scale global health programs; these included predictable and adequate funding, good management, and effective partnerships. PEPFAR’s Buck Buckingham says that Indiana–Moi had strong management and partnership in place by 2004, allowing AMPATH to seize on the suddenly plentiful PEPFAR funding. “There are two approaches to take when dealing with a global health crisis like AIDS,” Buckingham says. “Too often, organizations will take the first approach, which is to set up an absolutely perfect teeny tiny timid project. What sets AMPATH apart is that it immediately took the second approach, which is to recognize that people are dying, and we got to get the treatment to them ASAP. That kind of ‘just do it’ attitude takes dynamic leadership, which AMPATH clearly has with Joe Mamlin. 98 walking together, walking far 98 walking together, walking far “What also makes AMPATH unique is that it is a true partnership . It avoids the donor-recipient dynamic, because each partner has real value to contribute to the work being done. I’ve seen other university partnerships struggle to get beyond research, and too often the American partner to an African institution wants everything to happen in a twenty-four- to thirty-six-month grant timeline. Things just don’t happen that way, especially in the developing world. So part of the challenge is to encourage longterm thinking.” Dr. Jean Lebel of the Ontario-based International Development Research Centre, an expert on health and research partnerships between the global north and the global south, agrees that the challenge of relationships like Indiana and Moi’s lies in adapting expectations about what health programs can achieve. “We northerners tend to go to the south and try to simply replicate what we have done in our home settings,” Lebel says. “But the infrastructure may be limited in the global south, and the programs that match what we are doing in the north may not exist at all. “The secret to success lies in the ability of the two partners to learn from each other, and maintain an equilibrium so that one partner is not dominating the scheme, which has a lot to do with respect and trust. If that can be achieved, both partners have the ability to go beyond their usual boundaries.” Sylvester Kimaiyo acknowledges that it has not always been easy for Indiana and Moi to maintain a balance in their relationship . “There are clearly cultural differences,” Kimaiyo says. “The people from IU [Indiana University] are a little faster and more aggressive in things like publishing papers, which can lead to them overrunning our Kenyan colleagues. So we responded by requiring that Americans publishing papers out of AMPATH try to include Kenyan counterparts in all of their work. Also, in the AMPATH management structure, from the very top to areas like community mobilization or economic self-sufficiency, we have set it up so that every leadership role is filled with a Kenyan and U.S. counterpart.” With personnel and expertise flowing into Kenya from Indiana University, the Kenyan medical community is the most obvious beneficiary of the partnership. But program participants The Power of the Academic Health Center 99 from both countries are quick to point out that Indiana enjoys significant benefits as well. Hundreds of Indiana medical students and doctors in the Indiana University–Wishard Memorial Hospital network have spent time in Kenya, and they often return from the experience with valuable exposure to the treatment of infectious diseases and more sensitive to the impact of lifestyle and poverty on the health of their patients. Dr. Ben Wince, an Indiana University School of Medicine graduate, says his Kenya experience made him a better doctor. “Dr. Einterz swears that Kenya is the best place to learn medicine, and I know what he means now,” Wince says. “I had a college background in biomedical engineering, and I used to think technology was everything. But the experience in Kenya, where literally all you have is patient history and an examination, forced me...