Indiana University formed a partnership with a new medical school in Kenya nearly 35 years ago and created a model of global health collaboration that was visionary in its emphasis on equitable partnerships and long-term sustainability.
The results of the Academic Model Providing Access to Healthcare, or AMPATH, partnership that “leads with care” include the creation of one of Africa’s first, largest and most comprehensive HIV care and control programs supported by the United States Agency for International Development; sub-Saharan Africa’s first transitional home for people with mental health challenges; and Kenya’s first medical fellowships in pediatric oncology and maternal-fetal medicine.
“When the IU School of Medicine formed a partnership with Moi University School of Medicine in Kenya in 1989, the trajectory of both institutions changed for the better,” IU School of Medicine Dean Jay L. Hess said. “The AMPATH partnership has provided care for more than 250,000 people living with HIV and has hosted thousands of trainees and conducted research that has changed lives, not just in Kenya and Indiana, but around the world.”
AMPATH now includes a global network of 15 academic health centers led by IU working in partnership with Moi University and Moi Teaching and Referral Hospital in western Kenya. The success of the innovative global health model in Kenya has led to recent partnerships with additional academic health centers in Ghana, Nepal and Mexico.
“Together we have improved access to quality health services for people in western Kenya, and in doing so have saved many, many lives,” said Dr. Adrian Gardner, director of the IU Center for Global Health Equity and executive director of the AMPATH Consortium. “Together we have taught, mentored and inspired the next generation of healers from multiple continents. And together we have produced impactful research that informs Kenyan and global health policy.
“But this partnership has allowed us to do so much more. We have laughed, celebrated and dreamed together; learned from each other; struggled together; and, at times, bickered with each other, cried together, mourned together and supported each other through good and challenging times.”
A foundation of educational exchange
The four IU physicians who initiated the partnership in Kenya were looking in 1988 for an academic partner in a low- or middle-income country that would provide IU School of Medicine students with the same life-changing and career-inspiring experience they each had earlier in their careers. They insisted that the partnership provide bidirectional opportunities for Kenyan medical students and residents to train at IU, and that each IU faculty member living in Kenya work in partnership with a Kenyan colleague to provide care and build a health care system that was responsive to the community’s needs.
The vision that doctors Joe Mamlin, Robert Einterz, Charles Kelley and Dave Van Reken shared with leadership at Moi University was pioneering for the time and has become a premier model for equitable global health partnerships. More than 1,200 IU learners have had health care experiences in Kenya, and more than 425 Moi University students and residents have trained at IU and other AMPATH Consortium schools. Students and faculty members from IU schools of nursing, public health, liberal arts, law, dentistry and others have participated in various aspects of the partnership throughout the years. These medical exchanges are possible because of donor generosity.
“The IU Center for Global Health Equity prepares learners for their experience, ensures a safe and comfortable living and working environment in Kenya and Indiana, and provides mentorship and support during and after their trip,” said Dr. Debra Litzelman, director of education for the center.
Research on AMPATH’s global health experience shows that the partnership provides medical students and health professional trainees with “a highly impactful, transformative learning experience that fosters the development of global mindedness and community involvements, whether local or global, long after the experience.”
“AMPATH’s 360-degree care model has become a critical aspect of my education,” said Dr. Victoria Sanchez, who received the Brater Scholarship as an IU School of Medicine student and is now a surgery resident at Stanford University. “A goal of mine was to learn about how a global partnership should be structured to optimize ethical operations. I think IU School of Medicine models an excellent bidirectional and sustainable partnership with Moi University through AMPATH.”
Faculty committed to sustainable care system
Several IU School of Medicine departments support full-time faculty in Kenya who teach and mentor Kenyan and IU trainees and provide clinical care at Moi Teaching and Referral Hospital and several local facilities throughout western Kenya.
“It’s simple: We ‘lead with care,’” said professor Sylvester Kimaiyo, chief of party for USAID AMPATH Uzima and AMPATH executive director of care. “Notably this is what sets us apart from other health institutions doing similar work, because it is the needs of the patient that draw us closer. We respond to their needs by setting up sustainable interventions to combat realistic challenges they face every day.”
AMPATH’s partners provide care for a population of more than 24 million people in western Kenya including oncology, child health, adolescent care, women’s health, surgery, anesthesia, antimicrobial resistance, non-communicable diseases including cardiovascular disease and mental illness, and economic empowerment and agriculture.
“With support from the faculty at the IU Simon Comprehensive Cancer Center, the AMPATH oncology program is a leading comprehensive cancer care program in Africa seeing over 1,500 cancer patients per month and providing radiotherapy for over 60 patients per day,” said Distinguished Professor Dr. Pat Loehrer, director of the cancer center’s Center for Global Oncology and Health Equity.
Dr. Brenda Chepkoech was one of six Kenyan registrars, which are equivalent to residents, who traveled to Indianapolis in 2023 as part of the two-way exchange, working at Riley Hospital for Children at IU Health. She hopes to be part of the team setting up a pediatric intensive care unit in Eldoret, Kenya, in the near future.
“I want to be a part of the bridge that connects where we are back home with where Riley is,” she said. “The gap is so big, literally ages apart! I want to contribute to providing options for the children back home who would have survived had they been cared for at Riley.”
In addition to the pediatric intensive care unit, a pediatric cancer center, burn hospital and neurodevelopmental clinic are all under development with support from IU faculty and the AMPATH partnership. Individual donors, corporate and foundation supporters, and grants from the U.S. President’s Emergency Plan for AIDS Relief through USAID, the National Institutes of Health and other agencies have contributed more than $900 million to AMPATH care, training and research efforts over the past three decades.
Research that informs policy
Since the first research collaboration in 1992, AMPATH has invested heavily in infrastructure and training to conduct research to strengthen care systems, quickly respond to health challenges and push for new breakthroughs in health, policy and justice worldwide.
“AMPATH is known for leading with care, but research has informed a lot of the work we do in care, so it’s a very complementary relationship,” said professor Winstone Nyandiko, AMPATH co-director of research and a pediatrician at Moi Teaching and Referral Hospital.
The AMPATH research program includes more than 20 collaborating institutions and has received $247 million in total research funding since 1998.
“The resulting 1,400 publications in peer-reviewed journals stay true to AMPATH’s ideals by including investigators from Kenya, North America and Europe,” said Dr. Kara Wools-Kaloustian, AMPATH co-director of research, director of research for the IU Center for Global Health Equity and recipient of IU’s John W. Ryan Award for Distinguished Contributions to International Programs and Studies.
Improving Hoosier health
Reciprocal innovation describes the process of high- and low- and middle-income countries working together to continuously innovate solutions to shared health challenges. In Indiana, programs to improve infant and maternal mortality, identify counterfeit medication and improve care for immigrant and refugee communities rely on lessons learned from IU’s longstanding partnership in Kenya.
“Our global health community in Indiana has a deep knowledge base and has worked with talented colleagues around the world to improve health outcomes in communities with incredible challenges,” said Dr. Laura Ruhl, director of reciprocal innovation for the IU Center for Global Health Equity. “When these global health experts join in partnership with people from communities in Indiana facing some of the same challenges, we have the collective power to make real progress toward improved health outcomes.”
