A4 Pust Ron Kenya comp

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Launching Family Medicine Education in Kenya: 

Launching Family Medicine Education in Kenya Ron Pust, MD Professor, Family and Community Medicine & Public Health University of Arizona Tucson, Arizona, USA Global Health Education Consortium Toronto April 2006

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KENYA

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Mzee Jomo Kenyatta statue in Nairobi: Kenya’s first President, and leader of the Mau Mau movement in 1950s

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Jomo Kenyatta International Conference Centre, Nairobi

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…is Kenya’s motto: “Let’s all pull together”

Kenya: Independent since 1963 : 

Kenya: Independent since 1963 Kenyatta and Mau Mau rebellion 1952-56 Makerere U. medical school in Uganda Internship in Kenya: “M-P-O-S” 4 x 3 mo. U. Nairobi and Moi U. have medical schools now 4600 doctors for 31 million Kenyans 1:7000 Family (USA)& General (UK) Practice specialties founded in the 1970s—after Kenya independent Family Practice in Africa: Where? When? Why?

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KENYA’S THREE PRESIDENTS Mwai Kibaki 2003- (NARC) Daniel arap Moi 1978-2002 (KANU) Jomo “Mzee” Kenyatta 1963-78 (KANU)

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Nairobi HQ of Christian Health Association of Kenya--CHAK

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Nairobi (pop. 4 million) skyline, overlooking Uhuru Park

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Diversity…

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Site of Al-Queda 1998 bombing of US Embassy, now a park in downtown Nairobi…

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…where this couple relaxes at lunch time.

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Nearly all of the 200-plus who died were Kenyans…

Family Practice at the interface…: 

Family Practice at the interface… Government of Kenya Ministry of Health Moi University Faculty of Health Sciences and Asante Consortium: Indiana, Brown, Utah et al Churches of Kenya and other NGOs

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Providing doctors for the 72 District Hospitals in Kenya is a major goal of the Moi U. Family Health Division and its Master of Medicine 3 year residency program

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Kenya Ministry of Health: Afya House, Nairobi

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Kenya’s President and citizens in AIDS awareness

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The Ministries of Health in eastern Africa rely strongly on their cadre of Clinical Officers, trained at their larger provincial hospitals.

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Moi University in Eldoret: Graduation and installation of Vice-Chancellor, 2003

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An academic interloper

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Village son graduates from Moi University

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Farming at 8200 feet – above Kenya’s Rift Valley

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Moi Teaching & Referral Hospital and Faculty of Health Sciences

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Moi medical school class; small group problem- based learning also is emphasized.

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Moi U. Teaching & Referral Hospital, Eldoret, Kenya

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The “Indiana House” compound in Eldoret, Kenya

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The Pentagon Pub, D. Rumsfeld, proprietor

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The “door to the division” : Family Health at Moi University Eldoret, Kenya 2005

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Bruce DahlmanMD of Infamed; Dean Barasa Otsyula of MUFHS

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Faculty, staff and first 3 registrars, Moi U. Family Health M. Med,2005

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Dean B. Khwa-Otsyula with FamilyHealth Grad Studies Comm, Nov04

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Bruce Dahlman MD of Kijabe Hospital “sealing the deal” with Moi U.

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FH Grad S Comm meeting with 8 registrars, November 2004, in Eldoret

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Visit of WONCA/GHETS team to Drs. Ayuo, Nshaho, Otsyula, Mining

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Drs. J. Thigiti, P. Chege, P. Mwaka and P. Manschot (Netherlands)

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Can EBM work in all nations…?

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CD-ROM is best “intermediate technology” for Kenya curriculum

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First A.L.S.O. Course in Africa

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WHO – oriented obstetrical resources in M.Med (FH)

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Footling breech, Apgar 3 at 1 minute … feeling fine at 1 hour at Lugulu Friends’ Hospital

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Post C-section… …the question of HIV and ART (anti- retroviral therapy) is always in the back- ground

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Surgical contraception

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An AMPATH course on HIV/AIDS in Eldoret, September, 2003

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The Mosoriot Ministry of Health Rural Health Teaching Centre

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Mosoriot HART farm, visited by Joe Mamlin, MD of Indiana/AMPATH

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Family Medicine training hospitals in Kenya, 2005 Chogoria, Kijabe, Tenwek, Webuye/Lugulu

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In contrast to TB, Leprosy is declining markedly in Africa. A patient with old complications at Chogoria PCEA Hospital.

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Chogoria’s community health outreach program HQ

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MCH messages at Chogoria’s women’s clinic

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C D C East at Chogoria

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William Ringera, MBBS in teaching session with Clinical Officers

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Kijabe Hospital (Africa Inland Church), 30 miles NW of Nairobi

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Rift Valley Academy (RVA) at Kijabe, Kenya

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One of the oldest “mission dispensaries in Kenya, c. 1897

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…serving the Masai

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…who, like most Nilotic Kenyans, are pastoralists.

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Masai cattle between Kijabe and Tenwek hospitals

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A place to stay as you travel to Tenwek Hospital

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…not that far from Tenwek

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Typical house of the Kipsigis, a Kalenjin sub-group near Tenwek

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The better road to Tenwek Hospital, located on the hill at 6000 ft.

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Tenwek Hospital surgeons

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Three causes of childhood oedema: Tenwek Hospital children’s ward

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Anasarca and murmurs

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Chest film of previous patient, with Class IV CHF due to rheumatic heart disease

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Oedema and “peeling paint” skin in underweight child with marasmic kwashiorkor Tenwek Hospital, Oct 2003

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Burkitt’s Lymphoma

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Tenwek Hospital School of Nursing

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Tenwek Community Health Programme: Sand filters for water, made by household members.

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KEPI Immunizing against 9 childhood diseases from 0-9 months old

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…and Webuye District Hospital, Kenya Ministry of Health

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Webuye, site of PanPaper mill, East Africa’s largest

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Western Province, between Eldoret and Uganda

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Dr. D. Lugaria, surgeon/director of Lugulu Hospital

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Kenya’s TB diagnostic flow-chart

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Sr. Ruth and a cured TB patient, Webuye Hospital

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Kenya/WHO TB treatment card carried by patient (front side)

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“Chest clinic” – devoted to the TB/HIV epidemic

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The view box…

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TB? Not TB? HIV positive? HIV negative?

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Luyia man,34: HIV&TB, pneumothorax, lung abscess

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TB/AIDS at all ages…

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Is this lingular infiltrate pneumonia? …or TB in a patient with a low CD4 cell count? How to determine??

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Still, there are celebrations…

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Dr. Dan Keseje, director of TICH in Kisumu, Kenya

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Luo homestead near Saiya, paternal hometown of US Senator Barack Obama (D-Illinois)

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Jack Bryant, MD, former Columbia SoPH Dean

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Hellen Owala, ITDG researcher in Kisumu on household smoke abatement, the leading cause of chronic lung disease in many nations.

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Research thesis is a requirement in the Master of Medicine ( M.Med) “residencies” at Moi University

More info on Family Med education in Kenya: 

More info on Family Med education in Kenya Infamed: www.chak.or.ke/infamed.asp or bdahlman@kijabe.net Moi U Dept of Family Health: mufhsfh@mtrh.org Ron Pust MD: rpust@u.arizona.edu Family Medicine (STFM journal): in press

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Did the elder (mzee) learn anything…?

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The last lesson: Don’t open your big mouth too wide

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Look around you… not just straight ahead. You might learn something…

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Progress is slow, but steady…

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Safari near the Masai Mara

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Flamingos at Lake Nakuru

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African sunset on the Masai Mara