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

Slide2: 

KENYA

Slide3: 

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

Slide4: 

Jomo Kenyatta International Conference Centre, Nairobi

Slide5: 

…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?

Slide8: 

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

Slide9: 

Nairobi HQ of Christian Health Association of Kenya--CHAK

Slide10: 

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

Slide13: 

Diversity…

Slide14: 

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

Slide15: 

…where this couple relaxes at lunch time.

Slide16: 

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

Slide20: 

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

Slide21: 

Kenya Ministry of Health: Afya House, Nairobi

Slide22: 

Kenya’s President and citizens in AIDS awareness

Slide23: 

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

Slide24: 

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

Slide25: 

An academic interloper

Slide26: 

Village son graduates from Moi University

Slide27: 

Farming at 8200 feet – above Kenya’s Rift Valley

Slide28: 

Moi Teaching & Referral Hospital and Faculty of Health Sciences

Slide29: 

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

Slide30: 

Moi U. Teaching & Referral Hospital, Eldoret, Kenya

Slide31: 

The “Indiana House” compound in Eldoret, Kenya

Slide33: 

The Pentagon Pub, D. Rumsfeld, proprietor

Slide35: 

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

Slide36: 

Bruce DahlmanMD of Infamed; Dean Barasa Otsyula of MUFHS

Slide37: 

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

Slide39: 

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

Slide40: 

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

Slide41: 

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

Slide42: 

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

Slide44: 

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

Slide45: 

Can EBM work in all nations…?

Slide46: 

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

Slide47: 

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

Slide48: 

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

Slide49: 

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

Slide50: 

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

Slide52: 

Surgical contraception

Slide54: 

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

Slide57: 

The Mosoriot Ministry of Health Rural Health Teaching Centre

Slide59: 

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

Slide60: 

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

Slide62: 

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

Slide63: 

Chogoria’s community health outreach program HQ

Slide64: 

MCH messages at Chogoria’s women’s clinic

Slide65: 

C D C East at Chogoria

Slide66: 

William Ringera, MBBS in teaching session with Clinical Officers

Slide67: 

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

Slide68: 

Rift Valley Academy (RVA) at Kijabe, Kenya

Slide69: 

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

Slide70: 

…serving the Masai

Slide71: 

…who, like most Nilotic Kenyans, are pastoralists.

Slide72: 

Masai cattle between Kijabe and Tenwek hospitals

Slide73: 

A place to stay as you travel to Tenwek Hospital

Slide74: 

…not that far from Tenwek

Slide76: 

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

Slide77: 

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

Slide78: 

Tenwek Hospital surgeons

Slide80: 

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

Slide81: 

Anasarca and murmurs

Slide82: 

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

Slide83: 

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

Slide84: 

Burkitt’s Lymphoma

Slide87: 

Tenwek Hospital School of Nursing

Slide89: 

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

Slide90: 

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

Slide91: 

…and Webuye District Hospital, Kenya Ministry of Health

Slide92: 

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

Slide93: 

Western Province, between Eldoret and Uganda

Slide101: 

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

Slide110: 

Kenya’s TB diagnostic flow-chart

Slide111: 

Sr. Ruth and a cured TB patient, Webuye Hospital

Slide112: 

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

Slide113: 

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

Slide115: 

The view box…

Slide116: 

TB? Not TB? HIV positive? HIV negative?

Slide117: 

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

Slide118: 

TB/AIDS at all ages…

Slide119: 

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

Slide121: 

Still, there are celebrations…

Slide122: 

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

Slide123: 

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

Slide124: 

Jack Bryant, MD, former Columbia SoPH Dean

Slide125: 

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

Slide126: 

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

Slide130: 

Did the elder (mzee) learn anything…?

Slide132: 

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

Slide133: 

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

Slide134: 

Progress is slow, but steady…

Slide136: 

Safari near the Masai Mara

Slide140: 

Flamingos at Lake Nakuru

Slide141: 

African sunset on the Masai Mara