If ever there were a “tour du force” word for Kenya, it has got to be the acronym AMPATH, which stands for “Academic Model Providing Access To Healthcare”. When it became apparent to all the world that HIV/AIDS was decimating Africa, various non-profit agencies established a presence on the continent in an effort to staunch this mortal wound. By far, the best known in Kenya is AMPATH, a partnership between Moi University, MTRH (Moi Teaching and Referral Hospital) and a consortium of American medical schools, led by the University of Indiana. It’s goal was to provide a vision for living with AIDS rather than dying from it – and they are persevering and succeeding. About 80% of all Kenyan adults who are infected do not know it, and 75% of those in partnerships do not know their partner’s status. Among married/cohabitating adults, 55% have a partner who is currently infected. And with a 40% unemployment rate, few people have money for basic needs. Read that again, these are shocking statistics.
Tucked in on the main hospital campus is a modern and architecturally-pleasing 3 story structure known as the Riley Mother-Baby Hospital. It was built with funding provided by James Lemons, a Univ. of Indiana neonatologist, who had visited Eldoret in 1994. At that time, newborns slept in small wire baskets and the neo-natal unit was heated by a charcoal fire. He named it in memory of the Indiana children’s poet James Whitcomb Riley. A short time later, Dr. Charles Test and his wife from Indiana established the Sally Test Pediatric Center for sick and HIV infected children, and orphans abandoned by their mothers. Thanks to its great success, it has also expanded its services to include parenting classes, outreach programs to rural health centers, library services and sewing lessons to provide money-earning skills to HIV patients (Imani workshops).
HIV/AIDS spread insidiously thru Africa due to the well-traveled “truck routes” (see attached map routes) as goods were distributed thru the large continent. Foreign imports arrived regularly by ship to major port cities and were then trucked to inner countries. In Kenya, goods arrived at Mombasa on the east coast and were loaded onto hundreds of semi’s that hogged the broken-down roads with their heavy loads, spewing stinky diesel as they headed inward thru Nairobi and Eldoret and on to Ethiopia, Sudan and Zaire and Nigeria. They return to the coast empty, refill with goods, then head out again. Since these trucks are not allowed to drive at night, they pull off the road at well-known spots and accept food etc. from prostitutes.
An intense educational program has helped change this behavior but more is needed.
What AMPATH has done for sub-Saharan Africa is to create a system for identifying and tracking infected individuals so they can receive treatment, education and follow-up care. They currently have over 150,000 registered patients and enroll approx. 2,000 new patients monthly in their 60 –plus satellite clinics throughout western Kenya. Anti-retroviral Therapy (ART) is available and free for Kenyans but unfortunately it functions poorly in the face of poor nutrition, and compromised immune system, common to so many.To counteract this dilemma, MTRH has dedicated 50 acres of farmland adjacent to the hospital for growing crops, which are distributed to malnourished patients. Besides staffing its large clinic site on campus, AMPATH also offers business consulting, agricultural training and handicraft groups (Imani Workshops) for those who have been shunned and in need of a livelihood. Social workers are included in the staff to help preserve family life in such adversity.
There is no vaccine yet for HIV/AIDS but infants born of infected mothers are frequently being “cured”. Mothers are encouraged to limit breastfeeding (due to transmission) and newborns who are treated immediately at birth have a 76% lower death rate than those who had treatment at a later date. If regular blood tests indicate the virus has been arrested, children by the age of 5 are considered to be clear and no further testing is needed. The Sally Test Pediatric Center, nestled in the central campus of MTRH, cares for babies and youth who have been dealing with AIDS or other cancers. There also is an on-site orphanage to facilitate placement for those who have been abandoned or lost their parents due to AIDS.
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Follow-up is extensive and relentless. I asked to spend a day with AMPATH in their “Outreach” program and was paired with a lovely young Kenyan woman named Emily. We left early in the morning, using one of the 20 service vans MTRH has available. Emily had a list of 12 patients who had either not kept a follow-up apptointment, moved or just “self-detached” from the clinic. Contact is always first attempted by cell phones, which are very cheap and can be readily loaded with a few minutes air-time for just a couple schillings. In the poverty areas where AMPATH visits there are no street names, just loosely defined landmarks of where these shacks and hovels were last located (ie, “next to the store with a Coca-cola sign” or “a short ways after a maize field”). Our driver, Thuo, stops at a distance so as not to “hinder” our search by revealing the AMPATH logo on our van and causing embarrassment to those we seek. Emily says we are east of Eldoret in a small township called Ndata and we now head out on foot. She stops and asks a man we meet if he knows where we can find a family named -----.
He points back the way we came, but says in Swahili that we should turn right then continue to the clearing. We return to the van and drive back the way we came. Then again we are on foot, we ask directions from a fellow on a bicycle, and now it seems more clear. Emily points out the miniscule shack in the field ahead of us and I see a toddler sitting in the dirt and a couple of chickens pecking by the dirty sheet that serves as a front door. We slowly approach. (Does somebody actually LIVE in this?? I think to myself. Isn’t this just a dung-walled toolshed?) A thin young woman and her husband emerge and we all shake hands. They invite us in. (In to where??) The “house” isn’t any bigger than 8’x10’, with a dirt floor, 3 dilapidated car seats for sitting and no electricity or windows. She holds the sheet open so our eyes have a moment to adjust to the darkness and the chickens scoot right in and peck around our legs, jumping on the seats. I laugh and bravely sit down, remembering that I still have several pairs of clean scrubs at the Club. As my eyes adapt, I am startled to see a wide-eyed baby next to me on the torn naugahyde car banquette. I assume this little one had never seen a white person before because he immediately started to wail. This “dirt cave” is divided by another dirty sheet that separates a tiny sleeping area, so the 6 of us (mom, dad, 2 babies, Emily, plus me and the chickens, yes it was their "coop", too) are actually sitting in an area no larger than 6’x8’. The woman reaches behind the curtain and shows Emily her AMPATH treatment book, confirming that yes, she was at her appt. last month. Emily apologizes for the clerk’s error to note it in her hospital file. Both husband and wife are HIV positive and Emily encourages them to bring the babies in for testing. Do they have food? No, not much food, that’s evident...and if they did, I wonder, how would they clean it? Where would they cook it?The land surrounding the shack is not part of the rental, it belongs to a farmer who raises these crops for his own livelihood so they must not pick the maize or vegetables. Emily makes a note to increase their allotment of fresh produce at their next visit. They comment that they have no money for transportation and the hospital is at least 10 miles away, but they will do their best. I ask if I can take their picture, they smile and agree. I think they had never had their picture taken before. We say goodbye and walk back to the van.
Next on the list, says Emily, is a woman we need to find who last lived in Kabongo. !Kabongo! I exclaim, that’s where my Patrician School is! Emily had seen the sign by the road on a previous site visit but knows nothing more, so I tell her about Brother Paul. The ride goes quickly. Again Thuo parks and we walk and walk, hoping to meet a passer-by who can help us find our next patient. We finally cross paths with a young barefoot girl in a torn and filthy brown dress. She doesn’t know the woman we are looking for but points to someone in the distance who is washing clothes in a big basin, perhaps she knows. Emily tells me to wait and she will try to get more information. I stand beside this forlorn little snippet of a girl and ask her her name. In a very tiny voice she replies “Veronicah”. I ask her age – she says 10, and then I ask the big question on my mind – “Why aren’t you in school today?” Her bare toes fidget in the dirt and she shrugs her shoulders. Are you going to school tomorrow? I ask. She shakes her head. Were you in school yesterday? She shakes her head again. Are you sick? No, she mouths and keeps staring at the ground. How strange, I thought. I wait for Emily to come back and explain this to me. I brace myself and my stomach turns. I have a feeling that I’m about to hear a sad story.
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| Sally Test Mother and Baby Center |
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| The spread of AIDS along the trucking routes thru Africa. |
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| Imani worshops. All hand-crafted items are sold at fair market value. |
