AMPATH Week   Leave a comment

May 4-10, 2009

AMPATH (Academic Model Providing Access to Healthcare) is a division of the IU Kenya Partnership dedicated to battling the HIV epidemic.  It is arguably the most successful and impactful aspect of the partnership and certainly receives the most international recognition.  AMPATH functions to both treat existing cases of HIV/AIDS as well as to prevent it’s spread both between adults and from mother to child.  The program has bases in over 19 regions of western Kenya.  These sites provide HIV testing, clinical evaluation, anti-retrovirial drugs, food, and psychological counseling.  The numbers of patients treated in the AMPATH centers is constantly growing and will soon pass the 100,000 mark.  Each site is staffed by clinicians, medical officers, pharmacists, and various support staff.  Program directors, including Dr. Mamlin, travel daily to these sites to see patients and ensure quality control.  AMPATH also maintains a series of farms to provide food security for the ever growing population of patients.  Students who work in the IU/Kenya partnership are given a week to experience the AMPATH program in the community first hand.  My experience occurred the week of May 4, 2009.

AMPATH Farms – Eldoret

Two days working on the AMPATH Farm in Eldoret gave us a significant change from our normal routine in Moi Hospital.  There are several farms throughout Kenya that all produce food solely for the patients of the AMPATH program.  Justina and I were assigned to the farm in Eldoret located directly behind the new Mother Baby Hospital at Moi Hospital.  The farm is a beautifully maintained piece of land that is worked entirely by hand by a dedicated staff, many whom are patients of the program.  Row upon row of carrots, onions, sukuma wiki, managu, and cabbage stretch for several hundred meters.  Each plot is manned by a team of two workers which creates a friendly air of competition.  There are no power tools so all of the work is done by hand.  Justina and I helped with weeding, planting, tilling, harvesting and plot maintenance.  Lunch was a cup of sour uji warmed in a pot in the fire.  The farm currently produces 1,800 kg of vegetables a day and their goal is to soon reach 2,000 kg per day.  The harvested crops are loaded on large trucks for distant distribution and on bicycles for local dispersal.  The vegetables are supplemented at the AMPATH clinics by bags of grains and rice from America provided by USAID.  We came to learn later that this food in no way can support all 100,000 patients but is instead dedicated to those patients who are just starting their drug therapy or who are deteriorating medically.  Working in the sun warmed fields with the AMPATH staff was a welcome change of pace and a highlight of my time in Kenya.

            

AMPATH Clinics

I had the opportunity to travel to several AMPATH clinics in the towns of Amukura, Chulaimbo, and Mosoriot.  Many of these sites are accessible only by traveling on some of the worst roads in Kenya.  We often would drive for over 4 hours round trip to work at the clinic for less than 2.  We were exhausted doing this for one week.  The AMPATH program directors sign on for 2 year contracts.  The clinics consist of cinder block buildings with corrugated steel roofs and wooden benches in the waiting areas.  Buildings range from food storage to pharmacy and clinical buildings.  We arrived at each clinic to find close to 100 patients waiting in long lines in the shade to be seen.  Many have traveled for long distances on the same terrible roads we arrived on.  Some patients come to refill their medications which are given in 1 to 2 month supplies both due to availability and also as a means of ensuring compliance.  Many HIV+ pregnant mothers come to the clinics in an attempt to prevent transmission of the virus to their unborn infants.  With proper drug therapy, most will be successful.  In stark contrast to the west, infected mothers in Kenya are encouraged to exclusively breast feed their infants for 6 months.  The risk of dying from malnutrition exceeds that of contracting HIV from the virus laden breast milk.  Adults and children alike come to the clinic to learn the results of their HIV testing.  The patients are often stoic in their reaction, but the results clearly impact them deeply.

The AMPATH clinics have experienced such a high volume of patients that they have the diagnosis and treatment of HIV down to a science.  The vast majority of the patients we see in the clinics have no visible signs of being ill.  Herein lies a bit of a paradox that exists in the success of the clinics.  They are not curing anyone of their disease.  Every person that is treated by the AMPATH centers becomes another carrier of the virus and can live a relatively normal life.  There are a number of reasons why the HIV/AIDS epidemic has hit Kenya particularly hard.  First of all, researchers believe the disease began infecting humans roughly in this part of the world.  The virus has been spreading here longer than anywhere else and the treatment has reached Africa relatively late.  Culture also has a major impact on the dissemination of the virus.  Kenyans are very accepting of a loosely structured polygamy.  The tradition of wife inheritance, where a man is expected to take the wife of his deceased brother into his bed, also creates a problem.  Men traveling for work visit roadside prostitutes (90% of whom are infected) on a regular basis.  These cultural practices fuel an already raging fire that is devastating Africa.  A vaccine (which has been a painfully elusive holy grail of HIV research) or a viable cure are badly needed to stem the tide.

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