Orientation Guidebook - AMPATH-Kenya

INDIANA UNIVERSITY
AND
MOI UNIVERSITY
SCHOOL OF MEDICINE
PARTNERSHIP
2011-2012 ORIENTATION
GUIDEBOOK

INDIANA UNIVERSITY
AND
MOI UNIVERSITY
SCHOOL OF MEDICINE PARTNERSHIP
2011-2012 ORIENTATION GUIDE BOOK

TABLE OF CONTENTS
SECTION I. THE PROGRAM AND PRACTICAL MATTERS
A. Karibu … Welcome
B. Contact Information ......................................................................................................................2
C. Practical Matters
1. Travel Planning Timetable ..................................................................................6
2. The Partnership Between IUSM and MUSM: A Model....................................8
3 Participants List 2011-12.....................................................................................16
4. Participants List 2010-11.....................................................................................18
5. Documents
Memo to Kenya Faculty and Resident Travelers.....................................22
Guidelines for International Electives and Experiences ........................24
Visa Requirements and Application ..........................................................28
The Medical Practitioner’s Permit Application.......................................32
Emergency Contact Information................................................................34
2011-2012 Student Liability Waiver ..........................................................36
iAbroad Online Forms ................................................................................38
Student Travel Insurance Application Form............................................40
Kenya Travel Warning................................................................................42
Overall Crime and Safety Situation.........................................................44
6. Policies
Vehicle Use Policy of Indiana University..................................................50
Drug/Device Adverse Event Reporting ......................................................52
Needle Stick & Body Fluid Exposure Recommendations.......................54
Housing & Board .........................................................................................56
Evacuation Insurance ..................................................................................57
Student Health Insurance EXCLUSIONS ...............................................58
Travel Policy................................................................................................64
Waiver of Liability Policy ...........................................................................65
Vacation Policy.............................................................................................66
Grading Policy..............................................................................................67
Tuberculosis Screening ..............................................................................68
Competencies ...............................................................................................70
Page
C. Curriculum, Goals, Objectives...................................................................................................74
D. Travel Preparation
1. Letter from IUCGH Director of Education, Deb Litzelman, MA, MD ..................78
2. Example of Typical Week for Students and Residents ...........................................82
3. Expectations of Students.............................................................................................84
4. Opportunities for Sally Test and Tumaini ..............................................................87
5. Global Health Case Files “How To” Guide..............................................................92
6. AMPATH Clinic Contact Information & Dates.......................................................94
7. Kenya Web Resources .................................................................................................96
8. Suggested Reading Material ......................................................................................98
9. Suggestions for Eldoret Travelers ...........................................................................102
10. Student Recommendations for Kenya Elective......................................................106
11. Kiswahili Translation Guide ...................................................................................112
12. MTRH Lat Test Costs................................................................................................117
13. Case Study in Kenya.................................................................................................118
14. Kenyan Abbreviations and Terminology ................................................................122
15. Common Adult Medical Conditions........................................................................126
16. Pediatric Morbidity and Mortality Data .................................................................128

SECTION II. INFORMATIVE READING MATERIAL
International Electives: Maximizing the Opportunity to Learn and Contribute
(Rajesh Gupta, MPG; Paul Farmer MD, PhD)...............................................130
9 Die in Kenya Highway Mishap .............................................................................134
Student Essay “Three Empty Beds” (Caitlin Dugdale) ........................................136
3

May 4, 2011
Karibu!
Welcome to a wonderful and challenging medical experience in Kenya! As a participant in the
Indiana University-Moi University School of Medicine Partnership or as a member of the
AMPATH Consortium, you are preparing to accept an assignment which we believe will enhance
your professional and personal growth.
Kenya is a wonderful nation; but, uncertainty is a fact of life there. If you are flexible and can
maintain a broad perspective, you will be better prepared for your journey. Our goal is to assist
you to become as well prepared as possible. Included in this packet you will find Guidelines for
International Electives and Experiences as well as orientation materials. Please read these
documents carefully. Their purpose is to help you understand the purpose of the program and to
help you make the most of your experience in Kenya.
Please complete, sign and return Guidelines (pg.24) and any other necessary documents to Ron
Pettigrew or Sally Ben-hameda, M200 OPW, Wishard Hospital, 1001 West 10 th Street,
Indianapolis, IN 46202 at least six weeks prior to your departure date.
The staff of the Indiana University—Moi University Partnership is willing and able to help you
with any questions or concerns you might have. Please note the contact information on page 2.
If at any time before, during, or after your activity in Kenya, you have any questions, comments,
or suggestions, please contact the program office. In the meantime, we wish you success as you
prepare to travel to Kenya.
Asante sana and safari salama!

CONTACT INFORMATION
May 1, 2011 - June 30, 2012
Name Address Phone**/Fax/E-Mail
Robert Einterz, M.D. Wishard Hospital P: 317/630-7075
Associate Dean, Global Health 1001 W. 10 th St. OPW-M200 F: 317/630-7066
Director, IU Center for Indianapolis, IN 46202 H: 317/769-6497
Global Health C: 317/840-3185
Director, IU-Moi Program Pg: 317/312-1655
E: reinterz@iupui.edu
Jill Helphinstine Wishard Hospital P: 317/554-4600
Co-Director, IU-Moi 1001 W. 10 th Street, OPW M200 C: 317/752-4282
4 th Year Elective Indianapolis, IN 46202 H: 317/ 635-8133
Director, Global Health Pg: 317/ 310-7786
Residency Track
E: jhelphin@iupui.edu
Ron Pettigrew Wishard Hospital P: 317/630-8695
Program Manager 1001 W. 10 th St. M200 F: 317/630-7066
Indianapolis, IN 46202 H: 317/848-9798
C: 317/727-3332
Pg: 317/312-1657
E: rpettigr@iupui.edu
Sally Ben-hameda Wishard Hospital P: 317/630-6770
Program Assistant 1001 W. 10 th St. M200 F: 317/630-7066
Indianapolis, IN 46202
E: sbenhame@iuupui.edu
Dunia Karama
IU House
Program Administrator IIGH Kenya C: 011-254 (0)721-724-633
PO Box 5760
E: iuadmin@iukenya.org
Eldoret, Kenya
Geren Stone IU House E: gsstone@iupui.edu
Team Leader & IIGH Kenya C: 011-254 (0)724-679-898
Medicine Field Director P.O. Box 5760
Eldoret, Kenya
Laura Ruhl IU House E: ljruhl@iupui.edu
Pediatric Field Director IIGH Kenya C: 011-254 (0)728-279-002
P.O. Box 5760
Eldoret, Kenya
Joe & Sarah Ellen Mamlin Eldoret Kenya C: 011-254-(0)722-374-558 (Joe)
Field Director, AMPATH
C: 011-254-(0)733-580-495 (Sarah Ellen)
E - Joe: joe@iuteam.org
E - Sarah Ellen: sarahellen@iuteam.org
John Sidle IU House C: 011-254-(0)734-893-871
Co-Field Director of Research IIGH Kenya E: jsidle@iupui.edu
P.O. Box 5760
Eldoret, Kenya
2

Naiomi Lundman IU House C: 011-254-(0)723-246-198
Assoc. Field Director IIGH Kenya E: nlund2@hotmail.com
Family Preservation Initiative P.O. Box 5760
Eldoret, Kenya
Elizabeth Chester IU House C: 011-254-(0)723-270-234
Assoc. Field Director IIGH Kenya E: ampathovc@yahoo.com
Orphans and Vulnerable Children P.O. Box 5760
Eldoret, Kenya
MTS Travel 717 N. Main Street P: 800/835-0106
ATTN: Diane Houseman Box 505 F: 316/283-2397
Newton, KS
E: dianeh@mtstravel.com
Kwa Kila Hali Safaris Eldoret and Nairobi P: 011-254-(0)20-248-653
Netta and/or Christine C: 011-254-(0)722-725347
E: kwakilahalisafaris@yahoo.com
E: kkhssafaris@yahoo.com
Endoroto Travel Eldoret E: endorototraveltd@gmail.com
Damarice Wathika
Joseph Chacha Eldoret P: 011-254-(0) 53-2060236
Taxi from Eldoret Airport C: 011-254 (0) 721-215-074
Manager of Eldoret Airport
Within one month of departure for Kenya, please write to Medicine and Pediatric Team Liaisons with your arrival and
departure dates. Include a one paragraph description of your current global health experience, future global health plans and
your career goals.
**A zero is required before the “area code” when calling in country. For example, if you need to reach Dunia Karama from Nairobi,
you would dial 0721-724-633. Omit the zero when calling from outside of Kenya.
www.iukenya.org
3

The Partnership Between Indiana University School of Medicine and Moi
University School of Medicine
Introduction
The partnership between Indiana University in the United States and Moi University in
Kenya represents a unique model. Since 1989, Indiana University School of Medicine
and Moi University School of Medicine (MUSM) in Eldoret, Kenya have collaborated to
promote collegial relationships between American and Kenyan medical doctors,
scientists, and students, and to develop leaders in health care in Kenya and the United
States. The mission of this new partnership was to develop leaders in health for the
United States and Africa, foster the values of the medical profession, and promote health
and well-being in both countries.
This medical school-medical school partnership is built on the premise that individual
and institutional good derives from the integrity of individual counterpart relationships.
The IUSM-MUSM partnership emphasizes bilateral exchange, mutual benefit, and longterm
commitment. The partnership is departmentally based and integrated across
multiple disciplines and throughout all levels of both institutions from student body to
Department Heads and Deans. Funding comes from multiple sources including
philanthropic support.
The IUSM-MUSM collaboration is an equitable partnership that helps to satisfy Moi
University‘s need for additional academic instructors, while at the same time creating
opportunities for professional and personal development and scholarly achievements by
medical faculty, staff, and students at both institutions. While demonstrating the power
of medical education to improve the lives of vulnerable populations, the IUSM-MUSM
partnership fosters the tripartite academic mission of care, education and research and
promotes the values of the medical profession: integrity, service, intellectual inquiry,
academic freedom, and responsible citizenship.
Institutional Partners
MUSM, one of only two medical schools in Kenya, enrolled its first class of students in
late 1990, graduating them in 1997. Currently, MUSM admits 80-100 students per year,
selected from the best and brightest high school graduates in a country with almost 30
million people and only 13 medical doctors per 100,000 inhabitants. The school has
adopted and refined an innovative, six-year curriculum designed to produce well-trained
medical doctors to serve Kenya‘s urban and large rural populations. This curriculum
emphasizes problem-based learning and community based education and service
(COBES).
Indiana University School of Medicine was established in 1903 and has developed into
one of the nation‘s largest and premier medical centers. IUSM occupies an 85-acre
campus with four general medical-surgical hospitals, Indiana‘s primary pediatric hospital,
a psychiatric hospital and a number of unique teaching and research facilities. IUSM
faculty and students also work in a large number of urban- and rural-based community
health centers and offices. IUSM graduates over 270 medical doctors each year.
Medical students pursue a four-year, competency-based curriculum.
8

Program Overview
Individual, collaborative relationships form the cornerstone of the IUSM-MUSM program.
Each American visitor in Kenya endeavors to link with his/her appropriate counterpart.
For example, IUSM physicians in Kenya work with their Kenyan colleagues under the
direction of the Kenyan department head. IUSM medical students work and live with
Kenyan medical students, and IUSM post-graduate physicians in training, or residents,
work alongside Kenyan medical officers and interns. Counterpart relationships are
similarly emphasized when Kenyan faculty and students visit IUSM.
Indiana University supports multiple positions on-site in Eldoret. The Executive Field
Director maintains a permanent presence on site and oversees all of IU‘s activities onsite
in Kenya. The Executive Field Director in 2000-11 is Joe Mamlin, MD. The Medical
Liaison supervises all visiting residents and students and coordinates the medical
activities of all visiting faculty members. The Medical Liaisons in 2011-12 is Geren
Stone MD (Internal Medicine). Geren is joined by Laura Ruhl MD (Medicine/Pediatrics)
and Sierra Washington MD (OB/Gyn). The Program Administrator, Dunia Karama,
provides logistic/scheduling support and runs the IU Houses. John Sidle, MD
(Med/Peds) and Paula Braitstein PhD (Epidemiology) serve as co-Field Directors of
Research. They oversee and coordinate on-site all of IU‘s research activities. Naiomi
Lundman, MBA, is the Associate Field Director of the Family Preservation Initiative, a
program that enables impoverished patients to achieve income security. Elizabeth
Chester, MSHS, is the Associate Field Director of Orphans and Vulnerable Children.
Sarah Ellen Mamlin heads the Sally Test Pediatric Center and supports outreach to
children on the Nyayo wards and in several orphanages. IUSM‘s Division of General
Internal Medicine and Geriatrics coordinates all travel and work schedules, and
maintains a ten-unit housing compound and a fleet of vehicles in Eldoret.
The IUSM-MUSM partnership enables the residents of IUSM‘s training programs to take
eight-week electives in Eldoret under the supervision of the IUSM Medical Liaison. Since
1990, nearly 350 residents have participated in elective rotations in Kenya. Most of the
residents are in primary care training programs at IUSM. While at Moi University, the
residents‘ responsibilities include patient care, teaching, research and public health
activities in the Moi Teaching and Referral Hospital and urban and rural health centers.
While in Kenya, IUSM residents establish collegial relationships with junior Kenyan
doctors and help teach Kenyan medical students. Residents consistently describe the
experience in Kenya as ―life-changing‖ and rate the elective as one of the premier
experiences of their residency training.
In 1994, an elective opportunity for senior medical students was introduced. Since then,
more than 300 senior students have taken clinical electives at Moi University. A twomonth
long summer ―Slemenda Scholar‖ elective for sophomore medical students was
introduced in 1998. Two to five sophomores participate in this program each year. Four
sophomores will travel to Kenya in the summer of 2011.
The majority of IUSM faculty participating in the IUSM-MUSM program are from the
Department of Medicine; however, additional IUSM departments and divisions have
played significant roles. The Department of Pediatrics has contributed both faculty and
financial support. IUSM‘s Departments of Pathology, Oncology, Dermatology,
Anesthesiology, Family Medicine, Psychiatry, Radiology, Obstetrics/Gynecology and
Surgery have each contributed to Kenyan faculty development in Kenya and Indiana.
9

One member of the IUSM Department of Surgery served five years in Eldoret. Basic
scientists at Indiana University‘s regional centers for medical education have supported
bilateral faculty exchange. New collaborations are forming with Public Health, Nursing,
Social Work, Liberal Arts, Social Sciences, Dentistry, Physical Education and Tourism.
Many internists from US academic medical centers other than IUSM have traveled to
Eldoret under the auspices of the IUSM-MUSM program to participate in teaching and
service activities. This has resulted in creation of the AMPATH Consortium, a
collaboration of other medical schools (Brown, Utah, Duke, Toronto) and academically
affiliated, medical training centers (Portland-Providence, Oregon; Lehigh Valley,
Pennsylvania) that have made long-term commitments with IUSM to MUSM.
While the majority of this exchange occurs from the US to Eldoret, IUSM and its partners
in the AMPATH consortium provide full scholarship support each year for selected
MUSM students (18 in 2011) to take 6 week electives in North America. More than 80
Kenyan faculty members and post-graduate trainees have also been supported by IUSM
to visit Indiana medical centers for the purpose of faculty development and collaborative
research.
While the underlying commitment to developing future leaders in health in both the US
and Kenya remains the primary mission of the IU-Kenya Partnership, combating the
HIV/AIDS pandemic has been current focus for the last nine years. More recently, we
have begun to focus on ―lateral expansion‖, that is, leveraging our success fighting
HIV/AIDS to build more effective primary care systems that can respond particularly to
the needs of women and children. Previously, AMPATH represented Academic Model
for the Prevention of HIV and AIDS, but for the past two years, it represents a more
comprehensive approach to healthcare in Kenya and has become the Academic Model
Providing Access to Healthcare. The ensuing document (pg.14) contains a more indepth
description of the work.
Sustainability
Funding for the IUSM-MUSM program comes from a number of sources. The program
was initially contained in IUSM‘s Division of General Internal Medicine and Geriatrics
with funds coming from pooled clinical income and the Moore Foundation, a local private
foundation. Currently, the partnership derives funding from a broad base including
federal grants such as the Presidents Emergency Plan for AIDS Relief (PEPFAR),
individual donations, local Indianapolis institutions and private and public foundations.
Multiple departments at IUSM have provided departmental funds to support exchange of
selected faculty and residents. Individual private donations have enabled a number of
projects in Kenya. Indiana University faculty, residents, and students working in Eldoret
do not accept any salary, travel reimbursement, or means of support of any kind from
Moi University or the government of Kenya. Individual and foundation contributions have
been essential in building this program, and donations are always needed and gratefully
accepted.
Outcomes
Scholarly Achievements
Numerous grants from U.S. federal agencies and several foundations totaling more than
three million dollars in direct costs have funded faculty and student exchange and the
development of clinical, teaching, and research personnel and programs in Kenya,
10

especially for HIV prevention and treatment. The President‘s Emergency Plan For
HIV/AIDS Relief (PEPFAR) pledged more than $60 million to ramp up HIV prevention
and treatment efforts at twenty-three sites in Kenya. The partnership has completed
multiple collaborative projects including an extensive evaluation of the first decade of the
curriculum at Moi University School of Medicine. The partnership has also produced
numerous publications and presentations co-authored by Americans and Kenyans.
Publications have focused on a range of topics including medical informatics, medical
education, basic sciences research, and clinical, epidemiological and health services
research.
Program Enhancement and Development in Kenya and at MUSM
Through philanthropic development spearheaded by IUSM, MUSM funds a work-study
program for medical students in Eldoret, tuition reimbursement scholarships for
impoverished medical students, leadership and merit scholarships for Kenyan medical
students, and awards to promote Kenyan women in medicine. In the current year, using
funds provided by IUSM, MUSM supports 50 students in work-study and 50 full tuition
scholarships. IUSM with its US consortium partners also provides full funding to enable
18 MUSM students to take elective rotations in North America. Additional funds have
supported Kenyan research and faculty development, community based education and
service, and the limited procurement of educational resources, medical equipment, and
medicines.
A new surgical suite, including four operating rooms and recovery facilities, was built at
MUSM with the support of a unique collaboration between IUSM and Second
Presbyterian Church in Indianapolis. The operating theatres were needed to fulfill both
service and education needs. The IU-Kenya Partnership has recently opened the Riley
Mother and Baby Hospital, located at Moi Teaching and Referral Hospital. In 2005, the
AMPATH Centre, an 80,000 square foot building dedicated to HIV care, training and
research opened to provide care and treatment to HIV-positive patients Both of these
major construction and building projects were funded mostly by private philanthropic
donations. The development of the first outpatient electronic medical record in sub-
Saharan Africa was a particularly key achievement for the partnership. The electronic
AMPATH Medical Record System successfully bridged the ―digital divide‖ and has
evolved into the information system supporting clinical and research activities in the
partnership‘s HIV clinics.
Personal and Professional Development
The IUSM-MUSM partnership promotes responsible citizenship and health for the
human family and fosters integrity, service to others, and intellectual growth. All
participants in the collaboration emerge as changed persons, enriched with these core
values.
We have assessed the effect of the program on US faculty members, residents and
students using survey instruments completed by selected participants, reports written by
all students, and interviews with most of the participants upon their return to Indiana.
Program participants report that their experience in Kenya had some value in improving
history-taking skills, broadening general medical knowledge and improving diagnostic
skills. One student wrote:
11

―I found myself learning more than I had expected from students two to three
years my junior. I was ashamed by my lack of physical exam skills, at which my
Kenyan counterparts were so adept.‖
Enhancement of teaching skills seems to be a significant outcome of the ―Kenya
experience.‖ Most faculty members who stayed for a month or more, indicate that the
experience significantly enhanced their teaching or mentoring. An individual who went
to Eldoret as a resident and is now in private practice says simply:
―I use lessons from Kenya a lot in teaching medical students and mentoring high
school students.‖
Most participants note improvement of stateside job satisfaction as an important
outcome of their time in Kenya. How long they stayed does not seem to affect the
impact of the international experience in this area. The following comments represent
the feelings of most participants:
―I definitely have a new appreciation for the relative conditions and professional
atmosphere [in the US].‖
―Although I‘ve always said, ‗I‘m in this profession to help people,‘ I feel it now!‖
―I learned that being a doctor is not just ordering tests and prescribing expensive
medications. Instead, I learned that being a doctor goes beyond that and
includes providing the basic human needs – such things as love, understanding,
the human touch and compassion.‖
For Americans, the experience affects their use of personal time and appears to
influence community involvement and citizenship at home. Typical comments include:
―I realize the impact that monetary support of charitable organizations can have.
I am also very aware of the limitations of relief agencies to change fundamental
attitudes of the people they serve.‖
―The experience taught me the importance of looking at the ‗big picture‘ of
culture, religion and belief systems before making any rash judgments.‖
Personal beliefs and family relationships may be the areas in which participants feel that
the experience is of most significance.
―My wife and I shared a quite profound experience, which we continue to discuss
and learn from. We feel closer to one another.‖
―This experience was honestly bordering on, often crossing over into, a religious
experience. It has made me feel as though I have a greater appreciation for all
God‘s creation and for my role in this world.‖
―My time in Kenya allowed me to articulate my values at an early point in my
medical career.‖
Comments written by the American participants reveal how powerful the experience can
be for many of the participants.
―The time I spent in Kenya certainly has given me a more accurate frame of
reference to evaluate my country, community and professional life. I realize how
12

important abstract fundamental beliefs are to the concrete realities of daily life. I
have, therefore, spent more time examining the core values in my life.‖
―I saw in [my Kenyan colleague‘s] eyes the same anger and frustration that I
felt...of knowing what to do without having the tools with which to do it.‖
According to exit interviews and evaluations completed by Kenyan students and faculty
members who spent time in the US, the experience reinforces their commitment to
certain aspects of their own curriculum and exposes them to different attitudes toward
work, different styles of teaching and leadership, and a different organizational construct.
Representative comments include:
―I simply believe now that as an individual and as a teacher, the concept of selfdirected
learning is paramount to keep abreast. I may not have the chance to
practice similar [to my American counterparts], but I will be aware of what is
going on. My students should do the same. ―
―I was impressed by the climate set in which students do their clerkship. It is not
an intimidating atmosphere.‖
―Today, I learned that anything is possible.‖
―[The experience] opened my eyes to many concepts that I have taken for
granted and did not know.‖
The Kenyan faculty participants report that their experiences increase creativity in
solving problems in health care delivery and make them less accepting of the status quo
in Kenya. Importantly, Kenyan faculty and students note that the partnership is fair and
equitable.
There have been no formal, external assessments of the partnership. However, an NIH
special emphasis panel charged with reviewing the partnership in the context of a grant
review gave the partnership a superior rating. According to one of the reviewers, the
partnership “serves as a model program for how collaboration between U.S. institutions
and those in developing countries can be established, nourished, maintained, evaluated
and enhanced….This linkage has been developed in such a way that the interests of Moi
University and the people of Kenya have been kept uppermost.” [Personal
communication, NICHD Special Emphasis Panel, ZHD1 DSR-R (TW), 1/22/2001]
Miscellaneous Achievements
Spouses and partners traveling with IUSM personnel working in Kenya have been
involved in many community outreach projects. They have donated time and resources
to several schools and orphanages. They have promoted hospice care for dying patients
and provided hospitality, comfort, and educational services for children on the pediatric
wards of the Moi Teaching and Referral Hospital. IUSM has also made it possible for
selected patients to obtain lifesaving surgery in the U.S.
13

“AMPATH” is now known as Academic Model Providing Access To Healthcare
Dr. Bob Einterz, director of the IU-Kenya Partnership, formally announced the change of
AMPATH‘s name to Academic Model Providing Access To Healthcare. This change
promises to bring the partnership back full circle by focusing on many healthcare needs
of the Eldoret catchment area and brought the story of the IU Kenya program back full
circle.
Indiana University School of Medicine chose to partner with Moi University School of
Medicine back in 1989 in part because of Moi University‘s dedication to a COmmunity-
Based Education and Service (COBES) curriculum. Since then, IU pediatricians like
Drs. Ed Liechty, Jill Helphinstine, Jason Woodward and Rachel Vreeman helped
establish the IU commitment to pediatric care.
―Even though the HIV/AIDS pandemic inevitably caused us to focus on the disease that
was ravaging eastern Africa, we never stopped working to improve primary care,‖
Einterz says. ―Now, with the help of many partners, we are able to build on the structure
of AMPATH in Kenya to meet the many pressing health needs, including but not limited
to HIV/AIDS.‖
Along with Indiana and Moi physicians, the partnership now includes the leadership of
Brown University in tuberculosis care, University of Toronto joining IU and USAID in a
new commitment to obstetrics. Duke University is leading a new concerted effort in
cardiac care by placing long-term faculty on ground in Kenya. Eli Lilly has provided
generous product support in mental health and cancer care, Procter and Gamble is a
partner in USAID-AMPATH safe water efforts, and Purdue University, Abbott and Lilly
lead an aggressive intervention on behalf of Kenyans suffering from diabetes.
Discussion
The Indiana University-Moi University partnership has made a significant difference in
the lives of thousands of individual Kenyans and Americans and it has made positive
contributions to the development of Moi University School of Medicine and the local and
national health system in both urban and rural Kenya. The Indiana-Moi experience
demonstrates the powerful effect that can be achieved through partnership of academic
medical centers in the United States and Africa. We believe there are several keys to the
success of the partnership: equitable counterpart relationships among faculty members;
a systematic approach to partnership that is inclusive of research, teaching, and service;
and leadership committed to the mission of the partnership.
We are pleased that the success of the partnership has been recognized with two Nobel
Peace Prize nominations, was awarded the ―International Citizen of the Year‖ in 2008,
honored with awards and praise from global health organizations and leaders, and was
the focus of many articles in local and national mass media and professional journals.
All participants in the partnership expect and work for mutual benefit. Altruism is a
necessary but insufficient reason for either institution to continue in the partnership.
There must be demonstrable benefit to both institutions. To achieve mutual benefit, the
institutional relationship strives for equity, not equality, because medical systems in the
developed and developing world are inherently unequal. For example, Indiana University
does not expect financial commitment on the part of Moi University to support Indiana
University‘s participation. At the same time, however, Indiana University does expect its
14

trainees and faculty members to be given the opportunity at Moi University to benefit
personally and professionally from involvement in the program.
Indiana University‘s commitment to keep at least one of its faculty members on-site in
Kenya forms the cornerstone of its institutional commitment. This team leader enables
open and regular communication, grassroots understanding and responsiveness to new
situations, and sustainable interventions. By focusing on the system as a whole, the
team leader facilitates continuous remolding of the partnership‘s vision for how research,
training, and service integrate with one another.
As in any institutional relationship, leadership is of critical importance. Leaders of both
institutions support the partnership, and the partnership supports leadership positions at
both institutions. Persons at the highest levels of both institutions are vested in the
partnership. If differences arise between the two institutions, relevant counterparts seek
common ground in shared values and goals.
Lastly, one of the most important lessons we learned is to start small, stay focused,
maintain control of fundamental administrative processes, and ensure that the driving
forces for growth of the program are creativity, values, mission and long-term
sustainability—not money. This grassroots, hands-on approach also enables
transparency and accountability of funds, and is appealing to some funding sources that
tend to be wary of investing in sub-Saharan Africa. Work continues in the areas of
tuberculosis, preventing mother to child transmission (pMTCT), Voluntary Counseling
and Testing (VCT), Home Counseling and Testing (HCT), Orphans and Vulnerable
Children (OVC), community mobilization, food security through food distribution and
nutrition, income security through the Family Preservation Initiative (FPI), outreach and
counseling and support groups. Additionally, the AMPATH Medical Record System
continues to track all patients and combine data into a single database utilizing state-ofthe-art
computerized medical records for each patient.
Conclusion
The IUSM-MUSM partnership provides an important affirmation of each medical school‘s
commitment to the world community. The success of the IUSM-MUSM partnership
reveals the promise such collaborative projects hold for the development of tomorrow‘s
medical leaders, both within Africa and the United States.
15

Indiana University-Moi University School of Medicine Partnership
List of Participants, 2011-2012
IUSM Students
Name
Months in Kenya
Sashana Gordon (Slemenda) June/July 2011
Chris Mosher (Slemenda) June/July 2011
Darren Plummer (Slemenda) June/July 2011
Sheiphali Gandhi June/July 2011
Rowan Hurrell June/July 2011
Philip Maher June/July 2011
Jun Chung July/August 2011
Sarah Dilley August/September 2011
Alana Barbato September/October 2011
Sandeep Mehta September/October 2011
Kathryn Stevens September/October 2011
Rui Chen September/October 2011
Danielle Cowan September/October 2011
Adam Nevel September/October 2011
Kate Mills October/November 2011
Jonathan Hoover November/December 2011
Anna Marie Gramelspacher January/February 2012
Joseph Kopp January/February 2012
Joshua Rouch January/February 2012
Micah Hatch January/February 2012
Jessica Donaldson January/February 2012
Gregory Martens February March 2012
Kate Nugent March/April 2012
Lenny Weiss March/April 2012
Katie Krieger March/April 2012
Michael Toole March/April 2012
Victoria Fahrenbach March/April 2012
Abigail Rice March/April 2012
Daniel Flood April/May 2012
Cici Zhang April/May 2012
Abigail Ley May/June 2012
Eric Shin May/June 2012
16

IUSM Residents
NAME SPECIALTY MONTHS IN KENYA
Darla Leins PGY-3 EM/Peds July/August 2011
Elise O'Connell PGY-2 Med July/August 2011
Matthew Malone PGY-2 M/P July/August 2011
Emily Malone PGY-2 Peds July/August 2011
Vikas Kalra PGY-3 M/P August/September 2011
Liz Dahlberg PGY-2 Peds September/October 2011
Samer Ajam PGY-2 Med September/October 2011
An Dang Do PGY-3 M/P September/October 2011
Naga Pannala PGY-2 Med November/December 2011
Vandna Handa PGY-2 M/P January/February 2012
Kim Paisley PGY-2 M/P January/February 2012
Kelli McCauley PGY-2 Med Child January/February 2012
Zarmina Ehsan PGY-2 Peds February/March 2012
Frances Chen PGY-2 Peds February/March 2012
Sethal Jacob PGY-2 Peds February/March 2012
Kimberly Lo PGY-2 Peds/Child Psych February/March 2012
Chet Walters PGY-2 Med March/April 2012
Emily Pearce PGY-3 M/P April/May 2012
Sethal Jacob PGY-2 Peds April/May 2012
Robert Long PGY-2 Med May/June 2012
17

Indiana University-Moi University School of Medicine Partnership
List of Participants, 2010-2011
IUSM Students
Name
Months in Kenya
Katie Eckerle (Slemenda) June/July 2010
Brandon Hood (Slemenda) June/July 2010
Rachel Koontz (Slemenda) June/July 2010
Megan Moore (Slemenda) June/July 2010
Jon Weyerbacher (Slemenda) June/July 2010
Steve Hoyt June/July 2010
James Taggart June/July 2010
Colby Wilson June/July 2010
Danielle Brueck June/July 2010
Richelle Baker July/August 2010
Asim Sheriff August/September 2010
Rahul Sharma August/September 2010
Kashif Shaikh August/September 2010
Lindsay Anderson August/September 2010
Katherine MacDonald August/September 2010
Megan VanNatta
September/October/2010
Christopher Kniese
September/October/2010
Amy Ratliff
September/October/2010
Kathleen Williamson
September/October/2010
Jamie Kiehm October/November 2010
David Chambers October/November 2010
Laura Quilter October/November 2010
Jennifer Patchett October/November 2010
Elizabeth Jones December 2010/January 2011
Megan Uhl January/February 2011
Amanda Walter January/February 2011
Kathryn Dickerson January/February 2011
Amanda Jackson February/March 2011
Shreyas Joshi February/March 2011
Norman Yeh February/March 2011
Ryan Capps February/March 2011
Tim Mercer February/March 2011
Lianna Heidt February/March 2011
Christine Heumann March/April 2011
Sanjay Mohanty April/May 2011
Meaghan Kuczora April/May 2011
Stephen Michael Keller April/May 2011
Helen Flippin May/June 2011
18

IUSM Residents
NAME SPECIALTY MONTHS IN KENYA
Maheen Quadro Peds July-September 2010
Meagan O’Neill Peds August/October 2010
Julia Richards Med/Peds September/November 2010
Jennifer Shoreman Med/Peds September/November 2010
Stephanie Bynum Medicine September/November 2010
Mona Desai Medicine October/December 2010
Amy Munchhof Med/Peds October/December 2010
Sheryl Mascarenhas Medicine October/December 2010
Kara Goss Med/Peds November 2010/January 2011
Samuel Kimani Medicine November 2010/January 2011
Kate Miller Peds January/March 2011
Salina Paarlberg Peds January/March 2011
Rachel Thompson Peds January/March 2011
Carolyne Jepkorir Medicine January/March 2011
Njeri Maina Medicine February 2011
Keriann Van Nostrand Medicine May/June 2011
Beth Gates Med/Peds May/June 2011
Brad Locke Peds May/June 2011
Mackenzie Lupov Medicine May/June 2011
19

DOCUMENTS

M E M O
TO:
FROM:
SUBJ:
Kenya Faculty and Resident Travelers
Ron Pettigrew, Program Manager
Requirements for Kenya Rotation for Faculty and Residents
DATE: May 4th, 2011
_______________________________________________________________
It is important that we receive the following documents in our office as soon as possible in
order for you to receive a visitor’s license to practice during your overseas rotation. This
does not apply to students.
1. License Fee – Currently $75 (Please contact Ron for updates on this amount)
2. A completed form for Medical Practitioners Permit (pg.32)
3. Curriculum Vitae
4. Copy of medical school diploma
5. Copy of U.S. medical license
6. Color 2”X2” passport photo
7. Three letters of reference* (addressed to:)
Dr. Paul Ayuo
Moi University
School of Medicine
PO Box 4606
Eldoret, Kenya
PLEASE SEND THESE LETTERS TO OUR OFFICE. DO NOT SEND THEM TO
DEAN AYUO.
8. A copy of your passport
PLEASE SEE THAT ALL DOCUMENTS ARE DELIVERED TO OUR PROGRAM
ASSISTANT, SALLY BEN-HAMEDA, FOR FORWARDING TO ELDORET.
Residents should submit documents prior to July 1, 2011. Faculty should submit
documents at least three months prior to departure or earlier.
*Letters of reference do not need to be elaborate
22

Guidelines for International Electives and Experiences
Indiana University School of Medicine
Each year a number of students and residents participate in credit-bearing activities outside of the
United States as both organized courses and independently arranged experiences. In many cases, the
countries where these activities take place present a variety of challenges and risks to students for
which they may not be prepared. These risks include unfamiliar cultures and languages, political
instability, and infectious diseases and other health hazards that are uncommon in the United States.
To assist students in preparing for these eventualities, the Indiana University School of Medicine
requires that all students enrolled in a credit-bearing course or independent activity with an
international component perform the following prior to departure from the United States:
1. Participate in a course, seminar series, or supervised self-study for cultural orientation and
preparation for the trip.
2. Register online at www.iabroad.iu.edu and complete all materials at least two months prior to
departure.
3. Complete (if required) any documents required for permission to practice medicine in a foreign
country at least three (3) months before your departure date.
4. Obtain medical travel advice and immunizations appropriate for the country to which travel is
planned at least three (3) months before your departure date.
5. Obtain medical/accident insurance which includes provision for emergency evacuation to a
United States medical facility Provide proof of special evacuation insurance offered by MNUI
(www.mnui.com), SOS (www.sosinternational.com), IUPUI Office of International Affairs, or
your personal insurance carrier to Ron Pettigrew at least 2 months before departure.
6. Prepay room and board costs at least 1 month before your departure date to Ron Pettigrew.
Check should be made payable to Indiana Institute for Global Health, Inc.
7. Designate persons in the United States who may be contacted in the event of an emergency and
return form to Ron Pettigrew at least two months before your departure date.
8. Abide by all program expectations and rules or decisions established by the Kenya Program
Manager and/or Professor of Clinical Medicine, understanding that failure to comply may result
in failure to receive academic credit and/or involuntary repatriation to the United States.
Completion of these steps is the responsibility of the individual student or resident and not that
of Indiana University School of Medicine.
I, ________________________________ , have read and understand the above guidelines. I further
understand that the decision whether to undertake study abroad is mine alone, and Indiana University
School of Medicine bears no responsibility for health or safety risks presented by such study.
(Signed)___________________________________ Date____________________
24

VISA REQUIREMENTS (If acquiring visa upon entry to Kenya at the Nairobi Airport)
1. $25.00 US cash
2. Visa application form duly completed and signed by the applicant (in Orientation Manual).
3. Valid passport with sufficient number of unused pages for endorsements abroad. Passport must be signed
and valid for at least six months.
STANDARD VISA FEES
Visa fee is payable by money order made to the Embassy of Kenya.* (Washington D.C. only)
Type of Visa Fee Chargeable (US $)
Multiple Journey Entry Visa US $50.00
Single Journey Entry Visa US $25.00
Transit Visa (issued at port of entry into Kenya) US $10.00
Referral Visa US $5.00
Diplomatic, Official, Service & Courtesy Visa
gratis
VISA REQUIREMENTS (If acquiring Visa through Kenya Embassy in Washington D.C.) *send at least 6
months before departure from the US*
1. Valid passport with sufficient number of unused pages for endorsements abroad. Passport must be signed
and valid for at least six months.
2. Visa application form duly completed and signed by the applicant (in Orientation Manual on pg. 30)
3. Two recent passport size photographs attached to the application form.
4. Valid round trip ticket, your e-ticket or a letter from your travel agent certifying that the applicant holds
prepaid arrangements.
5. A self-addressed stamped envelope for Priority Mail, Express Mail, FedEx, UPS, Airborne Express, or
DHL. (Metered stamps are not acceptable.)
6. Be sure to include your home, work and cell phone (if applicable) numbers.
7. US $10.00 for rush or expedited service on documents
PLEASE ENSURE THAT THE VISA FORM IS CORRECTLY COMPLETED, PHOTOGRAPHS ENCLOSED
AND THE CORRECT FEE ENCLOSED BEFORE SUBMITTING YOUR APPLICATION TO ENSURE
PROMPT PROCESSING OF YOUR APPLICATION.
*Only required if you are processing your visa through the Kenyan Embassy in Washington D.C. If you choose
to mail your Visa application to the Embassy, we recommend you send your Visa application to the Kenya
Embassy at least six months before your scheduled departure date.
REGISTER WITH US STATE DEPARTMENT ONLINE AT:
https://travelregistration.state.gov/ibrs/ui/index.aspx
HEALTH
Immunizations against Yellow Fever, Meningitis, Hepatitis A, Typhoid Fever and Polio are recommended.
Anti-Malaria prevention medications are recommended for those visiting tropical regions.
Visit the Kenya Embassy Website and download your visa forms at http://www.kenyaembassy.com/
26

FORM V.
EXAMPLE FORM
EMBASSY OF THE REPUBLIC OF KENYA
WASHINGTON, D. C.
2249 R. ST. N. W.
WASHINGTON, D. C. 20008
Tel: (202) 387 6101
Fax: (202) 462-3829
VISA APPLICATION FORM
(To Be Completed In Block Letters)
SINGLE/ MULTIPLE / VISA (Circle one) _____________________________________________________________
1. A. Surname (Mr. /Mrs. / Miss) ____DOE____ B. Other Names In Full _____JOHN HENRY____________
C. Full Name Father/ Husband/ Wife__________________________________________________________________
2. A. Date of Birth __10 Oct 1980______Country and Place of Birth __INDIANA, USA__ Sex _____MALE_______
B. Profession/ Occupation ___MEDICAL DOCTOR or STUDENT__________________________________
3. A. Country of Residence ____USA_____________________________________________________________
B. Nationality at Birth _____USA______ C. Present Nationality, if different _____________________________
4. Passport/ Travel Document Held:
A. No: _____A9125678_____________ Place & Date of Issue ___CHICAGO, ILLINOIS USA______________
B. Issued By ___US DEPT. OF STATE______Valid Until ____6/2012_________________
(Name of Authority issuing Passport/ Travel Document)
5. Contact Address and Telephone number in the U. S.___5745 BROADWAY STREET _____________________
__________________________________________ INDIANAPOLIS, IN ____(317)555-5555_________
6. A. Reason For Entry ___MEDICAL EXCHANGE WITH MOI UNIVERSITY____________________________
B. Proposed Date of Entry 3 FEBRUARY 2010_________Duration of Stay__ 8 WEEKS___________
7. Full names and Addresses of Friends, Firms or Relatives To Be Visited, if any:
DR. JOSEPH MAMLIN, MUSOM, PO BOX 5760______________________________________________________
_ELDORET, KENYA_30100_______________________________________________ _________________________
8. Dates and duration of previous visits to Kenya (FILL IN IF APPLICABLE)_________________________________
9. Will You Be Returning To Your Country of Residence/ Domicile?____YES __________________________________
10. It should be noted that possession of a visa is not the final authority to enter Kenya.
I hereby declare that the foregoing particulars are correct in every detail.
Date: _____________________________Signature of Applicant: __________________________________________
28

FORM V.
EMBASSY OF THE REPUBLIC OF KENYA
WASHINGTON, D. C.
2249 R. ST. N. W.
WASHINGTON, D. C. 20008
Tel: (202) 387 6101
Fax: (202) 462-3829
VISA APPLICATION FORM
(To Be Completed In Block Letters)
SINGLE/ MULTIPLE / VISA (Circle one) __________________________________________________________
1. A. Surname (Mr. /Mrs. / Miss) ______________ B. Other Names In Full _______________________________
C. Full Name Father/ Husband/ Wife_____________________________________________________________
2. A. Date of Birth __________________Country and Place of Birth ____________________Sex _____________
B. Profession/ Occupation_____________________________________________________________________
3. A. Country of Residence ______________________________________________________________________
B. Nationality at Birth ___________________ C. Present Nationality, if different ________________________
4. Passport/ Travel Document Held:
A. No: __________________________________ Place & Date of Issue_________________________________
B. Issued By ___________________________________Valid Until ___________________________________
(Name of Authority issuing Passport/ Travel Document)
5. Contact Address and Telephone number in the U. S._________________________________________________
______________________________________________ ____________________________________________
6. A. Reason For Entry__________________________________________________________________________
B. Proposed Date of Entry ______________________________Duration of Stay_______________ __________
7. Full names and Addresses of Friends, Firms or Relatives To Be Visited, if any:
____________________________________________________________________________________________
____________________________________________________________________________________________
8. Dates and duration of previous visits to Kenya _____________________________________________________
9. Will You Be Returning To Your Country of Residence/ Domicile?_____________________________________
10. It should be noted that possession of a visa is not the final authority to enter Kenya.
I hereby declare that the foregoing particulars are correct in every detail.
Date: _____________________________Signature of Applicant: ______________________________________
30

PHOTO
REPUBLIC OF KENYA
FORM VIII THE MEDICAL PRACTITIONERS AND DENTISTS ACTS
(CAP 253)
APPLICATION FOR A LICENCE TO RENDER MEDICAL OR DENTAL SERVICES
1. Surname (BLOCK LETTERS) ………………………………………………………………………………………………………………………..
2. Other Names (BLOCK LETTERS)……..……………………………………………………………………………………………………………
3. Address…………………………………………………Town……………………………………………Code……………………………………………….
4. Tel……………………………………………………………………..Email……………………………………………………………………………..
5. Date of Birth…………………… ………………………………………Place of Birth………………………………………………………………
6. Nationality…………………………………………………………………………………………………………………………………………………..
7. Basic Degree, Diploma or Licence held (give name of medical school and date qualified)
……………………………………………………………………………………………………………………………………………………………………
(Legible certified true photocopies should be supplied)
8. Particulars of Experience (e.g. posts held, type of practice in which the applicant has been engaged, countries in which
the applicant has practiced:
……………..……………………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………………………………….
9. Testimonials Covering the Period (s) of Experience
……………………………………………………………………………………………………………………………………………………………………………..
(photocopies should be supplied for record purposes )
10. Have any arrangements been made regarding employment? (if so details…………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………..
11. Is this New application or Renewal?…………………………………………………………………………………………………………………………..
(if renewal photocopy of licence should be supplied)
A fee of Kshs.10,000 is payable for a licence except for interns under section 11 of the Act.
Signature of Applicant………………………………………………Date ……………………………………………
FOR OFFICIAL USE:
Approved/Not approved
(if not approved, give reasons)……………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………….
Name……………………………………………………………………
Signature………………………………..…………………Designation…………………….…………
Date………………………………………

EMERGENCY CONTACT INFORMATION
IU-MOI UNIVERSITY PROGRAM
_____________________________________
Name (Last, First)
________________
Dates in Eldoret
__________________________ ________________________ _______________
Passport Number Place of Birth Date of Birth
_________________________
Date Issued
______________________
Place Issued
______________________________________________________
PRESENT ADDRESS: Street, Apt. No., Etc.
_________________________________ ________________________ _________________________
City/State/Zip Telephone Email
_________________________________
Pager
________________________
Cell Phone
_________________________________
NEXT OF KIN: Name
________________________
Relationship
______________________________________________________________________
Street Address
_____________________________________
City/State/Zip
_____________________________
Home Telephone
_____________________________
Office Telephone
_____________________________
Cell or Pager
NAME OF PERSON/S TO NOTIFY IN CASE OF EMERGENCY (if other than person listed above)
_________________________________
NEXT OF KIN: Name
________________________
Relationship
______________________________________________________________________
Street Address
_____________________________________
City/State/Zip
_____________________________
Home Telephone
_____________________________
Office Telephone
_____________________________
Cell or Pager
34

Indiana University Students Intending to Study in Kenya
2011-2012 Liability Waiver
I hereby acknowledge that I have read the Overall Crime and Safety Situation on
the following pages (pages 46-52) as well as the U.S. Department of State Travel
Warning regarding travel to Kenya by United States citizens dated December 28, 2010
at http://travel.state.gov/travel/cis_pa_tw/tw/tw_923.html and that in spite of such
warnings I have made the decision to travel to Kenya for an educational program abroad
in the Fall 2011 and/or Spring 2012 semester as a registered Indiana University student.
I understand that I am solely responsible for my safety. I agree to exercise my
best judgment and to follow the advice of my program organizers, both at IU and abroad,
but I recognize that in spite of such advice, no one can guarantee my safety.
Further, I recognize that should I decide to come home before the end of the
semester because of security concerns there is no guarantee that I will receive credit or a
refund of tuition or any other fees paid for the program.
______________________________
Student Signature
__________________
Date
______________________________
Student Name Printed
36

1
38

1
39

1
Insurance Enrollment Form
HTH World Wide Insurance
You are required to have health insurance through the IU group plan during the dates of your study abroad program.
The start and end date for your insurance coverage will be the program dates, including the dates of travel to your
destination and back to Indianapolis.
If you are traveling on your own outside of the program dates (either before or after the program), you may choose
to purchase additional insurance at your own expense so you have international health insurance during your entire
stay abroad; however, you will not be able to purchase this additional insurance through the IUPUI Study Abroad
Office. Please visit the “Student Resources” section on the Study Abroad Office's website for information on other
international insurance providers.
The insurance plan is administered by HTH Worldwide Insurance Services. Some study abroad programs include
the cost of the insurance in their program fees while others do not. Please verify with the director of your program if
the insurance cost is included in the program fees already paid to them.
If your insurance premium is included in the program fee: complete this form but do not submit a check to the
IUPUI Study Abroad Office.
If your insurance premium is not included in the program fees: complete this form and submit your insurance
payment to the address listed at the bottom of this page.
If your program begins before May 1, 2011, insurance costs $26 per month.
If your program begins May 1, 2011 or later, insurance costs $27.50 per month.
Note: Insurance cost is subject to change.
Make check or money order payable to “Indiana University”; cash and credit card not accepted. Insurance may only
be purchased in full month increments, not partial months.
(E.g. 7/25/2011 – 8/25/2011 = 1 month; 7/25/2011 – 8/26/2011 = 2 months)
Please print clearly:
Legal Name: ______
Program Name:
Program Location: ______________________________________________
Is the insurance cost included in the program fee? Yes _______ No _______
Program Dates/
Dates of Coverage: (_____/_____/_________) (_____/_____/_________)
From: mm dd yyyy) To: mm dd yyyy
Insurance money submitted to the Study Abroad Office is NONREFUNDABLE.
40
IUPUI Study Abroad Office
ES 2129B, 902 W. New York Street, Indianapolis, IN 46202
abroad@iupui.edu; phone - 317-274-2081
1/2011

Travel Warning
United States Department of State
Bureau of Consular Affairs
Washington, DC 20520
KENYA
March 16, 2010
The U.S. Department of State warns U.S. citizens of the risks of travel to Kenya. U.S.
citizens in Kenya and those considering travel to Kenya should evaluate their personal
security situation in light of continuing threats from terrorism and the high rate of violent
crime. This replaces the Travel Warning of July 24, 2009 to highlight continued security
concerns in northeast Kenya near the Somali and Ethiopian borders.
The U.S. Government continues to receive indications of potential terrorist threats aimed at
U.S., Western, and Kenyan interests in Kenya. Terrorist acts could include suicide
operations, bombings, kidnappings, attacks on civil aviation as evidenced by the 2002
attacks on an Israeli airliner, and attacks on maritime vessels in or near Kenyan ports. Many
of those responsible for the attacks on the U.S. Embassy in 1998 and on a hotel in Mombasa
in 2002 remain at large and continue to operate in the region. Travelers should consult the
Worldwide Caution for further information and details.
In July 2009, three NGO workers were kidnapped and taken into Somalia by suspected
members of a terrorist group that operates out of Somalia. In November 2008, armed
groups based in Somalia crossed into Kenya near the town of El Wak and kidnapped two
Westerners. The U.S. Embassy in Nairobi has designated a portion of Kenya bordering
Somalia and Ethiopia as “restricted without prior authorization” for purposes of travel by U.S.
Government employees, contractors, grantees, and their dependents. Travelers should be
aware that U.S. Embassy security personnel recently expanded the restricted area to include
the Lamu district. This designation is based on reports of Somali-based armed groups that
have on occasion crossed into Kenya to stage attacks or to commit crimes. This restriction
does not apply to travelers not associated with the U.S. Government, but should be taken
into account when planning travel. The restriction is in effect for the following areas:
All of Mandera District.
The entire area north and east of the town of Wajir, including travel on Highway C80 and areas
east of C80 and an 80-kilometer wide band contiguous with the Somalia border. Travel to and
within the towns of Wajir and Moyale remains unrestricted.
Within Garissa District, an 80-kilometer wide band contiguous with the Somalia border. Travel to
and within the town of Dadaab remains unrestricted.
Within Ijara District, an 80-kilometer wide band contiguous with the Somalia border; Boni National
Reserve.
Within Lamu District, a 60-kilometer wide band contiguous with the Somalia border. Towns and
resorts within/contiguous to the Kiunga Marine Reserve are now included in the restricted area.
Violent and sometimes fatal criminal attacks, including armed carjackings, home
invasions/burglaries and kidnappings can occur at any time and in any location, particularly
in Nairobi. As recently as February 2010, U.S. nationals were victims of carjackings. In the
short-term, the continued displacement of thousands of people by the civil unrest of 2008
42

combined with endemic poverty and the availability of weapons could result in an increase in
crime, both petty and violent. Kenyan authorities have limited capacity to deter or investigate
such acts or prosecute perpetrators.
U.S. citizens in Kenya should be extremely vigilant with regard to their personal security,
particularly in public places frequented by foreigners such as clubs, hotels, resorts, upscale
shopping centers, restaurants, and places of worship. U.S. should also remain alert in
residential areas, at schools, and at outdoor recreational events, and should avoid
demonstrations and large crowds.
U.S. citizens who travel to or reside in Kenya are encouraged to register through the State
Department’s travel registration website, https://travelregistration.state.gov. By registering,
U.S. citizens make it easier for the Embassy to contact them in case of emergency. U.S.
citizens without Internet access may register directly with the U.S. Embassy in Nairobi. The
U.S. Embassy is located on United Nations Avenue, Gigiri, Nairobi, Kenya; telephone (254)
(20) 363-6000; fax (254) (20) 363-6410. In the event of an after-hours emergency, the
Embassy duty officer may be contacted at (254) (20) 363-6000. The Embassy home page is
http://kenya.usembassy.gov.
Updated information on travel and security in Kenya may be obtained from the Department
of State by calling 1-888-407-4747 1-888-407-4747 toll-free in the United States
and Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-
501-4444 1-202-501-4444 . In conjunction with this Travel Warning, U.S. citizens
traveling to Kenya should also consult the Country Specific Information for Kenya and the
Worldwide Caution, which are available on the Bureau of Consular Affairs Internet website at
http://travel.state.gov.
43

Overall Crime and Safety Situation
Kenya remains critically rated for both Crime and Transnational Terrorism. The Travel Warning
for Kenya was updated in December 2010 to note the increased security concerns in northeast
Kenya near the Somali border. U.S. government personnel are now restricted from traveling
northeast of the town of Wajir to the Somalia border without special embassy clearance.
The greatest threats in Kenya continue to be road safety, crime and terrorism. The most common
crime in Kenya's major cities, and in particular Nairobi, is carjacking. In virtually every
instance, carjackers use weapons to rob their victims. Most victims, if they are completely
cooperative, are often released unharmed with their vehicles. However, victims are sometimes
tied up and put in the back seat or trunk of their own car. Criminals who commit these crimes
will not hesitate to shoot victims who are the least bit uncooperative or who may appear to
hesitate before complying with their assailants.
Street crime is a serious problem and more acute in Nairobi and other larger cities. Most street
crime involves multiple armed assailants. In some instances, large crowds of street thugs incite
criminal activity, which has the potential to escalate into mob-like violence with little notice.
Pick-pockets and thieves often carry out "snatch & grab" attacks on city streets in crowded areas,
as well as from idle vehicles in traffic, and commit other crimes of opportunity. Vehicle side
mirrors are a favorite prize of street boys, who can pull them off in a matter of seconds while a
vehicle is stopped or in slow-moving traffic. Visitors are advised not to carry expensive
valuables such as jewelry, electronics, etc., or large amounts of cash on their person, but rather
store them in their hotel safety deposit boxes or room safes. However, it is not prudent to travel
with such items at all, since hotel safes can be broken into or taken out of a room and might also
be accessible by hotel personnel even when locked. Walking alone is not advisable especially in
downtown areas, public parks, beach areas, and other poorly lit areas, especially at night.
Terrorism remains a high priority concern for Americans in Kenya. The porous border with
Somalia has been of particular concern as certain fundamentalists travel between Somalia and
Kenya. A recent counterterrorism operation conducted by Kenyan authorities in the coastal town
of Malindi failed to apprehend the highly sought-after al-Qa'ida operative Harun Fazul, but
revealed his previously unknown support network. Since then, several al-Qa'ida linked
44

supporters have been questioned or detained. Several persons (possibly tied to al-Qa'ida)
suspected of involvement with the 1998 East Africa Embassy attacks and the 2002 Kikambala
attacks in Mombasa remain at large and potentially dangerous to U.S. citizens and interests. In
January 2009, Usama al-Kini and Sheikh Ahmed Salim Swedan, Kenyan nationals on the FBI's
most wanted terrorist list for their alleged role in the East Africa Embassy attacks, were killed in
Waziristan near the Afghan border.
Political Violence
Kenya is generally a peaceful country in terms of political activism, but it is common during
elections, referendums and other political votes for sporadic campaign violence to occur around
the country. On 29 December 2007, the day after Kenya's National Parliamentary and
Presidential Elections, violence erupted in major cities across Kenya, to include Nairobi,
Mombasa, and Kisumu. Clashes were reported throughout Kenya, which resulted in the deaths
of over 600 Kenyans. None of these incidents was targeted against Americans or the expatriate
community. With the formation of the Grand Coalition Government in February 2008, the
violence ceased.
There are limited numbers of significant radical Kenyan and third-country national elements that
are openly hostile to U.S. influence. The perpetrators of the 1998 U.S. embassy bombings in
Nairobi and Dar es Salaam resided mostly in the coastal regions of Kenya (Lamu, Malindi, and
Mombasa). The suspected perpetrators of the terrorist attack on the Paradise Hotel in Mombasa
and the unsuccessful missile attack against an Israeli charter jet included Kenyan nationals.
Post-specific Concerns
Road safety and crime is clearly the most significant threat to persons residing in or visiting
Kenya. Vehicle travel is extremely hazardous under normal conditions in Kenya, but
particularly so at night. Defensive driving is a must for all drivers. Traffic laws are routinely
ignored by most local drivers, who possess poor driving skills and/or training. In particular,
many of the "matatus," or small passenger vans, show little courtesy and drive erratically and
dangerously. Many vehicles are in poor mechanical condition with worn tires and broken or
missing tail lights, brake lights, and headlights. Road conditions are considered poor at best and
worse in outlying or rural areas. This is especially the case after the rainy season, when roads
deteriorate at a rapid rate, causing extensive potholes and other road hazards.
45

Police Response
The Kenyan Police Service (KPS) is almost solely a reactive force and demonstrates moderate
proactive law enforcement technique/initiative to deter or investigate crime. Police often lack the
equipment, resources, training, and personnel to respond to calls for assistance or other
emergencies. The police have a poor record of investigating and solving serious crimes.
Inadequate legislation results in lack of prosecution or large numbers of acquittals. Corruption
occurs at all levels, which results in an ineffective legal and justice system.
Medical Emergencies
Kenya's country-wide emergency number is 999. There are three hospitals in Nairobi which
U.S. personnel and other western expats typically use: Nairobi General Hospital, Aga Khan
Hospital, and Gertrude Garden Children's Hospital. The quality of care at each is considered
good, and U.S. embassy personnel assigned to Kenya often use their services. However, the
blood supply in Kenya is generally considered unsafe and the use of blood products is not
recommended. It is advised that those needing blood utilize trusted sources such as family or
friends.
Tips on How to Avoid Becoming a Victim
Normal crime prevention methods will help lessen the likelihood of becoming a victim of crime
while in Kenya. Being aware of one's surroundings has been the time-tested method for avoiding
becoming an inviting target of opportunity for crime. Carjacking and burglaries and the
occasional home invasion are the most serious crimes in Kenya, but if the necessary measures
are taken, they can generally be avoided. Perpetrators are likely to be armed and any resistive
behavior causes more violence by the attackers. Ensure vehicle doors and windows are locked at
all times while traveling, even during daylight hours. The best way to avoid being a victim of a
carjacking is to be aware of your surroundings at all times, particularly during late night or early
morning hours, though carjacking occurs during all times of the day and night.
If you see something or someone suspicious, be prepared to react quickly. Allow sufficient
distance between you and the vehicle ahead of you while stopped in traffic. If you believe you
are being followed, don't drive directly to your intended destination, but rather detour to a public
or well-lit and guarded area and seek help. It is important to limit the amount of valuables and
cash you carry with you, specifically ATM or credit cards. Should you be carrying an ATM card
46

or credit card, the criminal will prolong the incident so they can take the victim to multiple ATM
machines for withdrawals.
Travelers should only use banks and ATMs in well-lit locations and never at night. Credit cards
can be used in certain establishments, such as major hotel chains and some local restaurants, but
caution in use is advised. Although there are a number of security and private guard companies
throughout Kenya's larger cities, it is advisable to research any prospective security company for
quality and reliability when considering hiring their services.
Contact Information
Consular Section/American Citizen Services: (254) (20)375-3704/375-3700
Foreign Commercial Service: (254) (20)363-6438
Regional Security Office: (254) (20)363-6301
Emergency/Post One (After Hours/Holidays): (254) (20) 363-6170
Dialing Instructions:
Outside of Kenya: Dial the international code to get out of the country you are calling from, the
dial the city code and then the 5-8 digit telephone number:
Kenya's country code is 254
City Codes:
Nairobi 20
Mombasa 41
Kisumu 57
Kericho 52
Garissa 46
Eldoret 53
Lamu 42
Garissa/Wajir 46
Nanyuki 62 (Mt. Kenya)
Naivasha 50
Nakuru 51
47

Marsabit 69
Masai 44
Malindi 42
Kalifi 41
Diani Beach 40
Cell Phone Code (use in place of city code)
072X = Safaricom
073X = CelTel
When dialing a cell phone from outside of Kenya drop the first "0", but when dialing a cell
phone from a cell phone or a landline within Kenya keep the "0" (e.g. from the U.S.: 011-254-
722-xxx-xxx for a cell phone, and for a landline 254-20-363-6170. From within Kenya dialing a
cell phone from a landline or from another cell phone, dial 072x-xxxxxx).
Landline numbers may be 5, 6, 7, or 8 digits long. Cellular telephone numbers are 6 digits after
the 4-digit "city/cell" code.
48

POLICIES

Vehicle Use Policy in Kenya for ALL Indiana University Personnel
The policies of Indiana University prohibit travel in 12-15 seat vans anywhere in the
world. IU’s policy is very clear: 12-passenger and 15-passenger vans will not be
used by any Indiana University personnel (faculty, staff, or student).
Furthermore, any person found in violation of this policy is
subject to the university's disciplinary policies. In addition, any
person who violates this policy will be deemed to be acting
outside the scope of the Trustees Officer's Liability Insurance
policy. In the event of a claim or suit arising from an accident
involving the use of a 12-passenger or 15-passenger van
employees and/or agents in violation of this policy will not be
indemnified.
If a 12 or 15 passenger van arrives to transport me and/or any of my fellow travelers while I am
in Kenya and participating in any IU Kenya elective or program, I will make other arrangements
for transportation. I understand that the IU Kenya program will either cover the costs of
alternative transportation or reimburse me for the costs of acquiring an alternative form of
transportation to the 12-passenger or 15-passenger van option (receipt required).
I have read these policies and agree to comply.
Printed Name:
Signature:
Date:
50

Adverse Event Reporting
Compliance requirements for use of Eli Lilly & Company donated drugs including Adverse
Event reporting:
An Adverse Event is defined as any undesirable medical occurrence in a patient
administered a Lilly product (drug or device), including side effects already listed in the
package insert.
Any event involving a known or suspected death, counterfeiting, or tampering related to a
human health product of device must be reported immediately (within 24 hours of
receipt).
All other reports must be made within one business day.
Reports of AEs shall be made via FAX to the following number: 27-11-510-9433.
52

POLICY: HOUSING AND BOARD
Indiana University School of Medicine—Moi University
School of Medicine Housing and Board Policies
1) Faculty and residents will be housed at the IU House Compound on a space available basis. Spouses
and dependents may stay on a space available basis.
2) Meals will be served at IU House Sunday evening through Friday. Food for breakfast, lunch and dinner
is available for faculty and residents seven days per week.
3) Medical students: will be placed preferentially in the medical student dormitories at the School of
Medicine. Students will pay $36/week for room. Students are expected to purchase their own food on
a daily basis. The cost of food is anywhere from $2.50 to $10/day. Students should bring enough
money with them to pay for their own food expenses. Note: Do not pay anyone at the hostel for your
room. If asked for payment, please inform Dunia Karama. Medical students with spouses will be
housed at the IU House Compound on a space available basis and will pay $36/day to defray the cost of
room/board and programmatic expenses. Spouses of medical students will pay $20/day, and
dependents will each pay $20/day.
4) Medical Residents from IU School of Medicine and AMPATH Schools of Medicine: will stay at the
IU House Compound and will pay $36/day to defray the cost of room, board, and programmatic
expenses. Spouses will pay $20/day, and dependents will each pay $20/day.
5) All other persons affiliated with the IU School of Medicine or AMPATH Schools of Medicine: will
stay at IU House on a space available basis and will pay $56 per night to defray the cost of room, board,
and programmatic expenses. Spouses will pay an additional $20/day. Dependents will each pay an
additional $20/day. A detailed and prorated schedule of room and board charges is available from Ron
Pettigrew.
6) Any persons affiliated with the IU School of Medicine or AMPATH Schools of Medicine staying
over 30 days: will pay $36/day for the entire length of their stay
7) Persons traveling to Kenya for research projects: room and board rates for research personnel will
be determined. Please check with Ron Pettigrew for the current rate structure.
8) All persons staying at the IU House Compound are expected to pre-pay the charges for room, board and
programmatic expenses. There will be no room and board rebate for time spent away from Eldoret.
Before departing for Kenya, payment should be made to the IU-Kenya Program Office in Indianapolis.
Checks should be made payable to “IIGH, Inc.” and given to Sally Ben-hameda or Ron Pettigrew for
deposit at least two weeks prior to your departure day.
9) IUSM Students and Residents are offered the use of a Kenyan cell phone to be checked out of the IU-
Kenya office before departure with a $70 deposit. Upon return of the cell phone to the IUKP office, the
student or resident will receive his/her $70 deposit back. Check with Ron Pettigrew for more details. If
phones are not available, a mobile phone will be available through the IU House office.
10) Charges for room, board, and programmatic expenses do not include such items as fax, phone usage,
in-country travel, snacks, meals taken away from the IU House, weekend safaris, etc. Persons using
such services or participating in such activities may be charged additional costs as determined by the
Kenya Program Administrator. Invoices for extra charges incurred while in Kenya will be prepared and
invoiced to you before your departure from IU House.
11) All charges are current as of 6/1/2011 but are subject to change without prior notice.
56

POLICY: EVACUATION INSURANCE POLICY
Indiana University School of Medicine - Moi University
School of Medicine Evacuation Insurance Policy
1) Students and residents must currently have* or purchase evacuation
insurance prior to departure (This can be done online). The IU-Kenya
Program suggests that you purchase your evacuation insurance through
either MultiNational Underwriters, Inc (www.mnui.com) or SOS
International (www.sosinternational.com).
* Note: The IU School of Medicine (Aetna) student health insurance
may contain an evacuation policy. It is the responsibility of the
student to know how to access this benefit in the event of an
emergency. It is also the responsibility of each policy holder to
understand the limits, liabilities and exclusions of each policy.
* Note: Evacuation Insurance is provided through IU’s Personal
Accident Insurance plan for those IU Faculty and Staff that
have opted for this during the annual enrollment period.
2) VERIFICATION OF PURCHASE OF EVACUATION INSURANCE IS REQUIRED
PRIOR TO DEPARTURE.
Please provide proof of insurance to the Kenya Program Office at
least two months prior to your departure date.
57

EXCLUSIONS
This Policy does not cover nor provide benefits for:
1. Expenses incurred as a result of dental treatment, except for treatment resulting from injury to sound, natural
teeth or for extraction of impacted wisdom teeth as provided elsewhere in this Policy.
2. Expenses incurred for services normally provided without charge by the Policyholder's Health Service,
Infirmary or Hospital, or by health care providers employed by the Policyholder.
3. Expenses incurred for eye refractions, vision therapy, radial keratotomy, eyeglasses, contact lenses (except
when required after cataract surgery), or other vision or hearing aids, or prescriptions or examinations except
as required for repair caused by a covered injury.
4. Expenses incurred as a result of injury due to participation in a riot. "Participation in a riot" means taking part
in a riot in any way, including inciting the riot or conspiring to incite it. It does not include actions taken in
self-defense, so long as they are not taken against persons who are trying to restore law and order.
5. Expenses incurred as a result of an accident occurring in consequence of riding as a passenger or otherwise
in any vehicle or device for aerial navigation, except as a fare-paying passenger in an aircraft operated by a
scheduled airline maintaining regular published schedules on a regularly established route.
6. Expenses incurred as a result of an injury or sickness due to working for wage or profit or for which benefits
are payable under any Workers' Compensation or Occupational Disease Law.
7. Expenses incurred as a result of an injury sustained or sickness contracted while in the service of the Armed
Forces of any country. Upon the Covered Person entering the Armed Forces of any country, the unearned
pro-rata premium will be refunded to the Policyholder.
8. Expenses incurred for treatment provided in a governmental hospital unless there is a legal obligation to pay
such charges in the absence of insurance.
9. Expenses incurred for elective treatment or elective surgery except as specifically provided elsewhere in this
Policy and performed while this Policy is in effect.
10. Expenses incurred for cosmetic surgery, reconstructive surgery, or other services and supplies which improve,
alter, or enhance appearance, whether or not for psychological or emotional reasons, except to the extend
needed to:
• Improve the function of a part of the body that:
• is not a tooth or structure that supports the teeth, and
• is malformed.
• as a result of a severe birth defect, including harelip, webbed fingers, or toes, or
• as direct result of:
• disease, or
• surgery performed to treat a disease or injury.
Repair an injury (including reconstructive surgery for prosthetic device for a Covered Person who has
undergone a mastectomy,) which occurs while the Covered Person is covered under this Policy. Surgery
must be performed:
• in the calendar year of the accident which causes the injury, or
• in the next calendar year.
11. Expenses incurred as a result of preventive medicines, serums, vaccines or oral contraceptive.
12. Expenses incurred as a result of commission of a felony.
58

13. Expenses incurred for voluntary or elective abortions unless otherwise provided in this Policy.
14. Expenses incurred after the date insurance terminates for a Covered Person except as may be specifically
provided in the Extension of Benefits Provision.
15. Expenses incurred for services normally provided without charge by the school and covered by the school fee
for services.
16. Expenses incurred for any services rendered by a member of the Covered Person's immediate family or a
person who lives in the Covered Person's home.
17. Expenses incurred for injury resulting from the play or practice of collegiate or intercollegiate sports, including
collegiate or intercollegiate club sports and intermurals.
18. Expenses incurred by a Covered Person not a United States Citizen for services performed within the Covered
Person's home country.
19. Expenses for allergy serums and injections.
20. Treatment for injury to the extent benefits are payable under any state no-fault automobile coverage, first party
medical benefits payable under any other mandatory No-fault law.
21. Expenses for the contraceptive methods, devices or aids, and charges for or related to artificial insemination,
in-vitro fertilization, or embryo transfer procedures, elective sterilization or its reversal or elective abortion
unless specifically provided for in this Policy.
22. Expenses for treatment of injury or sickness to the extent that payment is made, as a judgment or settlement, by
any person deemed responsible for the injury or sickness (or their insurers).
23. Expenses incurred for experimental or investigative procedures.
24. Expenses incurred for which no member of the Covered Person's immediate family has any legal obligation
for payment.
25. Expenses incurred for custodial care. Custodial care means services and supplies furnished to a person mainly
to help him or her in the activities of daily life. This includes room and board and other institutional care. The
person does not have to be disabled. Such services and supplies are custodial care without regard to:
• by whom they are prescribed, or
• by whom they are recommended, or
• by whom or by which they are performed.
26. Expenses incurred for blood or blood plasma, except charges by a hospital for the processing or administration
of blood.
27. Expenses incurred for the repair or replacement of existing artificial limbs, orthopedic braces, or orthotic
devices.
28. Expenses incurred for or in connection with: procedures, services, or supplies that are, as determined by Aetna,
to be experimental or investigational. A drug, a device, a procedure, or treatment will be determined to be
experimental or investigational if:
• There are insufficient outcomes data available from controlled clinical trials published in the peer
reviewed literature, to substantiate its safety and effectiveness, for the disease or injury involved, or
• If required by the FDA, approval has not been granted for marketing, or
• A recognized national medical or dental society or regulatory agency has determined, in writing, that it is
experimental, investigational, or for research purposes, or
59

• The written protocol or protocols used by the treating facility, or the protocol or protocols of any other
facility studying substantially the same drug, device, procedure, or treatment, or the written informed
consent used by the treating facility, or by another facility studying the same drug, device, procedure, or
treatment, states that it is experimental, investigational, or for research purposes.
However, this exclusion will not apply with respect to services or supplies (other than drugs) received in
connection with a disease, if Aetna determines that:
• The disease can be expected to cause death within one year, in the absence of effective treatment, and
• The care or treatment is effective for that disease, or shows promise of being effective for that disease, as
demonstrated by scientific data. In making this determination, Aetna will take into account the results of a
review by a panel of independent medical professionals. They will be selected by Aetna. This panel will
include professionals who treat the type of disease involved.
Also, this exclusion will not apply with respect to drugs that:
• Have been granted treatment investigational new drug (IND), or Group c/treatment IND status, or
• Are being studied at the Phase III level in a national clinical trial, sponsored by the National Cancer
Institute, or
• Are recognized for treatment of the indication of at least one standard reference compendium, or
• Are recommended for that particular type of cancer and found to be safe and effective in formal clinical
studies, the results of which have been published in a peer reviewed professional medical journal published
in the United States or Great Britain. If Aetna determines that available, scientific evidence demonstrates
that the drug is effective, or shows promise of being effective, for the disease.
29. Expenses incurred for gastric bypass, and any restrictive procedures, for weight loss.
30. Expenses incurred for breast reduction/mammoplasty.
31. Expenses incurred for gynecomastia (male breasts).
32. Expenses incurred by a Covered Person, not a United States citizen, for services performed within the
Covered Person’s home country, if the Covered Person’s home country has a socialized medicine program.
33. Expenses incurred for acupuncture, unless services are rendered for anesthetic purposes.
34. Expenses for: (a) care of flat feet, (b) supportive devices for the foot, (c) care of corns, bunions, or calluses, (d)
care of toenails, and (e) care of fallen arches, weak feet, or chronic foot strain, except that (c) and (d) are not
excluded when medically necessary, because the Covered Person is diabetic, or suffers from circulatory
problems.
35. Expenses incurred for hearing aids, the fitting, or prescription of hearing aids.
36. Expenses incurred for hearing exams.
37. Expenses for care or services to the extent the charge would have been covered under Medicare Part A or Part
B, even though the Covered Person is eligible, but did not enroll in Part B.
38. Expenses for telephone consultations, charges for failure to keep a scheduled visit, or charges for completion of
a claim form.
39. Expenses for personal hygiene and convenience items, such as air conditioners, humidifiers, hot tubs,
whirlpools, or physical exercise equipment, even if such items are prescribed by a physician.
40. Expenses for services or supplies provided for the treatment of obesity and/or weight control.
41. Expenses for incidental surgeries, and standby charges of a physician.
60

42. Expenses for treatment and supplies for programs involving cessation of tobacco use.
43. Expenses incurred for massage therapy.
44. Expenses incurred for, or related to, sex change surgery, or to any treatment of gender identity disorder.
45. Expenses for charges that are not Reasonable Charges, as determined by Aetna.
46. Expenses for charges that are not Recognized Charges, as determined by Aetna, except that this will not apply
if the charge for a service, or supply, does not exceed the Recognized Charge for that service or supply, by
more than the amount or percentage, specified as the Allowable Variation.
47. Expenses for treatment of covered students who specialize in the mental health care field, and who receive
treatment as a part of their training in that field.
48. Expenses for treatment of injury or sickness to the extent payment is made, as a judgment or settlement, by any
person deemed responsible for the injury or sickness (or their Insurers).
49. Expenses arising from a Pre-Existing Condition, unless (a) no charges are incured or treatment rendered for
the condition for a period of six months while covered under this Policy, or (b) the Covered Person has been
covered under this Policy for twelve consecutive months, whichever happens first.
50. Expenses for routine physical exams, including expenses in connection with well newborn care, routine vision
exams, routine dental exams, routine hearing exams, immunizations, or other preventive services and supplies,
except to the extent coverage of such exams, immunizations, services, or supplies is specifically provided in the
Policy.
51. Expenses incurred for a treatment, service, or supply, which is not medically necessary, as determined by
Aetna, for the diagnosis care or treatment of the sickness or injury involved. This applies even if they are
prescribed, recommended, or approved, by the person’s attending physician, or dentist.
In order for a treatment, service, or supply, to be considered medically necessary, the service or supply must:
• be care, or treatment, which is likely to produce a significant positive outcome as, and no more likely to
produce a negative outcome than, any alternative service or supply, both as to the sickness or injury
involved, and the person's overall health condition,
• be a diagnostic procedure which is indicated by the health status of the person, and be as likely to result in
information that could affect the course of treatment as, and no more likely to produce a negative outcome
than, any alternative service or supply, both as to the sickness or injury involved, and the person's overall
health condition, and
• as to diagnosis, care, and treatment, be no more costly (taking into account all health expenses incurred in
connection with the treatment, service, or supply), than any alternative service or supply to meet the above
tests.
In determining if a service or supply is appropriate under the circumstances, Aetna will take into consideration:
information relating to the affected person's health status, reports in peer reviewed medical literature, reports
and guidelines published by nationally recognized health care organizations that include supporting scientific
data, generally recognized professional standards of safety and effectiveness in the United States for diagnosis,
care, or treatment, the opinion of health professionals in the generally recognized health specialty involved, and
any other relevant information brought to Aetna's attention.
In no event will the following services or supplies be considered to be medically necessary:
• those that do not require the technical skills of a medical, a mental health, or a dental professional, or
• those furnished mainly for the personal comfort or convenience of the person, any person who cares for
him/her, or any persons who is part of his/her family, any healthcare provider, or healthcare facility, or
• those furnished solely because the person is an inpatient on any day on which the person's sickness or
injury could safely, and adequately, be diagnosed, or treated, while not confined, or those furnished solely
because of the setting, if the service or supply could safely and adequately be furnished in a physician's or
a dentist's office, or other less costly setting.
61

Any exclusion above will not apply to the extent that coverage of the charges is required under any law that applies
to the coverage.
62

Policy: Travel
Indiana University School of Medicine - Moi University
School of Medicine Vehicle Policies
1) In-country transportation between Nairobi and Eldoret is the responsibility of
the program participant.
2) MTS Travel is the suggested international flight travel agent for program
participants.
3) A travel itinerary must be provided to Ron Pettigrew or Sally Ben-hameda
two months prior to departure and reconfirm with our office at least two
weeks prior to departure
4) It is the participant’s responsibility to communicate with the Kenya Program
Administrator (Dunia Karama) in Kenya about his or her arrival time in
Nairobi. The traveler is responsible for understanding his or her pick-up
arrangements at Nairobi airport. The participant must communicate with
Dunia Karama (with a cc to Ron Pettigrew eight or more weeks before arrival
in Nairobi at iuadmin@iukenya.org.
5) The policies of Indiana University prohibit travel in 12-15 seat vans anywhere
in the world. IU’s policy is very clear: 12-passenger and 15-passenger vans
will not be used by Indiana University personnel.
Furthermore, any person found in violation of this policy is subject to
the university's disciplinary policies. In addition, any person who
violates this policy will be deemed to be acting outside the scope of the
Trustees Officer's Liability Insurance policy. In the event of a claim
or suit arising from an accident involving the use of a 12-passenger or
15-passenger van employees and/or agents in violation of this policy
will not be indemnified.
64

Policy: Waiver of Liability
Indiana University School of Medicine - Moi University
School of Medicine Waiver of Liability Policy
1) Students and residents must sign and return to Sally Ben-hameda or
Ron Pettigrew the waiver of liability document known as “Guidelines for
International Electives and Experiences” (pages 36-44). Students (not
residents) will also be responsible for signing and returning to Sally Benhameda
or Ron Pettigrew the “Agreement and Release Form” from Indiana
University at least two months before your scheduled departure.
65

POLICY: VACATION
Indiana University School of Medicine-Moi University
School of Medicine Vacation Policy
1) Residents: While in Kenya, each resident MUST take at least one week of
his/her allotted vacation time. S/he may take up to two weeks of vacation, but
all vacation days must be reported to the residency program director.
** Note: Travel time to and from Kenya is not included in vacation time.
2) Fourth Year Students: An elective unit in the fourth year equals one
calendar month, which represents 4 academic credits. All units begin on the
first day of the month and end on the last day of the month. An elective
entails a full-time program which may include night call and/or weekend call.
Holiday, weekend and night call scheduling is arranged by the course director.
During the fourth year, a brief time off (1-3 days) for interviewing is at the
discretion of the course director and may or may not be granted. Students are
to use vacation months for interviewing. Time off from course work in a
third or fourth year elective for any reason (except national examinations
and commencement activities) may not exceed 3 days. If additional time
off is needed for personal problems, the student should contact the Medical
Student Academic Affairs Office to request a Leave of Absence or schedule a
Vacation unit. When not involved with clinical, laboratory or classroom
scheduled activities, it is expected that appropriate time will be used by the
student for reading, analyzing and reviewing course work.
3) All students on a 2 month rotation will be allowed five (5) days vacation. If
the student chooses to take a half day for a weekend trip, this half day will
count as a full vacation day.
4) ** Note: Travel time to and from Kenya is not included in the 5 days of
vacation. Students must arrive by the 3 rd of the month. Any exceptions
should be discussed with Ron Pettigrew and either the medicine field
director, pediatrics field director or the IU OB/GYN field director in
Kenya.
66

POLICY: GRADING
Indiana University School of Medicine-Moi University School of Medicine Student
Grading Policy
1) Requirements for the course include a written evaluation by preceptor and a report
of minimum 10 pages, double spaced, 12 pt. font.
** All student essays should be submitted electronically within 15 days of return
to the US from Kenya. **
2) Optional requirement is a research project.
3) Grading Policy
Pass: Satisfactory participation as judged by course director and by preceptor in
country and satisfactory report
High Pass: Above average participation and above average report
Honors: Exemplary participation and performance and excellent report
67

POLICY: TUBERCULOSIS SCREENING
1) All IU staff, faculty members, residents and students are required to have tuberculin skin
testing (PPD) within 12 months before departure for Eldoret.
2) All IU travelers are required to be evaluated by occupational health three months after
return from Eldoret.
3) Those travelers whose PPD was negative before departure for Eldoret are required to
have the PPD rechecked 3 months after return.
4) Those travelers whose PPD was positive before departure will be required to complete a
symptom questionnaire, and CXR if indicated.
5) This policy is effective immediately.
68

COMPETENCIES
All 4 th year medical students participating in the Kenya elective are
eligible to register for the following competencies:
(1) III. Competency #3 – Using Science to Guide Diagnosis, Management,
Therapeutics, and Prevention
Basic Overview: The competent graduate knows and can explain the
scientific underpinnings, at the molecular, cellular, organ, whole body, and
environmental levels for states of health and disease based upon current
understanding and cutting-edge advances in contemporary basic science.
The graduate uses this information to diagnose, manage and present the
common health problems of individuals, families, and communities in
collaboration with them. The graduate develops a problem list and
differential diagnosis, carries out additional investigations, chooses and
implements interventions with consultation and referral as needed,
determines outcome goals, recognizes and utilizes opportunities for
prevention, monitors progress, shares information and educates, and
adjusts therapy and diagnosis according to results.
To Attain Level 3 in this Competency:
The advanced student will be able to:
A. Meet the Criteria for Assessment for this competency in those
situations that are less common, more complicated, and more
problematic. They will be attuned to subtle cues and nuances.
B. Demonstrate an integrated approach to the care of individuals in the
context of their families and communities, taking advantage of
opportunities for prevention and education in addition to the
immediate physical cure.
C. Exhibit clinical decision analysis that weighs the risks and benefits of
proposed interventions in complex situations.
D. Demonstrate the ability to teach others how to use science to guide
diagnosis, management, and prevention.
E. In a 10 page paper, summarize your analysis of a specific health
problem in Kenya, including its etiology, pathogenesis, epidemiology,
clinical presentation, treatment, control, and prevention if relevant.
70

VIII. Competency #8 – Problem Solving
Basic Overview: The competent graduate recognizes and thoroughly
characterizes a problem. The graduate develops an informed plan of
action, acts to resolve the problem, and subsequently assesses the results
of his/her action.
To Attain Level 3 in this Competency: Level 3 students will take
appropriate steps to address multi-dimensional problems of a biomedical
nature that require a detail knowledge base. Students should be able to
integrate the basic sciences and clinical aspects of medicine with
knowledge of the behavioral sciences, spanning the spectrum from the
molecular to the community level and from conception to old age. Using
well-developed problem-solving frameworks and tools that facilitate
activation and integration of the other knowledge bases to accomplish the
above problem-solving criteria.
To Attain Level 3 in this Competency:
Complete satisfactorily all objectives.
Write a 10 page paper that reflects on each of the objectives.
Please refer to the IU Medical School’s Competency website for more detailed
information on each competency
71

GOALS & OBJECTIVES

Curriculum for the IU-Kenya Partnership
Goals and Objectives for American Residents and
Students in Kenya
GOALS and OBJECTIVES
Each resident and student will:
GOAL 1.
Understand the clinical presentation and management of common diseases in Kenya.
Objective 1.1- Evaluate, manage, and participate in the care of patients admitted to the Medicine or
Pediatrics service on the wards of the Moi Teaching and Referral Hospital.
- Participate in daily work rounds Monday through Friday mornings.
- Participate in all teaching rounds
- Participate in all relevant conferences and seminars.
- Perform daily an initial history and physical on at least one new patient admitted to the
Medicine or Pediatric service at the Moi Teaching and Referral Hospital.
- Participate in ward activities from 2PM to 5PM, Monday through Friday except when
involved in clinical outreach programs, or a research project.
Objective 1.2. Evaluate, manage, and participate in the care of patients presenting to the ambulatory
clinics at the Moi Teaching and Referral Hospital. The amount of time spent in the ambulatory clinics
will be at the discretion of the Medical Liaison.
Objective 1.3. Engage in self-directed learning. A significant portion of evening hours Monday
through Friday should be dedicated to self-directed learning.
GOAL 2.
Become more proficient in history and physical examination skills.
Objective 2.1. Deliver diagnostic and therapeutic services in the "technology-poor" environment of
Eldoret, Kenya.
GOAL 3.
Understand the structure of medical care delivery and education in Kenya.
Objective 3.1. Participate in the delivery of clinical and educational services at one of the rural health
centers and at one of the urban health centers in the Eldoret area.
Objective 3.2. Participate in community outreach programs in conjunction with the community-based
experience and service (COBES) program at MUSM.
Objective 3.3. Observe at least one group tutorial at MUSM.
Objective 3.4. Visit the campus of Moi University.
GOAL 4.
Understand the concept of primary health care and correlate the theory of primary health care with the practice
of primary health care.
Objective 4.1. Participate in four hours of lectures/small group discussions prior to the elective that
provide an introduction to primary health care and cross-cultural understanding.
Objective 4.2. Read the booklet of reprints/articles about primary health care that is provided to each
student/resident.
GOAL 5.
Relate Kenyan culture to health.
Objective 5.1. Read a history of Kenya.
Objective 5.2. Read contemporary news articles in Kenya.
Objective 5.3 Read the books listed on the "suggested reading list" provided to each resident/student.
74

Objective 5.4. Discuss with the faculty preceptor(s) in Eldoret the relationships of social, political,
and economic factors to health in Kenya and the U.S.A.
GOAL 6.
Reflect on differences and similarities in the American and Kenyan systems of health care delivery and
education.
Objective 6.1. Meet at least weekly with the Medical Liaison to review and discuss progress,
perspectives, and insights.
GOAL 7.
Demonstrate effective cross-cultural communication skills, knowledge, and attitudes.
Objective 7.1. Dress in a manner that reflects an understanding of and respect for the local culture,
e.g., men will usually wear shirts and ties and sport coats/white coats, women will wear dress slacks or
dresses below the knee/white coats.
Objective 7.2. Develop a rudimentary ability to speak Kiswahili.
Objective 7.3. Participate in orientation seminars prior to traveling to Kenya.
GOAL 8.
Develop collegial relationships and personal friendships with Kenyan health care professionals and students.
Objective 8.1. Interact professionally and socially with his/her counterpart(s).
Objective 8.2. Participate as a member of a medical team on the wards of the Moi Teaching and
Referral Hospital
GOAL 9.
Be supportive of his/her Kenyan counterparts.
Objective 9.1. Question one’s own assumption(s) when tempted to offer a solution(s) to a perceived
problem(s).
Objective 9.2. Demonstrate respect for the Kenyan medical officer/intern who is the primary care
physician responsible for the management of patients at the Moi Teaching and Referral Hospital.
GOAL 10.
Minimize risks to personal health.
Objective 10.1. Avoid traveling after dark.
Objective 10.2. Avoid traveling in unsafe vehicles.
Objective 10.3. Take all recommended immunizations and malaria prophylaxis
Objective 10.4. Purchase or ensure the ownership of evacuation insurance prior to departure.
GOAL 11.
Keep a daily journal.
Objective 11.1. Write daily in a diary.
GOAL 12.
(Residents Only)
Each resident will participate in the teaching of Kenyan students.
Objective 12.1 Assist Kenyan medical students with their daily patient notes.
Objective 12.2. Provide guidance as needed for Kenyan students with their H&P's ("clerking
patients") with an emphasis on creating problem lists and differential diagnoses.
Objective 12.3. Lead or facilitate teaching sessions/discussions concerning interesting
patients/problems.
Objective 12.4. Provide guidance as needed for students performing procedures.
GOAL 13.
Abide by Team and School Guidelines
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Objective 13.1. (Medical Students)
IU School of Medicine policy states that time off from course work in a fourth year elective for any
reason may not exceed three days/month.
Objective 13.2. (Medical Students)
Given Objective 13.1, it is expected that vacation time during the Kenya elective for medical students
be minimized.
Objective 13.3. (Residents)
While in Kenya, each resident MUST take at least one week of his/her allotted vacation time. S/he
may take up to two weeks of vacation, but all vacation days must be reported to the residency program
director.
Objective 13.4.
While on elective in Kenya, students and residents should travel in Indiana University vehicles.
Travel in non-university vehicles to destinations outside Eldoret may be done only with authorization
from the Medical Liaison. While on vacation in Kenya, students and residents will travel at their
discretion.
Objective 13.5.
Any resident or student who violates this policy may:
- not receive credit for the elective and/or
- be asked to return to Indiana at his/her expense.
GOAL 14.
Be encouraged to develop, carry out and write up a research project (strongly recommended, not required).
Objective 14.1. Discuss with Dr. Einterz possible research areas and submit a proposal to them.
Objective 14.2. Develop and carry out the research proposal according to standard guidelines and
submit a written report.
GOAL 15.
Submit a written report that reflects on goals 1-13 (required).
Objective 15.1. Submit a written report reflecting on goals 1-13 (minimum length: 10 pages, double
spaced, 12 pt. font). Please submit report electronically.
Competencies
IU’s residency program requires its residents to obtain competencies in six areas. The ensuing list relates the
goals of this elective to the required competencies.
Patient Care: goals 1, 2, 11, 12, 15
Medical knowledge: goals 1, 4, 11, 12, 15
Practice-based learning: goals 4, 11, 12, 15
Interpersonal and communication skills: goals 5, 7, 9, 11, 12, 15
Professionalism: goals 5, 7, 8, 9, 10, 11, 12, 13, 15
Systems-based practice: goals 3, 4, 5, 6, 11, 12, 15
76

TRAVEL PREPARATION

Greetings World Travelers,
I’m working to create a series of unique teaching cases for IUSM students and residents
pursuing electives in foreign countries. The goal is to better prepare everyone for their
experience in various international settings and may even be used as a part of the new Global
Health curriculum for IUSM medical students and residents. This Case Files project will use this
website: http://fromthecasefiles.com/.
By submitting your unique case to the Case Files website, it can live on forever in our
online collection. As images and photos can enhance cases, please include any images (Chest X-
Rays, physical findings) taken and a short PowerPoint presentation if you choose. Please
remember to remove patient identifiers from the radiographic and physical findings used in your
case. The desired format of the case is in normal morning report fashion (HPI, PMH/PSH,
ALL/MEDS, SH/FH/ROS, Vitals/PE) with the addition of a case summary and the inclusion of
two clinical questions for the reader (i.e. On what criteria was the diagnosis made?). Your case
should provide these clinical questions as teaching points for the reader, whether it is a unique
disease process or a site-specific treatment for a common disease. Comparing and contrasting
parts of the case (workup, treatment, etc.) with your experience in the U.S. can be very useful for
the reader. Also please make sure to include what country (e.g. Kenya, Mexico, Honduras) the
case is from in the description.
To contribute your case to this educational website, please follow the link above for the
case files website then use the following login information:
Login: iusom
password: crabb
Thank you very much for sharing your cases with us to include!
Sincerely,
Deb Litzelman
Debra K. Litzelman, MA, MD
Director of Education
Indiana University Center for Global Health
78

Jambo Daktaris,
I’m working to create a series of unique teaching cases for students and residents visiting MTRH
from IUSM and other schools around the country. The goal is to better prepare students and residents for
their experience on the wards and may even be used to help the Kenyan medical students in their
transition from the classroom to the wards in the 4th year if Moi University School of Medicine if
interested. This Case Files project will use this website: http://fromthecasefiles.com/.
You will attend the Morning Report, every Tuesday and Thursday during your rotation in Kenya.
You will even have the opportunity to present one morning report case. However, this doesn’t have to be
the last time your case is reviewed. By submitting your case to the Case Files website, it can live on
forever in our online collection. As images and photos can enhance cases, please include any images
(Chest X-Rays, physical findings) taken and any PowerPoint presentations given along with the talk. I
have been granted preliminary IREC approval for this project at MTRH so images of radiographic and
physical findings (both without patient identifiers) can be used.
Kelvin Ogot is the manager of PACS at MTRH and has graciously agreed to help you track down
imaging on your patients if you provide him with their patient name or number. His email is:
kelvin.ogot@gmail.com
The desired format of the case is in normal morning report fashion with the addition of a case
summary and the inclusion of two clinical questions for the reader (i.e. On what criteria was the diagnosis
made?) If you would like to contribute your case to this educational website, follow the link above for the
case files website then use the following login information:
Login: iusom
password: crabb
Thank you very much for sharing your cases with us to include!
Sincerely,
Deb Litzelman
Debra K. Litzelman, MA, MD
Director of Education
Indiana University Center for Global Health
80

Indiana University-Kenya Partnership
EXAMPLE OF A TYPICAL WEEK FOR VISITING
MEDICAL STUDENTS AND RESIDENTS
Medical Academic Calendar
January 2011
Monday Tuesday Wednesday Thursday Friday
Pre-rounding (7-8) Pre-rounding (7-8) Pre-rounding (7-8) Pre-rounding (7-8) Pre-rounding (7-8)
Rounding
AM Report (8-9)
Peds and Medicine
Department
Conference* (8-9)
AM Report (8-9)
Rounding
Sally Test (12-1p)
Rounding
Rounding
Rounding
Sally Test (12-1P)
Tumaini Health
Talk (2-3pm)
Case Discussions
(2P)
Case discussions
(2P)
Peds Registrar
Lecture (3:00P)
Cardiology Lecture
in Ampath lecture
rooms (3:30P)
Patient care (postrounds
until 5pm)
Patient care (postrounds
until 5pm)
Patient care (postrounds
until 5pm)
Patient care (postrounds
until 5pm)
Patient care (postrounds
until 5pm)
Fireside Chat
(7:30-8:30P)
82

One afternoon per week may be allocated to a non-ward activity, pending Registrar approval. This should
take place on a non-admitting afternoon.
Non-ward activities include:
1. Visit Rural HIV Clinics/AMPATH sites (see above time/place for options and need to discuss
Medicine opportunities with Medical Team Leader or J. Mamlin and Pediatric opportunities with
Peds. Team Leader). This clinical activity may be a full day session
2. Specialty Clinics w/ Medicine and Pediatrics Attendings are available (Chest Clinic, Heme/Onc
Clinic, Diabetes Clinic, etc.)
3. Learn about Family Preservation Initiative (FPI), a program to help improve the economic
stability of HIV-affected families, including a visit to the Imani Workshop
4. Learn about HAART and Harvest Initiative (HHI), a program for food-insecure HIV-affected
families, including a visit to an AMPATH Farm and food distribution sites, and/or attendance at
community based nutrition classes
5. Monthly HIV Community Education Workshops at Imani (students to be involved in
presentation)—1 st Wednesday evening of the month
6. Visit to Orphanage, Women’s Shelters, Support groups, Rehabilitation Center
We are open to other ideas for improvement in your rotations/educational experience/fun
*Students and Residents--Present interesting cases from wards for Morning Report. Projector available
if interested—please inform the Team Leader 2 days in advance if this will be needed.
Team Leader: Geren Stone Cell: 0724-679-898
Laura Ruhl Cell: 0728-279-002
Joe Mamlin Cell: 0722-374-558
Taxi Numbers: Cha Cha Cell: 0721-215-074
83

MSIV Students
Expectations on Medicine (required for minimum of 4 weeks) 1
Prior to arrival or on arrival, brief explanation of why you have taken this rotation, career interests, and expected
arrival/leave dates (2-3 paragraphs) – email to gsstone@iupui.edu
Prior to leaving, fill out the form documenting the date of each activity attended while in Kenya.
Required Participation
Morning Report
Basic Structure – 30 minute case presentation (morning report format), 15 minute presentation on relevant topic, 15
minute presentation by pharmacy student (if applicable)
Case to be shared with Pharmacy Student at least 2-3 days in advance of presentation – contact Sonak for
appropriate pharmacy student.
Presentation to have accompanying brief write-up of the case (relevant parts of the medical presentation and history,
images of unique findings encouraged), the diagnostics (with images if possible), the treatments. These are to be
emailed to the Adult and Pediatric TL for review, and final revisions will be given as a PowerPoint to TL through
email. Eventually these will be uploaded to a web-based case presentation program, and compiled for a manual of
medicine in Eldoret.
Rounding with Team
Participating in admission on admitting days – pick up 1-2 patients to follow during each admitting day
Please turn in list with bi-weekly reports of clerked patients and diagnoses (even tentative)
Attendance at least 1 remote AMPATH clinic (assignments below, and contact me if interested in additional time – this
may or may not be possible)
Burnt Forest (Thursdays, 9AM-3PM), with John Sidle – call John @ 0728217901 to arrange pick-up
Mosoriot (Wednesdays, early-late), with Joe Mamlin – 07:45 Joe's House
Turbo (Fridays, morning), with Joe Mamlin – 08:00 Joe's House
Attend Interesting Case Rounds (Tuesday and Thursday, 2PM)
Attend both medicine and pediatrics. Peds limited to 6 people.
Be ready to present on one case each day
Sally Test Center Parent Talk (Monday, Friday 12-1pm)
Give one presentation about health topic of your choice. See schedule below and handout for more information.
Please pick your topic and prepare your handout 1 week in advance.
Tumaini Center Adolescent Health Talk (Monday 2-3pm)
Tumaini Center is a drop-in center for street children near IU House.
Give one presentation about relevant health topic of your choice. See schedule below and handout for more
information. Please pick your topic and prepare your handout 1 week in advance.
Attendance at Fireside Chats (Thursday 7.30PM)
Discussion of public health, social or cultural topics. Topic listed each week in Food House. Read relevant articles
before discussion.
Participation in the Heart and Harvest Initiative (HHI)
Visit to Buffett Farm. Manual labor volunteer work.
Contact: Abraham Boit - HHI Manager - in charge of all AMPATH food production farms.
Wear work clothes. Bring sunscreen, water. There is limited space to store belongings.
Monday mornings from 9-1 pm. Sign-up at least one week in advance – sign-up sheet is in the computer room.
Visit Imani Workshops
Thursday 3:30-5pm. Sign-up at least one week in advance – sign-up sheet is in the computer room.
Visit to Neema House, children’s orphanage
Wednesday afternoons from 2-5 pm. Sign-up at least one week in advance – sign-up sheet is in the computer
room.
Optional Activities:
Volunteer at Tumaini Center
1 The remaining 3-4 weeks will be spent on either Peds or divided between Medicine and pre-arranged non-med/peds observational experiences
– faculty availability dependant. The default is medicine – the Pediatric TL may facilitate additional time in Peds on an individual basis.
84

Monday, Wednesday 2-5pm. You must attend an orientation prior to volunteering (given every Monday at 4:30).
Sign-up sheet is in the computer room.
Weekly Events
Monday Tuesday Wednesday Thursday Friday
Tumor Board
(7-8:30a) MBH
conference room
AM Report (8-9)
Peds Department
Conference* (8-9)
AM Report (8-9)
Rounding
Rounding
Rounding
Rounding
Rounding
Sally Test (12-1p)
Sally Test (12-1P)
Tumaini Health Talk
(2-3pm)
Interesting Cases (Med
2P)
Interesting Cases (Peds
2P)
Resident Lecture
(3:30P)
Fireside Chat (7:30-
9P)
* Peds Department Conf: !st Wednesday – consultants only, 2 nd – mini grand rounds, 3 rd – mortality, 4 th – radiology rounds
Other Clinical Opportunities Weekly (no promises if these are happening, so be flexible)
Monday Tuesday Wednesday Thursday Friday
9-3 Medical Oncology
(adult and peds)
(AMPATH Basement)
9-12 CC Screening +
FP + Ante-natal Care
Module 1, Rm5
9-12 AMPATH TB
Clinic Module 2
(corner, Rm 15 or 50),
Diero, Rn Daisy
Module 1 Kiboi (CO)
9-12 CC Screening +
FP + Ante-natal Care
Module 1, Rm5
9-12 General
Medicine (MTRH
Outpt)
9-2 Gyn Clinics
MTRH
2-4:30pm Cardiology
Clinic (MTRH)
2-4:30pm Warfarin
Clinic
Morning Report Presentation Schedule
9-12 CC Screening +
FP + Ante-natal Care
Module 1, Rm5
9-12 Pediatric
Oncology (AMPATH
Basement, every other
Wednesday)
9-2 Gyn Clinics
MTRH
9-12 CC Screening +
FP + Ante-natal Care
Module 1, Rm5
9-12 General Medicine
(MTRH Outpt)
12-5 Pulmonary Clinic
(MTRH Outpt)
7:30-4 Diabetes Clinic
(Webuye, contact
Sonak Pastakia –
Purdue Faculty)
9-12 Gyn Procedures –
LEEP, Colposcopy,
Punch Bx Module 1,
Rm 5
12-1 AMPATH
Complex Gyne Case
Clinic Module 1, Rm 5
Morning Report (Tuesday Morning 8-9) Report (Thursday 8-9)
8/2-8/6 Strother None
8/9-8/13 Reilly Anderson
8/16-8/20 Sherif
OB (Macdonald)
8/23-8/27 Cole Evans
8/30-9/3 Mecca
85

Sally Test Presentation Schedule
Sally Test (Monday 12-1) Sally Test (Friday 12-1)
8/2-8/6 N/A N/A
8/9-8/13 Ravindron Hudson
8/16-8/20 Evans Mecca
8/23-8/27 Quadri
Sherif
8/30-9/3 Cole Anderson
Tumaini Center Adolescent Talks
8/2-8/6 N/A
8/9-8/13 Reilly
8/16-8/20
8/23-8/27 Cole
8/30-9/3
Monday 2:00PM
Quadri
Sherif
Remote AMPATH Clinic Schedule
Wednesday (Joe) Thursday (Sidle) Friday (Joe)
8/2-8/6 N/A N/A
8/9-8/13 Anderson Sherif
Cole
8/16-8/20 Evans Mecca Hudson
8/23-8/27 Ravindron
Quadri
Reilly
8/30-9/3 MacDonald
86

How to Give a Sally Test Center Parent Talk
During your rotation, you will be asked to discuss a health topic of your choice at the Sally Test Center. These talks are scheduled
on Monday and Friday from 12-1. Medical students may be paired with MPH students to give a talk together – residents are
scheduled alone. Parents (primarily mothers) of pediatric patients at MTRH make up the majority of the audience. Although
there are parents that attend several sessions because their child requires a long hospitalization, most of the audience is transient.
Also, much of the audience has minimal health education.
Here are some general tips on how to prepare:
1. Choose a topic that interests you. Previous speakers have chosen a wide variety of topics ranging from
diarrhea/sanitation to hypertension to the importance of reading to your child. We suggest choosing a topic you feel
passionate about and comfortable discussing with a group. Attached is a list of suggested topics – do not limit yourself to
this list.
2. Prepare a handout regarding your topic in advance of your scheduled date. These handouts should be brief (less
than 1 page) and the language should be simple (2-3 grade level). They should contain the most important points you
want your audience to remember. Check with Sarah Ellen to see if a handout about your topic has already been prepared
and just needs updating. Looking at previous handouts can also help you brainstorm about your topic.
3. The handouts should be turned in to Ernest one week prior to your scheduled date. You can email your document to
Ernest at kimue1950@yahoo.com.They will then be translated into Kiswahili and photocopied by the STC staff.
4. List your chosen topic and phone number on the schedule posted in the STC at least one week prior to your
scheduled date. Talk to Marisa (pediatric team leader) or Sarah Ellen Mamlin to make sure your topic hasn’t been
recently addressed. If you switch your date with someone else, do so at least one week in advance.
5. Start by introducing yourself. Include where you’re from, your role within the AMPATH consortium (medical student,
etc.), and how long you’ve been in Kenya.
6. Talk generally about your topic for approximately 15-20 minutes. Start by defining your topic and listing the
objectives of your talk. End with general recommendations regarding treatment and/or prevention.
7. Speak in short sentences so that your interpreter is able to translate effectively. Often, translation from English to
Kiswahili requires the translation of concepts, which takes time. Don’t be concerned if the translation takes several
minutes longer than your statement.
8. Make sure to leave plenty of time for audience questions. This is the best part of the talk! The questions are often
very interesting and provide insight into community beliefs. Our primary interpreter, Joseph Okuyu, is a trained nurse
and has years of experience working with the different communities in Western Kenya. He understands many of the
prevalent community beliefs regarding health and will guide you through this part of your presentation.
9. Don’t be afraid to say you don’t know. You can’t prepare for all the questions you will be asked. Try turning the
question back to the audience – this encourages good group discussion.
Speakers almost universally appreciate this experience. Please let us know if you have any other questions. Asante sana!
87

Possible STC Parent Talk Topics
Specific diseases:
Asthma
Eye Diseases
Malaria
Tuberculosis
Respiratory Infections
Meningitis
HIV/AIDS
Sexually Transmitted Infections
Renal Failure
Cancer
COPD
Hypertension
Sickle Cell Disease
Rheumatic Heart Disease/ Congestive Heart Failure
Diarrhea/Dehydration
COPD
Intestinal Worms
Diabetes
Depression
Bipolar Disorder
Alcohol Abuse
Shaken Baby Syndrome
Hydrocephalus/Spina Bifida
Burn – avoidance and care
Anemia
Childhood development:
Breastfeeding
Immunizations
Age Appropriate Nutrition
Developmentally Appropriate Discipline
Child Abuse
Learning Disabilities
Puberty & Adolescence
How to Help a Grieving Child
Women’s Health:
Menarche to Menopause
Communicating with Your Doctor
Contraception
Female Genital Mutilation
Safe pregnancy
Domestic Violence
88

THE TUMAINI PROJECT
BACKGROUND
Tumaini in Kiswahili means hope. The Tumaini Project seeks to improve the lives of street children in Eldoret by empowering
them with hope, knowledge, skills, opportunities and resources to allow them to find a healthy alternative to street life. The
Tumaini Children's Center is a drop-in center in Eldoret where street children can rest, wash, eat, play, learn, and interact in a safe,
positive environment away from the streets.
DESCRIPTION OF THE CHILDREN POPULATION (AGES, TYPICAL BACKGROUND)
Street children roam the streets all day in search of food, money, and friendship. Some are orphaned, but most come from families
who are the poorest of the poor, unable to provide for their children. Living on the street inhibits their growth and development
and puts them at risk for a myriad of infectious diseases. Substance abuse is nearly ubiquitous among street children and most
have been harassed or abused by community members or the police. However, we have found that most street children are not
inherently delinquents or criminals, and are ultimately in need of care and support. These children are living without positive role
models and relationships, missing their opportunity for education, vulnerable to violence and disease, and without access to health
care or other social services. They are fundamentally denied their rights as children by the demands of living a life of survival on
the streets.
NAMES AND ROLES OF TUMAINI EMPLOYEES
1. Samuel Kimani – Program Manager 0723783178
GROUP COORDINATORS
1. Andrew Mwangi – Project Coordinator / Outreach Worker - 0723716444
2. Marion Gitahi - Head Social Worker
SUGGESTIONS OF INTERACTING WITH STREET CHILDREN
What to do;
- Participate in activities to avoid being seen as a spectator.
- Always ask for help before tackling any tasks in the center.
- Leave your belongings at home (including money,watches, cell phones, etc.)
- In case of stolen goods or property report immediately.
- Say no when children demand things, both on the street and at the center.
- If you see a street kid outside the center you recognizes you and you need assistance, call Andrew Mwangi immediately.
What not to do;
- Do not show special preference to a particular child to avoid the notion of discrimination. (ie: DO NOT give gifts,
money, etc. directly to a street child)
- Do not be with a street kid in the center without the presence of a Social Worker or an Outreach Worker.
- Do not give money, gifts, or food stuff directly to the street child - better present them to the office.
- Do not show or tell street kids where you reside.
89

TUMAINI CENTER ADOLESCENT HEALTH TALKS
During your rotation, you will be asked to discuss an adolescent health topic of your choice at the Tumaini Center. These talks are
scheduled each Monday from 2-3. Your audience will be a group of approximately 20 street children ages 7-18 that come to the
drop-in center. Your topic will dictate which age group will make up the majority of your audience.
Here are some general tips on how to prepare:
1. Choose a topic that interests you and is appropriate for your audience. Previous speakers have chosen a wide
variety of topics. We suggest that you choose a topic you feel passionate about and comfortable discussing with a
group. Discuss your chosen topic with Samuel Kimani (phone number on the front of this sheet) one week in
advance to ensure it’s appropriate and will be interesting for the street kids. Below is a list of suggested topics – do
not limit yourself to this list.
2. Start by introducing yourself. Include where you’re from, your role within the AMPATH consortium (medical
student, etc.), and how long you’ve been in Kenya.
3. Talk about your topic for approximately 15 minutes. Start by defining your topic and listing the objectives of
your talk. End with general recommendations regarding treatment and/or prevention.
4. Include games, role plays, or other interactive activities in your session. These children have short attention
spans, so you need to keep them engaged throughout your session. Ask Samuel Kimani and other Tumaini Center
staff for ideas.
5. Speak in short sentences so that your interpreter is able to translate effectively. Often, translation from English
to Kiswahili requires the translation of concepts, which takes time. Don’t be concerned if the translation takes
several minutes longer than your statement.
6. Make sure to leave plenty of time for audience questions. This is the best part of the talk! The questions are
often very interesting and provide insight into community beliefs.
7. Don’t be afraid to say you don’t know. You can’t prepare for all the questions you will be asked. Try turning the
question back to the audience – this encourages good group discussion.
8. Be culturally relevant. Ask questions before your talk so you understand what therapies are available, etc.
Specific diseases:
HIV/AIDS
Sexually Transmitted Infections
Diarrhea/Dehydration
Malaria
Tuberculosis
Respiratory Infections
Intestinal Worms
Asthma
Depression
Alcohol use
Drug use
Burn – avoidance and care
Life Skills:
Hygiene
Peer pressure
Nutrition
Domestic Violence
Contraception
Possible Adolescent Health Talk Topics
90

Global Health CaseFiles “How-To” Guide (as of July 5, 2010)
1. Go to fromthecasefiles.com.
2. To join, enter your information in the form on the right-hand side of the main page.
3. Login and select “Global Health” from the drop-down menu.
4. Select a case and go through each tab to get an idea for the required case format.
5. Prepare your case in a Word document in the following format:
o Case Info
o Author: YOU
o Title: Example – “Cardiovascular Conundrum in a Kenyan Female”
o Institution: Moi Teaching and Referral Hospital (for Kenya cases)
o Chief Complaint: Example –“Difficulty in Breathing and Swelling”
o Case Type: Global_Health
o Age Group: Adults or peds
o Country: Kenya
o HPI (1-2 paragraphs)
o PMH/PSH
o Allergies/Meds
o SH/FH/ROS
o ROS can be reported by system, or by pertinent positives and negatives
o Vitals/Physical Exam
o If possible, try to take a picture of remarkable physical exam findings.
o Digital camera available in team leader’s house
o This project already has Moi approval for taking pictures of
patients (with their permission) and tests/imaging.
o If the staff on the wards object, you can carry a copy of the letter of
approval for the project (see team leader).
o Lab Tests
o Please include normal ranges when using non-U.S. values.
o Imaging
o Please provide the official radiology read if it is available.
o Try to take pictures of Echo, EKG, CXR, and CT Scans when possible,
even if the studies are sub-par (adds to the authenticity of cases in a
global health setting).
o Hospital Course
o Day 1, Day 2, Day 3… with pertinent lab/PE findings, treatment
approach, and clinical improvement/deterioration.
o Clinical Question
o Learning points/objectives from the case
o Discussion
o Post the differential diagnosis generated on rounds or at AM report
o If didactics were also done as a part of the case, can post in this section.
6. Send to the Team Leader via e-mail for review and amend the case as necessary.
7. Once approved, to post the case, go to (username) controls Case admin Add case.
8. Submit the case, including relevant images and lab values for review by the site.
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Instructions Specific for Kenya Elective
- Each case takes quite a long time to put together, since you must gather all of the
important history, physical, and laboratory data, take photos of relevant imaging,
write up the clinical course of the patient, create clinical questions on each case, and
then send to the Team Leader for review. Therefore, it is recommended that you
start your first case within the first two weeks of the elective and finish it by the
beginning of the 4 th week. The second case should be finished two weeks before the
end of your rotation to allow time for Team Leader questions and follow-up.
- If you want to write up a case on a patient who has already been discharged from
the hospital, you can find the patient chart in the medical records office, room 42 in
MTRH, near the main entrance. The office is open 24 hours a day, including
weekends. In order to retrieve patient data, you will need the patient’s full name and
hospital number. If you do not have the hospital number, you can bring the full
name, age, and admission date to one of the hospital registration sites, and they can
look the number up for you.
- Since cost is a very relevant part of patient care at MTRH, you may also choose to
include a breakdown of your patient’s hospital bill in the discussion portion of the
case write-up.
93

AMPATH Clinic Dates -- Clinicians and Contact Information
IF YOU ARE AWARE OF ANY UPDATES TO THIS INFORMATION, PLEASE E-MAIL UPDATED FILE TO: ghsig@iupui.edu
Jackline (Jacky) Sitienei - Clinical Administrator (0722 926 800); AMPATH building, 1st Floor, Rm 106
Francis - AMPATH vehicle coordinator (0721 410 253); office located near Cool Stream / AMPATH Farm
AMPATH CLINICS
Academic Model Providing Access To Healthcare
P.O. Box 4606, ELDORET
STATION/SATELLITE (Pts 4/09) IN CHARGE TELEPHONE CLINIC DAYS COMMENTS
Mosoriot (2768) Lilian 0733 783 563 Wed (Adult), Thur (Peds) Wed (Dr. Mamlin, 7:45), Thur (Dr. Audrey)
Pioneer (54) Kibor Alt Mon
Turbo (3414) Rachel 0722 449 226 Fri (Adult), Mon (Peds) Fri (Dr. Mamlin)
Mautuma (124) Thur
Chepsaita (15) Chepkok x1 Wed/mo
Burnt Forest (1682) John Sidle 0728 217 901 Thur (Adult), Tue (Peds)
Kaptagat/Kesses Some 0722 651 264 x1 Mon/mo
Plateau (55) Some " x1 Wed/mo
Chulaimbo (6201) Emma 0721 698 271 Wed (Adult), Thur (Peds)
Webuye (3488) Jentrix 0728 379 646 Tues (Peds), Wed (Adult) Tue 7am (Dr. ?)
Bokoli (125) Jentrix " Alt Mon
Mihuu (9) Alt Thu
Sinoko (13) Jentrix " Alt Mon
Milo (19) Jentrix " Alt Fri
Busia (5932) Wed (Adult), Thur (Peds) Dr. Siika
Bumala A (597) Tue
Kitale (6371) Yator 0722 439 103 Tues (Adult), Thur (Peds)
Kitale Prisons Chege x1 Wed/mo
Saboti
Tulwet
Amukura (1152) Dr. Kaibei 0722 446 196 Tues (Adult)
Lukolis (369) Dr. Kaibei x1 Wed/mo
Naitiri (1146) Kivairo 0734 509 109 Wed (Adult)
Teso (1321) Lillechi 0722 402 066 Tues (Adult)
Angurai (396) Patrick Thur
Kapenguria (1152) Kamar 0726 600 368 Wed
Kapenguria (5)
Thur
Mount Elgon (589) Janet Robai 0723 213 130 Thur (Adult) Dr. Akidiva
Cheptais/Chesikaki (220) Janet Robai " Wed
Kaptama Janet Robai " x1 Tue/mo
Iten (799) Maiyo 0722 378 808 Wed (Adult)
Kabarnet (934) Ben 0725 179 051 Wed (Adult) Dr. Odour
Marigat (326) Francis " Mon
Port Victoria (2680) Susan Nandi 0721 315 032 Mon (through Weds) Dr. Kisang (0721 216 989)
Mukhobole (213) Susan Nandi " Tue,Wed
Khunyangu (2594) Consolata 0710 250 054 Wed (Adult)
Nambale (208) Gitau Tue, Wed
Uasin Gishu District Hosp (653) Cheserek 0711 835 052 Wed (Adult), Thur (Peds)
Huruma (77) Alt Tue
Module 4 (2868) M-F
Module 3 - Barracks (3564) Njenga x2 Fri/mo.
Module 3 - Ngeria Prisons Nancy x2 Fri/mo.
Module 3 - Eldoret Prisons Odhiambo Mon & Fri
Module 2 - Ziwa (3589) Kipsang x2 Fri/mo.
Module 2 - Moiben x2 Fri/mo.
Module 1 - Moi's Bridge (3519) Nancy x2 Fri/mo.
Module 1 - Moi University/Soy
94

Kenya Web Resources
Prepared by Dan Croft, March 2010
Dr. Braun's website: Medicine in Kenya –
http://medsci.indiana.edu/c602web/kenya/start.htm
Dr. Braun’s pathology website –
http://medsci.indiana.edu/c602web/602/start.htm
96

Reading Material for Participants in the IU-Moi Partnership
REQUIRED READING
Any history of Kenya
It is absolutely essential that every student, resident, or faculty who visits Kenya have a
reasonable understanding of Kenyan history, cultures, and traditions. Acquiring this
understanding before going to Kenya will make it more likely that you will have a successful and
rewarding time in Eldoret. Some good Kenyan historians are Atieno Odhiambo, Tabitha
Konogo and Jean Davidson.
WEB SITES
Weekly Review and Daily Nation
Daily Nation - http://www.nationaudio.com/News/DailyNation/Today/index.htm l
Weekly Review - http://africanonline.co.ke/AfricaOnline/review.html
US Embassy in Kenya - http://kenya.usembassy.gov/wwwureg.do
US State Dept. - http://travel.state.gov/travel_warnings.html
CDC - http://cdc.gov/travel/travel.html
Lonely Planet - http://www.lonelyplanet.com/destinations/africa/kenya/
USAID Country Profile - http://www.usaid.gov/locations/sub-saharan_africa/countries/kenya/index.html
Regional Maps - http://www.reliefweb.int/mapc/afr_east/
Kiswahili Language - http://www.yale.edu/swahili/
Kenyan News - www.kentimes.com and www.nationmedia.com
SUGGESTED READING
Walking Together, Walking Far (2009) Quigley, Fran
This brand new resource, written by our own Fran Quigley, talks about how a U.S. and African Medical
school partnership is winning the fight against HIV/AIDS. This must read explains how the combination
of American resources and Kenyan ingenuity along with their shared determination to care for patients, has
created a model for how to tackle huge challenges. Forward is written by Paul Farmer.
Unbowed: A Memoir (2004)
Autobiography by 2004 Nobel Peace Laureate
Wangari Maathai
Training in Developing Nations (2005) Daly, John L.
This practical text offers students, consultants and training specialists proven strategies for launching
successful training initiatives in developing nations. While there are many resources available for trainers,
no other book takes the expatriate perspective—to prepare international trainers for the unique challenges
they face when conducting training in underdeveloped regions.
Kenya’s Democratic Transition (2003) Mullei, Andrew
Convinced that the movement to democratisation is unstoppable, this book discusses opportunities open to,
as well as challenges facing, Kenyans in political and social-economic governance, human rights,
nationhood, citizenship, corruption, and ultimately people's involvement in their governance. The book
highlights issues requiring urgent attention and the need for restructuring the state, restoring confidence in
institutions of governance, adopting a new development strategy, building the nation, enhancing
accountability by public servants, protecting and safeguarding rights of Kenyans, and for morality and
integrity in national life.
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Health, State and Society in Kenya (2001) Ndege, George
This book examines the conflicts brought on my the introduction, management and institutionalization of
western biomedicine into Kenya.
Witches, Westerners and HIV: AIDS and Cultures of Blame in Africa (2006) Rodlach, Alexander
Written by an anthropologist and former missionary working in Zimbabwe, this book examines cultural
and social explanations of HIV/AIDS and how these understandings can pose barriers to the prevention
and treatment of this disease. Though Zimbabwe culture is the focus, the general insights will be relevant
to most African nations suffering the pandemic
AIDS in the Twenty-First Century ((2006)
Barnett, Tony and Whiteside, Alan
The authors have written a book that examines the social and economic of the AIDS epidemic, failures in
responding to the epidemic, and what must be done to combat the epidemic. This volume devotes
considerable attention to these topics in Africa. The bibliography is extensive and would be a valuable
resource .
Ethics and AIDS in Africa. The Challenge to our Thinking (2005) van Niekerk, Anton A. and Kopelman,
Loretta (eds)
This is one of the first books in which primarily African experts systematically review the ethical
implications of the AIDS pandemic in Africa. Some of the questions they explore are: What is the
relationship between AIDS and poverty? Should First World ethical standards for research on AIDS drugs
and vaccines apply unchanged in Africa?
AIDS in Africa. Second Edition 2002) Essex, Max et al (eds.)
This comprehensive reference book addresses the unique challenges facing many African nations as poor
infrastructure and economics continue to obstruct access to advances in treatment and AIDS care training.
This second edition of AIDS in Africa includes a detailed analysis of the magnitude and nature of the
epidemic, as well as regionally specific information on such topics as pathogenesis, diagnosis,
epidemiology, treatment, prevention, socio-cultural and socioeconomic impact and ethical considerations.
Weep Not Child
Ngugi wa Thiong'o
Ngugi wa Thiong'o is one of Kenya's best authors. He writes on political themes, so many of his books
have been banned in Kenya. Other recommended titles include Detained, Petals of Blood, and Writer in
Politics.
The Lunatic Express
Miller, Charles
This book is a history of Kenya up to and including the period of colonization. A major focus of the book
is on the building of the railroad from Mombasa to Uganda. One section of the book details the trials and
tribulations caused by the infamous "lions of Tsavo". The book is a "must" read for anybody who plans
take the Nairobi to Mombasa train trip while on safari.
Things Fall Apart
Achebe, Chinua
Published in 1958, the book is the seminal African novel in English. Although there were earlier examples,
notably by Achebe's fellow Nigerian, Amos Tutuola, none has been so influential, not only on African
literature, but on literature around the world. Its most striking feature is to create a complex and
sympathetic portrait of a traditional village culture in Africa. Achebe is trying not only to inform the
outside world about Ibo cultural traditions, but to remind his own people of their past and to assert that it
had contained much of value. All too many Africans in his time were ready to accept the European
judgment that Africa had no history or culture worth considering.
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OTHER SUGGESTED READING
Africa
Ungr, Sanford
It has been reprinted a bunch of times and has some interesting things on Kenya.
Africa: Dispatches from a Fragile Continent Harden, Blaine
Controversial book. It has some unkind things to say about Moi.
Global Inequalities
Bradshaw, York; Wallace, Michael
This book, published in 1996, was written by two professors of sociology at IU-Bloomington. If you do
not have time to read the entire book, read the chapter “ A Continued Decline?” The chapter gives a
succinct overview of many of the problems Africa faces.
The Flame Trees of Thika
Red Dust on Green Leaves
Class and Economic Change
The Poisonwood Bible
(Nigeria)
The Joys of Motherhood
Stars of the New Curfe
(Kenya)
A Grain of Wheat
(Zimbabwe)
Nervous Conditions
(South Africa)
In the Fog of the Seasons End
None to Accompany Me
Playing in the Light
Huxley, Elspeth
Gay, John
Kitching, G.N.
Barbara Kingsolver
Buchi Emecheta
Ben Okri
Ngugi wa Thiong'o
Tsitsi Dangarembga
Alex La Guma
Nadine Gordimer
Zoe Wicomb
The chapter on malaria in any standard textbook of tropical medicine is also recommended reading.
Hunter's Tropical Medicine and Manson’s Tropical Diseases both have an excellent chapters on tropical
disease and malaria.
There are several Kiswahili language texts/primers on the market, including Twende by Joan Maw and
Teach Yourself Swahili by D. V. Perrott. Twende is a standard textbook and Teach Yourself Swahili is a
basic primer. For purposes of quickly learning on your own a basic understanding of the language and
rudimentary vocabulary and phrases, Teach Yourself Swahili is best. Some prefer Simplified Swahili,
published by Longman Ltd. in England. It may be difficult to obtain in the US, but new Swahili textbooks
can be found on the NALRC website at U. Wisconsin-Madison.
There are several guide/tourist books on the market as well. A favorite has been The Real Guide to Kenya
(also printed overseas as the Rough Guide to Kenya). Many travelers use the Lonely Planet guide to
Kenya. They also publish a good map. There are usually extra copies of these at the IU House in Eldoret,
but do not plan to take them with you on your travels.
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Suggestions for Eldoret Travelers
NOTE: “DON’T BRING ANYTHING YOU CANNOT AFFORD TO LOSE”
Binoculars (optional but a must if you plan to safari!)
Camera *There aren’t adequate plug-ins on some trips so a digital camera may not be
best, in fact some of our students could not take any pictures while in the village because
they couldn’t recharge
Film *Sometimes it’s hard to find film/disposable cameras and the prices are not
comparable (always more expensive there)
(Kodak, Agfa, and Fugicolor film of different speeds and exposures are readily
available in Eldoret in case you run out. Prices for purchasing film and developing
film are comparable to the United States. Slide film is also available.)
Sunscreen
Hat - Baseball cap okay *A lot of women wear scarves
Sunglasses *cheap
Comfortable shoes (shoes that can get dusty or muddy depending upon the season)
Sandals *Think about what you will be walking on with flip-flops and how brave you
feel
Small knapsack/bag for weekend trips
Skin moisturizer/lip balm (it can be very dry)
Sport coat (a must for faculty; suggested for residents and students)
Tie (for men)
Sweatshirt, light jacket or sweater - for cool evenings
Alarm clock *Again the electricity isn’t always great so a battery powered (or even
wind-up) is better
Rain gear and/or small umbrella
Books for pleasure reading (Note that IU House has a sizeable collection)
Clothing
You are responsible for washing your own clothes so you will need approximately
one week’s worth of changes. For example: five pairs of underwear, five pairs of
socks, five shirts/blouses, two pairs of slacks/jeans, etc. should be sufficient.
(Note: clothes are hung out on the clothesline to dry so there will be a public
display of undies—word to the wise!)
You will wear long pants for recreation instead of shorts and t-shirts most of the
time because of sun, mosquitoes or cultural sensitivity. Some participants have
found old scrubs to be convenient for jogging, sports, etc. *Hat and gloves and
wool socks if you will be climbing Mt.s, zip-off short/pants are nice for hikes,
long basketball shorts are good for jogging
Most of what you need can usually be purchased in Eldoret, however, the
availability of specific items is variable.
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For Travel
For Work
Bathing suit
1 white coat with name tag
Towel (for Hostel Students)
Index cards
Neosporin
Notebook
Kleenex (for Hostel Students)
Stethoscope**
Money belt or pouch (recommended)
Reflex hammer
Army knife or knife-like tool (not on person Pen light**
or carry on luggage)
Travel umbrella
Pens**
Small flashlight / headlamp
Scrubs (if doing surgery)
Personal first aid kit: band aids, personal
prescriptions, Mefloquine*, Imodium,
Cipro or Septra (diarrhea with blood or
fever—take one stat, then q/12 hr for 3
days), Tylenol or ASA
Spare eyeglasses
Shower sandals/house shoes
Insect repellent
A couple of checks
ATM card
Card sized calculator (optional)
as well as pocket-sized drug
Moist towelettes / baby wipes
reference charts
TUMS
Hand sanitizer (when there is no soap & water)
Converter (optional)
Mosquito Coils (matches if needed)
Razor
Tweezers
Fingernail Clippers
Water bottle that is easy to carry and can be re-used
*Begin taking Mefloquine before
you depart. Note: It is cheaper in
Kenya so buy only enough to start.
**If you have extra instruments, you
can choose to give them to needy
Moi students. They also appreciate
teaching aids (handouts, charts, etc.)
You can also bring:
Protein bars, breakfast stuff if you are a big fan (pop-tarts, nutrigrain bars)
Candy and bubbles for the kids you meet along the way
Candy and gum for yourself, hard to find sometimes
Phone card, make sure it is Africa compatible
Music and pictures from home to share - the other students love it!
Work Attire
Men: Shirts, ties, pants as you would wear in June in Indiana. Faculty should bring a
sport coat and tie. Footwear that is comfortable and sturdy and that you will not mind
sacrificing i.e. sneakers or loafers.
Women: Skirts, dresses, dress pants. Avoid very short sleeves. No shorts or short skirts.
You will often walk to and from work on a dusty or muddy road, so you may be most
comfortable in sneakers or loafers.
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Documents
Passport (Be sure the passport is good for well over six months past re-entry as some
countries will not allow you to enter unless it is good for over six months after entry)
Visa ($50 or $25 US cash at port of entry in Nairobi or obtained from the embassy in
Washington, DC, $50.00. Ron Pettigrew has the application or for an additional
charge, the travel agent will get it for you)
International certificate of vaccination (yellow book). This will include all of your
vaccines.
Bring photocopies of your passport, visa entry, credit cards, evacuation insurance
information and health insurance information, eye prescriptions, and your vaccination
records. You might keep one set with your luggage or store in a safe place
Immunizations
Yellow fever, meningitis, tetanus, typhoid, measles, hepatitis B, hepatitis A, polio and
malaria prophylaxis.
Your Arrival in Kenya
The first stop is immigration (visa station), then you enter the baggage claim area. There
is a limited supply of carts but this shouldn’t be a problem as the distance from the
baggage claim to the airport exit is not far. If you are carrying an IU suitcase, make sure
you have the customs exemption letter with you. Sally Ben-hameda or Ron Pettigrew
can provide that before you leave.
After the baggage claim, you will pass a place to change money. We recommend
changing $100 to $200 into Kenyan shillings at that time. The best option is to use the
Barclay’s ATM machine just inside the lobby (to the left) after exiting baggage claim.
You will be able to change money later in Eldoret, as well. The Kenyan shilling is
currently about 83 Ksh to the US dollar. Be sure to get some Ksh 100, 200 and 500
notes.
A driver from the agency with which you have made arrangements will meet you in the
airport. If you arrive in the evening or at night, you will need to stay over in Nairobi until
morning. If you stay over, you will have the option of staying at the Fairview Hotel
($125-$150/night) or some other nearby hotel. A cab to town should cost approximately
1000 shillings. You are responsible for making all in-country arrangements for travel and
accommodation. For a list of recommended and reputable travel agents and Nairobi
hotels please contact Ron Pettigrew (rpettigr@iupui.edu) or Sally Ben-hameda
(sbenhame@iupui.edu)
You can travel to Eldoret in a few ways. There are flights that depart daily from Jomo
Kenyatta International Airport in Nairobi to Eldoret on two separate carriers. There are
early morning, afternoon and evening flights, Monday through Sunday. The costs of
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these flights are variable, but tend to be Ksh 6000 to 6900 (Approx. $70 to $110) oneway.
You can purchase tickets online through Jet Link (www.jetlink.co.ke) or you may
contact either Endoroto Travel – endorototraveltd@gmail.com or
damaricew@yahoo.com (Damarice Wathika) or Kwa Kila Hali Safaris –
kwakilahalisafaris@yahoo.com (Christine McKenzie) to help you arrange these flights at
least four weeks before your trip to Kenya. Copy Dunia Karama on all final
arrangements and she will ensure that you are met at the Eldoret Airport upon your
arrival. Payment for these flights is due to either Endoroto Travel or Kwa Kila Hali
Safaris upon your arrival. If you’ve made special arrangements with them, as a
convenience, you may pay Dunia once you arrive at IU House in Eldoret. There is a one
carry-on bag and 20kg checked bag weight limit for each person traveling to Eldoret by
plane. Extra luggage may travel on the plane with you, but at a charge of 50 Ksh per
kilo. Please contact Ron Pettigrew for more information.
If you choose to hire a driver, please tell the driver before you leave that you will tip him
depending on the safety of the trip and ask him to drive below 100 km/hour or so.
Drivers in Kenya tend to drive very fast and take some unnecessary chances. If you are
satisfied with the safety of the trip, tip approximately 10% of the fare. If not, tip less and
tell the driver why. The trip by individual van takes about 4-5 hours due to poor road
conditions, however roads have improved. We highly recommend air travel vs. road
travel for the initial trip from Nairobi to Eldoret.
When you get to Eldoret you will be able to get Kenyan currency with an ATM card.
The ATM’s in Eldoret are relatively dependable. Traveler’s checks are not easy to cash
and give lower exchange rates, therefore they are discouraged. Charge cards are not
usually accepted anywhere in Western Kenya, but may be where you might travel on
weekends. Some travel agents will take personal checks but very few will take credit
cards. Make sure to ask your travel agent of their preferences regarding payment
before you arrive to Kenya. If they prefer to be paid in US Dollars, please bring
only US bills that were printed after 2000 (2001, 2002, 2003, etc.) Purchases with
credit cards are usually subject to a 5%-10% additional fee.
Travel Options
Nairobi to Eldoret
Safari van: cost about $450 one-way
Air: Cost about $110 one-way (20kg,– can pay extra fee to check more baggage and
weight)
Eldoret to Nairobi
Air: Cost about $110 one-way. Two different airlines now fly directly into Jomo
Kenyatta International Airport. If you are leaving on a continuing flight, you might not be
assessed an extra-weight luggage fee.
105

Recommendations for IU Kenya elective
Orientation Guidebook
Packing List Additions
o Blood pressure cuff (can give to hospital upon departure)
o Diagnostic set (bring it, even if you are not planning on leaving it in Kenya)
o Extra penlights for Kenyan colleagues
o Clothes
o Bring some warm clothes (i.e. pants, fleece, rainjacket), because Eldoret is at
approximately 7,000 ft elevation and it gets quite cold, particularly in the rainy
season (April-September).
o Jogging/Workout clothes (many IU House guests run in the morning. You can
bring shorts for working out in.
o There is a saying amongst past program participants, “You cannot out-dress a
Kenyan.” The students, registrars, and consultants dress very formally on the
wards. Bring professional attire (at least 3-4 pairs of pants, because they get very
dirty in the rain). Men, be sure to bring ties. If you bring multiple, ties, you can
even give them to your Kenyan colleagues when you leave.
o It’s very muddy – if you bring tennis shoes (and you should), plan to leave them
there. For work shoes, crocs are great and they wash off easily.
o There is only one attending on peds who prefers that females wear skirts. Bring
dress pants if that is what you are comfortable wearing in the US.
o Bags frequently get temporarily lost for about a week on the way to Eldoret.
Make sure to pack an extra change of clothes and a set of dress clothes (for
work) in your carry-on bag.
o Alcohol wipes, wet wipes, and hand sanitizer are all available in Eldoret, but bring at
least a small supply
o A small notebook that can fit in your white coat
o If you are an avid coffee drinker, bring instant coffee packets!
o Peanut butter (near-impossible to find in Eldoret)
o Don’t worry about bringing a 2-month supply of toiletries – shampoo, conditioner, etc.
are all readily available in Eldoret. Girls – please note that tampons are hard to find in
Eldoret.
o Contact lens solution and contact cases. And bring back-up glasses.
o Purse/shoulder bag for walking around town (avoid open pockets).
o If you plan on going to the OR, please bring a stock of sterile gloves and gowns. Goggles
and OR shoes are also strongly recommended.
o Headlamp (especially for students on OB/GYN)
o Computer (students STRONGLY recommend bringing a laptop if possible). The IU
House is quite secure. Many people bring expensive electronics to Kenya, and they are
fine. There are safes to lock up your valuables, and all of the rooms have locks.
o Pocket pulse oximeter (residents especially)
o Recommended Pocket Resources (cannot get in Kenya):
o Massachusetts General Hospital Handbook of Internal Medicine (Medicine Red
Book)
o Oxford Handbook of Tropical Medicine
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o Pocket Pharmacopia
o Stanford’s Guide to Antibiotic Therapy
o Your address in Eldoret
Recommendations from past program participants…
STUDENTS
o Rounding on the weekend is not required, but it is strongly encouraged. You will
form stronger relationships with your intern(s) and registrar(s) if you round with
them on the weekends. Just get their phone numbers the Friday before, and ask
what time rounding will begin. After just one weekend of rounding, I went from an
observer to an active participant on the team.
o Early in the rotation, try to learn where all of the different labs and radiology
facilities are located. You can offer to take blood to the hematology lab, or biopsy
specimens to the histopathology lab. Take the opportunity to learn how to do LPs
well (they are done almost daily), and then tag along with a Kenyan medical student
to perform CSF studies with microscopes in the medical student lab. If a patient of
yours has a head CT done, you can go to radiology and get the film yourself instead
of waiting for it to be delivered by a patient attendant – this may speed up the care
of your patient by 1-2 days. Learn where the Cardexes (vitals/nursing notes) are
located, and take your own BPs on patients in the morning.
o Take a few hours to look at the archive of malaria parasite slides in the medical
student lab.
o TAKE SWAHILI LESSONS!!! They are only 300 Ksh/1-hr lesson for group lessons or
350 Ksh/1-hr lesson individually. It is well worth it to take 5-6 lessons right at the
beginning of the rotation so that you can understand some of the Swahili that is
spoken on the wards. The patients really appreciate every effort that you make to
speak Swahili, however poorly. The contact person is Wycliffe who frequents the IU
House.
o The hostel gets a really bad rap… sure, it is pretty “cozy,” and the bathrooms are less
than great, but it is the absolute best option if you want anything close to an
immersion experience. You can easily (unfortunately) spend all of your two-month
elective in Muzungu-land up at IU House, missing the wonderful opportunity to
really get to know your Kenyan colleagues. Spend as much time at the hostel as
possible – the friends you will make will be well worth any hardship you endure
with bathrooms and such. Also, the food, especially breakfast, is quite good. You can
easily eat at the hostel for less than 100 Ksh/day ($1.25).
o Try to “clerk” patients as early and often as possible. To clerk in Kenya means to do
the patient’s complete history and physical. Tag along with a Kenyan 4 th or 6 th year
student on the ward and ask them to help you translate when you get new patients.
On medicine, teams admit every other day, and on peds they admit every 4 th day.
Also, be ready and willing to present on rounds (consultant dependent). If you clerk
a patient, try to write a SOAP note in their file every day.
o The best time to clerk on admitting days is at night. Kenyan students usually come in
after visiting hours, around 6-9pm. Tag along with one or more of them coming from
107

the hostel. Make sure to use the buddy system, as walking along at night is a very
bad idea. Try to get phone numbers of students on your team before admitting days.
o Make sure the team knows what level of training you are at. Some of the registrars
and consultants will never ever pimp you, because they don’t know where you fall. If
you tell them it is okay to pimp you, and you try to present patients like the 4 th or 6 th
year students, the team will be more likely to acknowledge you in an appropriate
role.
o Go out of your way to try to inform patients and their families of what is going on.
The Kenyan training system does not put much emphasis on informing patients.
Please try to engage your 4 th and 6 th year colleagues in talking with the family, as
many of them will continue this practice after you leave.
o Don’t be afraid to help your intern with the discharge paperwork! The interns have
SO much on their plate – any help with paperwork is much appreciated!
o You can get dress pants made, tailored to your size, for less than $10. Clothing
repairs are very inexpensive as well. Just talk to Penina, one of the IU House cooks.
o Learn how to cook Kenyan food! The IU House guards are more than happy to teach
you how to make Kenyan Chai, and if you observe the cooks, you can learn to make
staple Kenyan foods like Sikuma wiki, ugali, chapati, etc.
o There is a list of Kenyan medical student lectures every week in the hostel. You are
more than welcome to attend any or all of these, even in other disciplines than
medicine or pediatrics. Ask your Kenyan colleagues about time and place, and be
forewarned that these lectures are frequently moved and/or cancelled.
o You can order custom paintings from Imani Workshops – they make great
souvenirs.
o The ATMs will give you 1000 Ksh notes that are difficult to break at small kiosks.
Most of the banks (including Barclays) will give you smaller denominations if you
ask.
o If you have some time to spending Nairobi, we would recommend going to Crocodile
Farm (Manba Park). You can feed the giraffe there, and it is all around better than
the giraffe park.
Fun things to do in and around Eldoret
RESTAURANTS
o Sunjeel Palace – Indian, downtown, $$$, arguably the best Indian food in town
o Sikh Union – Indian, downtown, $$$, can accommodate very large groups
o Mamma Mia’s—American/Indian, near IU House, $$$, popular place for pizza (yes,
they even deliver
o Siam – Chinese, downtown, $$, lots of vegetarian options (best place for tofu)
o Cool Stream – Kenyan (lunch), behind hospital, $, great place to get fast, cheap, and
easily accessible meals with traditional Kenyan food (also an AMPATH project)
o Red Bean Café – Kenyan/American, downtown, $$$, best hot drinks in town
o Poa Place – Kenyan, $$, away from town on Nandi Road, great outdoor/open air
atmosphere and very good yama choma (roasted goat by the kilo)
108

o Oasis – American, $$, away from town on Nandi Road, best milkshakes in town
(dairy products by Doiynos Lessos) only open until 6pm
o Sizzler –Kenyan/American, downtown, $$, good milkshakes and masala tea
o The Klique – Kenyan, downtown, $$, fun club/lounge atmosphere and good yama
choma
o Freddies – Kenyan/American, downtown, $$, good chips (French fries) and okay
milkshakes
CLUBS
o Signature – Dance floor, DJ, plenty of seating area, lots of TVs, traditional live Kenyan
bands on Thursday.
o Spree – Karaoke on Tuesday nights, small dance floor, lots of TVs
o Caesar’s Palace – All varieties of music. Very large TV (good for watching football)
OTHER PLACES IN ELDORET
o Cultural Museum at Poa Place – Can learn about tribes, also ostriches. (400 Ksh)
o Poa Place – Pool at the resort, open to the public for 100 Ksh/session.
o Doinyo Lessos Creamery – Free cheese tasting. Great yogurt and ice cream. Can also
ask for the tour.
o Hotel Sirikwa – Amazing breakfast buffets (even on Sundays), pool, and gardens.
DAY TRIPS
o Lake Nakuru National Park – Great for a one-day safari, or an overnight.
Accommodations at Flamingo Hill or Sarova Lion Hill Lodge. Recommend bringing
your lunch if only a day trip, because on-site restaurant is very expensive. Wide
array of wildlife including: flamingo, rhinos, zebra, antelope, monkeys, baboons, and
lions. Bring binoculars. (Approx. $100 for the day trip)
o Kakamega – Rainforest, hiking, and some wildlife (birds, monkeys, butterflies, etc.).
Can do “short hike” for 1.5-2 hours, “long-hike” for 6-8 hours, or mixture for 3-4
hours. You will get a guide when you arrive. If you stay overnight, the dawn hike is
not to be missed. Pack a lunch for the day-trip. (Approx. $20-$30)
o Umbrella Falls/Kruger Farm/Kerio View – Talk to Cha-Cha. Will begin at Umbrella
Falls. Hike is short, but rocky, requiring some climbing (bring appropriate
footwear). Trail passes behind the waterfall, which is very beautiful. Expect to pay
for a “guide” upon arrival (negotiable). The next stop of the day is Kruger Farm, a
giraffe farm. Opportunities to get photos of giraffes from only a few feet away.
Hiking the “hill” takes ~1 hour and is quite a workout, but well worth it for the view.
Kerio View features an excellent restaurant, with some of the best goat around.
Order your food, and then go for a hike, because it will take a while to prepare.
(Approx. $50-$80 for all)
WEEKEND TRIPS
o Masai Mara – The ultimate safari experience. 2-3 day trip with 8-hour car ride oneway.
Recommend staying at Camp Oloshaiki. Bring binoculars.(Approx. $350-$500)
o Lamu Island – Coastal Island 130 miles northeast of Mombasa; one of the oldest and
best-preserved Swahili settlements of East Africa. (Cost ???)
109

o Lake Baringo – Fun in the sun, drinks by the pool, and a boat ride with hippos. Very
chill weekend. Overnight or entire weekend. (Approx. $120 for the 1-night stay).
o Hell’s Gate/Lake Naivasha – Biking excursion, 1-2 hours at a leisurely pace.
(Approx. $80 if you camp – tent and sleeping bag from the Mamlins’).
Other general recommendations
o Home-based Counseling and Testing
o Dr. Ndege = Associate Program Manager, AMPATH
o Currently testing in Burnt Forest, but plan to move to Teso in August
o Dr. Ndege = ndegekip@yahoo.com
o Rose Kioko= kiokorose@yahoo.com
o There are 2 vehicles leaving Eldoret daily, but they are always full
o Per a Kenyan friend, “Lack of cultural sensitivity isn’t a failure of education, it’s a
failure of integration. They put us together and say ‘get along,’ but we need more
than that. If we were hanging out more outside the hospital, these conversations
would happen naturally…”
o Once or twice monthly hang-out with current 6 th years who studied in the States or
in Canada.
110

KISWAHILI – MEDICALLY
Here is a beginning list of words you might find helpful as you work. Kiswahili is NOT
a language that one can begin to speak readily since nouns are divided into eight classes,
which do not always make sense to the English speaker. Prepositions, verbs, adjectives,
etc. must agree with the class of the noun being modified – AND it gets worse before
things fall into place (IF they ever do!).
If you ask a question of a patient, you may find it difficult to understand his or her
answer. Still, knowing a few words may help you to understand the jist of the
conversation occurring at bedside. Generally, if a patient or Kenyan counterpart is
referring to a certain person within the hospital, the following holds true:
“Sisters” = nurses
“Nursing officers” = male nurses
“Matron” = head nurse
“Medical Officer” (MO) = post intern physician assigned to the District Hospital
“Clinical Officer” (CO) = similar to a physician assistant
“Intern” = interns
“Consultant” = consultants
All of the above mentioned speak English and will happily interpret for you IF they can
be found.
If you think of other words or phrases you would like to have, let us know, and we‟ll try
to research them for you…
Editors: Diana Menya
Caroline Jepkorir
Eunica Kasay
Peninah Musula Soita
Wycliffe Odongo
BODY PARTS:
Mwili/miili = body/bodies
Moyo/mioyo = heart/hearts
Mkono/mikono = hand/arms, hands
Kiko cha mguu = elbow
Kionwa/vichwa = head/heads
Bega/mabega = chest/chests
Titi/matiti = breast/breasts
Ubavu/mbavu = rib/ribs
Tumbo/matumbo = stomach/stomachs
uume, [vulgar, mbco] = penis
actually, one NEVER refers to genitals
by name
One says “down there” which is
ukochini.
IF one has to be more specific one refers
to the mans “thing” as kitu
kuma or uke = vagina
One can also refer to the birth canal as
mjia va uzazi
Mguu/miguu = leg/legs, foot/feet
Goti/magoti = knee/knees
Kidole/vidole = finger/fingers, toe/toes
Uso/nyuso = face/faces
Jiono/macho = eye/eyes
112

Sikic/maskio = ear/ears
Pua/mapua = nose/noses
Mdomo/midomo = mouth/mouths
Ulimi/ndimi = tongue/tongues
Jino/meno = tooth/teeth
MEDICAL WORDS:
Kidonda/vidonda = Sore (noun)
Mganga/waganga = (native?) Doctor/s
(ku)ganga = To treat
Mgonjwa/wagonjwa = Patient/s, sick
person/s
Mafi = Feces (not often used –
considered rude [shit]) (usually “choo”
is used for a “heavy load”)
Mkocho = Urine (“light load”)
Kifo = Death
Sumu = Poison
(ku)tapika = To vomit
Dawa = Drug
Hospitali = Hospital
Magonjwa = Diseases
Ugonjwa = Illness, sickness
Uzee = Old age
Angalia pale = Look there
Ukuta = Wall
Tazama = Look
Pumua = Breathe
Pumua nje = Breathe out
Pumua ndani = Breathe in
Pumua tena = Breathe again
Toa shati nyako = Take off your shirt
Toangua = Take off things
Vuaangua = Take off your clothes
Wacha kupumua = Don‟t (to) breathe
Kohoa = Cough
Shika = Hold, catch, keep
Sema = Say
Pinduka = Turn around (oneself)
Kati = Sit
Ka = Sit
Simama – Stand up
Nyamaza = Be quiet
Fungua = Open
Funga = Close
Jilegeze = Relax
Daktari = Doctor
Sabuni = Soap
Kiwete = Cripple/deformed person
Cheka = Laugh
Ngozi = Skin (of human or animal)
Toa ulimi nje = Stick out your tongue
Viini = Germs
Kifua Kikuu = TB
Kisonono = GC
Tago = syphilis
Ukimqi = AIDS
Kwa muda gain? = How long?
Kwa siku gapi? = How many days?
Damu = Blood
VERBS (which have to agree with the
noun class):
(ku)na = to have
(ku)sema = to say
(ku)lala = to sleep
(ku)meza = to swallow
(ku)ja= to come (Kuja hapa! = Come
here!)
(ku)kwenda = to go
(ku)tambea = to walk
(ku)sikia = to listen
(ku)andika = to write
(ku)tenda = to do
(ku)la = to eat
(ku)nywa = to drink
(ku)dhuku = to taste
NUMBERS (these also agree with the
associated noun class):
Moja = one
Mbili or wili = two
Tatu = three
Nne = four
Tano = five
Sita = six
Saba = seven
Nane = eight
113

Tisa = nine
Kumi = ten
Nusu = one half
Kumi na moja = eleven
Kumi na mbili = twelve
Ishirini = twenty
Thelathini = thirty
Arobaini = forty
Hamsini = fifty
Sitini = sixty
Sabini = seventy
Themanini = eighty
Tisini = ninety
Mia = one hundred
Elfu = one thousand
NON-MEDICAL WORDS AND
PHRASES THAT MAY RELATE TO
YOUR WORK:
Words:
Na = and
Au = or
Ndiyo = yes
La = no
Kitabu/vitabu = book
Chakula/vyakula = food/s
Choo = latrine
Kiti/viti = chair/s
Mwalimu/walimu = teacher/s
Mwanume/wanume = man/men
Mwanamke/wabawaje = woman/women
Mwana/wana = son/s, child/children
Mtoto/watoto = child/ren
Mzee/wazee = old or respected man/men
Mwavuli/mivuli = umbrella/s (for IF you
are traveling to Kenya during the raining
season)
Mkate/mikate = bread/s
Mlango/milango = door/s
Nyumbani = home
Tea = Chai
Milk = maziwa
PHRASES:
Tafadhali = Please
Jambo = Hello
Ndiyo = Yes
Hapana = No
Kulia = Right
Kushoto = Left
Kidogo = Little
Sawa = OK
Tena = Again
Moto = Hot
Baridi = Cold
Asante = Thank you
Karibu = Welcome
Sana = A lot
Bas = That‟s all
Pole pole = slow
Pole = sorry
Kwaheri! = Goodbye!
MEDSWAHILI
This is a crib sheet for medical
personnel. Take it with you to the wards
and use it to assist in communicating
with your patients. We‟ve made it as
condensed as possible so you can fold it
up and stick it in your pocket.
Greetings:
Je, unajua Kingereza = Do you know
English?
Habari yako? = How are you?
Nzuri, na wewe? = I‟m fine, and you?
Jina lako ni nani? = What is your name?
Jina langu ni Daktari Dukes = My name
is Doctor Dukes
Unatoka Kijiji gani? = What village are
you from?
Una umri gani? = How old are you?
History:
Unasikiaje leo? = How do you feel
today?
Unauguaje? = How are you sick/suffer?
Tangu lini? = How long?
114

Unaumwa wapi? = Where do you hurt?
“ kitchwa? = Does your head
hurt?
“ macho? = Do your eyes hurt?
“ mapua? = Does your nose
hurt?
“ sikio? = Does your ear hurt?
“ koo? = Does your throat hurt?
“ kifua? = Does your chest hurt?
“ tumbo? = Does your stomach
hurt?
“ mgongo? = Does your back
hurt?
“ mkono? = Does your arm hurt?
“ mguu? = Does your leg hurt?
“ Viungo? = Do your joints
hurt?
Una Homa? = Do you have a fever?
Unatapika? = Are you vomiting?
Unahara? = Are you having diarrhea?
Unakohoa? = Are you coughing?
Unapumua haraka? = Are you breathing
faster (SOB)?
Una sikia jasho usiku? = Do you have
night sweats?
Unapunguza uzito? = Are you losing
weight?
Unakula na kunywa vizuri? = Are you
eating and drinking well?
Review of Systems:
HEENT:
Unaweza kusikia na kuona vizuri? = Can
you hear and see O.K.?
Ulikuwa na una damu kwa mapua? =
Are you having a nosebleed?
Maji katika masikio? = Do you have
drainage from the ears?
Unaumwa koo? = Are you having pain
in the throat?
CHEST/CORE :
Je, Unapumua haraka kwa
kulala/kutembia? = Are you SOB
lying/walking?
Je, Unakohoa makohozi? = Are you
coughing phlegm?
Je, Rangi gani? = What color?
- Mayai = Yellow
Nyeupi = White
Nyekundu = Red
Damu = Blood
G.I./G.U.:
Je, Unaenda haja kubwa? = Have you
have a B.M? (gone for a „long call‟)
Je, Unaenda haja ndogo? = Have you
urinated? (gone for a „short call‟)
Je, Unahara damu? = Are you having
bloody diarrhea?
EXT:
Je, Unafura miguu? = Any swelling of
the legs?
Je, Una kidonda? = Do you have a
sore/ulcer?
Je, Unavipele? = Do you have a rash?
CNS:
Usingizi mzilo = coma
Kifafa = Epilepsy/fit
Dhaifu = Weakness
Kufaganzi = Numbness
Hakuna kutemba vizuri – I can‟t walk
right
PMH:
Una allergy kwa dawa? = Are you
allergic to medicine?
Unapata dawa? = Are you getting
medicine?
Unanunua dawa? = Can you by
medicine?
Shida yeyotea zamani? = Have you had
illness in the past?
Unavuta sigara? = Do you smoke?
Unakunywa pombe? = Do you drink
alcohol?
115

Physical:
Sasa nitapima wewe = Now I will
examine you.
Tafadhali, toa shati/koti/viatu = Please
take off your shirt/coat/shoes
Keti = Sit up
Lala = Lie down
Fungua mdomo = Open your mouth
Sema ah = Say ah
Unaumwa hapa = Does it hurt here?
(tenderness)
Pumua ndani/nje = Breathe in/out
Wacha kupumua = Stop breathing
Unainua mguu/mkono = Lift up your
leg/arm
Legeza = Relax
Ina misha kichwa = Bend your head
116

Kenya – MTRH Morning Report
January 2010
CC: Difficulty Breathing and Swelling
HPI: Patient is a 43 y/o Kenyan Female who has experienced increasing difficulty in breathing (DIB) and
swelling in left leg and hand for the past 2 weeks (2/52). Her difficulty in breathing first began four
months ago, and she was progressively unable to continue her normal household duties. This began
with problems doing heavy jobs like digging on the farm but progressed to an inability to take a bath.
Her dyspnea is exacerbated when lying down, with some relief from elevation of the head of her bed.
The swelling in her left leg and hand are associated with paralysis in her left arm and leg for the
past two weeks. She was unclear the nature of the paralysis (ascending, descending, etc.). She also
reports abdominal distension and discomfort for 2 weeks, made worse by food intake and relieved by
vomiting. She has experienced 3 episodes of post-prandial vomiting in the past two weeks. She has also
experienced hotness of body (fever) with drenching night sweats. After being admitted to two separate
local hospitals she was referred to MTRH.
MedHx: Hospitalized 28 years ago for swelling of the legs; admitted to Kapsabet District Hospital 2
weeks ago and Kaimosi Mission Hospital (this week) for current symptoms. No history of blood
transfusions. No known history of hypertension, diabetes, or cardiac failure.
Ob/GynHx: G9P9 (last delivery one year ago)—all spontaneous vaginal deliveries. LMP 14 months ago.
SurHx: None.
Meds: None.
Allergies: NKDA
SocHx: Married living with husband in Ponjoke; works as a farmer. Denies use of alcohol, cigarettes, and
drugs.
FamHx: No known medical illnesses.
ROS: Patient denies headaches, recent weight loss, or loss of consciousness. Also denies any episodes of
confusion, chest pain, or cough. Positive for palpitations, difficulty breathing (as above), orthopnea,
edema of extremities, left-sided paralysis, abdominal distention, abdominal discomfort, post-prandial
vomiting, diarrhea x3, hotness of body, and night sweats.
Vital Signs:
T 35.4 C
HR 110
BP 120/64
SpO2 94% RA
Physical Exam:
Gen: Sick looking; (+)pallor, (+)cyanosis; no jaundice.
HEENT: PERRL, sclera anicteric; mildly dehydrated. No lymphadenopathy.
Neck: Soft and supple; (+)JVD.
CV: Apex at the 6 th intercostals space, displaced toward axilla; active precordium; parasternal heave;
palpable P2; auscultation with pansystolic murmur. Peripheral pulses weak, irregular, collapsing;
(+)finger clubbing; decreased capillary refill. Pitting edema in bilateral lower extremities.
Resp: Respiratory distress with flaring nostrils and use of accessory muscles; auscultation reveals
vesicular breath sounds bilaterally.
118

Abd: distended with symmetrical stria; no venous engorgement. Non-tender to palpation.
(+)Hepatomegaly 9cm below subcostal line; (+)Shifting dullness to percussion. Bowel sounds present.
CNS: AAOx3; No cranial nerve palsy; RUE strength 4/5 with intact sensation; LUE strength 2/5 with intact
sensation; RLE strength 4/5; LLE strength 2/5.
Clinical Course:
Admission:
FHG:
WBC 13 per µL [4.5-10.5]
Lymph 18.1%
Neut: 79.5%
Mono: 2.1%
Hgb 12.9 g/dL [11-18]
Hct 38.7%
MCV 94.2 fL
Plt 207 per µL [150-450]
U/E/C:
Creatinine 175 umol/L [44-80]
Na + 118.5 mmol/L [136-145]
K + 5.78 mmol/L [3.5-5.1]
Cl - 90.2 mmol/L [98-107]
Urea 26.37 mmol/L [0-8.3]
CXR: Cardiomegaly; right perihilar lymphadenopathy and interstitial infiltrate.
Non-contrast Head CT: Subtle hypodense lesion in the right basal ganglia; multiple hypodense areas in
the right temporal region. Remainder of brain appears normal.
Patient initiated on ceftriaxone, aldactone, furosemide, aspirin, atenolol, elevation of head of bed, and
decreased salt diet.
Day 2:
Physical exam: Patient in respiratory distress; left-sided weakness unchanged. BP 110/82 mmHg.
Discontinued digoxin and aldactone (due to high K+); increased furosemide to 80mg BID.
ECG: Atrial fibrillation with RVR (~130 bpm); right axis deviation; right ventricular hypertrophy; poor R-
wave progression.
119

U/E/C:
Creatinine 152 umol/L [44-80]
Na + 119.3 mmol/L [136-145]
K + 4.93 mmol/L [3.5-5.1]
Cl - 91.9 mmol/L [98-107]
Urea 27.1 mmol/L [0-8.3]
ECHO: EF 60%. Severe mitral regurgitation; mild-to-moderate mitral stenosis; severe aortic insufficiency
(regurgitation); severe triscuspid regurgitation; severe pulmonary HTN with RVSP 63 mmHg; LA/RA
dilatation; frequent arrhythmias.
Day 3:
Physical exam: abdominal distention, bilateral lower extremity edema; left-sided weakness, unchanged.
Patient continued on current management. Ordered physiotherapy.
U/E/C:
Creatinine 152 umol/L [44-80]
Na + 121.6 mmol/L [136-145]
K + 5.71 mmol/L [3.5-5.1]
Cl - 93 mmol/L [98-107]
Urea 26.87 mmol/L [0-8.3]
Day 4:
Physical exam: abdominal swelling with pain; fever last night; left-sided weakness; BP 100/70, T 36.7 C.
Patient continued on current management. Considered initiation of warfarin therapy. Plan Doppler LLE.
Day 5:
Physical Exam: HR 155, Bp 130/80. Currently in A-Fib. Continues to have abdominal discomfort.
Patient continued current management. Monitor strict ins & outs.
U/E/C:
Creatinine 129 umol/L [44-80]
Na + 119.2 mmol/L [136-145]
K + 5.11 mmol/L [3.5-5.1]
Cl - 90.7 mmol/L [98-107]
Urea 28.02 mmol/L [0-8.3]
Doppler U/S positive for DVT in left lower extremity.
Day 6:
Physical exam: jaundice, pallor. Complains of hemoptysis, dyspnea, left calf pain. BP 130/80 mmHg.
LFTs:
Albumin 29.82 g/L [35-50]
ALT: 395.2 U/L [

Diagnostic paracentesis:
Clear yellow fluid
Sent for cell count, gram stain, and culture.
Abdominal ultrasound: Possible cholecystitis with gallbladder sludge.
Rapid HIV: negative.
Anti-HepB: negative.
HepBsAg: negative.
Anti-HepC: negative.
Day 7:
Continue therapy with furosemide, digoxin, aspirin 325 mg daily.
Plan to repeat INR and follow-up on sputum AFB.
Repeat LFTs:
AST 57.1
ALT 108
Day 12:
Discontinued digoxin, initiated therapy with enalapril. Holding warfarin.
Clinical Question:
What is the most likely cause of this patient’s valvular heart disease?
What singular intervention could have been made to prevent her cardiac condition?
How did therapeutic plan and follow-through affect the hospitalization of this patient?
Discussion:
121

Kenyan (MTRH) Abbreviations & Terminology:
HOB = Hotness of body (fever)
DIB = Difficulty in breathing (SOB)
ISS = Immunosuppressed state (HIV+)
O/E = On Exam (Physical Exam)
P o = no pallor; P + = pallor
J o = no jaundice; J + = jaundice
LN o = no lymphadenopathy
Cy o = no cyanosis; Cy + = cyanosis
DeH 2 O o = no dehydration; DeH 2 O + = mild dehydration; DeH 2 O ++ = severe dehydration
O o = no oedmea (British English)
FGC = Fair general condition (NAD)
PBERL = Pupils bilaterally equal & reactive to light (PERRL)
“JVP increased” = JVD
Vesicular breath sounds bilaterally = clear to auscultation (CTAB)
P/A = Abdominal Exam
DWR = Daily ward rounds
Ascitic tap = diagnostic paracentesis
2/7 = 2 days
2/12 = 2 months
2/52 = 2 weeks
CCF = Congestive cardiac failure (CHF)
Labs:
FHG = Full Hemogram (CBC)
U/E/C = Urea, Electrolytes, Creatinine (closest equivalent to BMP)
DTC = Diagnostic testing & counseling (HIV test)
PITC = Provider-initiated testing & counseling (HIV test)
GXM = Blood group & cross-match
PBF = Peripheral blood film
BS for MPS = Blood smear for malaria parasite
Meds:
Paracetamol = acetaminophen
X-Pen = penicillin-G
Diflucan = fluconazole
122

Kenyan Laboratory (MTRH) Reference Ranges:
FHG: (CBC)
WBC: 4.5-10.5 per µL
Hgb: 11-18 g/dL
Hct: 35-60%
Plt: 150-450 per µL
RBC: 4-6 per µL
MCV: 76-96 fL
MCH: 27-31 pg/cell
MCHC: 33-37 Hgb/cell
RDW: 11-13.7
MPV: 7.8-11
U/E/C: (BMP)
Urea: 1.7-8.3 mmol/L
Creatinine: 44-80 µmol/L
Na: 136-145 mmol/L
K: 3.5-5.1 mmol/L
Cl: 98-107 mmol/L
Serum Glucose: RBS

Common Adult Medical Conditions at MTRH (Kenya)
Based on MTRH data, Aug2009 – Feb2010 – DO NOT COPY WITHOUT PERMISSION
Total Admissions: 412; Total Mortality: 102 (25%)
Infectious Disease:
#1 – HIV – 231 (56%)
Kaposi’s Sarcoma – 7 confirmed (3 empiric)
#2 – Tuberculosis (TB) – 52 (104)
Pulm TB – 37 (75)
TB meningitis – 1 (15)
Disseminated TB – 10 (10)
TB pericarditis – 3 (3)
Pott’s Dz – 1 (1)
#3 – Bacterial pneumonia – 15 (106)
Malaria – 15 (38)
Bacterial meningitis – 12 (39)
PCP pneumonia – 13 (29)
Gastroenteritis – 7 (43)
Dysentery – 1
Chronic diarrhea (HIV+) – 1
Urinary tract infection – 11 (14)
Cryptococcal meningitis – 10 (14)
Oral Candidiasis – 11 (10)
Toxoplasmosis – 6 (13)
Sepsis – (7)
Herpes Simplex (HSV) – 2 (2)
Bacterial endocarditis – 3
Pelvic Inflammatory Disease – 1 (2)
Cellulitis – 1 (2)
Typhoid – 1 (2)
Cutaneous mycotic infection – 1 (1)
Pyelonephritis – 1 (1)
Otitis Media – 1 (1)
Febrile neutropenia – 1 (1)
Amoebiasis – 2
Brain abscess – 1
Scabies – 1
Intestinal worms – (2); Schistosomiasis – (1)
Leishmaniasis – (1)
Rabies – (1)
Cardiovascular:
#4 – Anemia – 62 (27)
CHF – 36 (23); especially rheumatic heart dz
Rheumatic Fever/RHD – 16 (9)
Stroke – 15 (11)
Cor Pulmonale – 12 (4)
DVT – 10 (8)
Atrial Fibrillation – 3
Pericardial effusion – 3
Acute Coronary Syndrome – 1
126
Pulmonary:
COPD – 9 (12)
Asthma – 3 (8)
Pulmonary HTN – 13 (2); esp. chemical pneumonitis
Pleural effusion – 2
Pulmonary edema – 1
Interstitial Lung Disease – 1
Other Organ Systems:
#5 – Diabetes Mellitus – 47 (15)
Liver Disease – 26 (35)
Ascites – 15 (9)
Cirrhosis – 2 (7)
Hepatitis A – (2)
Hepatitis B – 4 (6)
Hepatitis C – (6)
ARF/ESRD – 22 (14)
Nephrotic/Nephritic Synd – 2 (4)
Gastrointestinal:
PUD/GERD – 5 (27)
Intestinal obstruction – 1 (1)
Intestinal perforation – 1
Cholecystitis – 1 (1)
Esophageal stricture – 1
Fibrous stomach mass – 1
Hemorrhoids – 1
Gastritis – (1)
Neoplastic/Hematologic:
Malignancy, Tumor – 16 (18)
Leukemia – 5 (11)
Lymphoma – 8 (11)
Sickle Cell – 2 (1)
Rhabdomyosarcoma – 1
Neuro/Psych:
Psychosis/Schizophrenia – 14 (27)
Alcoholism – 7 (15)
Seizure – 9 (1)
Encephalopathy – 5 (10); PML – 1
Overdose – 7 (2); Organophosphate – 6 (2); APAP – 1
Epilepsy – 3 (7)
Depression – 2 (2)
Bipolar Disorder – 2
Peripheral neuropathy – 2

Delerium – 1 Dementia – 1
Other:
Dehydration – 18 (12)
Drug Reaction – 3 (1)
Toxic Epidermal Necrolysis – 2
Stevens-Johnson Synd – (1)
Zidovudine – 1
Guillain-Barre Synd – (2)
Eye discharge – 2
Systemic Lupus Erythematosus (SLE) – 1
Rhabdomyolysis – 1
Diaphragmatic injury – 1
Rheumatic arthritis – 1
Psoriasis – 1
Hematoma – 1
Epistaxis – 1
Anal fissures – 1
Pellagra – (1)
127

MTRH Pediatric Morbidity and Mortality Data – Fall 2009
Data from Tumaini Ward (Ward 4)
Total Admissions: Oct Nov Dec Total
165 182 164 511
M:F Ratio: 95:70 114:68 89:76 298:214
Age Distribution:
Infants: 64 (39%) 60 (33%) 59 (36%) 183 (36%)
13mo-5yrs: 45 (27%) 83 (46%) 65 (40%) 193 (38%)
>5yrs: 56 (34%) 39 (21%) 40 (24%) 135 (26%)
Disease Burden:
Pneumonia 42 44 30 116 (23%)
Diarrhoea 34 25 40 99 (19%)
Malaria 33 17 24 74 (14%)
Meningitis 13 7 2 22 (4%)
Malnutrition 9 17 8 34 (7%)
Convulsions 7 6 6 19 (4%)
Glomerulonephritis 6 2 8 (2%)
Heart Disease 6 10 3 19 (4%)
Anemia 6 7 13 (3%)
Pulmonary TB 9 9 (2%)
Asthma 4 4 (

9 die in Kenyan highway mishap
BY BERNARD MOMANYI
The bus was headed to Nairobi from Busia when the accident occurred at 5am, police said.
“Eight people were killed on the spot while another one died on the way to hospital. Many other
passengers sustained injuries and are admitted to hospital,” Rift Valley Provincial Police
Commander Francis Munyambu said.
Mr Munyambu told Capital News the exact cause of the accident had not been established “but there
is a likelihood the bus was overtaking when the collision occurred.”
“The injured passengers were taken to hospitals in Nakuru and Naivasha,” Mr Munyambu told
Capital News when reached on telephone.
He did not give details of the identities of the victims who perished in the dawn accident „because
their next of kin were yet to be informed.‟
Police said the accident occurred at a place considered a black spot for motorists due to the high
number of accidents that have occurred there.
At least two or three accidents occur on the Mai Mahiu-Naivasha stretch weekly, with many more
occurring on the Narok-Mai Mahiu road, according to statistics available at the Traffic Headquarters
in Nairobi.
The statistics further show that 10 to 15 people are killed in road accidents which occur in various
parts of the country every week.
Capitol News 23 April 2010
134

STUDENT
ESSAY

Caitlin Dugdale, MS IV
Kenya Reflection Paper
Three Empty Beds
It was my last day on the medicine wards at Moi University Teaching and Referral
Hospital (MTRH). I could hardly believe that a month had already passed. It seemed like
just yesterday that I had arrived in Eldoret, Kenya, bright-eyed and eager to dive into my
two-month elective experience. I had been looking forward to seeing the IU-Kenya
Partnership for many years, and going into the experience, my expectations could not have
been higher. Learning tropical medicine every day, studying under Kenyan physicians, and
the promise of working side-by-side with Dr. Mamlin – participating in this program was a
long-awaited dream.
When I first started working on the women’s wards, I was assigned to a firm with an
American resident. He and my Kenyan registrar made a great team, as they demonstrated
mutual respect and amicability, but neither was afraid to question the other’s thinking for
the betterment of the patient. Both of them helped show me the ropes when I first started.
At first, I was completely clueless. I remember one early exchange with a nurse,
“Where are the vitals?”
“In the Cardex.”
“Where is the Cardex?”
“In the nurse’s room.”
“Okay, thanks. Oh, and one more question…where is the nurse’s room?”
Every day, I had to go on a scavenger hunt just to find the patient’s last recorded
blood pressure. The greater challenge still was trying to locate the treatment sheets, or T-
sheets as we called them. At times, they were in the pharmacy. Occasionally, they were
scattered around the nurses’ room. Once in a while, you would even find them by the
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bedside (often the wrong bedside). I can remember more than a handful of times when the
T-sheets were lost entirely. Even when I had the T-sheets in hand, I would have needed a
pharmacologic Rosetta Stone to decipher what medications the patient was taking and the
last time they were administered (if they were indeed administered at all). Starting work in
any new place can be overwhelming, but the wards in Kenya took confusion to a whole new
level. Just as I was finally figuring out how the system worked, it was time for me to leave it.
For me, the real key to learning the way of the wards was to come in on the
weekends. I spent my first weekend on service with the Kenyan intern and registrar, as the
sole student on the team. I learned more in that weekend than I had the entire week before.
With only three of us on rounds, I was afforded the luxury of learning about each patient
without straining to hear through the throngs of nurses, students, and auxiliary personnel
that usually crowded the bedside. I picked up charts and read each one as we passed. I
learned how to write out lab sheets, and I assisted the intern in jotting the daily notes in a
modified SOAP format. In short, that first weekend on service is when I actually became a
semi-useful member of the team, and I tried to come in on weekends ever since.
When the American resident returned to the States after my first week, there was a
void left in his wake. All of a sudden, EKGs were getting passed to me, the sole Muzungu on
the team, for initial interpretation. Clinical questions that I would pose to the group out of
shear curiosity began to be taken as suggestions for patient care, and were all-too-often
implemented. Even though I made every effort to affirm my role as a student, I was treated
more like an intern or registrar, as if my team expected me to fill the shoes of the American
resident after his departure.
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Although the team was not urging me to perform risky procedures, or make the final
management decisions, I still did not feel comfortable in this role of a pseudo-resident,
especially given the relative lack of attending oversight. Therefore, I compromised and
adopted the role of a SUB-I of sorts. My patients became my patients. I put in long hours,
and although I was still new to the system, I jumped through every hoop necessary in the
spirit of patient care. Fortunately, halfway through my time on service, Kate, a newlyminted
attending from Brown University, joined the team, relieving a lot of the pressure I
felt on the wards. Nevertheless, I was impassioned and empowered by my newfound
responsibility.
Bed #1: Teresia
My last day on medicine, Kate and I woke up early and ventured to the tumor board
meeting on the top floor of Mother and Baby Hospital. That Monday morning was
bittersweet. As someone pursuing a career in internal medicine, I was sad to be leaving the
medicine wards. I had been following some of these patients for weeks and had become
very invested in their care. On the other hand, I was excited about the freedom and
flexibility permitted in my second month. I am interested in global health program
development, so I wanted to get a broad view of AMPATH and its interrelationship with the
Kenyan public health system. To that end, I created a plan for my second month that
included visiting several remote clinics, touring the non-medical initiatives of AMPATH,
sampling the outpatient clinics at MTRH, spending a week with Astrid on OB/GYN, and also
rotating on the pediatrics ward with Dr. Helphinstine.
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This choose-your-own-adventure circuit of global health was originally scheduled to
begin on this Monday of my fifth week. This morning, however, Dr. Mamlin was going to be
rounding on my old medicine team, an experience, in my mind, that was not to be missed.
So, I decided to come back one final day for major ward rounds, which gave me the chance
to say goodbye to the handful of patients whom I had been following for several weeks.
Tumor board ran late, so I did not have time to pre-round as usual. Although the
team had already started rounding by the time I arrived, I decided to first check on some of
my old patients and then rejoin them. The very first bed that I went to was Teresia’s. She
was the first patient that I had picked up my first day on the wards. A 35-year-old mother
of three, she had lost her husband to HIV several years back. Looking at her, you could tell
that those last several years had been a struggle. Months ago, after taking Bactrim as PCP
prophylaxis, she developed a Stevens-Johnson-esque desquamating skin rash that had left
her diffusely hypopigmented. At first glance, one could not tell that the lighter skin was not
her natural color, because the rash was so wide-spread. When I looked at the dark hue of
her fragile hands, however, I could tell that the lighter patches were the aberrations. Her
true skin was a deep black, made more so from years of toiling under the sun. A sulfa drug
had left her skin permanently marked, an indication to all that her health was in jeopardy.
She had learned to live with the rash over the preceding months and had presented
instead for a persistent cough with shortness of breath. Given the high prevalence of
tuberculosis, she was put in Cube III, the “isolation” ward, until TB could be ruled out.
Rather than the negative-pressure room with disposable N95 masks that hospitals would
use in the States, isolation here simply meant a relocation to the last row of beds. Those
patients of particular concern for transmission, like a suspected MDR patient whom we had
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cared for a few weeks back, were placed under the window for sun exposure and better
ventilation. In Teresia’s case, she was next to the main aisle, the sole patient in her row. She
occupied bed 17, which I visited faithfully nearly every day for a month.
Teresia had actually been admitted three separate times the month that I was on
service. When she presented that first time for cough and shortness of breath, we found a
large mural thrombus in her heart, so we attributed her symptoms to a PE with
decompensated heart failure from HIV-DCM. She improved substantially in her first week,
so we enrolled her in the anticoagulation clinic and discharged her. Unfortunately, she did
not have the money to pay her final bill, so she remained in her hospital bed for several
days during which time her cough worsened. She was formally re-admitted and a repeat
CXR was concerning for pneumonia. Tuberculosis was again in our differential, because
although her initial round of sputums had been negative, she had been surrounded for
weeks by other patients with TB who shared the “isolation” room.
We treated Teresia for her suspected pneumonia over the course of another week
and she improved. On the day of her second discharge, Teresia and I talked at length about
her warfarin anticoagulation regimen, her heart condition, her resolving pneumonia, and
her family. When I told her she could go home, she smiled at me and shook my hand with
both of hers. I remember telling her that I was very happy she was feeling so much better,
and that while I enjoyed getting to know her, I hoped to never see her again.
Two days later, Teresia’s sister brought her back to the hospital. While eating dinner
at home, she had suddenly lost the ability to speak. Her sister reported that her eyes rolled
back in her head, and then she began convulsing, falling to the ground. They brought her
immediately back to the hospital where she was re-admitted to our service a third time.
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Her INR was higher than 8.0, indicating that she was overly anticoagulated, and she was
now at great risk for a bleed. We waited a whole day for the head CT, expecting it to
confirm what we had feared at re-admission: an intracranial bleed. To our great surprise,
the scan returned entirely normal. Within a couple of days, her INR trended back down,
and she started regaining the ability to speak, if only in whispers. I had last checked on her
on Saturday, two days before. That morning, she was sitting up in bed with some shortness
of breath, but she was able to respond to all of my questions and follow instructions
appropriately. Her sister was pleased with the progress she was making, though we still did
not have a clear explanation for what had happened.
Now, Monday morning, bed 17 was empty. The sheets were jumbled and half pulled,
the bed ominously unmade. On some level, I knew before asking, but I stopped the nurse
anyway. “Where’s Teresia?” I questioned. “She passed,” the nurse replied callously, walking
away. At that moment, I didn’t think to ask when or how or why. I was frozen. My mind
shot back to that image of her from Saturday, showing so many signs of improvement.
What had happened? Did the team already know? Where was her sister? My confusion was
quickly replaced with waves of anger at all that “could have been done,” under different
circumstances. Maybe the nurses forgot to give her the medications? Maybe someone let
her eat and she aspirated? Maybe the lasix I had recommended the day before had tipped
her over the edge? Maybe her INR became too high again and she developed a bleed… or
too low and developed a PE? So many things must have gone wrong in her care that her
death had to be someone’s fault, right?
If it was someone’s fault, why not mine? After all, I had checked on her on Saturday,
but I made the decision not to come in on Sunday. Sunday, I did something that I had not
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done in over a year – I slept until I woke up. No alarms, no meetings, no work, no wards. I
woke up with a smile on my face, and nearly cried from the joy of it. What if I had rounded
on Sunday instead of indulging in a few extra hours of sleep? Would I have seen that she
was deteriorating? Would I have picked up on some subtle clue that the new intern on the
team had missed? I had known the daily details of this patient, this person, for a month.
Surely I could have done something. After all, she was my patient.
Really, I knew better than to think this way. Her death was not any one person’s
fault, least of all my own. For weeks, I had worked hard to provide the best possible care for
her, fighting for her lab tests, begging techs to retake x-rays too poor to be used, and
handing the patients medications with a nurse by my side, just to be certain they had been
given. I was so tempted to direct my frustration at the broken system that allowed her
death. Even though MTRH is the second largest public hospital in Kenya, we would
routinely run out of some of the most basic of medications on the wards. Charts, t-sheets,
radiographs, and lab results were often permanently lost in transit. Many of the tests were
prohibitively expensive for the patients unless we petitioned to have the costs waived, so
patients would wait for days on end for imaging, wracking up a larger hospital bill all the
while. At discharge, when they could not pay, the patients would be stuck in the hospital for
days or weeks, at risk of catching a new infection from a patient in the bed next to them, as
had probably happened in Teresia’s case.
At first, the thing that bothered me most was that, on the surface, so many of my
Kenyan colleagues appeared indifferent to the everyday deaths on the wards, including
Teresia’s. At times, it seemed like the nurses could hardly be bothered to give the patients
their medications, much less distribute food, water, or clean sheets. My first week on the
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wards, we came upon a patient who was actively seizing during rounds. She had not been
checked on recently, so no one knew how long she had been seizing. She had bitten her
tongue while thrashing around in bed, so she had blood covering her face, neck, and pillow.
It was a horrific sight. My team ordered an anticonvulsant from the pharmacy (which
ended up being out of stock), and then calmly proceeded to the next bed, the first patient
still actively seizing in a pool of her own blood not three feet behind them. I am ashamed to
admit it now, but one of my first impressions of Kenya was that it was a country that did
not care about itself.
I am thankful that one person quickly changed that view. Isaac was the Kenyan sixth
year medical student who was initially assigned to Teresia before I arrived. I remember
being impressed by him on my first day on the wards. His presentations were thorough,
and he was one of the rare few on the team who spoke confidently (but still quietly). I was
not at all surprised to learn that he was one of the top students in the sixth year class, and
had spent six weeks at Brown University the year prior. Isaac continued to follow Teresia
even after I picked her up as a patient. I saw him return to her bedside in the afternoons
and explain or clarify treatment plans in Kiswahili. I remember several times when I came
in to pre-round on my patients in the mornings, only to find that Teresia’s daily note had
already been written.
The Monday that I found Teresia’s bed empty, Isaac and the rest of my medicine
team were starting a new rotation on OB/GYN. I texted him to let him know that she had
passed. Later he would tell me that he became as angry as I had been at hearing this news,
but he did not express it at the time. I would eventually learn that the reflex public
expression of emotion of any sort is not the Kenyan way. In the West, if we are happy, we
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shout our joy from the rooftops, and if we are angry we cause a scene. Our way of grand
outward expression is not the only way, and I think it is born out of a fundamental lack of
separation between public and private lives in the developed world. For Kenyans, the
emotional response is much quieter, and much more private, but it is no less profound.
Isaac was as frustrated as I was about the loss of our mutual patient, but he had long
since found a way to channel that frustration into productive pursuits. Once almost has to
learn to harness the rage they may feel at the gross inequities between the global north and
global south in order to function in a resource-limited setting like MTRH. I had seen other
Wazungu on the wards, including myself, respond much more poorly. Issac used this
analogy about outsiders’ vocal criticisms and frustrations on the wards, “If you bought me a
duvet for the bed, and then you ordered ‘fix your bed,’ I would be offended, it’s not your
bed, it’s mine. But since you bought a part of it, I can’t talk back, because that would be
ungrateful. I know the bed needs to be fixed, but I need to do it my way, on my time.” It is all
too easy to criticize the system when you only spend two months in it. Western generosity
seldom comes without strings attached, and those invisible strings tangle up the autonomy
and self-sufficiency that we outwardly encourage. In working and living side-by-side with
Kenyan colleagues and getting a glimpse of the AMPATH program, I have developed the
opinion that partnership is powerful, equal partnership is achievable, but perfect
partnership is impossible.
Bed #2: Edna
After staring at Teresia’s empty bed for a few moments, I retreated to the quiet
hallway by the medical student laboratory to collect myself. I have never been one to cry or
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Kenya Reflection Paper
wallow. Rather, I needed time to calm the inner rage that was playing havoc with my brain.
After a few deep breaths, I was ready to rejoin my team on the wards.
Kate had learned of Teresia’s passing by this time, and she offered a few words of
comfort and commiseration. The team was only in the first cube, and there were many
more patients yet to see. I found it much easier to turn off the anger and frustration boiling
within me while Dr. Mamlin was leading the team. He moved from bed to bed, a veritable
miracle worker, making swift and accurate diagnoses on patients who had stumped us for
days, and paving the way for free imaging and diagnostic tests with the waive of his pen.
When told that a patient was turned down for an endoscopy for suspected gastric cancer
because she could not pay, he promised that he would talk to so-and-so and get it all set
straight. He arranged for long-term nutritional supplements on one of the patients who was
wasted beyond recognition. One cannot help but be inspired by such a powerful figure of
hope and possibility.
The white-coated mob moved onto Cube II. I had been visiting the bed under the
window for the last month, checking on a patient labeled as a “lost-cause” from the moment
she was brought to MTRH. Edna was a 29-year-old schoolteacher and mother of two. She
was completely healthy until about a month ago when she developed a persistent headache
and general achiness. She was diagnosed with meningitis at an outside hospital, and
treated with an antibiotic, antifungal, and a steroid, but she continued to decline. By the
time that she was transferred to the wards, she was little more than a skeleton, cachexic
and verbally unresponsive.
The patient’s mother was a stark contrast to this grim picture. This woman, with a
wide-mouthed smile and a bright multi-colored handkerchief wrapped in her hair, never
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Kenya Reflection Paper
left her daughter’s side the whole month I was on the wards. She was vigilant in her
compassion and devotion, never losing hope for her daughter’s recovery in spite of her
progressive decline. Her optimism was infectious. The mother barely understood English,
but every day she greeted me warmly with what little English she knew. I reciprocated with
my piecemeal Swahili. My endless mispronunciations and animated miming of medical
questions always made her laugh.
After a while, Edna’s mother became something of a substitute nurse in the hospital.
When the breakfast cart came around, she collected bread and tea for all of the patients and
families in the near vicinity. She helped change Edna’s clothes and bed sheets, and
eventually even volunteered to do routine nasogastric tube feeds for a neighboring patient.
As outsiders, we criticize the lack of privacy on the wards, with 2-3 patients sharing a single
bed, and 10-20 patients in an open cube. However, out of this lack of privacy springs a
stronger sense of community. Although they start as strangers, these patients and their
families band together, forming their own support groups and becoming impromptu
nurses, ready to help when needed. How could I have ever thought that this was a country
that did not care about itself? Or, that these people did not care about each other?
Before I realized that Edna’s bed was empty, I noticed that her mother was gone.
After her month-long vigil, I knew that there was only one reason for Edna’s mother’s
absence. As in the case of Teresia, I did not need to ask to know what happened, but I did
anyway. “Passed,” they said. “Sometime around midnight.” Only one day, but here were two
empty beds of two patients I had known too long to let go.
In contrast to Teresia, Edna’s death was not unexpected. She was in bad shape from
day one. We continued her antibiotic and steroid when she was transferred to MTRH, but
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we also added RHZE for concern of TB meningitis in this newly diagnosed AIDS patient. A
head CT with contrast was ordered at arrival, but the hospital remained out of IV contrast
for nearly three weeks, so we could not get the scan. A private hospital nearby had a
functioning CT scanner with contrast, and even an MRI if we would have liked, but the
patient’s family lacked the funds to pay out of pocket for such an expensive test.
After two weeks with no improvement, we decided to repeat our CSF studies. I was
nominated to perform the LP, my first. My intern and three Kenyan sixth years on my team
helped me gather supplies and identify where to insert the needle. I placed my hands on
Edna’s iliac crests, with my thumbs in the midline. All of the necessary landmarks were
visible through sunken flesh, bony prominences with too little tissue left to guard them. I
inserted the needle, advancing cautiously until I felt the soft “pop” of the ligamentum
flavum. CSF flowed drop-by-drop into the collection bottles. I got the tap on my first try.
After sharing this experience with my silent patient, I felt inexplicably closer to her, and I
became much more invested in her care.
Isaac and I took the collection bottles to the laboratory where we were able to
examine the fluid ourselves under a microscope. My inner nerd was hoping that we would
visualize encapsulated yeasts with surrounding halos just like in the textbooks, but I am
thankful for the patient’s sake that we did not find anything interesting in the CSF. The
formal CSF report from the lab returned unchanged from the prior study, giving us no clear
etiology for her persistent neurological deficits. We added toxoplasmosis treatment to the
regimen and hoped for the best.
Two or three days after starting treatment for toxo, the mother reported marked
improvement. Though I never saw it myself, the mother reported that Edna spoke again,
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Caitlin Dugdale, MS IV
Kenya Reflection Paper
only monosyllabic words, but she spoke. She also began tracking people with her eyes and
would occasionally follow commands. I saw her sit up in bed once with a great deal of
assistance, but even this was considerable improvement. Not long after making these
strides, Edna became tachypneic and febrile. We ordered a CXR, but it was of such poor
quality that it was virtually unusable. Clinically, we were concerned about a LLL
pneumonia, so we started her on antibiotics, but she kept getting worse. When I saw her on
Saturday, she was breathing 40+ times a minute and her eyes looked more vacant than ever
before. I knew she did not have long to live, but I was still shaken by the sight of her empty
bed.
Bed#3: Chepkobus
After the one-two punch of these empty beds, I again had to take a moment to
recover. I returned, head bowed, to my student lab hiding place for a few seconds of
solitude. As an aspiring doctor, I know that dealing with death is a part of the job, and
perhaps an even bigger part in the resource-limited world of global health. Plenty of
patients had passed while I was on various services in the States. Some of the deaths that I
saw on trauma surgery were even more needless and non-sensical than the ones that I was
witnessing here in Kenya.
The difference, for me, was that in the States, I had been shielded from forming
relationships with patients with poor prognoses. My ward teams always rearranged the
census so that medical students would be distributed amongst the most interesting cases,
but they would generally not be assigned to follow patients that were already DNR. In
Kenya, every patient is DNR, because no resuscitation is readily available, and there is no
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shielding, because death is much more unpredictable. Losing patients in Kenya was the first
time that I had experienced the death of one of my patients, someone for whom I felt
directly responsible. I accept this as an important moment in my coming of age in medicine,
and also, my coming of age in global health.
Across the room from Edna was one final empty bed. This one, I also knew well and
had visited many times. Chepkobus was an 18-year-old student who presented with a
hemorrhagic stroke due to secondary hypertension. Our leading diagnosis was
fibromuscular dysplasia, but the hospital lacked the radiological tests (and interpreters)
needed to confirm the diagnosis. Chepkobus was at school in West Pokot, when she
suddenly developed a terrible headache and leg weakness. She began to have trouble
speaking, so her family brought her to the district hospital, and then on to MTRH. On
arrival to MTRH, she could not speak, but she followed commands appropriately. Her right
arm was limp, and her right leg was very weak. Her head CT showed a large bleed, but
neurosurgery declined to intervene.
Fortunately, a couple of days after admission, she began to speak, and then to smile.
Her right arm remained weak, but with herculean effort, she was eventually able to make a
tiny fist. After learning the Kiswahili words for basic body parts, I was able to enlist her
participation in daily neurologic exams. She was very pleasant, cooperative, and patient
with me when I brought the Slemenda Scholars to her bedside to teach them how to do
reflex testing on a patient.
Two weeks of daily physical therapy later, she was finally able to walk again. After
rounds one morning, I was flipping through a patient’s chart when Kate tapped me on the
shoulder. “Look,” she said, and pointed. Chepkobus was shuffling unsteadily down the
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Caitlin Dugdale, MS IV
Kenya Reflection Paper
hallway, holding on to walls, chairs, carts, and anything else that could support her. I jogged
over to her, and mimed that I would like to help her get outside. I supported her arm for
balance, and we shuffled outside together toward the favorite gathering place for several of
the women on the ward. Edna’s mother was there already, taking a brief respite from her
caregiver role. The sister of another of my patients was there too, and she helped
Chepkobus ease onto the ground. This gaggle of women giggled at me as I waved and said
“Tuonane baadaye!” As I started heading back towards the wards, I heard Chepkobus say,
“Asante.” I turned back and replied “Karibu!” She looked up at me with a big crooked smile.
Seeing Chepkobus walk again was one of the happiest memories I have from my
time in Kenya. This time, with this empty bed, I also knew why it was vacant before asking.
I approached my intern with just one word, “Chepkobus?”
“I discharged her on Sunday, he replied. “She went home.”
Finally, a story with a happy ending.
In my short time in Kenya, there were many stories with happy endings, including
my own. The elective experience met or exceeded all of my expectations. My only regret
was that I could not stay there longer, working alongside my new Kenyan friends and
colleagues. I learned things about global health, life, and myself that I did not even know I
did not know. Every time I travel to a place like Kenya where I am surrounded by
extraordinary people working for the betterment of others, I am reminded of why no other
path in life could make me happier or more fulfilled than a career in global health. For some
students, the Kenya elective serves as a “once in a lifetime experience.” I hope to have a
whole lifetime of these experiences, and I cannot wait to get out in the world again!
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