indiana university and moi university school of medicine ... - ampath

INDIANA UNIVERSITY AND MOI UNIVERSITY SCHOOL OF MEDICINE PARTNERSHIP

2013-2014 ORIENTATION GUIDEBOOK

INDIANA UNIVERSITY AND MOI UNIVERSITY SCHOOL OF MEDICINE PARTNERSHIP

2013-2014 ORIENTATION GUIDE BOOK

TABLE OF CONTENTS SECTION I. THE PROGRAM AND PRACTICAL MATTERS Page A. Karibu … Welcome B. Contact Information .................................................................................................................... 2 C. Practical Matters 1. 2. 3 4. 5.

6.

Travel Planning Timetable .................................................................................. 6 The Partnership Between IUSM and MUSM: A Model ................................... 8 Participants List 2013-14 ................................................................................... 16 Participants List 2012-13 ................................................................................... 18 Documents • Memo to Kenya Faculty and Resident Travelers..................................... 22 • Guidelines for International Electives and Experiences.......................... 24 • Visa Requirements and Application ......................................................... 26 • The Medical Practitioner’s Permit Application ....................................... 32 • Emergency Contact Information............................................................... 34 • 2013-2014 Student Liability Waiver ......................................................... 36 • Overall Crime and Safety Situation .......................................................... 38 Policies • Vehicle Use Policy of Indiana University .................................................. 46 • Housing & Board ........................................................................................ 48 • Evacuation Insurance Policy ..................................................................... 49 • Student Health Insurance EXCLUSIONS................................................ 50 • Travel Policy .............................................................................................. 55 • Waiver of Liability Policy .......................................................................... 56 • Vacation Policy ........................................................................................... 57 • Grading Policy ............................................................................................ 58 • Tuberculosis Screening .............................................................................. 59 • Competencies .............................................................................................. 60

C.

Curriculum, Goals, Objectives .................................................................................................. 64

D.

Travel Preparation 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Letter from IUCGH Director of Education, Deb Litzelman, MA, MD ................. 70 Example of Typical Week for Students and Residents............................................ 72 Expectations of Students ............................................................................................ 73 Expectations for Medicine Residents ........................................................................ 74 Expectations for Pediatric Residents ........................................................................ 75 How to Give a Sally Test Talk ................................................................................... 76 Tumaini Project .......................................................................................................... 78 Required and Suggested Reading Materials ............................................................ 80 Running/Walking Routes in Eldoret......................................................................... 83 Suggestions for Eldoret Travelers ............................................................................. 84 Student Recommendations for Kenya Elective ........................................................ 89 Global Health CaseFiles “How-to-Guide” ............................................................... 92 Kiswahili Translation Guide ..................................................................................... 94 Lab Units Conversion ................................................................................................ 99 Kenyan Abbreviations and Terminology ............................................................... 100 9 Die in Kenyan Highway Mishap .......................................................................... 103

SECTION II. INFORMATIVE READING MATERIAL Student Essay (Matthew Turissini) ......................................................................... 106

May 1, 2013

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, M200 OPW, Wishard Hospital, 1001 West 10th 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 June 1, 2013 - May 31, 2014 Name Robert Einterz, M.D. Associate Dean, Global Health Director, IU Center for Global Health Director, IU-Moi Program

Address Wishard Hospital 1001 W. 10th St. OPW-M200 Indianapolis, IN 46202

Phone**/Fax/E-Mail P: 317/630-7075 F: 317/630-7066 C: 317/840-3185 Pg: 317/312-1655 E: [email protected]

Jill Helphinstine Co-Director, IU-Moi 4th Year Elective Director, Global Health Residency Track

Wishard Hospital 1001 W. 10th Street, OPW M200 Indianapolis, IN 46202

P: 317/554-4600 C: 317/752-4282 H: 317/ 635-8133 Pg: 317/ 310-7786 E: [email protected]

Ron Pettigrew Program Manager

Wishard Hospital 1001 W. 10th St. M200 Indianapolis, IN 46202

P: 317/630-8695 F: 317/630-7066 H: 317/848-9798 C: 317/727-3332 Pg: 317/312-1657 E: [email protected]

Dunia Karama Program Administrator

IU House IIGH Kenya PO Box 5760 Eldoret, Kenya

Geren Stone Team Leader & Medicine Field Director

IU House IIGH Kenya P.O. Box 5760 Eldoret, Kenya

E: [email protected] C: 011-254 (0)724-679-898

Laura Ruhl Pediatric Field Director



Jordan Huskins Pediatric Team Liaison



Adrian Gardner Field Director, AMPATH


E: [email protected]

C: 011-254 (0)721-724-633 E: [email protected]

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Joe & Sarah Ellen Mamlin

Eldoret Kenya

C: 011-254-(0)722-374-558 (Joe) C: 011-254-(0)733-580-495 (Sarah Ellen) E - Joe: [email protected] E - Sarah Ellen: [email protected]

John Sidle Co-Field Director of Research


C: 011-254-(0)734-893-871 E: [email protected]

Elizabeth Chester IU House Assoc. Field Director IIGH Kenya Orphans and Vulnerable Children P.O. Box 5760 Eldoret, Kenya

C: 011-254-(0)723-270-234 E: [email protected]

MTS Travel ATTN: Diane Houseman

717 N. Main Street Box 505 Newton, KS

P: 800/835-0106 F: 316/283-2397 E: [email protected]

Kwa Kila Hali Safaris Netta and/or Christine

Eldoret and Nairobi

P: 011-254-(0)20-248-653 C: 011-254-(0)722-725347 E: [email protected]

Endoroto Travel Damarice Wathika

Eldoret

E: [email protected] C: 011-254-(0) 721-376-197

Joseph Chacha/Mangrove Tours Eldoret Taxi from Eldoret Airport

P: 011-254-(0) 53-2060236 C: 011-254 (0) 721-215-074

Taxi Max Eldoret-based taxi service

P: 011-254-(0) 725-885-733

Eldoret

*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.ampathkenya.org 3

PRACTICAL MATTERS

MEDICINE IN KENYA: Travel Planning Time Table (Dates of Travel? Activity

Contact/Resource

Become familiar with program goals and objectives

Participant’s responsibility

Faculty: contact Dunia Karama and Ron Pettigrew regarding IU House Availability Complete documentation for Visitor’s Medical License in Kenya (see page 32 in orientation materials)

Participant’s responsibility

Obtain passport, visa (see page in orientation materials), other travel documents

Orientation Materials

2 months before departure date 1 month before departure date

Obtain plane tickets Obtain ground transportation arrangements to Eldoret Provide our office with your travel itinerary. Complete all online iAbroad electronic submissions Obtain appropriate immunizations and prophylaxis medications (mefloquine, doxycycline, or malarone for Malaria)

Orientation Materials/Travel Agent Ron Pettigrew Ron Pettigrew

1 month before departure date

Attend mandatory orientation refresher with Jill Helphinstine and Ron Pettigrew

Ron Pettigrew

1 month before departure date

Contact Medicine and Pediatric Liaisons with arrival/departure dates and one paragraph describing your global health experience, future global health plans and career goals. Complete and sign Guidelines for International Electives and Experiences (see pg. 24), and Liability Waiver (see pg. 36)

Geren Stone (medicine) at [email protected] Jordan Huskins (pediatrics) at [email protected]

Complete and send in copy of Emergency Contacts (see page 34) Obtain insurance/provide verification (copy of policy or policy number) Contact Kenya Program Administrator in Kenya about Nairobi to Eldoret travel Prepay housing costs Make checks payable to “IIGH, Inc.” Submit electronic paper on Kenya experiences (students only)

Ron Pettigrew

Due Date Orientation Days AT LEAST 3 mos. Before departure Faculty: 3 mos. before Residents: Before July 1, 2011 3 months prior departure date 3 months before

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)

2 months before departure dates 2 months before departure 2 months before departure date 1 month before 2 weeks before 2 weeks after return

Orientation Materials/ Program Assistant

Participant’s responsibility ( initial doses available from Dr. Charles Kelley

Ron Pettigrew

Dunia Karama and Ron Pettigrew Ron Pettigrew Ron Pettigrew

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.

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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 is Adrian Gardner. The Medical Liaison or Team Leader supervises all visiting residents and students and coordinates the medical activities of all visiting faculty members. The Team Leader is Geren Stone MD (Internal Medicine). Geren is joined by Jordan Huskins, MD (Pediatrics).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. 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 fourteen-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 425 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 365 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. Two sophomores will travel to Kenya in the summer of 2013. 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, Otolaryngology, Oncology, Dermatology, Anesthesiology, Family Medicine, Psychiatry, Radiology, Obstetrics/Gynecology and Surgery have each contributed to Kenyan faculty development in Kenya and Indiana. One member of the IUSM Department of Surgery served five years in Eldoret. Beginning in August 2013, the IUSM Department of Surgery

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will support a full-time surgeon who will oversee IU’s efforts and collaboration with MTRH surgeons. 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 (Academic Model Providing Access To Healthcare) Consortium, a collaboration of other institutions (Brown, Utah, Duke, Toronto, Purdue, Notre Dame, and UMass) along with 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 North America partners in the AMPATH consortium provide full scholarship support each year for selected MUSM students (16 in 2013) to take 6 week electives in North America. More than 90 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 and AMPATH, combating the HIV/AIDS pandemic has been the current focus for the last ten 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 three 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 in-depth description of the work.

Sustainability Funding for the IU-Kenya program and AMPATH 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.

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Outcomes Scholarly Achievements Numerous grants from U.S. federal agencies and several foundations have funded faculty and student exchange and the development of clinical, teaching, and research personnel and programs in Kenya, 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 over 61 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 over 50 students in work-study and over 50 full tuition scholarships. IUSM with its US consortium partners also provides full funding to enable 16 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 and AMPATH have 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. Currently, a new Chronic Disease Management building featuring state of the art oncology, radiology and cardiac care units is undergoing construction. Plans call for the building to begin providing services to Kenyan patients in early 2015. 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.

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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: “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.”

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“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 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

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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. “AMPATH” or Academic Model Providing Access To Healthcare focuses on many healthcare needs of the Eldoret catchment area and brings 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 COmmunityBased 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,” Robert Einterz, MD and director of the IU Center for Global Health, 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 pulmonary 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, diabetes and cancer care, Pfizer in cancer care, 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 North America 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 multiple 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 is 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

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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 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 of HIV (pMTCT), Voluntary Counseling and Testing (VCT), Home-based 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-of-the-art computerized medical records for each patient.

Conclusion The IU Kenya-AMPATH partnership provides an important affirmation of each medical school’s commitment to the world community. The success of the partnership reveals the promise such collaborative projects hold for the development of tomorrow’s medical leaders, both within Africa and North America.

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Indiana University-Moi University School of Medicine Partnership List of Participants, 2013-2014 IUSM Students Name

Months in Kenya

Tirajeh Saadatzadeh, (Slemenda) Bruce McKee (Slemenda) Vince Gamma Joanna Campodonico Kirsten Reinecke Madhavi Singhal Chris Mueller Scott McCarty Jessica Rice Shama Mehta Ethan Morrical Patience Obasaju Manisha Patel Joshua Ring Farheen Sultana Ryan Kunkel Rachel Teat Chris Mosher Forrest Craig Emma Cordes Ganiyat Oladapo Amy Dreischerf Sashana Gordon Priyanka Kanakamedala

June/July 2013 June/July 2013 June/July 2013 June/July 2013 July/August 2013 August/September 2013 September/October 2013 September/October 2013 September/October 2013 October/November2013 October/November2013 October/November2013 October/November2013 January/February 2014 January/February 2014 January/February 2014 January/February 2014 January/February 2014 March/April 2014 March/April 2014 March/April 2014 March/April 2014 March/April 2014 March/April 2014

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IUSM Residents NAME

Sheila Krishnan Jason Slade Palka Patel Amy Ratliff Marlena Mattingly Chris Kniese Brittany Mohrman Jackie Stewart Girish Kunapareddy Amanda Walter Willie Robinson Hetal Shah Kristen Bendinger Neena Qasba Michelle Murray

SPECIALTY

PGY-2 Med PGY-2 M/P PGY-3 M/P PGY-2 Peds PGY-2 OBGYN PGY-2 Med PGY-2 M/P PGY-4 M/P PGY-3 Med PGY-2 Peds PGY-2 Med PGY-2 Med PGY-2 M/P PGY-2 OBGYN PGY-2 M/P

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MONTHS IN KENYA

July/August 2013 August/Sept 2013 September/October 2013 October/November 2013 October/November 2013 November/December 2013 November/December 2013 November/December 2013 February/March 2014 March/April 2014 April/May 2014 April/May 2014 May/June 2014 April/May 2014 May/June 2014

Indiana University-Moi University School of Medicine Partnership List of Participants, 2012-2013 IUSM Students Name

Months in Kenya

Rebecca Sorber (Slemenda) Laura Secor (Slemenda) Robert McCurdy Olayinka Afolabi Jordan Arkin Lisa Koers Rebecca Kincaid Brandon Hood Bryce Wininger Jonathan Weyerbacher Angela Choe Heather Brillhart Matt Pflederer Sara Sorrell Neha Patel Peter Baenzinger Francesca Monn Matt Turissini Benjy Katz

June/July 2012 June/July 2012 June/July 2012 July/August 2012 July/August 2012 August/September 2012 August/September 2012 September/October 2012 September/October 2012 September/October 2012 September/October 2012 September/October 2012 January/February 2013 January/February 2013 January/February 2013 January/February 2013 January/February 2013 January/February 2013 February/April 2013

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IUSM Residents NAME

Casey Armstrong Brock Medsker Christopher Watson Dan Guiles Vandna Handa Patrick Clements Suyog Kamatkar Josephine Wang Jenny Baenzinger Rose DeGrauw Sonali Jain Daniel Pino Hilary White Ryan Grimm

SPECIALTY

PGY-2 Med PGY-2 Peds PGY-4 Rad/Onc PGY-2 M/P PGY-2 M/P PGY-2 Peds PGY-2 Peds PGY-3 Peds PGY-2 M/P PGY-2 Peds PGY-2 Med PGY-2 M/P PGY-2 Peds PGY-2 Peds

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MONTHS IN KENYA

July/August 2012 August/Sept 2012 July/August 2012 August/September 2012 August/September 2012 September/October 2012 September/October 2012 September/October 2012 January/February 2013 January/February 2013 January/February 2013 January/February 2013 January/February 2013 May/June 2013

DOCUMENTS

MEMO

TO:

Kenya Faculty and Resident Travelers

FROM:

Ron Pettigrew, Program Manager

SUBJ:

Requirements for Kenya Rotation for Faculty and Residents

DATE:

May 1. 2013

_______________________________________________________________ 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. 2. 3. 4. 5. 6. 7.

License Fee – Currently $125 (Please contact Ron for updates on this amount) A completed form for Medical Practitioners Permit (pg.32) Curriculum Vitae Copy of medical school diploma Copy of U.S. medical license Color 2”X2” passport photo 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 RON PETTIGREW FOR FORWARDING TO ELDORET. Residents should submit documents prior to July 1, 2013. Faculty should submit documents at least three months prior to departure or earlier. *Letters of reference do not need to be elaborate

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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____________________

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VISA REQUIREMENTS (If acquiring visa upon entry to Kenya at the Nairobi Airport) 1. 2. 3.

$50.00 US cash Visa application form duly completed and signed by the applicant (in Orientation Manual). Valid passport with sufficient number of unused pages for endorsements abroad. Passport must be signed and valid for at least six months. 4. Pupil Pass – 5,500 ksh and 2 passport photos 5. Foreign Registration Card – 2,000 ksh and 2 passport photos (for visitors staying in Eldoret >1 month) STANDARD VISA FEES Visa fee is payable by money order made to the Embassy of Kenya.* (Washington D.C. only) Type of Visa Multiple Journey Entry Visa Single Journey Entry Visa Transit Visa (issued at port of entry into Kenya) Referral Visa Diplomatic, Official, Service & Courtesy Visa

Fee Chargeable (US $) US $100.00 US $50.00 US $20.00 US $10.00 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 after anticipated return to the US. 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://step.state.gov/step/ 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

EXAMPLE FORM

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) ____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: __________________________________________

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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: ______________________________________

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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………………………………………

32

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

_________________________________ Pager

________________________ Cell Phone

_________________________________ NEXT OF KIN: Name

_________________________ Email

________________________ 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

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Indiana University Students Intending to Study in Kenya 2013-2014 Liability Waiver

I hereby acknowledge that I have read the Overall Crime and Safety Situation on the following pages (pages 38-42) as well as the U.S. Department of State Travel Warning regarding travel to Kenya by United States citizens dated February 28, 2013 at http://travel.state.gov/travel/cis_pa_tw/pa/pa_5895.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 2013 and/or Spring 2014 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

Overall Crime and Safety Situation

Kenya remains critically rated for both Crime and Transnational Terrorism. 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 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 38

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. 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 39

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 or credit card, the criminal will prolong the incident so they can take the victim to multiple ATM machines for withdrawals.

40

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 Marsabit 69 Masai 44 Malindi 42 41

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.: 011-254722-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.

42

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). IU House policy also prohibits the use of or riding of motorcycles (piki piki), bicycles (boda boda) or 3-wheel taxis (toot toot) for any transportation anywhere in Kenya.

I have read these policies and agree to comply.

Printed Name: Signature: Date:

46

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 $38/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 $38/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 $38/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 $58 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 $38/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 IUKenya 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, incountry 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 6/1/2013

but are subject to change without prior notice.

48

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.

49

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.

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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

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• 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.

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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.

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

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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 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 [email protected]. 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. 6) IU House policy also prohibits the use of or riding of motorcycles (piki piki), bicycles (boda boda) or 3-wheel taxis (toot toot) for any transportation anywhere in Kenya.

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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 Ron Pettigrew the waiver of liability document known as “Guidelines for International Electives and Experiences” (pages 24 and 36). Students (not residents) will also be responsible for signing and returning to Ron Pettigrew the “Agreement and Release Form” from Indiana University at least two months before your scheduled departure.

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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. Residents are expected to arrive in Eldoret by the third day of their rotation block; no more than 5 days should be used for travel to and from Kenya. ** 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 3rd of the month. Any exceptions should be discussed with Ron Pettigrew and one of the Team Liaisons in Kenya.

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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 approximately 10 pages, double spaced, 12 pt. font. ** All student essays should be submitted electronically within 30 days of return to the US from Kenya. ** 2) Optional requirement is a research project approved by the course director. 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

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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.

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COMPETENCIES All 4th 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.

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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

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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. 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. 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. 64

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 • Objective 13.1. (Medical Students) IU School of Medicine policy states that time off from course work in a fourth year elective for any 65

• •

•

•

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

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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 XRays, 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 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, Debra K. Litzelman, MA, MD Associate Dean for Medical Education and Curricular Affairs Richard Powell Professor of Medicine Indiana University School of Medicine

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Weekly Events Monday

Tuesday

Wednesday

Thursday

Friday

Pre-rounding (7- Pre-rounding (7- Pre-rounding (7- Pre-rounding (7- Pre-rounding (78) 8) 8) 8) 8)

Rounding

AM Report (8-9)

Sally Test (121p)

Rounding

Tumaini Health Talk (2:153:30pm)

GH Talk (2:15P)

Cardiology Lecture in Ampath lecture rooms (3:30P)

Peds & Med Dept Conference* (89)

AM Report (8-9)

Rounding

Rounding

Sally Test (121P)

GH Talk (2:15P)

GH Jrnl Club/ Phys Diagnosis Rounds (2:15P)

Patient care (post-rounds until 5pm)


Rounding



Peds Registrar Lecture (3:30P) Fireside Chat (7:30-8:30P)


* Peds Department Conf 1stWednesday – consultants only, 2nd – mini grand rounds, 3rd – mortality, 4th – radiology rounds

Other Clinical Opportunities Weekly Monday

Tuesday

Wednesday

Thursday

Friday

General Medicine Cardiology AM General Medicine Cardiology AM Cardiology AM Report (8:00, COE) (9-12, MTRH Outpt) Report (8:00, COE) (9-12, MTRH Outpt) Report (8:00, COE) Peds Outpatient Diabetes Clinic Peds Outpatient Peds Pulm Clinic Clinic (9-12, MTRH (7:30-4, Kitale) Clinic (9-12, MTRH and Peds Outpt) Outpt) Contact Sonak Cardiology Clinic (9-12) Adult Medical Peds Diabetes Cardiology Pediatric Oncology (9-1, Clinic (9-12, MTRH Diabetes Clinic Clinic (9-5, Oncology Rm 64)- confirm with AMPATH Basement) AMPATH Basement) (9-12, AMPATH (7:30-4, Webuye) Laura Basement, every Contact Sonak Gyn Clinics other Wednesday) CC Screening + AMPATH TB Clinic FP + Ante-natal (9-2, MTRH) Gyn Procedures – (9-1, TB Clinic, CC Screening + Care (9-12, Module confirm with Adran LEEP, CC Screening + FP + Ante-natal Gardner) 1, Rm5) Colposcopy, FP + Ante-natal Care Punch Bx Care (9-12, Module 1, Chest Clinic (9-12, Module 1, Tumor Board

(7-8:30a, MBH conference room)

(9-12, Module 1, Rm5)

Rm5)

Warfarin Clinic

(9-2, MTRH)

(25, AMPATH Basement)

Gyn Clinics (2-4:30pm)

CC Screening + FP + Ante-natal Care (9-12, Module 1, Rm5)

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Rm 5)

AMPATH Complex Gyn Case Clinic (12-1, Module 1, Rm 5)

Expectations for MSIV Students Team Liaisons: • •

Geren Stone (Internal Medicine): 0724-679898, [email protected] Jordan Huskins (Pediatrics): 0725-271634, [email protected]

1 Expectations: Medicine (required for minimum of 4 weeks) and Pediatrics • One month prior to arrival, brief explanation of why you are taking this rotation, career interests, and expected arrival/leave dates (2-3 paragraphs) – email to both TLs listed above • Email TL’s weekly a list of clerked patients (initials only please) & diagnosis (even tentative) • Prior to leaving, email participation record to TL’s with date of each activity attended while in Kenya • Within 2 weeks of departure, email final Kenya paper to TL’s, Dr Einterz, & Ron Pettigrew

Required Participation •

•

Morning Report (every Tuesday and Thursday at 8am): one to two presentations per student o Basic Structure – 25 minute case presentation (morning report format), 10 minute teaching/discussion on relevant topic (powerpoint not required), 10 minute pharmacy student presentation (if applicable), 5 minutes for questions o Case to be shared with Pharmacy Student (on your ward team) at least 2-3 days in advance of presentation – contact Rakhi if question of appropriate pharmacy student. o Please inform one of the TLs the night prior to your presentation if you will need a Macintosh projector adaptor.

Case File (TO BE TURNED IN BY END OF WEEK 4 AND BE FINALIZED BEFORE DEPARTURE) o

•

Rounding with Team and Logging Patient List o o

•

•

• • • • •

•

• •

One case (which may be your morning report case) to be written up (relevant parts of the medical presentation and history, images of unique findings, diagnostic tests including images, differential diagnosis, treatment, cost analysis and key clinical questions with discussion). These are to be emailed to the Medicine and Pediatric TL for review and final revisions will be uploaded to a compendium of web-based case files BEFORE departure from Eldoret. Pre-round and write a note on your patients every day. Participate in admissions on admitting days – pick up 1-2 patients to follow during each admitting day

Attendance at least 1 remote AMPATH clinic o Mosoriot (Wednesdays) with Joe Mamlin — depart 7:45AM from Joe's House o Teso (Wednesdays) with Geren— depart 7:30AM from IU House Gate o Turbo (Fridays, morning) with Joe Mamlin — depart 8:00AM from Joe's House Outpatient Clinic Attendance o Assigned 1 day at Cardiology Clinic (Tuesday 9:00 AM) o At least 1 other including:  Medical Outpatient Clinic (Tuesday/Thursday) with your registrar and team.  Adult Oncology (Monday). Contact Chite.  Pediatric Outpatient Clinic (Tues/Thurs 9-12), MTRH outpatient. Contact Jordan.  Diabetes Clinic (Wednesdays at Kitale & Fridays at Webuye) with Sonak.  Pediatric Oncology Clinic (every other Wednesday 9-12), AMPATH basement. Contact Jodi or Jordan.  Chest Clinic (Thursday). Talk with Geren.  Pediatric Diabetes Clinic (Thusday 9-12), MTRH, Rm 64. Contact Laura.  Pediatric Cardiology/Pulmonary Clinics (Friday 9-12), AMPATH basement. Contact Jordan. Global Health Didactic Series (Tuesday and Thursday, 2:15PM) Physical Diagnosis Rounds & Global Health Journal Club (Alternating Fridays 2:15PM) Sally Test Center Parent Talk (Monday, Friday 12-1pm) o Give one presentation about health topic of your choice. Please sign up for your topic in Sally Test 2 weeks in advance and prepare your handout 1-2 weeks in advance. Fireside Chats (Thursday 7:30PM) nd th Tumaini Center Adolescent Health Talk (Orientation every 2 & 4 Monday 2-3pm) o Required to attend orientation session. Sign up in computer room. Further involvement invited if interested.

Participation in the Heart and Harvest Initiative (HHI) o Visit to Buffett Farm. Manual labor volunteer work. o Contact: Abraham Boit - HHI Manager - in charge of all AMPATH food production farms. o Wear work clothes. Bring sunscreen, water. There is limited space to store belongings. o 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 o 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 o Wednesday afternoons from 2-5 pm. Sign-up at least one week in advance – sign-up sheet is in the computer room.

Optional Activities: • • •

Cardiology Grand Rounds Lectures (Monday 3:30PM) Volunteer at Tumaini Center o Many opportunities including medical liaison, sports outreach, lifeskills talks, and more. Learn about them and sign up on orientation tour at Tumaini. Orphans and Vulnerable Children (OVC) Field Visits o Limited spots available. Sign-up on a first come, first served basis in the OVC office (below warehouse) o Be ready to depart OVC office promptly at 8:00AM on the morning of your visit. o Please see remainder of instructions on sign up sheet including proper apparel.

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.

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Expectations for Medicine Residents Team Liaisons: Geren Stone (Internal Medicine): 0724679898, [email protected] Jordan Huskins (Pediatrics): 0725-271634, [email protected] •

Morning Report (every Tuesday and Thursday at 8am): one to two presentations per resident o Basic Structure – 25 minute case presentation (morning report format), 10 minute teaching/discussion on relevant topic (powerpoint not required), 10 minute pharmacy student presentation (if applicable), 5 minutes for questions o Case to be shared with Pharmacy Student (on your ward team) at least 2-3 days in advance of presentation – contact Rakhi if question of appropriate pharmacy student. o Please inform one of the TLs the night prior to your presentation if you will need a Macintosh projector adaptor.

•

Rounding with Team o Though each team and even each day looks different, as much as possible, function as contributing team member each day to the care of all your patients o Participate in admissions on admitting days (Every other day on medicine) o Bedside teaching to clinical officers and medical students as well as supervision of procedures Attendance at least 1 remote AMPATH clinic o Mosoriot (Wednesdays) with Joe Mamlin — depart 7:45AM from Joe's House o Teso (Wednesdays) with Geren— depart 7:30AM from IU House Gate o Turbo (Fridays, morning) with Joe Mamlin — depart 8:00AM from Joe's House Outpatient Clinic Attendance o Assigned 1 day at Cardiology Clinic (Tuesday 9:00 AM) o At least 1 other including:  Medical Outpatient Clinic (Tuesday/Thursday) with your registrar and team.  Adult Oncology (Monday). Contact Chite.  Diabetes Clinic (Wednesdays at Kitale & Fridays at Webuye) with Sonak  Chest Clinic (Thursday). Talk with Geren. Global Health Didactic Series (Tuesday and Thursday, 2:15PM) Lead Physical Diagnosis Rounds (Alternating Fridays 2:15PM with Jrnl Club) o Find and teach visiting medical students and residents from cases on wards. Global Health Journal Club (Alternating Fridays 2:15PM with Physical Diagnosis Rounds) Sally Test Center Parent Talk (Monday, Friday 12-1pm) o Give one presentation about health topic of your choice. Please sign up for your topic in Sally Test 2 weeks in advance and prepare your handout 1-2 weeks in advance. Fireside Chats (Thursday 7:30PM) Cardiology Grand Rounds Lectures (Monday 3:30PM)

•

•

• • • • • •

Optional Activities: • Participation in the Heart and Harvest Initiative (HHI) o Visit to Buffett Farm. Manual labor volunteer work. o Contact: Abraham Boit - HHI Manager - in charge of all AMPATH food production farms. o Wear work clothes. Bring sunscreen, water. There is limited space to store belongings. o Monday mornings from 9-1 pm. Sign-up at least one week in advance in the computer room. • Visit Imani Workshops o Thursday 3:30-5pm. Sign-up at least one week in advance in the computer room. • Visit to Neema House, children’s orphanage o Wednesday afternoons from 2-5 pm. Sign-up at least one week in advance in the computer room. nd th • Tumaini Center Adolescent Health Talk (Orientation every 2 & 4 Monday 2-3pm) o Sign up in computer room. Further involvement invited if interested in working with street children of Eldoret including medical liaison, sports outreach, lifeskills talks, and more. • Orphans and Vulnerable Children (OVC) Field Visits o Limited spots available. Sign-up on a first come, first served basis in the OVC office (below warehouse) o Be ready to depart OVC office promptly at 8:00AM on the morning of your visit. o Please see remainder of instructions on sign up sheet including proper apparel.

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Expectations for Pediatric Residents Team Liaisons: Jordan Huskins (Pediatrics): 0725-271634, [email protected] Geren Stone (Internal Medicine): 0724679898, [email protected] •

Morning Report (every Tuesday and Thursday at 8am): one to two presentations per resident o Basic Structure – 25 minute case presentation (morning report format), 10 minute teaching/discussion on relevant topic (PowerPoint not required), 10 minute pharmacy student presentation (if applicable), 5 minutes for questions o Case to be shared with Pharmacy Student (on your ward team) at least 2-3 days in advance of presentation – contact Rakhi if question of appropriate pharmacy student. o Please inform one of the TLs the night prior to your presentation if you will need a Macintosh projector adaptor.

•

Rounding with Team o Actively contribute in rounds and patient care activities daily. o Participating in all daytime admissions on admitting days (every 4th day) by assisting and teaching the clinical officers, medical students or interns with new patients o Bedside teaching to clinical officers, medical students and interns. o Describe the presentation, exam, treatment for 2 interesting patients per week o Record a log of the age, presentation and diagnosis(tentative) for each patient admitted to ward over one week. Attend at least 1 remote AMPATH-HIV clinic o Mosoriot (Wednesdays) with Joe Mamlin — depart 7:45AM from Joe's House o Teso (Wednesdays) with Geren— depart 7:30AM from IU House Gate o Turbo (Fridays, morning) with Joe Mamlin — depart 8:00AM from Joe's House Attend 2-4 non-HIV AMPATH outpatient clinics. Please plan ahead and use your pre-call day for these clinics. o Assigned 1 day at Cardiology Clinic (Tuesday 9:00 AM) o At least 1 other clinic including:  Pediatric Outpatient Clinic (Tues/Thurs 9-12), MTRH outpatient. Contact Jordan.  Pediatric Oncology Clinic (every other Wednesday 9-12), AMPATH basement. Contact Jodi or Jordan.  Pediatric Diabetes Clinic (Thusday 9-12), MTRH, Rm 64. Contact Laura.  Pediatric Cardiology/Pulmonary Clinics (Friday 9-12), AMPATH basement. Contact Jordan. Give 2 bedside teaching sessions for medical students or interns. Global Health Didactic Series (Tuesday and Thursday, 2:15PM) Lead Physical Diagnosis Rounds (Alternating Fridays 2:15PM with Jrnl Club) Global Health Journal Club (Alternating Fridays 2:15PM with Physical Diagnosis Rounds) Find and teach visiting medical students and residents from cases on wards Cardiology Grand Round on Monday at 3:30pm or Pediatric Registrar lectures on Monday at 3pm in MBH Attendance at Wednesday 8am Pediatric conference in the MTRH board room on the top floor of the main building. Sally Test Center Parent Talk (Monday, Friday 12-1pm) o Give one presentation about health topic of your choice. Topic must be communicated at least one week in advance. See schedule and handout for more information. Fireside Chats (Thursday 7.30PM) o Discussion of public health, social or cultural topics. Topic listed each week in Food House. Read relevant articles before discussion. With the assistance of the TL, revise one page of the pediatric ward guide or help develop a protocol for the wards. Please provide a 1-2 page description of an ethical problem that arose during your time in Kenya and how you resolved it. Do you think it could have been resolved differently? Has it affected how you will respond to a similar situation in the future? If you plan to do your Senior Project in Kenya, please discuss your proposed project with the TL prior to arrival in Kenya.

•

•

• • • • • • • • • • • •

Optional Activities: • Participation in the Heart and Harvest Initiative (HHI) o Visit to Buffett Farm. Manual labor volunteer work. o Contact: Abraham Boit - HHI Manager - in charge of all AMPATH food production farms. o Wear work clothes. Bring sunscreen, water. There is limited space to store belongings. o Monday mornings from 9-1 pm. Sign-up at least one week in advance – sign-up sheet is in computer room. • Visit Imani Workshops o 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 o Wednesday from 2-5 pm. Sign-up at least one week in advance – sign-up sheet is in the computer room. • Tumaini Center Activities (Orientation every 2nd & 4th Monday 2-3pm) o Sign up in computer room. Further involvement invited if interested in working with street children of Eldoret including medical liaison, sports outreach, life skills talks, and more. • Orphans and Vulnerable Children (OVC) Field Visits o Limited spots available. Sign-up on a first come, first served basis in the OVC office (below warehouse) o Be ready to depart OVC office promptly at 8:00AM on the morning of your visit. o Please see remainder of instructions on sign up sheet including proper apparel.

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How to Give a Sally Test Centre Parent Talk During your rotation, you will be asked to discuss a health topic of your choice at the Sally Test Centre. These talks are scheduled on Monday and Friday from 12-1 PM. Parents (primarily mothers) of pediatric patients at MTRH make up the majority of the audience. Although there are some parents that attend several sessions (when their child has a prolonged 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: Choose a topic that interests you. Previous speakers have chosen a wide variety of topics ranging from diarrhea/sanitation to hypertension to how to advocate for your child on the hospital wards. 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. Please confirm topic with Sally Test Managers, Ernest Kirui ([email protected]) or Sarah Ellen Mamlin ([email protected]), to ensure you do no repeat recent presentations; then record your phone number and topic in the Sally Test Centre as soon as possible. Prepare a handout regarding your topic before 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. Handouts should be turned in to Ernest by the Thursday before a Monday talk or by the Wednesday before a Friday talk at the very latest. You can email your document to Ernest Kirui at [email protected] and Jordan Huskins (Pediatric Team Liaison) at [email protected]. They will then be translated into Kiswahili and photocopied by the STC staff. List your chosen topic and phone number on the schedule posted in the STC as soon as possible after arrival in Eldoret. Again, talk to Ernest, Sarah Ellen, or Jordan to make sure that your topic has not been presented recently. If you switch your date with someone else, do so at least two weeks in advance. Start by introducing yourself. Include where you are from, your role within the AMPATH Consortium (medical student, resident, etc.), and how long you have been in Kenya. 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. 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. Do not be concerned if the translation takes several minutes longer than your statement. 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. Do not be afraid to say you do not know. You cannot 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! Jordan (0725.271.634), Ernest (0722.938.979), and Sarah Ellen (0733.580.495) 76

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 How to Advocate for your Child on the Wards Women’s Health: Menarche to Menopause Communicating with Your Doctor Contraception Female Genital Mutilation Safe pregnancy Domestic Violence

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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; 1. Participate in activities to avoid being seen as a spectator. 2. Always ask for help before tackling any tasks in the center. 3. Leave your belongings at home (including money, watches, cell phones, etc.) 4. In case of stolen goods or property report immediately. 5. Say no when children demand things, both on the street and at the center. 6. If you see a street kid outside the center who recognizes you and you need assistance, call Andrew Mwangi immediately. What not to do; 7. 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) 8. Do not be with a street kid in the center without the presence of a Social Worker or an Outreach Worker. 9. Do not give money, gifts, or food directly to the street child - better present them to the office. 10. Do not show or tell street kids where you reside

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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(Fridays can be scheduled at special request if you would like to direct the talk to females). 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. Possible Adolescent Health Talk Topics Alcohol use Drug use Burn – avoidance and care

Specific diseases: HIV/AIDS Sexually Transmitted Infections Diarrhea/Dehydration Malaria Tuberculosis Respiratory Infections Intestinal Worms Asthma Depression

Life Skills: Hygiene Peer pressure Nutrition Domestic Violence Contraception

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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 Weekly Review US Embassy in Kenya US State Dept. CDC Lonely Planet USAID Country Profile Regional Maps Kiswahili Language Kenyan News -

http://www.nationaudio.com/News/DailyNation/Today/index.htm l http://africanonline.co.ke/AfricaOnline/review.html http://kenya.usembassy.gov/wwwureg.do http://travel.state.gov/travel_warnings.html http://cdc.gov/travel/travel.html http://www.lonelyplanet.com/destinations/africa/kenya/ http://www.usaid.gov/locations/sub-saharan_africa/countries/kenya/index.html http://www.reliefweb.int/mapc/afr_east/ http://www.yale.edu/swahili/ 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) Wangari Maathai Autobiography by 2004 Nobel Peace Laureate 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

Huxley, Elspeth Gay, John Kitching, G.N. Barbara Kingsolver

(Nigeria) The Joys of Motherhood Stars of the New Curfe

Buchi Emecheta Ben Okri

(Kenya) A Grain of Wheat

Ngugi wa Thiong'o

(Zimbabwe) Nervous Conditions

Tsitsi Dangarembga

(South Africa) In the Fog of the Seasons End None to Accompany Me Playing in the Light

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. Be prepared with an appropriate adapter plug and ensure that your charger is dual voltage. 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, *Begin taking Mefloquine before Cipro or Septra (diarrhea with blood or you depart. Note: It is cheaper in Kenya so buy only enough to start. fever—take one stat, then q/12 hr for 3 days), Tylenol or ASA Spare eyeglasses Shower sandals/house shoes **If you have extra instruments, you Insect repellent can choose to give them to needy Moi students. They also appreciate A couple of checks ATM card teaching aids (handouts, charts, etc.) 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 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. 85

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. 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 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 Pupil Pass application (5,500 ksh) and 2 passport photos (if possible, bring with you to Eldoret to facilitate the timely submission of your application) Foreign registration card application (2,000 ksh) and 2 passport photos (if you are remaining in Eldoret for more than 1 month)

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 84 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 86

accommodation. For a list of recommended and reputable travel agents and Nairobi hotels please contact Ron Pettigrew ([email protected]).

Students are allowed to travel to Eldoret from Nairobi BY AIR ONLY. Flights 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 these flights are variable, but tend to be $75 to $145 one-way. Tickets can be purchased online through Kenya Air or Fly540) or through either Endoroto Travel – [email protected] or [email protected] (Damarice Wathika) or Kwa Kila Hali Safaris – [email protected] (Netta Ruthman). Arrangements for in-country travel should be made at least four weeks before your trip to Kenya. Copy both Dunia Karama and Ron Pettigrew on all final arrangements to 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. 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 Air: Cost about $110-$150 one-way (20kg,– can pay extra fee to check more baggage and weight)

Eldoret to Nairobi Air: Cost about $110-$150 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.

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Running/Walking Routes in Eldoret Short out and backs: 2 or 2.5miles This would be the easiest route to do from the IU House, so it might be a good one to start out on to get the lay of the land (or at least, Elgon View Drive). Just turn left out of the outer IU House gates on to Ramogi Road, it will split as it goes up the hill. Veer left to get on Elgon View Drive. Continue on this until you get to a large intersection with a sign for Greenvale Schools on your left. To the intersection is one mile, so an easy out and back. Going to the blue fence where Emmanuel school is would be 1.25m, so a 2.5m out and back. http://goo.gl/maps/QlY9W

Short road loop: 2.7miles. From Elgon View Drive, turn right on Old Nairobi Road, which is the first major road you'll get to on the top of the hill (again, by the sign for Greenvale School). Old Nairobi Road is mostly dirt. You'll go a few hundred meters on that, then take a right on the first true dirt road on the right (don't get confused by driveways or small alleys). If you've gotten to the pavement, you're too far. Once you've turned right on this road, continue until it Ts, or runs into Nyerere Road. You'll take a right on a paved road. Then take a left at the quasi-roundabout and you'll end up with Momma Mia's on your right. Run down the hill to IU house. Good for rainy season. http://goo.gl/maps/AVrO4

Short field run: 3.25miles. After getting on Elgon View road, turn on the second dirt road on your left. After about 50m, there's a road that goes up a small hill on your right. Turn there and run up the little hill and make a left at your first opportunity. This will continue into a field. Once you get into the field, stay on the main path (or stay left) until you're nearing the treeline to your north and you're just about to head down a hill. The path forks, and you should take a right. Both ways will have you cross a creek, but the left fork is too marshy. After awhile on this path (right fork), you'll see two paths intersecting your path that lead up (south) to the green tin roof building. Take those up the hill. Once you get to the top, you'll find a dirt road. Take a right on that until it ends at Old Nairobi Road (or Plateau Road). Turn left, then follow the map back to IU house. http://goo.gl/maps/phRW4

Run mostly on paved roads, but also heavy traffic on Kisumu Road, and also when you enter town. Not to be done during rush hours 3.75miles http://goo.gl/maps/QAeOJ

Five mile route that is mostly on pavement- but again Eldoret-Nakuru Road is pretty busy. You'll likely be running on the shoulder, but its fine and feels safe. You turn from Eldoret-Nakuru Road onto Nandi Road by making the second left at the round about. Then take that back to IU house. http://goo.gl/maps/7RyRz Or if you'd rather have a more quiet road that runs right into Nandi Road, turn left on a dirt road immediately before Eldoret-Nakuru bends to the left. Run to the end of the dirt road (online map says you can't, but you can) and turn right when it T's. You'll run up a shaded street right into Nandi Road, and you'll turn left. (5.16miles) http://goo.gl/maps/LHQdJ

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Recommendations for IU Kenya elective Orientation Guidebook Packing List Additions o Blood pressure cuff (can give to hospital upon departure); bring pediatric size if joining pediatrics during your rotation 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 Ladies may wear dress pants or long skirts extending below the knee. 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 (i.e. Starbucks Via packets) 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 or Newborn Unit, please bring a stock of sterile gloves, gowns, scrubs, clean shoes (e.g. Crocks, Danskos, etc.), and goggles (OR). 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 o Pocket Pharmacopia 89

o Stanford’s Guide to Antibiotic Therapy o Your address in Eldoret: o P.O. Box 5760 Eldoret, Kenya 30100

Recommendations from past program participants… STUDENTS o You are expected to round at least one weekend during your rotation; rounding on other weekends is not required but is 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; he can be reached at 0720.133.575 but he will probably find you first! 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. Lunch is provided at the hostel for about 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 4th or 6th 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 4th 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. 90

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 the hostel. You must use the buddy system, as walking alone at night is forbidden. Try to get phone numbers of students on your team before admitting days. o Make sure the team knows your level of training. 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 4th or 6th 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 4th and 6th 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 Workshop and Robert’s Shop – they make great souvenirs. o The ATMs will give you 500 and 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 spend in 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

For locations of restaurants, clubs, and other places in Eldoret, see google map: www.goo.gl/maps/gGBJZ Restaurant menus and contact numbers for delivery available online at: wiki.ampath.or.ke/display/ERM/Eldoret+Restaurant+Menus

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Global Health CaseFiles “How-To” Guide (as of April 2013) 1. 2. 3. 4. 5. 6.

Go to fromthecasefiles.com. To join, enter your information in the form on the right-hand side of the main page. You will subsequently be given login information via email. Login and select “Global Health” from the drop-down menu. Select a case and go through each tab to get an idea for the required case format. 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 SI unit 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 Differential Diagnosis & Discussion o Post the differential diagnosis generated on rounds or in AM report o Briefly discuss clinical reasoning in ddx development and arriving at final diagnosis o If didactics were also done as a part of the case, can post in this section. o Hospital Course o Day 1, Day 2, Day 3… with pertinent lab/PE findings, treatment approach, and clinical improvement/deterioration. 92

o Cost Analysis – breakdown of costs incurred by your patient during hospitalization.

o Clinical Questions o Develop three clinical questions based on salient learning points from your patient case o Utilize articles from current academic medical literature to support your discussion for each question. 7. Send to the Team Leader via e-mail for review and amend the case as necessary. 8. Once approved, to post the case, go to (username) controls  Case admin  Add case. 9. Submit the case, including relevant images and lab values for review by the site. Instructions Specific for Kenya Elective -

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A case file takes quite a long time to put together as you gather all of the important history, physical, and laboratory data, take photos of relevant imaging, write up the clinical course of the patient, create three clinical questions, and then send to the appropriate team leaders for review. Therefore, it is recommended that you start your case within the first two weeks of the elective and finish your first draft by the beginning of the 4th week. Team leaders will return your case file for editing; final draft is due by the end of your seventh week.

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, please include a breakdown of your patient’s hospital bill.

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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 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

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

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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

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

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

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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!

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

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?

PHRASES:

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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

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?

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

Review of Systems:

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?

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

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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

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Lab Units Conversion Most of the laboratory results at MTRH are reported in standard international (SI) units which can differ quite markedly from the normal values of laboratory tests in America. Important conversions are listed below including how to convert between values. Any common laboratory test not listed below generally has normal reference ranges or units similar in both settings. We do encourage you to check the normal values as reported for each lab result to ensure proper interpretation ultimately.

SI Units

Conversion Factor NL USA Units

Albumin

35-55 g/L

Divide by 10

3.5-5.5 g/dL

Bilirubin (total)

5.1-20.5 µmol/L

Divide by 17

0.3-1.2 mg/dL

Bilirubin (direct)

0-5.1 µmol/L

Divide by 17

0-0.3 mg/dL

Blood Urea Nitrogen (BUN) 2.9-7.1 µmol/L

Multiply by 2.8

8-20 mg/dL

Calcium (serum)

2.2-2.6 mmol/L

Multiply by 4.1

9-10.5 mg/dL

Creatinine (serum)

61.9-115 µmol/L

Divide by 88

0.7-1.3 mg/dL

Glucose (fasting)

3.9-5.6 mmol/L

Multiply by 18

70-100 mg/dL

Lipids Total Cholesterol 3.88-5.15 mmol/L Multiply by 39

150-199 mg/dL

LDL ≤3.36 mmol/L

"

≤130 mg/dL

HDL ≥1.04 mmol/L

"

≥40mg/dL

Triglycerides