The Brown Kenya Program is a bilateral medical exchange program between the Alpert School of Medicine (Providence, RI, USA) and Moi University School of Medicine (Eldoret, Kenya). This program is a part of a large multi school consortium called AMPATH (Academic Model Providing Access to Healthcare). Brown Medical School has been part of the consortium since 1998. The exchange includes opportunities for medical students, residents and faculty to live and work at the opposite site.
Founded in 1989, AMPATH is an academic medical partnership between North American academic health centers led by the Indiana University School of Medicine in Indianapolis, Indiana, the Moi University School of Medicine, centered in Eldoret, Kenya, and both the US and Kenyan governments. The program seeks to provide comprehensive services to a population of 3.5 million people in western Kenya through its three-way mission of care, research, and training. Brown University joined the AMPATH consortium in 1998. Please click here to read more about the AMPATH program at Brown.
Cervical Cancer Screening and Treatment Program (CCSTP)
Dr. Susan Cu-Uvin, Director of the Brown Global Health Initiative, has worked for a number of years on gynecological cancer research with Dr. Elkanah Omenge Orang’o (Brown Fogarty Fellow), Lecturer at Moi University School of Medicine and Dr. Hillary Mabeya (Brown Fogarty fellow), Senior Lecturer and an Obstetrician Gynecologist at Moi University School of Medicine.
In 2006, Drs. Cu-Uvin, Omenge, and Mabeya received a Fogarty supplement to compare visual inspection with acetic acid (VIA) and Pap smear for cervical cancer screening among Kenyan Women. Grace Mwangi and Jackline Ndiema were the first 2 nurses to be trained in VIA and cryotherapy in Zambia. This was the first study at Moi that demonstrated the high rates of cervical neoplasia among HIV-infected women on ART and with high CD4 cell counts. It also showed that VIA done by nurses is equivalent to conventional Pap smear for cervical cancer screening in Kenya.
These findings led to the establishment of CCSTP and to the expansion of cervical cancer screening and treatment (see and treat with VIA and cryotherapy) in 8 AMPATH sites. To date, the program has screened 50,000 women.
Other NIH supported studies include: How best to follow up HIV infected women who have undergone VIA and cryotherapy; comparison of cryotherapy and loop electrosurgical excision procedure (LEEP) among HIV infected and uninfected women; a study to assess the feasibility of training primary care physicians, nurses and midwives to perform LEEP to increase the capacity to treat precancerous cervical lesions. Currently, only the 5 Obstetrician-Gynecologists in AMPATH can do LEEP, thus creating a back log, long wait times and significant loss to follow up for women needing LEEP. Newer studies are assessing the natural history of HPV infection among HIV infected and uninfected women in Western Kenya, comparing the morbidities after radical hysterectomy for early stage cervical cancer between HIV infected and uninfected women and using real time digital cervicography (using iphone) to improve VIA screening. You can read more about their most recent work here.
See below for our interview with nurses Grace Mwangi and Jackline Ndiema of the CCSTP:
1. What is your current position?
2. How did you first get interested in this type of work?
While working in the reproductive health clinic at the Moi Teaching and Referral Hospital, Eldoret, Kenya.
3. How did you get involved with your project?
We did a study of 150 women comparing Pap smear and visual inspection with acetic acid (VIA) and it was a success.
4. What is most difficult about your work?
Thus far nothing is difficult!
The most rewarding thing is that we have saved the lives of many women. We have also participated in outreaches that have made women aware of cervical cancer and the fact that they can be screened and diagnosed early.
5. How does your work fit in with your long term career plans?
Once we retire we shall do counseling and participate in creating cervical cancer awareness in our community and local health centers.
6. Any other thoughts / comments you’d like to add?
We would like to learn more about the new updates in technology and information on cervical cancer within and outside our country, Kenya.