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Related post: West Jefferson, North Carolina, USA Robert M. Einterz, MD Telephone: (317) 630-6455 Wishard Memorial Hospital Fax: (317) 630-7066 OPW M200 E-mail: reinterziupui.edu 1001 W. 10th Street International partnerships usually emphasize cross-cultural exchange of trainees but tend not to contribute to the development of the host health system. For 14 years, the Indiana University-Moi University (Kenya) Partnership has emphasized equitable relationships and exchange of both trainees and faculty members, and used faculty partnerships between universities to foster service, training, and research that benefit Kenya’s health system. This paper describes that academic partnership, reviews salient outcomes, and discusses key elements that have enabled the partnership to contribute to development of the health system in Kenya. An important achievement includes the development of a program for prevention and treatment of HIV/AIDS in Kenya. The Indiana University-Moi University partnership is a model for collaboration among US and African academic medical centers. It seems intuitive that a partnership between a medical school in the United States and a medical school in Africa would have the power to benefit health professionals at both institutions and contribute especially to the development of the African institution and its respective nation. However, most linkages between medical schools in the US and the developing world focus on specific research projects and agendas or short-term exchange of trainees (residents and/or students) and do not respond adequately to meeting the longer-term heath service needs of the developing country. International efforts tend to overemphasize curative care relative to disease prevention and health promotion, promote new technologies without assessing their impact or sustainability, and fail to facilitate improvements in the health care system of the developing country (1). At times, relationships between developed and developing countries have been criticized as being exploitative and inequitable. (2-4). There are several examples of linkages between medical schools in the US and the developing world that promote exchange of trainees (5-7). However, there are no published reports of long-term partnerships between US and African medical schools characterized by sustained involvement at a faculty level and broad institutional commitment on the part of the American medical school to the full tripartite academic Buy Lisinopril / Hydrochlorothiazide mission of teaching, research, and service in Africa that fostered the development of the health care system in the In the late 1980s, a small group of faculty members at Indiana University School of Medicine, Indianapolis, USA and Moi University Faculty of Health Sciences, Eldoret, Kenya envisioned a new institutional partnership that they hoped would be a replicable, effective, and equitable model of cooperation between an African and an American institution (8). 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 paper describes that partnership, reviews many of the salient outcomes, identifies challenges to sustainability, and discusses key elements that have enabled the partnership to prosper. We believe the partnership is uniquely successful because of its emphasis on building the health care system and its centrality to research and training. The partnership’s success also derives from its commitment to equitable, sustained counterpart relationships at the faculty level. We believe this partnership represents a powerful model that can be replicated by other American and African medical schools. The Indiana University-Moi University partnership was formally established in 1989. At its inception, the partnership focused on exchange of manpower and ideas, with the expectation that cooperation, mutual understanding, and the collective creative energy of the participants would grow the institutional partnership and enable it to achieve its mission. The initial goal of the partnership was to develop the systems of medical training and primary care delivery at Moi University and its affiliated delivery sites, with the expectation that these systems would establish a strong foundation upon which to build a robust and sustainable research collaboration. The institutional partnership began in earnest in 1990, the year that Moi University accepted its inaugural class of medical students. At that time, Indiana University’s commitment was straightforward: one of its clinical faculty members from the Department of Medicine would serve on site in Kenya, under the direction of the respective Kenyan head of department, and this commitment would be sustained for at least a decade at no cost to Moi University. The Indiana University faculty member’s job would be to coordinate relationships between the two institutions while serving the academic mission of Moi University Faculty of Health Sciences. Both institutions agreed to seek external funding to address needs and priorities as they arose. Individual counterpart relationships—based on mutual respect and trust and striving for sustained, mutual benefit—are the foundation of the Indiana-Moi University institutional partnership. Individual participants are expected to respect the autonomy of the host institution, and to be responsive when possible to local needs. Each American visitor in Kenya tries to link with his/her appropriate counterpart. For example, Indiana’s physicians in Kenya work with their Kenyan colleagues under the direction of the Kenyan department head. Indiana’s medical students work and live with Kenyan medical students, and Indiana University School of Medicine residents work alongside Kenyan medical officers and interns. Research mentors from Indiana University seek to help Kenyan investigators become first author on peer-reviewed publications and establish independent grant funding. Counterpart relationships are similarly emphasized when Kenyan faculty and students visit Indiana and other American institutions. At the inception of the partnership and extending to the current time, the Departments of Medicine have served as the principal, core link between the two medical schools. However, the institutional partnership currently involves virtually all of the major disciplines at each medical school, and exchange of personnel occurs at multiple levels including administrative staff, students, post- graduates, and faculty members. In total, more than 500 Kenyans and Americans have participated in the exchange since the inception of the partnership. One full-time physician from Indiana University works as the “team leader” in Kenya and shares with his Kenyan counterparts responsibilities for clinical service, teaching, and research at Moi University and its affiliated hospitals and urban and rural health centers. The team leader also supports and coordinates activities of many “short-term” visitors from Indiana University and other academic medical centers in the US. Eight internists, one surgeon, one internist/pediatrician, and one pediatrician from Indiana University have each spent one to five year terms at Moi University. More than 100 other faculty members from Indiana University and other US institutions have served short-term experiences at Moi University. Residents from Indiana University’s training programs may take eight-week electives in Eldoret under the supervision of the team leader. While at Moi University, the residents’ responsibilities include patient care, teaching, research and public health activities at the Moi Teaching and Referral Hospital and its affiliated urban and rural health centers. While in Kenya, the residents establish collegial relationships with junior Kenyan doctors and help teach Kenyan medical students. Since 1990, more than 140 residents have participated in elective rotations in Kenya. Most of the residents have been in primary care training programs at Indiana. Residents consistently describe the experience in Kenya as “life-changing” and rate the elective as one of the premier experiences of their residency training. On Indiana University’s annual housestaff rotation feedback ranking report, the Kenya rotation ranked number one out of 51 rotations that had been taken by more than five residents. In 1994, Indiana University introduced an elective opportunity for its fourth-year medical students. Since then, more than 100 senior students have taken clinical electives at Moi University. A two-month long summer elective for sophomore medical students was begun in 1995. Two to four second-year medical students travel to Kenya every summer. Students participate in academic, clinical, and community-based activities. Additional American medical institutions have joined Indiana University in a partnership called the America/sub-Saharan African Network for Training and Education in Medicine, or ASANTE Consortium. In addition to Indiana University, the ASANTE Consortium currently includes Brown Medical School, Lehigh Valley Hospital and Health Network, Providence Portland Medical Center, and the University of Utah School of Medicine. Brown Medical School has been a particularly key partner in a wide range of collaborative activities, including activities related to HIV/AIDS, bilateral student and faculty exchange, research, service, and strategic planning in Kenya.
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