Malawi, Zambia, and Kenya - Trip Notes

Travel dates: Malawi (7-10 Feb), Zambia (11-13 Feb),

and Kenya (14-18 Feb) 2016

Malawi

The UNC School of Medicine has enjoyed a long and robust research relationship with and platform in with Malawi since the mid-1990s, based at the Tidziwe Centre, Kamuzu Central Hospital (KCH), and led by Dr. Francis MARTINSON, UNC Malawi Project Country Director, and Mr. Innocent MOFOLO, UNC Project Associate Country Director and Executive Director Lilongwe Medical Relief Trust Fund (https://twitter.com/uncglobalgate/status/697626946641993728)

UNC Gillings School of Global Public Health (SPH) students with a specific research focus can be paired with one of four UNC faculty based in Lilongwe (see below). UNC medical, Rx, and dental students have also had practice experiences at the UNC Malawi Project previously. It is important to recognize that IRB approval is imperative prior to arrival in-country. This can take several months, as the local IRB meets only 3-4 times per year. MOH engagement is essential with any proposed research project.

UNC Project Malawi Guest House

The UNC Malawi Project operates a guest house which has 8 rooms; < 2 months stay double occupancy @ $15/day; ≥ 2 months single occupancy @ $10/day; cost covers room, utilities, guard service, and Internet; self-prepare meals or can hire Joyce who is guest house manager to cook for additional fee; self-serve laundry facilities on-site. Transportation in-country is typically via taxi for short-term or with the purchase of a local car for long-term stays. Road travel only during daylight hours is advised. Requests to conduct research in Malawi should be made to Mr. Irving HOFFMANN, UNC School of Medicine (SOM).

Dr. Mina Hosseinipour, Research Professor, UNC SOM, has been has been working in Malawi for > 10 years. The four UNC faculty/preceptors include herself (infectious diseases), Dr. Satish GOPAL (oncology/pathology), Dr. Jennifer TANG (OB/GYN and family planning) and Dr. Nora ROSENBURG (epidemiology and health behavior). Any SPH student interest to conduct research in Malawi must align with and be accepted by one of the above four UNC preceptors. Malawian faculty are not yet able/ready to receive/supervise UNC students. A limiting factor for accepting UNC students is grant funding, as students would need to bring own funding resources.

Tidziwe Centre, Kamuzu Central Hospital (KCH)

Dr. Satish GOPAL, is a clinical oncologist who has NCI funding (U54) to investigate cancer clinical pathogenesis in HIV-related disease (Kaposi sarcoma and lymphoma), esophageal (highest incidence rates in world along Rift Valley; see map below), breast, and cervix. He is applying for K01 on cervical cancer study and P20 as pilot for P30 center of excellence grant with Malawian investigators.

Dr. GOPAL has enjoyed working with SPH students, including M.J. HORNER, Dept of Epid doctoral student (cancer registry data assessment) and Kelly KOHLER, HPM doctoral student (Malawian perceptions of breast cancer); both are NIH Fogarty Fellows. Dr. GOPAL says the focus with UNC faculty and students is a “mutually beneficial team approach.” For students interested in cancer studies, he recommends they connect with Blantyre College of Medicine IARC-funded cancer registry lead by Charles DZAMALA and Victor MWAPASA (see below).
Dr. Peter KAZEMBE, Director, Baylor College of Medicine Children’s Clinic, started the UNC Malawi Project with Irving HOFFMANN 25 yrs ago. He was the former Director KCH and has enjoyed a positive and productive research relationship with Dr. Steve Meschnick, SPH Dept of Epidemiology. The prevention of mother to child transmission of HIV (PMTCT) is a central focus of the Baylor College of Medicine (BCM) which does follow up of children of HIV+ mothers. An

Esophageal cancer in Africa: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140107 

Elizabeth Glazer Foundation grant 10 yrs ago allowed VCT and Tx for children, from which a major policy change for Malawi resulted. BCM has expanded its work to include peds oncology, OG/GYN, sickle cell care, and an adolescent clinic on Saturdays, which sees N=150 pts per day. Dr. KAZEMBE would welcome SPH students who are self-funded.

Dr. Sam PHIRI, Executive Director, Lighthouse Project, Kamuzu Central Hospital (KCH), is a Fogarty ATRIP grantee who received funding to study for his PhD at the London School of Hygiene and Tropical Medicine (LSHTM. The Lighthouse is a “public trust” that has provided comprehensive HIV care since 2001and receives no funding from the MOH, only direct donations. The three areas of action at the Lighthouse include 1) HIV prevention, Tx, care, including VCT and home-based care; 2) model intervention and operational research to inform policy and practice, e.g., touch screen based EHR at 70 sites throughout country and TB and HIV integration with NCDs and mental health; and 3) training in clinical care and placements from primary to tertiary care with 10 rural health centers. They receive ARV Rx from MOH and PEPFAR and is considered a Center of Excellence in HIV/AIDS Tx, care, and prevention. UNC fellows have been received during summers, as identified by Dr. Mina Hosseinipour. The Lighthouse has also had students from Univ of Bern, Emory, Cologne, and Heidelberg Univ. Implementation science and nutrition care are developing areas of interest.

Dr. Nora ROSENBURG, Assistant Research Professor, Dept of Epidemiology, has been in working in Malawi for 3 1/2 years and considered it a great location for research. Her focus has been on analysis and manuscript writing with Malawian researchers. Her aproach with student fellows/practica is ad hoc and must go through Irving Hoffman. She has good collaboration with Baylor and the Lighthouse and will be applying for K99-00 with NIH National Institute of Mental Health (NIMH).

The US Ambassador to Malawi is Ms. Virginia PALMER and Dr. Sundeep GUPTA is the CDC/Malawi Country Director. Ambassador PALMER's mother was a Tar Heel, so she has strong affinity with UNC and is very supportive of UNC efforts in-country. Dr. GUPTA says UNC is highly collaborative, has a very positive reputation, and is beginning to recognize NCDs, e.g., diabetes, CVD, and cancers, as increasingly important contributors to the disease burden in Malawi. Ambassador PALMER says a major challenge to the implementation of overseas development assistance (ODA) in Malawi is corruption at all levels. Further, the GOM “10% research fee” is untenable, given signed US-GOM bilateral prohibits taxing USG funding, even if awarded to implementing partner like UNC.  

Ambassador PALMER is in diplomatic discussions with the GOM Foreign Minister regarding the “10% administrative research fee (of the total research budget)” that the GOM imposes on foreign research grants. See section 8 of http://hacri.org/attachments/article/29/NHSRC%20procedures%20And%20Guidelines.pdf).  She feels this fee is contrary to the USG's bilateral agreement with the GOM regarding overseas development assistance, of which research is a fundamental component.   

The Ambassador welcomes the suggestion (from Barbara Anderson, UNC Africa Studies Center) to add Fulbright Visiting Scholars Program http://www.cies.org/programs-visiting-non-us-scholars and Fulbright Foreign Language Teaching Assistant Program http://www.iie.org/Programs/Fulbright-FLTA to offerings at US Embassy and would refer interested students to connect with Mr. E.J. Monster, Public Affairs Officer, who coordinates the Fulbright programs.

Marie J (M.J.) Horner, is a 4th year PhD student, Dept of Epidemiology and Fogarty Fellow (July 2015 – June 2016) who has had a very positive experience, particularly noting the pre-departure training offered at Fogarty. Her research focus is a national cancer registry assessment with NCI funding; she worked previously on NJ and NM registry evaluations; is conducting a case control study and longitudinal study follow up. She anticipates funding from NIMH and NCI to allow her to continue after June 2016. Ms. Horner's experience as Fellow in Malawi is very positive. She says the local security and admin support are excellent and highly recommend the UNC Malawi Project as a practicum site. She says the Dr. Mina Hosseinipour cares deeply about students and their experience in-country.



Dr. Victor MWAPASA, Dean, Post-graduate Studies, College of Medicine (COM), Blantyre, did his post-grad studies in 2003 at UNC SPH with Steve Meshnick on malaria http://sph.unc.edu/hiv-infection-impairs-immunity-to-malaria-in-pregnant-women/ Says the COM trains about 90 MDs/year, offers lab training, GLP, GCP, grants management, IRB, data management, writing, and research support; would welcome external UNC lecturers to support each of these areas. Dr. MWAPASA has had several collaborators, e.g., JHU (since 1980s), Liverpool/Wellcome Trust, UK MRC, BMGF (reproductive health), and is hghly interested in NCDs (hypertension, stroke, diabetes, cancer), nutrition, health facilities management. Dr. MWAPASA says cervical cancer is serious problem in Malawi, particularly women < 30 yo who are asymptomatic and have low health seeking behavior; screening is poor; economic cost is high. The COM offers opportunities for summer research internships on 2nd data analysis of large data sets; positive experience few years ago with Fogarty funded 3 week summer program with Dr. Meshnick and research team; would like to replicate and expand this. Dr. MWAPASA has access to quality, affordable local guest houses in Blantyre; he says to plan early to get all approvals, at least year in advance; pair up with COM researchers; there is a $400 visiting scholar fee.

Dr. Charles DZAMALA, COM pathologist, and Mr. Steady, statistician, host the national cancer registries on two laptops. They would ideally like a local server or secure cloud access to protect data and a vehicle to collect data from the field. They have had a longstanding partnership with Scotland on breast cancer studies; GTZ assisted with sample collection; catchment population in 15 hospitals in urban Blantyre and surrounding rural areas; is working with MJ Horner on a linkage project. They use IARC software and standard forms and GIS coordinates to find/calculate survival rates. In April 2016, the cancer registry data will be posted.

Zambia

Dr. Margaret KASARO, Director, UNC Zambia Project, which was spun off from a previous arrangement between UNC SOM and Centre for Infectious Diseases Research-Zambia (CIDRZ). Dr. KASARO is an OB/GYN and worked previously for 10 yrs at CIDRZ with Dr. Jeff and Dr. Elizabeth STRINGER and Dr. Ben CHI, UNC SOM. The research focus of the UNC Zambia Project is Evidence for Contraceptive Options and HIV Outcomes (ECHO) which compares the risks and benefits of two hormonal contraceptives — the injectable depot-medroxyprogesterone acetate (DMPA or Depo) and the Jadelle implant — and one nonhormonal method, the copper intrauterine device (IUD); researchers will examine N=7800 participants in 12 sites in southern Africa, including N=2000 in Zambia, as to whether a link exists between the use of any of these reversible, highly effective methods of contraception and greater risk of HIV infection; some research results suggest that DMPA use increases a woman’s risk of acquiring HIV infection, but the evidence is limited and inconclusive. Dr. KASARO says Zambia offers a rich and positive research environment. UNC Fellows include Dr. Marcella CASTILLO and Dr. Catherine FORD.
Dr. Ben CHIRWA, Executive Director, University Teaching Hospital (UTH), also indicates that Zambia is a research rich environment, is positive on patient rights and ethics, with emerging research areas in the NCDs, e.g., oncology, diabetes, mental health, stigma, post partum depression, health behaviors. New research facilities offer CT scanning, radiology, cardiac catheterization, and fibroid imaging. He welcomes UNC engagement in cervical cancer screening, research studies, teaching new innovations and practices, and clinical care.

Dr. Charles MICHELO, Head of Public Health Dept, Univ of Zambia (https://twitter.com/uncglobalgate/status/698140133867053057) is one of14 Depts, SOM, SON, School of Health Sciences, and soon SPH (to be elevated from Dept). Dr.

MICHELO holds a PhD in epidemiology, Univ of Bergen. The Norway Centre for Global Health fully funded his doctoral studies. He has a diverse, young, and energetic faculty that has grown from 4 to 34 members in the last 5 years. His strategic plan focuses on preventive medicine, evidence-based policy, epidemiology. He envisions greater emphasis on population studies, nutrition, ethics, environmental health; climate health, including vector-borne diseases; science writing. A joint PhD with Univ of Bergen is being considered. His faculty are interested in exposure science, online courses, reproductive health, zoonoses, and National Environmental and Aquatic Research (NEARS);
Dr. Marcella CASTILLO, Dr. Carla CHIBEWSHA, and Dr. Catherine FORD (https://twitter.com/uncglobalgate/status/698813919834591232) are Fellows working in Zambia. Dr. CASTILLO toured me through UTH and 40’ shipping container lab facility (https://twitter.com/uncglobalgate/status/697805654438842368).

Dr. CHIBEWSHA has been working for 3 yrs in Zambia; was previously with Division Women’s Health, Univ of Alabama Birmingham; 2014 worked on “Right to Care” in South Africa; current research on point of care Dx for HIV in infants, validation and effectiveness; also interested in cervical cancer in HIV+ women. Her experience with UNC SPH has been positive, noting her work with Dr. Kim POWERS, Dept of Biostatistics, on modeling population level policy decisions and cost effectiveness. Zambia is regional leader in cervical Ca prevention and screening and has received NCI funding. She would welcome a GRA in the summer 2017. The SPH will need to plan ahead and need to send a one pager request.
Dr. Catherine FORD is a as OB/GYN and UNC Global Women’s Fellow for 2 yr (7 mo in-country); she wanted more global health research experience and found the environment in Zambia a good fit. Her research focuses on HAART during pregnancy and Plan B Plus at 6 district health clinics. The quality of life in Lusaka is good; the research environment positive; and local research nurses are skilled.
Dr. Groesbeck PHARNA, is a GYN oncologist surgeon, formerly at Univ of Alabama/Birmingham; now > 15 yrs in Lusaka at UTH. Dr. PHARNA is seeing unusual presentations of vulvar cancer in HIV negative young women age 20, a disease typically seen elderly women. He is also seeing wasting syndrome in HIV neg younger women < 30 who presented with very thin abdominal fascia. Both conditions could be nutritionally related, though he is uncertain. Dr. PHARNA was grateful that I connected him with Dr. Beth Mayer-Davis, Chair, Dept of Nutrition, in case there are junior nutrition dept faculty members who would be interested in exploring with this topic in Zambia, given the excellent research infrastructure.

Dr. Susan Citonje MSADABWE, radiation oncologist and Director, Cancer Diseases Hospital https://twitter.com/uncglobalgate/status/698151530852126720 provided a tour of this outpatient facility built in 2007 that sees 2,000 new patients annually; 75% cervix, 8% breast and 8% Kaposi sarcoma, followed by prostate, GI, lymphoma, and head/neck cancers. The hospital offers 2D radiotherapy with stereotactic body radiation therapy (SBRT) with immobilization devices for precise delivery; planned expansion to 3D radiotherapy (US standard) in 2016. An inpatient 260 bed facility is constructed and plans to open in 2016, which will also serve as research facility. Dr. MSADABWE welcomes collaboration from UNC; currently MD Anderson is assisting with improvement of quality of care efforts in radiology; Univ of Neb assisting with peds cancer care; cancer genomics not well understood but an area of planned study; a cancer epidemiologist will be head of cancer research. She is interested in nutritionally related conditions that appear to precede cancer presentations.

Dr. Donald KASOLO, pharmacy director, Cancer Diseases Hospital, welcomed the connection I made for him with Dr. Dhiren Thakker, Dr. David Steeb, and Dr. Stephen Eckel at UNC School of Pharmacy, for possible assistance with Cancer Diseases Hospital pharmacy system.
Dr. Michael HERCE, UNC SOM physician researcher https://www.med.unc.edu/infdis/about/faculty/michael-herce-md-mph-msc is based in Zambia but also works in Malawi with UNC Project there and in South Africa. He works closely with Sharon Weir on the Linkages Project. He notes branding of UNC is not proactive and sharing of research opportunities for UNC is ad hoc. He would like to see a UNC clearinghouse mechanism to make research opportunities more equitable for students and faculty. There are opportunities for faculty and students in NCDs, especially cancer, health systems strengthening implementation science, e.g., key populations seeking behavior for ARV treatment; Zambia offers strong research platform; he welcomes students, but they will need to bring own funding.

KENYA

Carolina for Kibera (CFK) http://cfk.unc.edu/ has had a >15 year

relationship with UNC and works in the informal community of Kiberia (pop ~400,000) outside Nairobi, where manages a Children’s Feeding Center and the Tabitha Medical Clinic https://twitter.com/uncglobalgate/status/699501659534336001

CFK was founded in 2001 by UNC sophomore Rye Barcott and Kiberia residents Mr. Salim Mohamed and Ms. Tabitha Atieno Festo, as documented in the book "It Happened on the Way to War."


The CFK children’s nutrition center opened 15 July 2013 where supplemental feeding is provided to under- and malnourished infants and children < 5 yrs old (N=255 since inception). Parents are asked for consent to have children treated with the therapeutic food supplement Plumpy Nut® provided by USAID, 1:1 parent’s counseling, promotion of locally available nutritious foods, home follow up visits, training in WASH (including providing plastic water containers with spout for hand washing at home), food security, exclusive 0-6 months breastfeeding, and family planning counseling for women of reproductive age (14-49 yrs), HPV screening N=355 women in 12 months; UNC student helped with intake form development; parents teach parents method; center provides vitamin A supplementation and de-worming medications to children in catchment area.

The Tabitha Medical Clinic is managed by Faith LANG’AT, a clean and orderly facility that provides Kibera residents with outpatient care for infectious diseases, minor trauma, x-rays, and routine immunizations; uses electronic medical record system where each patient has unique ID numbered card with scanned barcode on intake; Ms. Lang’at desires to have NCD equipment for NCD screening, e.g., hypertension, diabetes, OB/GYN personnel and training, dental care, improved pharmacy system and supplies, ophthalmic care including eye glasses, HPV vaccination for young girls, seasonal influenza immunizations, and pneumococcal immunization.

Ms. Elizabeth NA’GANG’A, Partnerships and Sustainability Manager, CFK, says the “biggest challenge is to get funding into the bank;” corporate and foundation administrative requirements also challenging, especially if they all want separate reports; small NGOs like CFK are not attractive to large funders like BMGF or EU; we must partner with larger organizations like Save the Children in order to win grant funding; RFA response capability is big challenge for CFK; has goal of $1 million (100 million KS) for 2016; research organizations have not been typical partner for CFK, but like to see that change; has MOU with CDC through the MOH; has guest housing in Kibera through several vetted host families at $9/night rent; no security issues with guests in 15 years; Kibera community members are protective of CFK guests.

Mr. Julian ROWA, new CFK Executive Director (started in Jan 2016 following career in banking), David MSHILA, Board Chair, and Hillary OMALA, current Board member and former Exec Director would like to see CFK grow from 100 to 1,000 volunteers in 5 years in order to better and expanded services to meet the health and welfare needs of the 400,000 Kibera residents. Mr.

L-R: Mark MUASA, Julian ROWA, author

ROWA sees community research as key to successful interventions in Kibera; public health is desperately needed and UNC SPH would be welcomed; CDC collaboration for 8 yrs has been very positive, though community would like more interventions and less data collection; community trust is high, though there was an initial challenge to explain the CDC medical logo “caduceus” with two snakes and CFK logo of two hands holding a sun, both of which appeared to be “idol worship” to some Kibera community members, These myths were dispelled through thoughtful, clear, transparent communications and actions; important to note that CFK did not experience any negative effects during 2007 post-election violence that engulfed much of Nairobi and informal communities, including Kibera; CFK offices, staff, volunteers, and Tabitha Medical Clinic were unharmed.


CDC /Kenya staff Drs. Marc-Alain WIDDOWSON, Director, Global Health Protection Division, and Jennifer VERANI, Deputy Director, International Emerging Infection Program, Global Health Protection Division; CDC/Kibera lab facility located 100 yards from CFK offices; space rented and staffed by KEMRI (Kenya

L-R: Dr. Widdowson and Dr. Verani at CDC/Kibera lab

Medical Research Institute http://www.kemri.org/) with funds provided by CDC/Kenya; CFK has MOU with CDC/Kenya since 2007 that allows CDC access to Tabitha Medical Center (owned by CFK); funding from CDC Global Health Protection with original focus on emerging infectious diseases, e.g., HIV and malaria, but not TB); greater focus now on NCDs, including hypertension, diabetes, cancer, as well as trauma, e.g., childhood burns due to open flame cook stoves http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665976/

CDC/Kibera lab technicians

The CDC/Kibera research lab is an excellent platform to attract other researchers; few external partners currently working in Kibera; rich and untapped datasets from surveillance of 25,000 population in Kibera; well characterized demographic data linked with PID electronic health records for each patient seen at Tabitha Medical Center; IRB process used by CDC/Kibera adheres to MOH and KEMRI guidelines. 

In 2015, US auditors uncovered apparent financial mismanagement of CDC funds held at KEMRI/Nairobi central offices that led to major shakeup in KEMRI leadership. CDC funding to KEMRI is now managed by the Henry M. Jackson Foundation http://www.hjf.org/ ; neither CFK nor CDC/Kibera was implicated in the apparent fraud at KEMRI; however, CDC/Kibera was forced to scale back significantly in home visits (1 every two weeks to 2 per year) and layoff the majority of home visit/surveillance workers and supervisors who live in Kibera due to budget cuts (they are ready to return to work).

Research needs include: health seeking behaviors; geospatial mapping; epid surveillance strengthening; dataset mining and analysis; alflatoxin exposure; food security/food borne illness; vector-borne and One Health issues; falsified medicines availability and implications for antimicrobial resistance; adding in-patient space to Tabitha Medical Center; referral hospitals are Mbagathi District Hospital (200 beds) http://www.ehealth.or.ke/Facilities/facility.aspx?fas=13080 and Kenyatta National Hospital (1455 beds) http://www.ehealth.or.ke/Facilities/facility.aspx?fas=13023

AMPATH, Eldoret, Kenya


The AMPATH Project http://www.ampathkenya.org/ and https://en.wikipedia.org wiki/Academic_Model_Providing_Access_to_Healthcare_%28AMPATH%29 in located in the highlands of Kenya, in Eldoret. Staff met with include Dr. Wendy Prudhomme O’MEARA, Associate Professor, Medicine and Global, Duke Global Health Institute, Dr. Suzanne GOODRICH, Indiana Univ (IU) faculty, Dr. Sonak PASTAKIA, Indian Univ faculty, Chelsea PEKNY, IU student, Suzie CROWE, IU student, Jemima KAMANO, AMPATH staff, Paula BRAITSON, AMPATH OB/GYN faculty, Dr. Joe MAMLIN, AMPATH Founder, Prof Fabian ESAMAI, Principal (Dean), College of Health Sciences, Moi Univ.

AMPATH began in 1989 as an educational medical partnership between Indiana University Medical School (IUMS) and Moi University to collaboratively improve health services, partake in health research and develop leaders in health care in the United States and Kenya. IU assisted in founding Moi University School of Medicine in 1990, Kenya's second medical school, and also consequently helped set up the healthcare system in Eldoret, Kenya (home of Kenya’s elite long distance runners). In 2001, in the face of the deadliest pandemic in human history, the partners joined forces to create one of Africa's largest, most comprehensive and effective HIV/AIDS control systems. The eight members are Indiana University School of Medicine, Brown University School of Medicine, Duke University Medical Center, Lehigh Valley Hospital, Providence Portland Medical Center, Purdue University, University of Utah School of Medicine, and University of Toronto Faculty of Medicine. Today, in partnership with the Kenyan Ministry of Health and the United States government, AMPATH is expanding from an HIV focus to address the critical needs for primary health care, chronic disease care, and specialty care.

AMPATH's definition of "healthcare" is to focus on the patient, not the disease; AMPATH leaders are trained as physicians; motto “Care Leads the Way.” New researchers are welcome at AMPATH; 1-2 page concept proposals are requested (forms available online) and reviewed by committee at a weekly research group meeting; if approved, researcher is invited to complete full application which is reviewed at a monthly research working group meeting.  

US students require a Kenyan preceptor/supervisor plus a US supervisor/mentor and are assigned a US Eldoret-based faculty member; standard operating procedures are in place for trainee planning; IRB is FWA-approved and overseen by the Institutional Research and Ethics Committee (IREC) http://irec.or.ke/, an institutional review board jointly constituted by Moi University College of Health Sciences (MU/CHS) and Moi Teaching & Referral Hospital (MT&RH). IREC derives its mandate from The National Commission for Science Technology and Innovation(NACOSTI).
AMPATH has 135 health facilities in catchment area of 4.5 million; data use, conflict of interest, procurement, contracts, overhead, letters of support, publication policies, and research planning procedures and timelines are in place and overseen by working groups/committees. AMPATH research and services grants derive from NIH (65%), foundations (20%), and NGOs (15%); infrastructure supports more than 90 active projects with research funding in excess of $83.4 million; has an ISO certified laboratory with enhanced capacity to support research projects.

Needs/areas for future research and training include emergency room care (teaching hospital has no ER physicians), pathology, microbiology (blood culture), bio-banking, environmental health, WASH, TB, NCDs (CVD, chronic HIV/AIDS, cancer, metabolic and endocrine disorders); implementation/operational science; health economics; cervical cancer (#1 cause of female mortality in Kenya, per Dr. Joe Mamlin, AMPATH Founder.

Guest house kitchen and dining room

The AMPATH guest house compound can accommodate ~15-20 short and long term stay students and faculty; 24/7 security present; cost is $38 per day full room and board.
Moi University College of Health Sciences immediate needs include training of faculty in biostatistics and epidemiology.