A global pulmonology health initiative designed to strengthen research, training, and clinical support in a teaching hospital in Western Kenya continues to grow after 6 years as a priority program within the Duke Division of Pulmonary, Allergy, and Critical Care Medicine.
The collaborative program with Moi University School of Medicine in Eldoret, Kenya, extends the research capability of Duke Specialists, serves as a recruiting magnet for faculty and fellows, and serves a population in need of pulmonary and critical care expertise and training.
“The program is designed around the tripartite mission of education, clinical care, and contributing to research,” says Peter S. Kussin, MD, a Duke pulmonologist who leads the division’s global initiative and has worked extensively in Eldoret. “Duke team members work in the ICU as well as in general medical service teaching medical students and residents.”
The 1,000-bed Moi Teaching and Referral Hospital is the second largest public hospital in Kenya. Duke fellows, and residents collaborate with Kenyan medical residents in an academic setting working in the ICU, on the general medicine wards, and assisting with pulmonary consults.
“We do many of the same medical practices and procedures we perform at Duke,” says Kussin, “but the work takes place in very different settings under often challenging conditions.” Recently, Kussin has focused on sepsis management studies in the Moi ED and characterizing chronic hypoxemia on the medicine wards. “We maintain a very active presence in clinical care, teaching and research.”
Pulmonologists face significant clinical challenges
The global health initiative is supported by the Hubert-Yeargan Center for Global Health, a Duke institution created to foster stronger patient advocates based on international experiences shared by students, residents, and faculty. The center supports basic and clinical research programs designed to reduce the effects of global diseases. “We see the full range of internal medicine chronic conditions, as well as tuberculosis, malaria, and more exotic infections often associated with HIV,” Kussin says.
Duke’s pulmonology effort in Kenya is part of the Academic Model Providing Access to Healthcare (AMPATH), a consortium of North American universities founded in 2001 to help address the growing HIV epidemic in Kenya, where the prevalence is 10%. AMPATH’s mission has expanded to include not only HIV testing and treatment but also maternal and child health, nutrition, and counseling as well as helping patients regain financial stability and independence. Duke pulmonologist David M. Murdoch, MD, MPH, also helps lead the global health program; he has spent most of his investigative and medical career in South Africa but is now based in the pulmonology division.
As part of the global mission, Kussin says many pulmonologists focus initially on critical care where the “challenges are substantial.” Patients present in the ICU with advanced untreated conditions, often following inadequate resuscitation, he says. The mortality rate stands at 25% in the Moi medical ward, Kussin says. In the ICU, the rate rises to 50%.
“Both our visiting specialists and the local staff deal with the challenges of taking care of people with limited resources in their communities who have very limited availability to medical care,” Kussin says. “It’s challenging but also unbelievably satisfying.”