Kelly Clark, MD: Kenyan Hospital Shortage

Munson Family Medicine Residency, a MSU affiliate, is now in its second year of a collaborative project with

PCEA- Hospital in Chogoria, Kenya. Chogoria is a rural town with a population of about 28,000 people located in

central Kenya. Chogoria Hospital is a 322-bed facility where Kenyan physician intems and (by 2014) where

Kenyan family medicine residents will train, The hospital is chronically understaffed which limits the amount of

supervision that in-training physicians are able to receive. Our senior resident and faculty presence is one way to

help alleviate that shortage. It also provides our residents with a stronger exposure to tropical medicine and a

level of cross cultural medicine exposure that could not be achieved elsewhere.


The International Medicine Project is a collaborative project between Munson Medical Center and PCEA Hospital.

This project expanded on the relationship that Munson and MSU College of Osteopathic Medicine already have with

PCEA Hospital. Dr. Franklin Ikunda, Kenyan tamily physician and MSU Clinical Assistant Professor, is our

program coordinator in Chogoria. The International Medicine Project brings together physician teams from

Munson and Kenya. Jointly, these teams are developing and implementing custom-made, standardized physician

order sets and clinical pathways for the PCEA Hospital. Standardized medical protocols have been proven in

Western hospitals to help improve patient outcomes including: overall composite death rate, length of hospital

stay and hospital complication rates. Physicians who have practicecl in Chogoria, as well as visiting physicians

from Munson, have jointly identified the need for establishment of standardized physician order sets in Chogoria.

In an understaffed hospital with limited medical oversight. such protocols could have dramatic benefits for both

physician training and patient outcomes.


A pilot project launched this spring introduced protocols for the hospital management of both adult and pediatric

pneumonia. This is a prospective trial with outcome measurements that will be compared to historical data

regarding patient morbidity and mortality. Our international research team has been CITI trained and this project

has been reviewed and approved by the Munson IRS. One of the goals for the 2014 teams travelling to Kenya is

evaluate how that protocol is utilized and what aspects need to be re-designed to better fit the needs of the PCEA



One new, exciting challenge for 2014 is the development of the first Family Medicine Residency Program in this

part of Kenya. Or. Ikunda will be the leader of this project. Our teams are well prepared to be able 10 provide

professional support for the development of administrative policies and resident education techniques. There are

many idiosyncrasies to the development and organization of resident education, Elements of didactic

programming, evaluation, supervision. and rotational experiences are some of these core features of running a

residency program. The goals of our 2014 teams are to help facilitate the development and coordination of th is

first class of residents. Included in this process is a sponsored trip for the program director, Dr. Franklin Ikunda,

to the United States. We have arranged for his trip to correspond with the Society of Teachers of Family Medicine

annual conference to maximize his postgraduate training in academic medicine as much as possible. After years

of continuous quality improvements in our own program, we have learned many things that work well for our

residents and our community. Our goal is to help establish that same process of plan - do - study - act in

respect to quality improvement specific to the individualized needs and goals of the Chogoria Residency.


On a previous triP. one of the residents. Dr. Robert Milanes, did a very detailed needs-assessment of the PCEA

Hospital. Together with the ward supervisors and Or. Ikunda's help, a need for various pediatric equipment was

identified. Our teams responded last year by bringing with them bags of supplies including a vacuum extractor for

obstructed labors and a high level neonatal oximeter. Drs. Milanes and Gerstle also taught courses in Neonatal

Resuscitation during their visits. We plan to continue our support of the pediatriC department in 2014 with our

learns planning to bring with them bilirubin phototherapy lights to help improve the outcomes of babies suffering

with severe jaundice,


So far this project has enriched the medical practice of the following resident physicians: Dr. Robert Mitanes MD.

Dr. Abbigale Wilson, MD, Dr. Emily Vogt DO, and Dr. Nathan Sailor. MD. Attending physicians Dr. David Klee

MO and Dr. Roger Gerstle have also participated. Drs. Jacob Flynn MD and Nicholas Crow MD as well as Drs.

Kelly Clark MO and Timothy Lambert DO are scheduled to go during the 2014 Academic year. The BlakeMemorial

SChOlarship helped launch our program in 2012-2013 and we are hoping for your continued supPOrt as

we continue this exciting project.