May 25, 2011

UW rural education blueprint compels Nairobi visitors

UW Health Sciences/UW Medicine

The visiting delegation from Nairobi saw facilities in Boise and Spokane. During the Spokane tour, simulation lab director Kevin Stevens, left, explains the use of simulators in training health professionals. From the University of Nairobi are (l to r) Drs. Grace Thoithi, Charles Omwandho, Dalton Wamalwa, and Erastus Amayo

Lindsey Kay

The visiting delegation from Nairobi saw facilities in Boise and Spokane. During the Spokane tour, simulation lab director Kevin Stevens, left, explains the use of simulators in training health professionals. From the University of Nairobi are (l to r) Drs. Grace Thoithi, Charles Omwandho, Dalton Wamalwa, and Erastus Amayo

Amassing serious frequent-flier points this month were 14 physicians and administrators from the University of Nairobi. The 18,000-mile roundtrip to the Pacific Northwest left them weary but invigorated.

They now possess a blueprint to transform medical education and improve healthcare in Kenya.

The contingent, here May 12-20, came for a deep dive into the WWAMI Program, a 40-year-old partnership of the UW School of Medicine and Wyoming, Alaska, Montana and Idaho. Its core tenet holds that medical students need to learn medicine where it is practiced – in the community, not just in an urban, academic hospital setting.

This maxim has succeeded magnificently at motivating graduating doctors to practice medicine in the clinics where some of their lessons took place.

That model is now riveted with hope in Kenya, said Professor Isaac O. Kibwage, principal of the College of Health Sciences at the University of Nairobi. He led the delegation, which included the schools deans of medicine, nursing, dentistry, pharmacy and public health.

“Students come to study in this city and then they dont want to go back to the rural areas,” he said. “If we give them opportunities to do rotations [as interns] in those rural areas, they may actually feel like working there. Thats the major takeaway for me.”

Kibwage and his colleagues got a look under the WWAMI Programs hood: structure, relationships, investment and the nuts-and-bolts issues that need routine tending, said UW Dr. Carey Farquhar.

Drs. James Kiarie (right) of Nairobi and Carey Farquhar of the UW are co-principal investigators of a $9.5 million, five-year U.S. grant to the University of Nairobi to expand medical students education to 12 peripheral sites in Kenya

Brian Donohue

Drs. James Kiarie (right) of Nairobi and Carey Farquhar of the UW are co-principal investigators of a $9.5 million, five-year U.S. grant to the University of Nairobi to expand medical students education to 12 peripheral sites in Kenya

Farquhar is an associate professor of medicine, epidemiology and global health. She and Dr. James Kiarie are principal investigators of a $9.5 million grant to the University of Nairobi to expand clinical training beyond the capital.

Kiarie, senior lecturer in obstetrics and gynecology at the University of Nairobi and affiliate associate professor of epidemiology and global health at UW, deemed the trip a great success.

“It was important to see WWAMI teams in action in Spokane and Boise – and that our group included not only the people who will propose the changes in Nairobi, but those who can approve the proposed changes,” he said.

After a few days of presentations and discussion in Seattle, the visiting delegation split up, heading either to Spokane or Boise to talk with residents and students and to get a minds eye of rural clinic sites, simulation labs and classrooms.

Dr. Isaac Kibwage, principal of the College of Health Sciences at the University of Nairobi, presented caps to Dr. Paul Ramsey, dean, UW School of Medicine, and King Holmes, chair, UW Department of Global Health.

Margaret Barrett

Dr. Isaac Kibwage, principal of the College of Health Sciences at the University of Nairobi, presented caps to Dr. Paul Ramsey, dean, UW School of Medicine, and King Holmes, chair, UW Department of Global Health.

Boise left him with two strong impressions: the high degree of one-on-one mentoring that med-school students experience, and the simulation labs.

“The major thing that wed like to start immediately – of course we will have to vote on it – is introducing on a small scale is the use of simulation labs – using mannequins for training. The tendency at our university is to learn the human body through cadavers, then go through some didactics and watching what clinicians do, then start handling patients under physician supervision.

“Wed like to bring the element of simulation so students can develop competencies and confidence, as well,” Kibwage said.

The visitors also saw UW presentations on:

  • Telemedicine – web-based audio-visual conferences in which specialists guide primary providers, by Dr. John Scott of Harborviews Allergy and Infectious Diseases Clinic;
  • Interprofessional team training – fine-tuning collaborations across health disciplines, by Brenda Zierler, associate professor of biobehavioral nursing and health systems;
  • Mobile-phone use – an algorithm-based application that steps doctors through diagnosing conditions that might be unfamiliar, by Gaetano Borriello, professor of computer science and engineering.

“Well give them the information that they can then adapt to their needs,” Farquhar said. “You know, they may not have superfast Internet but they have cell phones.”

The University of Nairobi trains more than 50 percent of Kenyas physicians. It has identified four hospitals around Kenya as its programs first satellites, and will select eight more in the following two years.

The UW is one of more than 40 medical schools and health organizations involved in the Medical Education Partnership Initiative, a U.S.-sponsored program to build Africas health workforce, infrastructure and research capacity.