The sleepy city of Eldoret lies in the lush, hilly regions of western Kenya, an area known for its agriculture and endurance athletes. Eldoret is also home to Kenya’s second medical school at Moi University (MU) and the Moi Teaching and Referral Hospital (MTRH). Over the last decade, a partnership between the Academic Model Providing Access to Healthcare (AMPATH) and the University of Toronto Department of Obstetrics and Gynecology has been working to improve reproductive healthcare for women in Kenya. The AMPATH mandate has been to improve access to primary healthcare, with U of T providing education for students at MU as well as community healthcare workers. Every year Dr. Eleanor Fish spends three weeks teaching and mentoring immunology to healthcare practitioners and students at MU as part of the AMPATH-UofT program.
When Eleanor is in Eldoret, each day is jam-packed giving seminars and meeting with faculty and students. Over the past few years, Eleanor has developed teaching modules that are used to educate medical, dental and nursing students, as well as undergraduate and graduate students at the MU Department of Immunology. The major focus of the program is to bring knowledge of basic and applied immunological concepts to the table when making clinical diagnoses. Eleanor is constantly updating these teaching modules so local lecturers can teach cutting edge immunology throughout the year. These modules have played a crucial role in modernizing teaching in place of outdated textbooks that were the previously used. As if that weren’t enough, following a full day of teaching, meetings and site visits in Eldoret, Eleanor sets out to complete a days’ work on Toronto time, including keeping on track with her graduate students and lab staff.
The Department of Immunology at MU is ahead of other departments in terms of recruiting students and faculty, but it is still largely under resourced. Many of the faculty do not currently hold PhDs, but have been recruited to lecture to the students based on their academic success at MU or other schools from the region. Eleanor has helped mentor faculty so that they can secure funding and better supervise their students.
Being a graduate student at MU is fraught with challenges. MU does not offer a PhD program, and the MSc program is still under develovpment. The labs available for research are located at the MTRH with no dedicated labs for each investigator, so the students must use what is available. These labs often don’t have all the resources available to do complicated immunological studies, so structuring experiments to fit budgets, time constraints, reagents available and equipment is key. Eleanor has mentored many of these students and assisted their experimental design to get the most meaningful data out of the specimens available. Many of the projects she oversees are clinical in nature, as gaining access to human samples is not a limiting factor.
As a result of Eleanor’s involvement with MU, a number of clinical studies have been set up. These studies range from looking at oral lesions and inflammation, to clinical parameters and responses to therapies being used in rheumatoid arthritis patients. Eleanor hopes that these studies may help to implement diagnostic strategies. By the same token, teaching about fetal-maternal immunology is helping to influence vaccination strategies for babies born to chronically infected mothers. All in all, the work that Eleanor does with Moi University has one directive – to link the basic science with the clinical community, especially with regards to women’s health.“Each time I consult with her, she opens my understanding into a bigger and much better picture of what lies ahead of me. Her ideas have provoked my thinking to address not just the academic, but the scientific and clinical aspects in my research.”—One of Eleanor’s MSc candidates at Moi UniversityWomen in Eldoret face a number of challenges when it comes to accessing clinical care. The society in Kenya is male-dominant, and as a result, women must be ‘allowed’, by the male in charge of their household, to see a physician. This creates a major gender-bias when it comes to health care as women suffering from chronic disease often don’t get to see a doctor until the disease has progressed past the point of effective treatment. The result of this is that women have poor prognoses with chronic illnesses such as breast cancer. This is in stark contrast to healthcare in Canada, where females are often reported to use healthcare services more often than males, even when pregnancy is taken into account. In Eldoret and the surrounding area, breast and gynecological cancers are widespread in the female population. AMPATH-UofT has improved screening for gynecological cancers greatly, and by combining screening for cancers with mother-baby care clinics, it has helped to train community healthcare workers to recognize when women are sick and need treatment. Again, Eleanor’s teachings on fetal-maternal immunology are helping to improve care for both mother and baby especially when it comes to babies born to chronically infected mothers.
Even though women face challenges in accessing healthcare it is not uncommon to find female graduate students at MU, with approximately half of the immunology graduate students at MU being female. Female students at MU have noted that they feel that MU is a very gender sensitive place and a positive environment for them to complete their studies.
In a partnership with the Beyond Science Initiative, based here in Toronto, Eleanor has founded a program where graduate students at MU will be partnered with a mentoring student from U of T. Students of Eleanor’s at MU are inquisitive and eager to learn, but often lack access to up to date knowledge. They also get nervous when talking science with their supervisors or with Eleanor. The hope is that the students from MU will be able to correspond by e-mail with their peers in Toronto and will be more comfortable asking questions and talking science with someone at their level. This program is gaining interest from universities in India and additional African nations.
Eleanor’s work both abroad and in Canada has led to fantastic partnerships that are making a difference. In Kenya, her teaching efforts have fostered a growing MSc program and helped establish research excellence that will contribute to improved healthcare. Increased access to healthcare is only valuable if the right kind of care is being offered. By educating the healthcare workers in Kenya, Eleanor’s goal of connecting basic science concepts to clinical practice is being achieved
Students interested in getting involved with the Beyond Science Initiative are encouraged to contact the lead organizer Payam Zarin (firstname.lastname@example.org) and co-organizer Magar Ghazarian (email@example.com).
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