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					Student Manual
        Purdue University
       College of Pharmacy

Kenya Program
Student Manual
                                                 DEPARTMENT OF PHARMACY PRACTICE

December 17, 2010


Congratulations on deciding to embark on an exciting and challenging pharmacy experience in
Kenya. You are preparing to complete a rotation that we feel will enhance your professional and
personal growth.

Kenya is a developing nation and uncertainty is a fact of life there. If you are flexible and can
maintain a broad perspective, your experience will be more rewarding. Our goal is to assist you
to become as well prepared as possible. Please read and review the documents contained in this
packet carefully. Their purpose is not only to prepare you for your journey but also to help you
understand the program and make the most of your experience in Kenya.

We are willing to answer any questions or concerns you might have. Contact information is
included in your orientation packet.

If at any time before, during, or after your rotation in Kenya, you have questions, comments or
suggestions, please contact us. In the meantime, we wish you success as you prepare to travel
to Kenya.


Ellen Schellhase, PharmD                                 Sonak Pastakia, PharmD, BCPS, MPH
Purdue Pharmacy Kenya Program Coordinator                Purdue Pharmacy Kenya Program
                                                         Team Leader

Monica Miller, PharmD, MSc                               Rakhi Karwa, PharmD
Kenya Program Preceptor                                  Kenya Program Preceptor

  College of Pharmacy
  W7555 Myers Building, WHS • 1001 West Tenth Street • Indianapolis, IN 46202
                 TABLE OF CONTENTS

I.    Program History, Description, and Policies
        A. Purdue Partnership Timeline
        B. Purdue Partnership Summary
        B. Kenya Rotation Description
               1. Goals and Objectives
               2. Rotation Site Opportunities and Expectations
        C. Purdue Kenya Program Policies
               1. Liability Waivers
               2. Travel
               3. Cancellation of Rotation
               4. Housing
               5. Needlestick and Body Fluid Exposure
               6. Time Away from Rotation
               7. Rafting
               8. Trunk Travel Policy
               9. Tuberculosis Screening Policy

II.   Travel Information
        A. Contact Information
        B. Travel Planning Time Table
        C. Required Paperwork
                1. Purdue Study Abroad Database
                2. Visa Requirements/Application Form
                3. IU Emergency Contact Information
                4. U.S. Embassy Registration
                5. IU House Agreement and Release
                6. Purdue Study Abroad Statement of Responsibility
                6. Liability Waiver
                    a. Travel Warning
                    b. Public Announcements
                    c. Country Specific Embassy Notice Travel Information
                    d. Safety Situation
                8. International Health Insurance
                    a. Policy Information Handout
                    b. Policy FAQs
        D. Vaccination Information
        E. Packing Guides
        F. Travel Risks
        G. Safety Abroad
III. Background Information
      A. Avoiding Culture Shock: There and Back Again
      B. Blending In by Stacey Hendrix, PharmD
      C. Attitudes Around the World
      D. Traveling in Kenya
      E. Suggested Reading Material
      F. Lonely Planet - Kenya

IV. Appendices
     A. IU/MUSM Partnership Article
     B. AMPATH Programs Descriptions
     C. Welcome to IU House
     D. Student Tips
     E. Kenya PharmD Projects
        a. Project Checklist
         b. Student SOP
         c. AMPATH research SOPs
         d. Obtaining data from AMPATH
         e. Project citations
     F. Kenyan Recipes
     G. Swahili Guides
        a. Pharmacy Counseling
        b. Medical Terminology
     H. Potential Weekend Travel and Estimated Costs
     I. Example Monitoring Forms & Prescription Order Forms
     J. Medication Donations
         a. Patient stories
         b. Adverse event monitoring
     K. Selected Articles
        a. International Electives
         b. Protecting Global Health Workers from Harm
     L. Pharmacy Handbook
I. Program History,
   Description and

     For a number of years, the Indiana University School of Medicine

and several other American universities have been partnered with the

Moi University and Moi Teaching and Referral Hospital in Eldoret,

Kenya. The purpose of this partnership is to expand knowledge on

behalf of both parties, and allow a fellowship to form from the

experience. Indiana University School of Medicine invited Purdue

University to explore this opportunity.

     The Department of Pharmacy Practice saw this as an excellent

opportunity for Doctor of Pharmacy clerkship students. By joining in

the existing partnership, Purdue brings another facet of healthcare to

the table: pharmaceutical expertise. Not only do our students

contribute to overall patient care in Kenya, we are also able to take

away a greater sense of the necessity for empathy and human kindness

in our own practices.

     For further information regarding the history of the IU/MTRH

partnership and AMPATH, please see Appendix or log on to
                          INTERNATIONAL MEDICINE
                            ADVANCED CLERKSHIP
                              INDIANAPOLIS, IN


By completing this elective the students will:

     1. Enhance their knowledge of disease states and drug therapy, treatment monitoring skills,
        and relationships with patients by providing care in a cross-cultural environment in which
        resources are limited and challenges abound.

     2. Become better equipped to practice in the US by:
        a. Enhanced sensitivity to cultural diversity
        b. Increased professional and interpersonal communication skills
        c. Enriched appreciation of possible mechanisms to build partnerships with other health
           care professionals


The goals of the Advanced International Medicine Clerkship are:

1.      To develop an appreciation of a multidisciplinary team approach to care, while
        developing an understanding of the clinical pharmacist's role within that team.

2.      To understand the differences in drug absorption, distribution, metabolism and excretion
        unique to the Kenyan population, and apply these principles to therapeutic drug
        monitoring and problem solving in this unique population.

3.      To become familiar with the pathophysiology and treatment of disease states commonly
        seen in the Kenyan population, and select safe, efficacious, and cost-effective
        medications for their appropriate management.

4.      To understand the principles governing drug delivery and selection in an environment
        with limited access to medications.

By completion of the Advanced International Medicine Clerkship and its required readings the
student will be able to demonstrate competence in the following areas:

1.     Knowledge of Drug Therapy
       The student shall continually increase his/her depth and breadth of knowledge about
       drugs and therapeutics throughout all facets of the clerkship. Emphasis will be placed on
       essential knowledge about drugs listed in the knowledge-based competencies and those
       administered to patients whom the student is monitoring. This essential knowledge
       includes, but is not limited to: mechanism of action, indications, adverse reactions, side
       effects, drug interactions, toxicities, pharmacokinetic principles and dosing, dosage
       forms, dosage regimens, and monitoring parameters.

2.     Knowledge of Disease States

       a.    Disease states – For the disease states outlined in the rotation description and the
             disease states in assigned patients, the student shall describe the signs and symptoms,
             etiology, complications, prognosis, and treatment both surgical and medical.

             •   Prevention and Treatment of Malaria
             •   Management of Ringworm, Hookworm, and Tapeworm
             •   Treatment of Typhoid
             •   Management of HIV in Patients with Minimal Resistance
             •   Toxoplasmosis and Cryptococcus in the HIV Patient
             •   Tuberculosis (pulmonary and extra-pulmonary)
             •   Diseases of Malnutrition

       b.    Diagnostic procedures – Given a specific disease state, the student shall be able to
             list the most appropriate diagnostic procedures used in confirming the diagnosis.

       c.    Laboratory tests – The student shall be able to list the normal ranges for laboratory
             tests including blood concentrations of drugs listed in the patient record. Given
             laboratory values above or below the normal range, the student shall be able to
             identify the possible or probable reasons for these abnormalities, especially when
             drug therapy is involved.

3.     Drug Therapy Monitoring Skills

       The student shall continually work to improve his/her problem solving skills throughout
       all facets of the clerkship. The student shall routinely evaluate the drug therapy of each
       patient that (s)he is monitoring. Emphasis will be placed on the following components of
       drug therapy: problem solving, identification of drug-related problems, assessment of
       identified problems, development of a Pharmaceutical Care Plan, and therapeutic
       intervention by the student.
4.     Communication Skills
       Collaborative interactions are an essential aspect of the practice of clinical pharmacy.
       These interactions require strong written and verbal communication skills. Emphasis will
       be placed on the student developing appropriate professional communication skills with
       patients, other health care professionals, and the student’s colleagues in the program.
       Verbal communications will be stressed through formal presentations, informal
       presentations such as journal club, medication histories and patient evaluation, regular
       meetings with the instructor, and daily contacts with patients and members of the health
       care team. Written communications will be stressed throughout the clerkship experience
       and will include handouts for presentations and in-services, drug product reviews,
       medication history write-ups, patient education sheets, newsletter articles, drug use
       evaluations and manuscripts for professional publication.

Activities and Responsibilities for Medicine Rotation

1.     Attendance and active participation in daily patient rounds

2.     Attendance and active participation in rural clinics

3.     Daily review of patients' medication orders, progress notes, and pertinent
       laboratory/study data to assess progress and prospectively identify problems related to
       drug therapy

4.     Provision of patient care related drug information to the medical team and other

5.     Provision of two in-services to the medical team, pharmacy or nursing personnel

6.     Prior to the experience, the student will write a reflection on pharmacy practice in Kenya.
       Upon return, the student will revisit this reflection and comment further on the

7.     Development of three case studies with a care plan for the following disease states:
       Treatment and prevention of Malaria, Tuberculosis, and another interesting case (e.g.,
       Typhoid, Toxoplasmosis and Cryptococcus in the HIV Patient, Treatment of Typhoid,
       Management of Ringworm, Hookworm, and Tapeworm, Diseases of Malnutrition).
The Clinics

         An important aspect of the Academic Model Providing Access to Healthcare

(formerly the Academic Model for the Prevention and Treatment of HIV/AIDS)

(AMPATH) program and thus the Purdue Pharmacy Kenya Clerkship Elective are the

rural clinics. A number of rural clinics and district hospitals exist throughout Kenya.

AMPATH has clinics at 23 of these sites. The program is ever expanding and more

clinic sites are expected in the future. Sites are shown on the map in Appendix D.

Current clinic sites include, Eldoret - Moi Teaching and Referral Hospital (MTRH),

Mosioriot, Turbo, Webuye, Teso, Amakura, Chulaimbo, Burnt Forest, Kitale,

Kapenguria, Port Victoria, Marigat, Kabarnet, Naitiri, Busia, Iten, Chepatis, and Mount


         Clinics are run primarily by Kenyans. Nurses (or sisters), clinical officers, and

medical officers all play roles in receiving patients, taking histories, performing

examinations, and dispensing medications. The latter of these is where pharmacy

students play a role. The knowledge of medications by pharmacy students affords them

a unique role in counseling the patient regarding medications. Most clinics have either

a pharmacy technologist or nurse dedicated to dispensing. Students are able to team

with this counterpart in order to provide optimal patient education.

         The language barrier may pose a significant limitation. It is strongly encouraged

to learn at the least a few key phrases in Swahili to aid in counseling. This does not

always help as some patients speak only their tribal language or have questions in
Swahili beyond the students’ grasp of the language. Pharmacy technologists, nurses

and other staff are quite helpful in these instances.

Moi Teaching and Referral Hospital

       Purdue Pharmacy students are highly involved in patient care at Moi Teaching

and Referral Hospital (MTRH). The hospital and medical wards are a collection of

buildings connected by walkways open to the outside. The various wards include

medicine, pediatrics, renal, psychiatry, casualty (ER), surgery, and isolation (isolation

being a loose term as neither positive nor negative pressure is used).

       The main site of practice for pharmacy students are the general medicine and

pediatric wards. They consist of four separate wards, collectively called the Nyayo

wards. The adult side consists of two wards, one male and one female. There are two

wards on the pediatric side. Each ward has about 42 beds however; the patient load

can be higher as it is not uncommon for patients to share a bed, head to foot.

       Soap is sparce on the wards so pocket hand sanitizer is quite nice. Charts are

far thinner than in the states and medications are recorded on Treatment sheets, fondly

called “T-sheets.” The medication supply is not as reliable as in the states (strict

hospital formularies are nothing compared to this!) Being on the hospital formulary

does not equate with availability.

       In addition to the typical responsibilities a pharmacist may have in the U.S., the

student also aids in determining what medications are available and aid in identifying

suitable alternatives if the desired drug is not in stock. Pharmaceutical care is a

developing area. Kenyans, for the most part, are not used to pharmacy students on their
teams. Questions are not always plentiful and it may be hard to make your presence

felt. It may also take some time to get used to the soft voices of the students. Be

patient though, you’re making more of an impact than you may realize.

       A final part of the Nyayo wards, and a favorite of many, is the Sally Test pediatric

playroom. It can be a very delightful place to visit after rounds. For all the places where

communication barriers cause problems, it doesn’t seem to matter much for children.

Some know English, and even if they don’t, you don’t need to speak the same language

to play. Or to love.
   Kenya Program

The following are policies specific to the Purdue Kenya Program.
     For general clerkship rotation policies and procedures:
            Please refer to CLPH Clerkship Manual.
                                Liability Waivers

                   Purdue Kenya Program Waiver of Liability Policy

Students must sign each of the following prior to departure. You will not be

allowed to participate in the clerkship experience without a signed waiver.

1. Waiver, Release and Hold Harmless Agreement for Purdue University Students

Intending to Study in Kenya 2010-2011.

This document will be signed during 457: Pharmaceutical Care in Developing Countries

and may need to be re-signed/updated if Travel Warnings or Public Announcements are

updated and/or changed.

2. International Programs Study Abroad Statement of Responsibility.

This form is a waiver that is signed by all students studying overseas through Purdue.

Some of the information may not seem applicable but this is a standard university form.

3. IU Housing Agreement & Release

The is a contract signed by students to adhere to the rule and regulations of the IU

Compound, the Kenya Program Team Leaders, and the AMPATH Consortium

leadership team.

*** These documents will be signed during CLPH 457. Re-signing may be necessary if

Travel Warnings or Public Announcements are updated and/or changed. AMPATH

Consortium universities are also adapting a new code of conduct which will require a

signature and agreement prior to departure.

            Purdue University Kenya Program

1) The PKP secretary will assist students in making travel arrangements.
   If the student elects to make their own arrangements, it is the
   participant’s responsibility to provide a travel itinerary to our office no
   later than six weeks before departure.

2) In-country transportation between Nairobi and Eldoret will be secured
   by the program secretary and communicated to the program

3) Travel preparation will typically begin three months prior to the
   scheduled rotation. A complete travel itinerary will be supplied to the
   student by the program secretary approximately one month prior to
     Cancellation of Rotation Policy

              Purdue University Kenya Program

1)      In general, no refund will be given for room and board fees.
        Exceptions may be made in certain situations.

2)      Once purchased, insurance fees are non-refundable per the
        insurance policy.

3)      Students who elect to return early or cancel the Kenya rotation will
        be placed in an alternate rotation.

4)      At the discretion of the faculty and staff on the ground in Kenya,
        students may be asked to return to the US and be placed on an
        alternative rotation when it is in the best interest of the student, or
        the other students and residents participating in AMPATH programs
        and residing at the IU House.

     ** The alternate rotation will be identified and arranged by the Director
     of Experiential Learning. Students should not solicit an alternate
     rotation on their own. There is no guarantee as to when this alternate
     rotation will be assigned.

     ** Due to the complexity of the clerkship schedule, the alternate
     rotation may be assigned during the students "OFF" month and/or at
     the end of the clerkship year (i.e., May and June of the next clerkship
     program). Students should be aware that this may delay their
     graduation until August.

     Purdue Pharmacy students will lodge in the IU Compound/IU

House. Specific information about housing is available in the Appendix.

This housing arrangement will allow you to be integrated with medical

residents, faculty, and other IU Kenya/AMPATH program visitors. It is

a privilege for Purdue to be included in this living situation and as such,

we expect that you will maintain respect for this throughout your stay.

Before departure, and again upon arrival at the IU House, you will be

required to sign the “IU House Agreement & Release”. This document

describes IU House rules that you must abide by as a guest.

     Rates for room and board are assessed on a daily basis for the

duration of the trip. Approximate cost for lodging and meals for the

2011-2012 participants is $2040 for eight weeks.
(This is subject to changes based on IU meal costs, costs associated with

housing, and program costs.)
                    TIME AWAY FROM ROTATION
To avoid any misunderstandings or misconceptions about weekend trips this policy will
serve as the standard agreement for all pharmacy student vacation requests.

Students will be able to take 2 vacation days for leisure trips around Kenya during their
rotation experience here. You may use these days however you choose provided that
you follow the rules listed below.

(Note: The following rules do not apply to days missed due to sickness or national holidays)

Vacation Planning Checklist:

    1) Fridays tend to be slow days at the hospital. Your work day will typically end at
       around 1 pm on Fridays so any weekend excursion which you can plan to leave
       after 1 pm on Fridays and return before dark on Sunday do not require approval
       from the preceptor. These also do not count as days off.
    2) If you are planning on taking a day off, it would be preferable that you plan your
       trip to miss a Friday. However, other weekdays can be taken off if you desire
       and it is necessary to facilitate a certain experience.
    3) If you have ongoing projects or rotation responsibilities, you must find coverage
       for these activities prior to considering a trip which requires you to miss rotation
       days. This includes preparing a sign out of things to follow up on for the patients
       your team is caring for.
    4) Request days off with your preceptor in writing, through email, or in paper at least
       3 days (at least one week in advance would be preferred) prior to travel.
       Information to be included in this request: destination, estimated time of
       departure from Eldoret, estimated time of return to IU house, and plan for
       coverage during your absence. The first three pieces of information should be
       sent to Dunia as well. The request must be approved prior to final booking of the
       trip. This requirement is to allow for appropriate planning of rotation activities
       around your absence.

    If you have any questions, please feel free to email Dr. Pastakia (
                      TRUNK TRAVEL POLICY
Each student completing the Kenya Clerkship experience should prepare to travel with
a program trunk. These are used to transport medical supplies, program supplies and
patient education materials. This will be counted as one of your two checked bags.
You will receive all the appropriate paperwork for traveling with these supplies. You will
not have to incur any expense related to the trunk. However, you should plan
accordingly when packing. While it is unlikely that each student traveling will need to
carry a trunk, you should plan for this. We will initially ask for volunteers. If none are
determined, you may be assigned this responsibility.

1. All faculty, staff, residents and student are required to have tuberculin skin testing
   (PPD) within 12 months before departure for Eldoret.
2. Those travelers whose PPD was negative before departure for Eldoret are
   required to have a PPD rechecked 3 months after return.
3. Those travelers whose PPD was positive before departure will be required to
   complete a symptom questionnaire, and CXR if indicated.
II. Travel Information
                    CONTACT INFORMATION
Purdue Contacts                 Address                       Phone/Fax/Email

Ellen Schellhase, PharmD        Wishard Hospital              P: 317-613-2315 ext 305
Assistant Professor             1001 W. 10 St                 Cell P: 317-753-2024
US-Based PKP Coordinator        W7555 Myers Bldg              F: 317-613-2316
                                Indianapolis, IN 46202        E:

Sonak Pastakia, PharmD,         IU House                      P:011-254-729-027-569
BCPS, MPH                       P.O. Box 4606                 E:
On-Site PKP Coordinator         Eldoret, Kenya

Betty Austin                    Wishard Hospital              P: 317-613- 2315, ext 308
Program Secretary               1001 W. 10 St                 F: 317-613-2316
                                W7555 Myers Bldg              E:
                                Indianapolis, IN 46202

IU House                        Moi University                P: 011-254-(0)53-20-32484
                                Faculty of Health Sciences    E:
                                IU House
                                P.O. Box 4606
                                Eldoret, Kenya

Joe and Sarah Ellen Mamlin,                                   P: 011-254-(0)53-2033511
Kenya Field Director                                          E:
                                                              C: 011-254-(0)733-580-495 (Sarah Ellen)
                                                              C: 011-254-(0)722-374-558 (Joe)

Study Abroad Contacts

Study Abroad Program Office                                   765-494-2383
(Purdue)                                                      765-494-8221

IU Contacts

Ron Pettigrew,                                                P: 317-630-8695
US Based Program Director                                     E:

Dunia                                                         P: 011-254-(0)53-20-61222
Kenya Based Program Director                                  Alt P: 011-254-(0)53-20-33512
                                                              C: 011-254-(0)723-942-234
                                                              F: 011-254-(0)53-20-33512

U.S. Embassy                                                  0722-204-445
After Hours Emergency Line

To call within Kenya you need to drop the 011-254 and add a 0 so to call Purdue House would
dial (0)53-20-3015.
Tentative Kenya Rotation Travel Dates for 2011-2012

This will be handed out once rotation schedules are
                  Travel Planning Time Table

Due Date                     Activity
Elective Class               Complete and return signed Waiver, Release and Hold Harmless
CLPH 457                     Agreement For Purdue University Students Intending to Study in
                             Kenya, Emergency Contact Form, and Statement of
                             Responsibility and Assessment of Risk
                             Complete Manual Acknowledgement
At least 3 months before     Obtain passport
At least 1 month before      Obtain appropriate immunizations and prophylaxis medications
The following activities are coordinated by PKP secretary and specific due dates will be sent to
students via email approximately 2-3 months prior to traveling.
6-10 weeks before            Pay for plane tickets
4-6 month before             Arrange for evacuation insurance
                             (Provide Betty with DOB and SSN)
2 - 4 weeks before           Pay for Room and Board and Evacuation Insurance costs
2 weeks before               Register with US Dept of State

Estimated Kenya Rotations Expenditures

Round trip airfare US/Nairobi                       $1800-2000
1 night lodging and round trip flight to Eldoret    $ 400
Room/Board ($40 per day x 51 days)                  $2040
Passport                                            $85
VISA                                                $50
Immunizations                                       $275
Evacuation Insurance ($38/month x 2 months)         $76
Program Administration Fee                          $150
Swahili Lessons $5/lesson x 10 lessons              $50
(Swahili lesson costs to be paid during rotation)
                REQUIRED PAPERWORK
The following pages take you through samples of the paperwork required for
safe travel to and from Kenya. Please take time to read through the examples
and refer to them when completing your own documents.
               PURDUE UNIVERSITY

Each student will need to enroll in the study abroad database.
This can be completed anytime prior to your departure.

Please go to the following website:


Click on the “Click here to enroll in this program!”

You will need to log in with either your career account or PUID
and password.

This just allows Study Abroad to track numbers of students
participating in programs abroad.
                         VISA REQUIREMENTS

Visa will be obtained upon entry to Kenya at the Nairobi
airport. $50.00 US cash (bill(s) should be 2006 or newer) is
required along with your valid Passport. You do not need to
acquire a vise before departure.

If there is some circumstance for which you do need to acquire the visa before
departure. You will need to following information.

If you choose to acquire your Visa through Kenya Embassy in Washington D.C.,
please visit for details.

    1. Valid passport with sufficient number of unused pages for endorsements abroad.
        Passport must be signed and valid for at least six months.
    2. Visa application form duly completed and signed by the applicant. – MAKE SURE TO
    3. Valid round trip ticket or a letter from your travel agent certifying that the applicant holds
        prepaid arrangements.


                           STANDARD VISA FEES
Visa fee is payable by money order made to the Embassy of Kenya.*
(Washington D.C. only)

                       Type of Visa                             Fee Chargeable (US $)
       Multiple Journey Entry Visa                                   US $100.00
       Single Journey Entry Visa                                     US $25.00
       Transit Visa (issued at port of entry into
                                                                         US $20.00
       Referral Visa                                                     US $10.00
       Diplomatic, Official, Service & Courtesy

*Only required if you are processing your visa through the Kenyan Embassy in
Washington D.C. If you choose to mail your Visa application to the Embassy, we
recommend you send your Visa application to the Kenya Embassy at least six
months before your scheduled departure date.

                                 EMBASSY OF THE REPUBLIC OF KENYA
                                           2249 R. ST. N. W.
                                      WASHINGTON, D. C. 20008
                                          Tel: (202) 387 6101
                                          Fax: (202) 462-3829

                                      VISA APPLICATION FORM

                                     (To Be Completed In Block Letters)
SINGLE/ MULTIPLE / VISA (Circle one) _________________________
1. A. Surname (Mr. /Mrs. / Miss) _______________________ B. Other Names In Full
     C. Full Name Father/ Husband/
2. A. Date of Birth ___________________Country and Place of Birth ___________________Sex
     B. Profession/ Occupation
3. A. Country of Residence
     B. Nationality at Birth _________________________ C. Present Nationality, if different
4. Passport/ Travel Document Held:
     A. No: _______________________________Place & Date of
     B. Issued By _____________________________________ Valid Until
          (Name of Authority issuing Passport/ Travel Document)
5. Contact Address and Telephone number in the U.
6. A. Reason For
     B. Proposed Date of Entry ______________________________________ Duration of
7. Full names and Addresses of Friends, Firms or Relatives To Be Visited, if any:


8. Dates and duration of previous visits to Kenya
9. Will You Be Returning To Your Country of Residence/
10. It should be noted that possession of a visa is not the final authority to enter Kenya.
   I hereby declare that the foregoing particulars are correct in every detail.

 Date: __________________________ Signature of Applicant:

                      IU-MOI UNIVERSITY PROGRAM

_____________________________________                            ________________
Name (Last, First)                                               Dates in Eldoret

__________________________ ________________________      _______________
Passport Number                   Place of Birth                Date of Birth

_________________________   ______________________
Date Issued                 Place Issued

PRESENT ADDRESS: Street, Apt. No., Etc.

_________________________________          _____________________________
City/State/Zip                             Telephone

_________________________________          ________________________
NEXT OF KIN: Name                          Relationship

Street Address

_____________________________________      _____________________________
City/State/Zip                             Home Telephone

                                           Office Telephone

                                           Cell or Pager

NAME OF PERSON/S TO NOTIFY IN CASE OF EMERGENCY (if other than person listed above)

_________________________________          ________________________
NEXT OF KIN: Name                          Relationship

Street Address

_____________________________________      _____________________________
City/State/Zip                             Home Telephone

                                           Office Telephone

                                           Cell or Pager
    Waiver, Release and Hold Harmless Agreement For Purdue University
              Students Intending to Study in Kenya 2011-2012
I hereby acknowledge that I have read the U.S. Department of State Travel Warning regarding
travel to Kenya by United States citizens dated December 28, 2010 and the Public
Announcement regarding East Africa dated August 31, 2007. I am aware that the State
Department may issue additional or more severe warnings and I accept responsibility for keeping
myself informed of such changes.

In spite of such information and warnings, I have voluntarily decided to travel to Kenya for an
educational program abroad (“The Kenya Program”) as a registered Purdue University student.

I understand that I am solely responsible for my own safety. I agree to exercise my best
judgment and to follow the advice of program organizers, both at Purdue and abroad, but I
recognize that in spite of such advice, no one can guarantee my safety.

I recognize that should I decide to come home before the end of the program because of security
concerns, I will not be entitled to receive credit or a refund of tuition or any other fees or expenses
paid for The Kenya Program.

Furthermore, I (together with my parent or guardian, if I am under the age of eighteen or under a
legal disability) represent, covenant and agree, on behalf of myself and my heirs, assigns, and
any other person claiming by, under or through me, as follows:

        1.      I acknowledge that participating in The Kenya Program involves certain risks
(some of which I may not fully appreciate) and that injuries, death, property damage or other
harm could occur to me or others. I accept and voluntarily incur all risks of any injuries,
damages, or harm which arise during or result from my participation in The Kenya Program,
regardless of whether or not caused in whole or in part by the negligence or other fault of Purdue
University, The Trustees of Purdue University, and/or its or their departments, affiliates,
employees, trustees, officers, agents or insurers ("Released Parties").

         2.     I waive all claims against any of the Released Parties for any injuries, damages,
losses or claims, whether known and unknown, which arise during or result from my participation
in this The Kenya Program, regardless of whether or not caused in whole or part by the
negligence or other fault of any of the Released Parties. I release and forever discharge the
Released Parties from all such claims.

           3.     I agree to indemnify and hold the Released Parties harmless from all losses,
liabilities, damages, costs or expenses (including but not limited to reasonable attorneys' fees and
other litigation costs and expenses) incurred by any of the Released Parties as a result of any
claims or suits that I (or anyone claiming by, under or through me) may bring against any of the
Released Parties to recover any losses, liabilities, costs, damages, or expenses which arise
during or result from my participation in The Kenya Program, regardless of whether or not caused
in whole or part by the negligence or other fault of any of the Released Parties.

      4.       I have carefully read and reviewed this Waiver, Release And Hold Harmless
Agreement. I understand it fully and I execute it voluntarily.

                    EXECUTED this __________ day of __________________, 20______.

___________________________________            _________________________
                 Student Signature                     Student’s Printed Name

___________________________________            __________________________
Parent or Guardian Signature (if applicable)    Parent/Guardian Printed Name
                            Travel Warning
                          United States Department of State
                              Bureau of Consular Affairs
                               Washington, DC 20520

 This information is current as of today, Fri Dec 14 2007 10:47:13 GMT-0500 (Eastern Standard

October 18, 2007

This Travel Warning is being issued to remind American citizens to consider carefully
the risks of travel to Kenya at this time and updates information on safety and security
concerns. This supersedes the Travel Warning of February 6, 2007.

The Department continues to recommend that private American citizens in Kenya
evaluate their personal security situation in light of continuing terrorist threats and
increasing incidents of violent crime. Terrorist acts may include suicide operations,
bombings, attacks on civil aviation, and attacks on maritime vessels in or near Kenyan
ports. Violent criminal attacks, including armed carjacking, kidnappings, and home
invasions/burglary, can occur at any time and in any location, and are becoming
increasingly frequent, brazen, vicious, and often fatal. In January 2007, two family
members of a U.S. Embassy employee were killed by armed carjackers. Kenyan
authorities have limited capacity to deter and investigate such acts.

U.S. citizens should be aware of the risk of indiscriminate and random attacks on civilian
targets in public places, including tourist sites and locations where foreigners are known
to congregate, as well as commercial operations associated with U.S. or other foreign

American citizens in Kenya should remain vigilant, particularly in public places
frequented by foreigners such as clubs, hotels, resorts, upscale shopping centers,
restaurants, and places of worship. Americans should also remain vigilant in residential
areas, schools, and at outdoor recreational events, and should avoid demonstrations and
large crowds.

Americans who travel to or reside in Kenya despite this Travel Warning are encouraged
to register through the State Department’s travel registration website, By registering, American citizens make it easier for
the Embassy to contact them in case of emergency. Americans without Internet access
may register directly with the U.S. Embassy in Nairobi. The U.S. Embassy is located on
United Nations Avenue, Gigiri, Nairobi, Kenya; telephone (254) (20) 363-6000; fax
(254) (20) 363-6410. In the event of an after-hours emergency, the Embassy duty officer
may be contacted at (254) (20) 363-6170. The Embassy home page is

Updated information on travel and security in Kenya may be obtained from the
Department of State by calling 1-888-407-4747 toll free in the United States and
Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-
501-4444 . For further information please consult the Consular Information Sheet for
Kenya, the East Africa Public Announcement, and the Worldwide Caution Public
Announcement, which are available on the Bureau of Consular Affairs Internet website at
Office of the Spokesman

 This information is current as of today, Fri Dec 14 2007 10:48:40 GMT-0500 (Eastern Standard Time).

                                           East Africa

August 31, 2007

This Public Announcement is being re-issued to remind Americans of the continuing
potential for terrorist actions against U.S. citizens in East Africa, particularly along the
East African coast, to alert Americans to continuing sporadic violence in Somalia, and to
note a number of incidents of maritime piracy near the horn of Africa and the southern
Red Sea. This supersedes the Public Announcement of January 4, 2007.

A number of Al-Qaida operatives and other extremists are believed to be operating in and
around East Africa. As a result of the recent conflict and continuing tension in Somalia,
some of these individuals have sought to relocate elsewhere in the region, and others may
seek to do so. Americans considering travel to the region and those already there should
review their plans carefully, remain vigilant with regard to their personal security, and
exercise caution. Terrorist actions may include suicide operations, bombings,
kidnappings or targeting maritime vessels. Terrorists do not distinguish between official
and civilian targets. Increased security at official U.S. facilities has led terrorists to seek
softer targets such as hotels, beach resorts, prominent public places, and landmarks. In
particular, terrorists may target civil aviation and seaports. Americans in remote areas or
border regions where military or police authority is limited or non-existent could also
become targets.

Americans considering seaborne travel near the Horn of Africa or in the southern Red
Sea should exercise extreme caution, as there have been several incidents of armed
attacks, robberies, and kidnappings for ransom at sea by pirates during the past several
years. Merchant vessels continue to be hijacked in Somali territorial waters, while others
have been hijacked as far as 200 nautical miles off the coast of Somalia in international

The U.S. Government maritime authorities advise mariners to avoid the port of
Mogadishu, and to remain at least 200 nautical miles off the coast of Somalia. In
addition, when transiting around the Horn of Africa or in the Red Sea, it is strongly
recommended that vessels travel in convoys, and maintain good communications contact
at all times.

Americans living or traveling in East Africa are encouraged to register with the nearest
U.S. Embassy or consulate through the State Department’s travel registration
website, Americans without internet access may
register directly with the nearest U.S. Embassy or Consulate. By registering, American
citizens make it easier for the Embassy or Consulate to contact them in case of

U.S. citizens planning to travel to East Africa should consult the Department of State's
country-specific Public Announcements, Travel Warnings, Consular Information Sheets,
the Worldwide Caution Public Announcement and other information, available
at Up-to-date information on security conditions can also be
obtained by calling 1-888-407-4747 in the US. and Canada, or for callers outside the
U.S. and Canada, a regular toll line at 1-202-501-4444.
Office of the Spokesman

 This information is current as of today, Fri Dec 14 2007 10:51:58 GMT-0500 (Eastern Standard Time).

                                     Worldwide Caution

October 09, 2007

This Public Announcement updates information on the continuing threat of terrorist
actions and violence against Americans and interests overseas. This supersedes the
Worldwide Caution dated April 10, 2007.

The Department of State remains concerned about the continued threat of terrorist
attacks, demonstrations and other violent actions against U.S. citizens and interests
overseas. Current information suggests that al-Qaida and affiliated organizations
continue to plan terrorist attacks against U.S. interests in multiple regions, including
Europe, Asia, Africa and the Middle East. These attacks may employ a wide variety of
tactics including assassinations, kidnappings, hijackings and bombings.

Ongoing events in Iraq and elsewhere in the Middle East have resulted in demonstrations
and associated violence in several countries. Americans are reminded that
demonstrations and rioting can occur with little or no warning.

In August 2006, British authorities arrested a significant number of extremists engaged in
a plot to destroy multiple passenger aircraft flying from the United Kingdom to the
United States. The September 2006 attack on the U.S. Embassy in Syria and the March
2006 bombing near the U.S. Consulate in Karachi, Pakistan illustrate the continuing
desire of extremists to strike American targets.

Extremists may elect to use conventional or non-conventional weapons, and target both
official and private interests. Examples of such targets include high-profile sporting
events, residential areas, business offices, clubs, restaurants, places of worship, schools,
public areas and locales where Americans gather in large numbers, including during
holidays. In August 2007, two bombs exploded almost simultaneously at an amusement
park and a restaurant in India, killing at least 42 people. In June 2007, two unexploded
car bombs were discovered in London. Financial or economic targets of value may also
be considered as possible venues; the vehicle-based suicide attack on an oil facility near
Mukalla and Marib in Yemen in September 2006 and the failed attack on the Abqaiq oil
processing facility in Saudi Arabia in late February 2006 are such examples.

In the wake of the August 2006 plot against aircraft in London, numerous terrorist attacks
on trains in India in 2006, the July 2005 London Underground bombings, and the March
2004 train attacks in Madrid, Americans are reminded of the potential for terrorists to
attack public transportation systems. In addition, extremists may also select aviation and
maritime services as possible targets. In June 2007, a car was driven into the main
terminal at Glasgow International Airport and burst into flames. The car bomb failed to

U.S. citizens are strongly encouraged to maintain a high level of vigilance, be aware of
local events, and take the appropriate steps to bolster their personal security. For
additional information, please refer to “A Safe Trip Abroad” found at

U.S. Government facilities worldwide remain at a heightened state of alert. These
facilities may temporarily close or periodically suspend public services to assess their
security posture. In those instances, U.S. embassies and consulates will make every
effort to provide emergency services to U.S. citizens. Americans abroad are urged to
monitor the local news and maintain contact with the nearest U.S. embassy or consulate.

As the Department continues to develop information on any potential security threats to
U.S. citizens overseas, it shares credible threat information through its Consular
Information Program documents, available on the Internet at In
addition to information on the Internet, travelers may obtain up-to-date information on
security conditions by calling 1-888-407-4747 toll-free in the U.S. and Canada or,
outside the U.S. and Canada on a regular toll line at 1-202-501-4444 .

As a participant in a Purdue University study abroad program you
will be required to purchase a health insurance plan designed
specifically for international travel. As many major insurance
companies will not cover their clients outside the U.S., this is a
fairly inexpensive way to ensure that good medical coverage will
be available overseas. More specific information will be provided
to you in class, or as your travel date approaches.

For more information, contact PKP secretary.
                      TRAVEL REGISTRATION
                      WITH THE U.S. EMBASSY
Taken from

All should visit the above site and register your trip with the US Embassy.
Please print a copy as well as forward to PKP Secretary.
Registration Instructions

- Enter your name, contact information, and Date of Birth in the Personal Information section. You
should have your passport ready if you would like to enter your Passport Information.
- Your Emergency Contact should be someone who is not traveling with you. Remember to leave
a detailed itinerary and the numbers of your passport or other citizenship documents with
someone who is not traveling.
- Add contact information about any Additional Travelers if you are traveling with one or more
family members or companions.
- Provide enough information about your travel destination to help a U.S. consular officer contact
you in case of an emergency, including the dates you will be traveling (approximate dates are
acceptable). Providing the hotel name, the city, and the country will be useful, even if you cannot
provide the hotel phone number. If you are traveling to additional cities or countries, press the
Add Additional Destination button to enter information about those destinations.
- You will be asked to confirm that you have read the Privacy Act Notice. In accordance with the
Privacy Act, information on your welfare and whereabouts may not be released without your
express authorization.

Travel Registration

The Travel Registration service for American citizens allows you to register your contact
information, including emergency contacts, through the Internet.
The data you provide is encrypted and secure behind Department of State firewalls, and
accessible only by authorized State Department personnel in Embassies, Consulates, and the
Department of State in order to assist you.
Should an emergency in your country arise, the Embassy will attempt to contact you immediately
to advise you of the situation.

What to put for Destination:

Destination Information:
Destination Type:

Address Line 1: IU House PO Box 4606

Address Line 2:

City: Eldoret

Postal Code:
        Country*: Kenya

Phone: 011-254-53-20-30151

Email Address: Your email address
The following medications and vaccinations are recommended for all
travelers to Kenya, per the CDC:

•   Anti-malarial prophylaxis

           o Atovaquone/proguanil (Malarone®)

           o Doxycycline

           o Mefloquine (Lariam®)

•   Vaccinations:

           o Yellow Fever vaccination

           o Hepatitis A

           o Hepatitis B

           o   Meningococcal (meningitis) vaccine (you do need this because you are

               working in a healthcare environment)

           o Typhoid

** As needed, booster doses for tetanus-diphtheria, measles, and a one-time

dose of polio vaccine for adults.

For more information:

Ask your doctor or check the CDC travel web site ( for more

information about how to protect yourself against diseases that occur in East Africa.

Source: Health Information for Travelers to East Africa. CDC Website. Revised 4 April 2005. Accessed 24 April 2005.
III. Background
        No matter how much or how little you’ve traveled, you are likely to encounter some

degree of culture shock. This is a brief background of what culture shock is, symptoms, stages

and ways of dealing. Also included is a discussion on reverse culture shock.

Some websites are included at the bottom for additional information. Other good sources for

culture shock information are study abroad offices and missionary organizations.

What is culture?

        Culture is everything that surrounds us. It is language. Food. Clothes. Time. Where to

sit, how to walk, and when to talk. It encompasses all of our day to day tasks, the cultures and

values that surround us. We don’t often recognize are own culture because its so much a part of

our existence. But once we are placed in a different culture, we notice the difference. The

classic analogy of this is the goldfish analogy. The goldfish lives in a bowl of water, but he can’t

tell you what its like because its all he knows. Until he is moved to a pond.

        Because culture is incorporated into values, a new culture can come as a shock because

it seems to violate what we feel inside as “right” and “wrong”. As American’s, we have specific

cultural assumptions and many societies beliefs and values run counter to these. Table 1

summarizes some of these assumptions

So what is culture shock?

        Culture shock also known as cultural disorientation is a term used to describe the anxiety

felt when one moves to a completely new environment. It can include the physical and emotional

discomfort one feels in reaction the overwhelming differences facing them. Robert Kohl

describes cultural disorientation as “The psychological disorientation most people experience

when they move into a culture markedly different from their own. It comes from the experience of

encountering a way of doing, organizing, perceiving or valuing things which are different from
yours and which threaten your basic, unconscious belief that you culture’s customs, assumptions,

values and behaviors are right.”

Symptoms of culture shock:

•   Exasperation

•   Aggravation,

•   Annoyance

•   Anxiety

•   Sadness, loneliness, melancholy

•   Preoccupation with health

•   Aches, pains, and allergies

•   Insomnia

•   Changes in temperament, depression

•   Vulnerability

•   Anger

•   Unwillingness to interact

•   Idealizing the old country

•   Loss of identity

•   Trying to hard to absorb everything

•   Unable to solve simple problems

•   Lack of confidence

•   Stereotyping the new culture

•   Obsessions-such as over cleanliness

•   Feeling lost, exploited, abused

•   Exhaustion

•   Short Tempered

•   Isolating ones self.
Stages of culture shock.

        1. Enchantment/Incubation Stage: Could also be described the honeymoon stage.

            Things encountered are new and exciting (sites, sounds, smells) and one may

            experience a euphoric feeling. Often includes a few weeks prior to travel to a few

            weeks after entering the new culture.

        2. Disenchantment: The honeymoon is over. The enchantment stage dissolves and

            differences are no longer exciting but frustrating. Feelings of discontent anger

            sadness and so forth become more prevalent. Basic tasks may be complicated and

            language barriers are often frustrating.

        3. Retreat: Disenchantment often leads to retreat. The emotional load seems

            unbearable and one finds it increasingly difficult to stay involved with those around

            him or to leave his home voluntarily. Homesickness sets in and there is usually

            minimal contact with others.

        4. Adjustment: In this stage, one comes to accept the reality of being in another

            country. He becomes more comfortable and begin to gain understandings of the

            culture around himself. One begins to recognize that the culture has both positive

            and negative aspects compared to ones own. Some experts call this a “roses and

            garbage” realization.

        There is no set time for these stages to last and it varies from person to person. Those

traveling for longer periods of time experience different courses than those traveling short term. It

is not unusual to cycle through various stages and emotions as one experiences the ups and

downs of travel abroad.

Coping Mechanisms

Some tips for coping include:

•    Exercise

•    Learn the language
•   Develop a hobby

•   Be patient

•   Don’t try too hard

•   Relax and meditate or pray

•   Maintain contact with others of your ethnic group

•   Maintain contact in the new culture

•   Allow yourself to feel sad

•   Establish goals

•   Find ways to live in the new culture

•   Ask for help

        Returning to one’s home country, or “reverse culture shock” is a often ignored stage.

However, it is one of the most important ones and can even be more difficult than entering a new

culture. Travel changes people and how they think about life. And usually, the home culture has

not changed in the same direction. The greater the changes in attitudes and values the more

likely the transition will be unsettling. Some key areas that may create dissonance are:

•   The affluence of one’s own culture

•   Superficial values presented in the media

•   Role changes or undefined roles (new rotations, graduation?)

•   Changes in responsibility

•   Disillusionment with one’s church, family, peer group over their abundance and seeming lack

of concern

•   Seeming lack of genuinely concerned friends

•   Inability to share experiences adequately

•   Awareness of habits, behaviors that were second nature that now seem meaningless or

        People react in a number of different ways to this reentry period. Some slide right back

into their own culture, but seem to have forgotten their experience. Others are “alienators” who

reject the home culture and are rather pessimistic about things. The most ideal situation however

is to learn to integrate the experiences abroad into ones own culture. Expect things to disturb

you, even if you aren’t sure what the problems will be. A few tips to help make the most of this

time include being sure to get adequate exercise and sleep and eat a balanced diet. It helps you

recover from travel, as well as helping emotionally. Look ahead before you return. What

changed in you? What values changed? How may this be a point of dissonance? Talk with

others who have traveled with you. Living around others from Purdue and IU helps you cope

along the way and can help upon return. Stay in touch with those you traveled with. Review

journals you kept and think about the events recorded. Praying and meditating may also help.

        Culture shock may be inevitable but it does not have to ruin your experience. There are

good sides to these periods of adjustment and transition. By being out of your own culture, you

are able to more clearly see it. Recall the fish story from the beginning? The changes brought

about from your travel will likely mold you into a different person with a different perspective on

the world. They may even help shape your career goals.

                               BLENDING IN
                       By: Stacey Hendrix, PharmD
     (Purdue Pharmacy Kenya Program Student Clerkship Participant 2005)

           The number one thing to remember about blending in is this:

                              YOU WON’T
       Even if you have darker skin, are of African or Indian descent, you tend to

stand out, although much less than most. But blending in is far much more than

skin color. Your speech, your dress, and your manner tend to give you away as a

foreigner, as a westerner. People might not guess that you are American; it is

often a third or fourth guess by some.

       The fact is you’re a mazungu, the Swahili word for “white person” or

“westerner”. Even if you aren’t white, you’re essentially a mazungu. It’s a word

that is curiously similar to the Swahili word for round-about--a connection that

has never been explained to me, but of which I am strongly suspicious. Children

will be fascinated by you, or terrified. A mazungu is a scary thing if you’ve never

seen one before. You may become something of a “petting zoo” as they are

fascinated by the difference of skin color and hair types.

       That being said there are a few things of note that will help you stand out a

little less, “blend in”, or at the least, seem a little less odd to the Kenyans.
Dress Code

       This is one of the most important areas when it comes to blending in.

Perhaps because it is one of the areas where we as Americans can differ most

from the Kenyans. Kenyans as a whole tend to dress far more formally than we

do. It is not an uncommon site to see a man herding cattle in a suit (often along

your way to work).

       Women usually wear dresses or skirts, although some will wear pants

outfits, though even these have a more African flare to them. In the cities, you

may see some more westernized looking outfits worn by both men and women,

but rural areas and villages, such as where clinics are located, are far more

traditional. Men also dress nicely. Nice slacks, shirt and tie will be suitable for

men at work. For women, nice slacks and a blouse, or a skirt or dress are best.

Skirts are highly recommended for clinics (it makes using the toilet far easier).

       For recreation and travel, it is still recommended to wear pants for a

number of reasons. This is particularly true for the females. Sun and

mosquitoes both contribute to making longer pants a better alternative. Weather

also adds to this as some days are rather cool up in the mountains. Cultural

sensitivity is another major reason for not wearing shorts, particularly around

town or places where lots of Kenyan’s gather. For the Kenyans, a woman

showing her thighs is considered somewhat crude. It would be comparable to an

American woman walking around topless. Please don’t think you are restricted

to pants though. Shorts are okay if they are longer in length or you will be in

areas where there are mostly Westerners around, such as around the Purdue
house or the IU house (but only in the evenings at IU). They are also acceptable

for some of the trips.

       In town, good luck. It’s an experience walking around downtown Eldoret.

You stick out and blending in is next to impossible. You eventually get used to

the shouts of “Mazungu!” and “Hey mazungu, how are you?” Or you at least

learn to ignore them. You’ll be stared at, asked to buy things, and asked for

money. The latter can be rather problematic at times as people can be rather

persistent. The trick is to be just as persistent back, for once you give money,

and the word gets out, things get worse. Plus, with street kids there are the

concerns of money being used for drugs instead of food.

       A few other helpful hints we’ve figured out in our time here as well.

Pedestrians do not have the right-of-way. The ladder of right away from bottom

to top flows something like this: pedestrian, boda-boda (bicycle taxi), car, lorry

(semi-truck), matatu. You’ll get good at dodging these things and not choking too

much on fumes. Remember, traffic is opposite from that in the states. So when

crossing roads, the “lane” closest to you comes from the opposite direction –

would recommend you get used to looking both ways before crossing the road.

This opposite flow of traffic seems to work somewhat for pedestrian flow as

people tend to pass each other on the left instead of the right. Although, when

things are really crowded, it doesn’t matter much.

       Use judgment and caution when taking pictures. Many people may be

upset by their picture being taken or may demand a copy or to be paid. Some
may ask you to take their picture. DO NOT take pictures of government

buildings. A trick for some things can be to pretend to take a picture of your

friends but take a picture of something else beyond or to the side. If taking

pictures on the wards, be sure to check with the charge nurse or attending and

with the patients first.

       As mentioned, there isn’t a lot you can do to truly blend in but change the

color of your skin. Still, I’ll close with one final piece of advice, something which

impresses many Kenyans. Learn Swahili! Even if you don’t know much and

struggle through it a bit, it is a nice gesture to attempt instead of expecting people

to speak English to you.

        This is a short description of the differences between the typical American

attitude and that of much of the rest of the world. It serves to make us all more

aware of the cultural differences that may be encountered in foreign travel.

Being prepared to encounter a much different attitude may make travel easier for

all involved.

             American assumption                               Counter-American assumption
Identity is within us, as individuals.               Identity is as part of a family, clan, tribe, etc.
We value a person’s special skills.                  Value is placed on a person’s background,
                                                     family connections.
We learn about life from personal experience.        We learn about life from the wisdom and
                                                     knowledge of others, such as elders.
Feelings of guilt if we do not live up to our        Feelings of shame if we do not live up to the
personal standards.                                  standards of our community.
Minimize the difference.                             Stress the difference.
Stress informality.                                  Stress formality.
Little distinction between male and female           Sharp differentiation between male and female
roles.                                               roles.
People may have close friends of both sexes.         People have close friends of the same sex
Friendship is a loose concept applied to many        Friendship is a specific concept applied to a
people.                                              few people.
Eye to eye contact with confrontation.               Conflict is unacceptable and embarrassing.
Doing things together is our primary way of          Being together is our primary way of social
social interaction.                                  interaction.
Life is fast, busy and conductive to getting         Life is slow, steady and conductive to getting
things done.                                         the most out of life.
Nature is physical and knowable.                     Nature is spiritual and mystical.
Fate is of little influence; we are the masters of   Fate is of great influence and we can do little to
our own destiny.                                     alter it.
Man should modify nature for his own need.           Man should accept and integrate with the
                                                     natural forces around him.
Time is seen in precise minutes and ours by          Time is seen in diffuse days, weeks, or months
which we organize our days.                          by which we organize our years.
Time is a limited resource not to be wasted.         Time is an unlimited resource to be used.
                              TRAVELING IN KENYA

Arrival in Kenya

         The first stop is immigration where you will purchase your Visa. Then you enter the

baggage claim area. If you are carrying an IU or Purdue trunk, make sure you have the customs

exemption letter with you. Betty Austin will provide this.

         After baggage claim, you will pass a place to change money or an ATM to withdrawal

shillings. Most places will only change newer (after 2004) bills. We recommend changing $100

to $200 into Kenyan shillings at that time. You will be able to change money later in Eldoret, as

well. The Kenyan shilling is currently about 70 Ksh to the US dollar. Be sure to ask for some Ksh

100, 200 and 500 notes.

         You will be met by a travel agency driver (usually Kwa Kila Hali Safari Travel Company)

holding a sign with either a traveler’s name, IU or Purdue on it. If you arrive in the evening or at

night, you will need to stay over in Nairobi until morning. If you stay over, you will be at a nearby

hotel. You will pay the driver for your hotel and your transportation to Eldoret (this can be done

with US dollars. Betty will provide you with the final cost and the driver will have an invoice. .

         Whether you leave right away or stay over, you will be taken to the departure point for

Eldoret by the Kwa Kila Hali driver. You will be met at the Eldoret Airport by either the Purdue

faculty or some one from IU.

         When you get to Eldoret you will be able to get Kenyan currency with an ATM card. You

can also exchange money at the bank but generally the exchange rate is worse. Credit cards

generally are not accepted anywhere in Western Kenya where you will be traveling on weekends.

Some travel agents will take personal checks but very few will take credit cards due to the

additional costs.

Note: Porter Service at Airports: Beware of people who want to carry your bags at the airport. They can spot

newcomers and will demand 1000 shillings or more. The standard tip for such service is 20-50 shillings. Do not give

money to their “boss” and if you don’t want this service, firmly say “No Thanks” when they try to take your bags. Once it

is in their hands you are committed.

Mountains Beyond Mountains: The Quest of Dr. Paul Farmer by Tracy Kidder

The End of Poverty by Jeffrey Sachs

Movie: The Constant Gardner

How to Be an African Lady by Uche Onyebadi

The Running Woman by Kehinde Ayoola

Before the Rooster Crows by Peter Kimani

I Swear by Apollo by Margaret A Ogola

Portraits of the Heart by Gitura Mwaura

Nice People by Wamugunda Geteria

By Grace Ogot:
       The Strange Bride
       Land Without Thunder
       The Other Woman
       The Promised Land

By Wahome Mutahi:
      Three Days on the Cross
      How to be a Kenyan

Striving for the Wind by Meja Mwangi

Son of Woman by Charles Mangua

Histories of the Hanged: the Dirty War in Kenya and the End of Empire by David Anderson

White Mischief by James Fox

By Kuki Gallmann:
       African Nights
       I Dreamed of Africa.

By Elspeth Huxley:
       The Flame Trees of Thika
       The Mottled Lizard
       Out in the Midday Sun
       Pioneers Scrapbook: Reminiscences of Kenya 1890-1968
       Red Strangers
       The Sorcerer's Apprentice: A Journey Through East Africa
By Joscelin Grant.
       Last Days in Eden
       Settlers of Kenya
       White Man's Country: Lord Delamere and the Making of Kenya

My Kenya Days by Wilfred Thesinger
IV. Appendices
                                        Appendix A:
     The Partnership Between Indiana University School of Medicine and Moi
    University Faculty of Health Sciences: a Model for US-African Cooperation

 Robert M. Einterz, MD,1 Haroun N. K. Mengech, MBChB,3,4 Barasa O. Khwa-Otsyula,
   MBChB,3 James Y. Greene, PhD,5 William M. Tierney, MD,1,2 Joseph J. Mamlin1,4

                  Running Heading: Indiana-Moi University Partnership

            Department of Medicine, Indiana University School of Medicine
                             Regenstrief Institute for Health Care
                                        Indianapolis, IN, USA

                         Moi University Faculty of Health Sciences
                                 Moi Teaching and Referral Hospital
                                           Eldoret, Kenya

                                    Wilkes Community College
                             West Jefferson, North Carolina, USA

Robert M. Einterz, MD                   Telephone: (317) 630-6455
Wishard Memorial Hospital               Fax: (317) 630-7066
OPW M200                                E-mail:
1001 W. 10th Street
Indianapolis, IN 46202
International partnerships usually emphasize cross-cultural exchange of trainees but
tend not to contribute to the development of the host health system. For 14 years, the
Indiana University-Moi University (Kenya) Partnership has emphasized equitable
relationships and exchange of both trainees and faculty members, and used faculty
partnerships between universities to foster service, training, and research that benefit
Kenya’s health system. This paper describes that academic partnership, reviews salient
outcomes, and discusses key elements that have enabled the partnership to contribute
to development of the health system in Kenya. An important achievement includes the
development of a program for prevention and treatment of HIV/AIDS in Kenya. The
Indiana University-Moi University partnership is a model for collaboration among US
and African academic medical centers.
It seems intuitive that a partnership between a medical school in the United States and
a medical school in Africa would have the power to benefit health professionals at both
institutions and contribute especially to the development of the African institution and its
respective nation. However, most linkages between medical schools in the US and the
developing world focus on specific research projects and agendas or short-term
exchange of trainees (residents and/or students) and do not respond adequately to
meeting the longer-term heath service needs of the developing country. International
efforts tend to overemphasize curative care relative to disease prevention and health
promotion, promote new technologies without assessing their impact or sustainability,
and fail to facilitate improvements in the health care system of the developing country
(1). At times, relationships between developed and developing countries have been
criticized as being exploitative and inequitable. (2-4). There are several examples of
linkages between medical schools in the US and the developing world that promote
exchange of trainees (5-7). However, there are no published reports of long-term
partnerships between US and African medical schools characterized by sustained
involvement at a faculty level and broad institutional commitment on the part of the
American medical school to the full tripartite academic mission of teaching, research,
and service in Africa that fostered the development of the health care system in the
African country.

In the late 1980s, a small group of faculty members at Indiana University School of
Medicine, Indianapolis, USA and Moi University Faculty of Health Sciences, Eldoret,
Kenya envisioned a new institutional partnership that they hoped would be a replicable,
effective, and equitable model of cooperation between an African and an American
institution (8). The mission of this new partnership was to develop leaders in health for
the United States and Africa, foster the values of the medical profession, and promote
health and well-being in both countries. This paper describes that partnership, reviews
many of the salient outcomes, identifies challenges to sustainability, and discusses key
elements that have enabled the partnership to prosper. We believe the partnership is
uniquely successful because of its emphasis on building the health care system and its
centrality to research and training. The partnership’s success also derives from its
commitment to equitable, sustained counterpart relationships at the faculty level. We
believe this partnership represents a powerful model that can be replicated by other
American and African medical schools.

The Indiana University-Moi University partnership was formally established in 1989. At
its inception, the partnership focused on exchange of manpower and ideas, with the
expectation that cooperation, mutual understanding, and the collective creative energy
of the participants would grow the institutional partnership and enable it to achieve its
mission. The initial goal of the partnership was to develop the systems of medical
training and primary care delivery at Moi University and its affiliated delivery sites, with
the expectation that these systems would establish a strong foundation upon which to
build a robust and sustainable research collaboration.
The institutional partnership began in earnest in 1990, the year that Moi University
accepted its inaugural class of medical students. At that time, Indiana University’s
commitment was straightforward: one of its clinical faculty members from the
Department of Medicine would serve on site in Kenya, under the direction of the
respective Kenyan head of department, and this commitment would be sustained for at
least a decade at no cost to Moi University. The Indiana University faculty member’s
job would be to coordinate relationships between the two institutions while serving the
academic mission of Moi University Faculty of Health Sciences. Both institutions agreed
to seek external funding to address needs and priorities as they arose.

Individual counterpart relationships—based on mutual respect and trust and striving for
sustained, mutual benefit—are the foundation of the Indiana-Moi University institutional
partnership. Individual participants are expected to respect the autonomy of the host
institution, and to be responsive when possible to local needs. Each American visitor in
Kenya tries to link with his/her appropriate counterpart. For example, Indiana’s
physicians in Kenya work with their Kenyan colleagues under the direction of the
Kenyan department head. Indiana’s medical students work and live with Kenyan
medical students, and Indiana University School of Medicine residents work alongside
Kenyan medical officers and interns. Research mentors from Indiana University seek to
help Kenyan investigators become first author on peer-reviewed publications and
establish independent grant funding. Counterpart relationships are similarly emphasized
when Kenyan faculty and students visit Indiana and other American institutions.


                                 Exchange of Personnel
At the inception of the partnership and extending to the current time, the
Departments of Medicine have served as the principal, core link between the two
medical schools. However, the institutional partnership currently involves
virtually all of the major disciplines at each medical school, and exchange of
personnel occurs at multiple levels including administrative staff, students, post-
graduates, and faculty members. In total, more than 500 Kenyans and Americans
have participated in the exchange since the inception of the partnership.

One full-time physician from Indiana University works as the “team leader” in Kenya and
shares with his Kenyan counterparts responsibilities for clinical service, teaching, and
research at Moi University and its affiliated hospitals and urban and rural health centers.
The team leader also supports and coordinates activities of many “short-term” visitors
from Indiana University and other academic medical centers in the US. Eight internists,
one surgeon, one internist/pediatrician, and one pediatrician from Indiana University
have each spent one to five year terms at Moi University. More than 100 other faculty
members from Indiana University and other US institutions have served short-term
experiences at Moi University.
Residents from Indiana University’s training programs may take eight-week electives in
Eldoret under the supervision of the team leader. While at Moi University, the residents’
responsibilities include patient care, teaching, research and public health activities at
the Moi Teaching and Referral Hospital and its affiliated urban and rural health centers.
While in Kenya, the residents establish collegial relationships with junior Kenyan doctors
and help teach Kenyan medical students. Since 1990, more than 140 residents have
participated in elective rotations in Kenya. Most of the residents have been in primary
care training programs at Indiana. Residents consistently describe the experience in
Kenya as “life-changing” and rate the elective as one of the premier experiences of their
residency training. On Indiana University’s annual housestaff rotation feedback ranking
report, the Kenya rotation ranked number one out of 51 rotations that had been taken by
more than five residents.

In 1994, Indiana University introduced an elective opportunity for its fourth-year medical
students. Since then, more than 100 senior students have taken clinical electives at
Moi University. A two-month long summer elective for sophomore medical students
was begun in 1995. Two to four second-year medical students travel to Kenya every
summer. Students participate in academic, clinical, and community-based activities.

Additional American medical institutions have joined Indiana University in a partnership
called the America/sub-Saharan African Network for Training and Education in
Medicine, or ASANTE Consortium. In addition to Indiana University, the ASANTE
Consortium currently includes Brown Medical School, Lehigh Valley Hospital and Health
Network, Providence Portland Medical Center, and the University of Utah School of
Medicine. Brown Medical School has been a particularly key partner in a wide range of
collaborative activities, including activities related to HIV/AIDS, bilateral student and
faculty exchange, research, service, and strategic planning in Kenya.

More than 30 Kenyan faculty members have visited Indiana for the purpose of faculty
development in a wide range of areas including graduate and post-graduate curriculum
development, general medicine, leadership training, cardiology, clinical pharmacology,
gastroenterology, pulmonary medicine, basic sciences, pathology, dermatology, medical
informatics, and health services research. For the last eight years, Indiana University
and its partners in the ASANTE consortium have provided full scholarship support for
Kenyan medical students to take two-month clinical electives in the US. Currently,
fourteen Kenyan medical students participate each year.

Program Enhancement and Development in Kenya
Within the first three years of the partnership, Indiana University initiated a fundraising
effort in the US designed to meet selected needs in Kenya. Through this effort, Moi
University annually supports its medical students with a work-study program, full tuition
scholarships for impoverished students, leadership and merit scholarships, and awards
to promote Kenyan women in medicine. In the current year, using funds raised in the
US, Moi University supports 50 students in work-study and 36 full tuition scholarships.
With funds raised by Indiana University from philanthropic contributions and competitive
grants from federal agencies and foundations, the partnership enhanced Kenyan
research and faculty development; facilitated community based education and service in
rural and urban communities; augmented educational resources, medical equipment,
and medicines; and completed multiple construction projects including four operating
theatres and a well at a rural health center. The most recent construction project is a
40,000 square foot building, costing more than $1 million, dedicated to HIV care,
training and research. The development of the first outpatient electronic medical record
in sub-Saharan Africa was a particularly key achievement for the partnership (9). The
electronic Moi University Medical Record System successfully bridged the “digital
divide” and has evolved into the information system supporting clinical and research
activities in the partnership’s HIV clinics.

In view of the magnitude of the growing HIV pandemic in sub-Saharan Africa over the
last two decades, the partnership decided in 2000 to focus its activities in Kenya on the
HIV problem. The Kenya Ministry of Health and Moi Teaching and Referral Hospital
joined with the Indiana-Moi University partnership and its US partners to establish a
working model of urban and rural HIV prevention and treatment. This model, called the
Academic Model for the Prevention and Treatment of HIV/AIDS , or AMPATH,
incorporates three vital components: (1) care programs that foster HIV treatment and
prevention, and are capable of hosting research and training missions; (2) research
programs that enable the development and evolution of “best-practice” strategies for
prevention and treatment; and (3) teaching programs where a wide range of health
professionals and outreach workers can learn to implement these strategies. AMPATH
is Kenya’s largest public sector program (as of December 2003, more than 2000
patients were being followed in the HIV clinics, about half of them on anti-retroviral
therapy) and has been designated by the Ministry of Health as the training site for
providers in western Kenya. The target population for AMPATH’s prevention programs
includes approximately two million persons living in the city of Eldoret and multiple rural
communities that historically are tied to Moi University’s community based education
and service program. AMPATH is now poised to lead and guide the scale-up of HIV
control in Kenya and sub-Saharan Africa.

                                  Scholarly Achievements
Numerous grants from U.S. federal agencies and several foundations totaling more than
three million dollars in direct costs have funded faculty and student exchange and the
development of clinical, teaching, and research personnel and programs in Kenya,
especially for HIV prevention and treatment. The partnership has completed multiple
collaborative projects including an extensive evaluation of the first decade of the
curriculum at Moi University Faculty of Health Sciences. The partnership has also
produced numerous publications and presentations co-authored by Americans and
Kenyans. Publications have focused on a range of topics including medical informatics
(9-12), medical education (13-17), basic sciences research (18-26), and clinical,
epidemiological and health services research (27-33).
Program Evaluation
We have assessed the effect of the program on US faculty members, residents and
students using survey instruments completed by selected participants, reports written by
all students, and interviews conducted by one of the authors of most of the participants
upon their return to Indiana.

Program participants report that their experience in Kenya had some value in improving
history-taking skills, broadening general medical knowledge and improving diagnostic
skills. One student wrote:
        I found myself learning more than I had expected from students two to three
        years my junior. I was ashamed by my lack of physical exam skills, at which my
        Kenyan counterparts were so adept.

Enhancement of teaching skills seems to be a significant outcome of the “Kenya
experience.” Most faculty members who stayed for a month or more indicate that the
experience significantly enhanced their teaching or mentoring. An individual who went
to Eldoret as a resident and is now in private practice says simply:
       I use lessons from Kenya a lot in teaching medical students and mentoring high
       school students.

Most participants note improvement of stateside job satisfaction as an important
outcome of their time in Kenya. How long they stayed does not seem to affect the
impact of the international experience in this area. The following comments represent
the feelings of most participants:
       I definitely have a new appreciation for the relative conditions and professional
       atmosphere [in the US].

       Although I’ve always said, “I’m in this profession to help people,” I feel it now!”

       I learned that being a doctor is not just ordering tests and prescribing expensive
       medications. Instead, I learned that being a doctor goes beyond that and
       includes providing the basic human needs – such things as love, understanding,
       the human touch and compassion.

For Americans, the experience affects their use of personal time and appears to
influence community involvement and citizenship at home. Typical comments include:
       I realize the impact that monetary support of charitable organizations can have. I
       am also very aware of the limitations of relief agencies to change fundamental
       attitudes of the people they serve.

       The experience taught me the importance of looking at the “big picture” of
       culture, religion and belief systems before making any rash judgments.

Personal beliefs and family relationships may be the areas in which participants feel that
the experience is of most significance.
       My wife and I shared a quite profound experience, which we continue to discuss
       and learn from. We feel closer to one another.

       This experience was honestly bordering on, often crossing over into, a religious
       experience. It has made me feel as though I have a greater appreciation for all
       God’s creation and for my role in this world.

       My time in Kenya allowed me to articulate my values at an early point in my
       medical career.

Comments written by the American participants reveal how powerful the experience can
be for many of the participants.
       The time I spent in Kenya certainly has given me a more accurate frame of
       reference to evaluate my country, community and professional life. I realize how
       important abstract fundamental beliefs are to the concrete realities of daily life. I
       have, therefore, spent more time examining the core values in my life.

       I saw in [my Kenyan colleague’s] eyes the same anger and frustration that I
       felt...of knowing what to do without having the tools with which to do it.

According to exit interviews and evaluations completed by Kenyan students and faculty
members who spent time in the US, the experience reinforces their commitment to
certain aspects of their own curriculum and exposes them to different attitudes toward
work, different styles of teaching and leadership, and a different organizational
construct. Representative comments include:

       I simply believe now that as an individual and as a teacher, the concept of self-
       directed learning is paramount to keep abreast. I may not have the chance to
       practice similar [to my American counterparts], but I will be aware of what is
       going on. My students should do the same.

       I was impressed by the climate set in which students do their clerkship. It is not
       an intimidating atmosphere.

       [The experience] opened my eyes to many concepts that I have taken for granted
       and did not know.

       Today, I learned that anything is possible.

The Kenyan faculty participants report that their experiences increase creativity in
solving problems in health care delivery and make them less accepting of the status quo
in Kenya. Importantly, Kenyan faculty and students note that the partnership is fair and
There have been no formal, external assessments of the partnership. However, an NIH
special emphasis panel charged with reviewing the partnership in the context of a grant
review gave the partnership a superior rating. According to one of the reviewers, the
partnership “serves as a model program for how collaboration between U.S. institutions
and those in developing countries can be established, nourished, maintained, evaluated
and enhanced….This linkage has been developed in such a way that the interests of
Moi University and the people of Kenya have been kept uppermost.” [Personal
communication, NICHD Special Emphasis Panel, ZHD1 DSR-R (TW), 1/22/2001]

Funding for the partnership comes from a number of sources. The program was initially
funded by Indiana University’s Division of General Internal Medicine and Geriatrics and
the Moore Foundation, a private foundation based in Indiana. Currently, the partnership
derives funding from a broad base including the Indiana University School of Medicine,
local Indianapolis institutions, local and national institutions and foundations, and private
philanthropy. Philanthropic gifts comprise nearly 50% of the total operating budget.
Multiple departments at Indiana University have provided departmental funds to support
exchange of selected faculty and residents. Individual private donations have been key
for a number of projects in Kenya. An inter-denominational response on the part of the
faith community of central Indiana has been very supportive of the Indiana-Moi
partnership, particularly of its efforts to control HIV/AIDS. Competitive grants from the
former Education Commission for Foreign Medical Graduates, the Bill and Melinda
Gates Foundation, the MTCT-Plus Initiative (34), the United States Agency for
International Development, the National Institutes of Health, and other sources have
supported clinical, educational, and research activities.

In order to begin to build an endowment for the partnership, Indiana University
successfully completed a 1.5 million-dollar development campaign several years ago.
This money was donated in response to a challenge grant from Indiana University
Department of Medicine. Since the inception of the partnership, philanthropic
contributions from individuals have totaled more than two million dollars. Development
through philanthropy remains an ongoing priority, and mechanisms have been
implemented to continue this development effort to meet operational and endowment

The Indiana University-Moi University partnership has made a significant difference in
the lives of thousands of individual Kenyans and Americans and it has made positive
contributions to the development of Moi University College of Health Sciences and the
local and national health system in both urban and rural Kenya. The Indiana-Moi
experience demonstrates the powerful effect that can be achieved through partnership
of academic medical centers in the United States and Africa. We believe there are
several keys to the success of the partnership: equitable counterpart relationships
among faculty members; a systematic approach to partnership that is inclusive of
research, teaching, and service; and leadership committed to the mission of the

All participants in the partnership expect and work for mutual benefit. Altruism is a
necessary but insufficient reason for either institution to continue in the partnership.
There must be demonstrable benefit to both institutions. To achieve mutual benefit, the
institutional relationship strives for equity, not equality, because medical systems in the
developed and developing world are inherently unequal. For example, Indiana
University does not expect financial commitment on the part of Moi University to support
Indiana University’s participation. At the same time, however, Indiana University does
expect its trainees and faculty members to be given the opportunity at Moi University to
benefit personally and professionally from involvement in the program.

Achieving mutual benefit requires attention to the needs of individuals. Kenyans and
Americans, for example, are both motivated by the need for financial security and
career mobility. However, due to severe resource constraints at their home institution,
Kenyan faculty members face challenging demands to provide for their nuclear and
extended families. The Indiana University-Moi University partnership, through its
capacity to access a broad array of funding sources, strives to enhance financial
security and provide sustained support for Kenyan faculty. Importantly, the partnership
does so by providing collaborations that support the academic missions of service,
training, and research.

Indiana University’s commitment to keep at least one of its faculty members—the team
leader—on-site in Kenya forms the cornerstone of its institutional commitment. The
team leader enables open and regular communication, grassroots understanding and
responsiveness to new situations, and sustainable interventions. By focusing on the
system as a whole, the team leader facilitates continuous remolding of the partnership’s
vision for how research, training, and service integrate with one another. AMPATH and
the rural electronic medical record, for example, would not have happened in a
partnership that was discontinuous or focused primarily on research or training. Such
creative interventions could evolve only out of many years of close cooperation, shared
experience, and commitment to health service.

As in any institutional relationship, leadership is of critical importance. Leaders of both
institutions support the partnership, and the partnership supports leadership positions at
both institutions. Persons at the highest levels of both institutions are vested in the
partnership. If differences arise between the two institutions, relevant counterparts seek
common ground in shared values and goals.

Lastly, one of the most important lessons we learned is to start small, stay focused,
control the fundamental administrative processes, and ensure that the driving forces for
growth of the program are creativity, values, mission and longterm sustainability—not
money. This grassroots, hands-on approach also enables transparency and
accountability of funds, and is appealing to some funding sources that tend to be wary
of investing in sub-Saharan Africa.

The Indiana University-Moi University partnership provides an important affirmation of
each medical school’s commitment to the world community. The success of the
partnership reveals the promise such collaborative projects hold for the development of
tomorrow’s medical leaders, both within Africa and in the United States. More US
medical schools could and should be working to develop long-term partnerships with
sister schools in the developing world.

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                                       Appendix B:
                Academic Model for the Prevention and Treatment

                                       of HIV/AIDS in Kenya

Joseph J. Mamlin, MD,1,3 Sylvester Kimaiyo, MBChB, 1 Winstone Nyandiko,

MBChB, 1 H.N.K. Arap Mengech, MBChB, 1,2 B.O. Khwa-Otsyula, MBChB,1 E. Jane

Carter, MD,5 William M. Tierney, MD,3,4 and Robert M. Einterz, MD3

                      Moi University College of Health Sciences
                             Moi Teaching and Referral Hospital

                                          Eldoret, Kenya

                                            — and —
                         Indiana University School of Medicine
                                    Regenstrief Institute, Inc.

                                   Indianapolis, Indiana, USA

                                            — and —
                             Brown University School of Medicine

                                 Providence, Rhode Island, USA

             Running Head: Preventing and Treating HIV/AIDS in Kenya

Corresponding author:
   Robert Einterz, MD                                Voice: 317-630-6455
   OPW M200                                          Fax: 317-630-7066
   Wishard Hospital                                  E-mail:
   1001 W. 10th Street
   Indianapolis, IN 46202

The Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) is one
of Kenya’s most comprehensive initiatives to combat HIV. AMPATH is a working model
of urban and rural HIV preventive and treatment services in the public sector. AMPATH
cares for more than 2100 HIV infected adults and children, with one-half of all patients
on anti-retroviral drugs. A robust program to prevent mother to child transmission of HIV
has been initiated including a bold opt-out testing policy and pilot programs fostering
triple anti-retroviral therapy of pregnant woman and formula feeding of newborns.
AMPATH has implemented programs that foster food and economic security for HIV
infected persons and their families. This paper describes the development and
implementation of AMPATH, reflects on lessons learned, and enumerates the process
of scaling up HIV treatment services in Kenya. AMPATH demonstrates the power of US
and African academic medical centers united by common vision.

No one questions the gravity of the HIV crisis now facing sub-Saharan Africa.1 In the
past, limited funding and overwhelming need left little choice beyond programs focusing
on prevention and palliative care. 2 Now the challenge facing sub-Saharan Africa
includes a focus on rapid scale up of treatment services. 3 Demonstrating models of
comprehensive HIV care that can work effectively in countries like Kenya is of the
highest priority.4

One important resource for Kenya and many other sub-Saharan countries, as they gear
up treatment services, is their academic medical community. Most African academic
medical centers have access to large numbers of HIV-infected patients in desperate
need of care. Besides patient care, academic medical centers are entrusted with
training the next generation of health care providers and have the potential to perform
meaningful research. This latent power within Africa’s academic medical centers must
not be underestimated. We believe that academic medical centers within Africa are
more likely to realize this power if bolstered by strong collaborative relationships with
academic medical centers in the developed world. This paper will describe just such
collaboration between Indiana University School of Medicine, USA and Moi University
Faculty of Health Sciences, Kenya and its impact as Kenya accepts the challenge to
offer treatment to the millions of its citizens suffering from HIV/AIDS.

Moi Teaching and Referral Hospital and Moi University Faculty of Health Sciences are
two of Kenya’s most vital resources in the battle against the HIV pandemic. As Kenya’s
second national referral hospital and medical school, these institutions have joined with
Indiana University School of Medicine to create an Academic Model for the
Prevention and Treatment of HIV/AIDS [AMPATH] as one of Kenya’s most
comprehensive initiatives to combat HIV. The overriding goal of AMPATH is to
establish a working model of both urban and rural comprehensive HIV preventive and
treatment services. Representing the unique attributes of academic institutions,
AMPATH has structured its patient care programs to simultaneously serve as
classrooms and laboratories for HIV-related teaching and research.

Bringing up AMPATH

AMPATH began in November, 2001 and had the following major objectives:
  1. Establish adult and pediatric HIV treatment services simultaneously in an urban
     [Moi Teaching and Referral Hospital] and rural [Mosoriot Rural Health Center]
  2. Develop a computerized medical record and data repository.
  3. Train providers in comprehensive multidisciplinary care of HIV-infected patients.
  4. Demonstrate cost-effective care.
   5. Establish an HIV reference laboratory capable of providing CD4 counts, viral
      loads and DNA-PCR.

The start up cost of AMPATH was borne largely by private donations from the friends of
Indiana University School of Medicine and limited grant support. It was AMPATH’s
expectation that programs that were working and worthy of scale-up would ultimately
gain ongoing support from the Government of Kenya, international donors and granting

Patient selection

AMPATH provides medical care for all patients presenting to the HIV clinics at Moi
Teaching and Referral Hospital and the Mosoriot Rural Health Center. Every patient
receives a basic history and physical examination and access to prophylaxis for
selected opportunistic infections, mainly tuberculosis and Pneumocystis carinii
pneumonia. As incremental increases in funding became available, the sicker patients
were given priority for antiretrovirals. With grants such as the MTCT-Plus Initiative,5
priority was given to HIV-infected pregnant women and their families. Currently,
AMPATH serves patients with a mix of funding sources including self support, employer
support, MTCT-Plus Initiative, other grant support, and philanthropic support. Many
patients still lack support of any kind and wait assignment.

Antiretroviral treatment regimens

The majority of patients are on the recommended initial standard regimen for Kenya
consisting of nevirapine, stavudine and lamivudine. Additional antiretrovirals are
available when indicated, but WHO-approved generic drugs are preferred in an effort to
sustain costs below $23 per month.

Human resources

More than fifty internists, pediatricians, clinical officers, nurses, pharmacists, outreach
workers and nutritionists have been formally trained in HIV/AIDS management by
collaborating U.S. universities and on-site workshops. In addition to the formal training,
providers have accumulated over two years of in-clinic mentored experience in cost
effective treatment and monitoring of patients on antiretrovirals and OI prophylaxis.

Clinic sessions are held daily at both urban and rural sites. Patients initiated on
antiretrovirals are seen every two weeks for the first several visits, then monthly.
Patients not on antiretrovirals are seen every three months. In addition, each patient is
given a cellular telephone number to call. Patients capable of accessing a telephone
can reach an on-call clinical officer or nurse with physician back-up during evenings and
Patient monitoring

Beyond the initial history and physical exam, all new patients receive a screening chest
x-ray, complete blood count and a serologic test for syphilis. A helper-t cell count (CD4)
and alanine aminotransferase (ALT) is added for patients who can pay or if the patient
qualifies for a funded AMPATH program. In the absence of a CD4 count, attention is
paid to the absolute lymphocyte count as a general approximation of the CD4 but with
full understanding of its limitations.6 All patients on antiretrovirals have a repeat
complete blood count and ALT every three to four months and CD4 every six months.
Viral loads are used for failing patients under consideration for a secondary regimen.
DNA testing for HIV virus by polymerase chain reaction is available for children.

All patient encounters are entered into an extensive electronic data repository.7 This rich
resource permits unlimited access to the AMPATH patient base, which is critical for
surveillance (e.g., for drug toxicities), identifying risk factors for adverse events, and
quality improvement activities.

The multidisciplinary team as providers of care

AMPATH is committed to a multidisciplinary model of HIV care because of the volume
of patients and the unique demands of adherence to antiretrovirals. Each team consists
of a physician, clinical officer, nurses, nutritionists, pharmacists and outreach workers.

Kenya is fortunate to have a long history of training well-rounded clinical officers. They
are well grounded in basic medical knowledge and general practice. AMPATH’s current
model teams a clinical officer with a single physician. All patients requiring
antiretrovirals are seen jointly by clinical officer and physician during their first or second
visit. The large majority of subsequent visits are managed by the clinical officer. Stable
patients are referred for physician review every six to twelve months. Explicit protocols
define levels of acuity that demand an earlier visit. AMPATH set a target ratio of 10:1
for clinical officer versus physician visits. For example, at the Mosoriot Rural Health
Center the physician is onsite to see patients one-half day per week. The clinical
officers see patients ten half-day sessions per week with mobile phone access to the
physician when needed. Scale up within AMPATH is impossible without the clinical
officer carrying the bulk of the patient load.

In addition, AMPATH hires a large number of its own HIV-infected patients as members
of the multidisciplinary team. They are invaluable in leading outreach into patient’s
homes, community education and patient support groups. Nurses and pharmacists play
a central role in adherence counseling.

Adherence support

Patients are given core information regarding the risks and benefits of antiretrovirals
before treatment is started. Adherence classes are held for new patients and any
patient demonstrating problems adhering to scheduled visits or medication regimens.
Patients must bring all of their medications to every visit where pill counts and additional
inquiries are made regarding adherence. This process occurs at the nurse’s check-in
desk, the examining room and, finally, by the pharmacist dispensing the antiretroviral
drugs. Every effort is made by the outreach team to make a home visit within a day of
missed appointments.

Impact of an opt-out HIV testing policy in the Moi Teaching and Referral Hospital
antenatal clinic

Empowered by AMPATH programs, Moi Teaching and Referral Hospital took the lead in
Kenya by writing a new hospital policy that approaches universal antenatal HIV testing,
where testing is done unless the patient opts-out. Soon after the policy was put in place
providers were discouraged to note little, if any, change in HIV testing. It was quickly
learned that the problem was not them [patient acceptance] but it was us [staff
acceptance]. This led to aggressive retraining of antenatal clinic staff along with onsite
HIV testing resulting in immediate patient feedback. In addition, AMPATH initiated
meticulous data gathering in the antenatal clinic with bi-weekly feedback to staff for self-
improvement. The result has been 95-100% HIV testing of all antenatal patients at Moi
Teaching and Referral Hospital. More importantly, close to 100% of all HIV positive
pregnant women are registered into the adult HIV clinic long before delivery. AMPATH
learned that patients are ready to accept aggressive policies for HIV testing in the
antenatal clinic. Hoverer, little actually changes if policies are not followed by the day-
to-day work necessary to develop a staff and system that refuses to accept less than
100% HIV testing.

Transforming pMTCT

Consistent with Kenyan guidelines, AMPATH's protocol for prevention of maternal to
child transmission (pMTCT) was to provide a single tablet of nevirapine to the mother
and child at the time of delivery. This limited the potential to maximally prevent mother
to child transmission of HIV. If done well, simplified pMTCT regimens demonstrate
reductions in transmission of one-half and a significant proportion of the babies spared
transmission at birth are subsequently infected from breastfeeding. 8 In addition,
actually getting nevirapine to the mother and child at time of delivery is further frustrated
by unattended home deliveries or deliveries occurring in other health care systems.
This outcome is in stark contrast to the 2-3% MTCT rate expected in developed
countries.9 Given AMPATH’s capacity to safely administer antiretrovirals and a very
positive experience with acceptance and safe use of formula feeding, AMPATH
changed its pMTCT strategy. AMPATH set a goal of limiting mother to child
transmission of HIV to less than 5% at Moi Teaching and Referral Hospital and Mosoriot
Rural Health Center. In an effort to reach this goal, triple antiretroviral therapy is
administered to the mother during her last trimester of pregnancy. If at the time of initial
presentation the mother qualifies for ongoing treatment with antiretrovirals, the drugs
are continued indefinitely. Otherwise, they are stopped during the first week after
delivery. All mothers are informed about the pros and cons of breastfeeding. Those
choosing formula are instructed in safe preparation, and the formula is provided by
AMPATH. Pregnant women whose initial visit is less than two weeks before delivery
and those who initially present in active labor are given standard single-dose nevirapine

Impact of comprehensive HIV services on the community

It is difficult to judge community impact in a city like Eldoret that seems to have a limited
sense of community. The impact of AMPATH programs on community awareness and
stigma in Eldoret will likely be more evident when current construction of the AMPATH
Center is completed. This will be Kenya’s only facility dedicated to patient care,
teaching and research in HIV, and the large patient volumes moving through the facility
will play a more prominent role in day-to-day life in Eldoret.

Kenya’s rural villages present a totally different story. Community perceptions were
evident from the first day the clinic opened in the Mosoriot Rural Health Center. Initially,
most of the community around Mosoriot was in denial regarding HIV. Among the first
10,000 visit records entered into the electronic Mosoriot Medical Record System,7 the
diagnosis of HIV infection or AIDS was not made a single time, despite a prevalence of
more than 10%. The words AIDS or HIV were never mentioned aloud without the
burden of stigma and despair. At start up, the Mosoriot HIV clinic had to see patients
with hypertension or diabetes to gain acceptance. There was no “name” over the clinic
door, but soon the patients began to come. Today the work of the clinic is woven into
the very fabric of the Mosoriot community. Over 90 traditional birth attendants are part
of the care team. [Figure 1 showing TBAs] They not only assist with pMTCT but
represent powerful and informed voices against stigma at the grass roots level. Dozens
of community meetings have been held throughout the Mosoriot area. All chiefs and
assistant chiefs participate in many aspects of program development.

Finally, there is the farm. Malnutrition complicates HIV/AIDS and its management. In
order to feed patients and their families, as well as develop long-term food security
among rural Kenyans who are mostly subsistence farmers, AMPATH developed a 10-
acre farm dedicated to feeding its patients in greatest need. A local Mosoriot High
School donated the land. The resulting program is known as the HAART and Harvest
Initiative [HHI] and is now producing vegetables, milk, eggs, meat and fruit. The farm
has also become a training center for area farmers and HIV-infected patients preparing
to return to farming and food security. An open house at the farm in September, 2003
brought together hundreds of guests including the top community leadership. [Figure 2
of group at the farm] AMPATH has witnessed the transition from whispered words of
stigma and blame to an outpouring of support for those in their community needing help
because of HIV.
Additional clinical outcomes

By December, 2003 AMPATH cared for over 2100 adult and pediatric HIV patients and
was Kenya’s largest public-sector provider of comprehensive HIV prevention and
treatment services. Two-thirds of these patients are cared for at Moi Teaching and
Referral Hospital and the remainder at the Mosoriot Rural Health Center. AMPATH
began an HIV clinic in a second rural health center in January 2004 and a third rural site
will be added by April 2004.

AMPATH can document a 90% retention rate of patients at both Moi Teaching and
Referral Hospital and the Mosoriot Rural Health Center. Current funding by the MTCT-
Plus initiative has made an active outreach/home visit team available to MTCT-Plus
enrollees. Thus much more is known at the moment about retention and survival of this
cohort of 380 patients. The retention rate for all MTCT-Plus patients is 93.8%. Seven
MTCT-Plus enrollees have died [3 adults and 4 children]. Close to half of the MTCT-
Plus patients at Moi Teaching and Referral Hospital are on antiretrovirals compared to
40% at the Mosoriot Rural Health Center. Less than 5% of patients currently on
antiretrovirals who were treatment naïve at intake have required a change to a
secondary regimen.

Important lessons learned

   1. Food security is an integral component of comprehensive HIV care.
   2. Existing medical facilities are not prepared to support the care needs of large
      numbers of ambulatory patients managed by multidisciplinary teams. Space
      becomes even more critical when one superimposes the academic
      responsibilities of training and research.
   3. Prevention of mother to child transmission is a simple concept, yet one of the
      most difficult programs attempted by AMPATH. Breakdown occurs at
      counseling, testing, result reporting to the mother, accessing antiretrovirals,
      assuring follow up after home deliveries, enhancing capacity for home visits for
      missed appointments, and forming and implementing a clear strategy for safe
      feeding for the infant. PMTCT is at the center of AMPATH’s prevention
      strategies and is the major source of patients for any treatment strategy that
      attempts to keep entire families well.
   4. Successful HIV treatment services are fundamentally a team effort. Successful
      adherence is clearly possible but demands access to a well-coordinated
      multidisciplinary team that includes physicians, clinical officers, nurses,
      nutritionists, pharmacists and outreach workers capable of home visits. [Figure 3
      of AMPATH team]
   5. In an urban setting without street names or house numbers, specially designed
      locator cards must be completed on all patients at the time of initial encounter or
      patients who miss scheduled appointments may be impossible to find.
   6. Persons living with HIV/AIDS and currently cared for within AMPATH are the
       greatest resource for establishing a network of patient support groups and
       successful outreach services.
   7. Scale up of urban services is unlikely to have a significant impact on rural
       settings and vice versa.
   8. Depth is better than breadth. The complexity of issues confronting any
       successful treatment program demands relentless attention to every detail.
       Unless great care is taken, one may scale up too rapidly and assume patient
       care responsibilities that are not sustainable.
   9. Attention must be given to provider morale. Special attention must be paid to
       patient loads for each provider and the hours they are working. Carefully
       thought-out incentives and other markers of recognition for successful providers
       will be important if scale up is to be accomplished without losing the very talent
       that made scale up possible.
   10. It is not possible to overemphasize the importance of the initial antiretroviral
       regimen. This initial regimen consists of the most cost-effective and easily
       tolerated combination of antiretrovirals. Casual adherence to the initial regimen
       leads to treatment failure. This in turn can lead to two tragic outcomes. Most
       systems will not be able to afford the higher costs of secondary regimens for
       failing patients, and Kenya will begin to isolate a growing reservoir of resistant
       viral strains capable of threatening their most ambitious plans.
   11. There is a powerful synergy between simultaneous prevention and treatment
       programs. More open discussions of HIV/AIDS are now possible in the
       community surrounding the Mosoriot Rural Health Center. Like anyone else,
       Kenyans need hope before they will allow themselves to be tested for an
       otherwise untreatable, stigmatizing condition. Much remains to be done to
       leverage greater prevention success in the face of a parallel treatment program.

Scaling up AMPATH

The pilot phase of AMPATH is complete. Now, AMPATH is in the process of scaling up
to demonstrate that the academic model can care for a minimum of 15,000 HIV-infected
persons in Kenya. The AMPATH sites at Moi Teaching and Referral Hospital and the
Mosoriot Rural Health Center are ready to expand to capacity. Two additional rural
sites have joined AMPATH. The initial thrust of AMPATH was appropriately focused on
patient care, but as patient volume is scaled up, teaching and research will establish
themselves as key determinants of success. During the current scale up, AMPATH
plans to:

   1. Complete construction of the AMPATH Center at MTRH and a dedicated HIV
      facility at each of the three rural health centers. The multidisciplinary nature of
      the practice combined with the additional teaching and research responsibilities
      unique to AMPATH make adequate space critical to success. The ground floor
      of the new AMPATH Center includes four patient care modules with space for
      counseling, research and training. The second floor includes classrooms,
     informatics support space, a reference lab and specialized basic research
2.   Scale up the clinical services in AMPATH locations to capacity. As a model
     system, specific size limitations have been set at each site. [see table] The teams
     have been trained and the space is under construction to meet the full demands
     of the AMPATH model.
3.   Demonstrate an aggressive model of pMTCT. AMPATH believes that programs
     with established comprehensive care capabilities should offer full antiretroviral
     therapy to HIV-infected women during their last trimester of pregnancy with the
     expectation of decreasing mother to child transmission to less than 5%.
4.   Demonstrate the role of nutritional support in the care of HIV-infected families
     while training these families for food security as they regain their health.
5.   Develop a model program in micro-enterprise training leading to improved
     economic security for AMPATH patients. The current ground swell in donor
     interest and support for HIV care in sub-Saharan Africa must be accompanied by
     equal enthusiasm for assuring sustainability. Every effort must be made to
     prepare HIV-infected families to regain some degree of economic security.
     AMPATH currently runs a pilot program known as the Family Preservation
     Initiative which seeks to help one hundred families generate income capable of
     supporting their personal and medical needs. If the pilot is successful, it will be
     expanded with the goal of achieving income security for a minimum of 20% of
     AMPATH patients.
6.   Turn AMPATH’s current electronic medical record system into one capable of
     broad replication in and outside of Kenya to support patient care, uniform
     reporting of results, teaching and research. Uniform data management and
     reporting of results represents another of the great challenges in HIV care.
     AMPATH has successfully piloted an electronic medical record system that
     currently supports all HIV-related patient care at the Moi Teaching and Referral
     Hospital and Mosoriot Rural Health Center. Next steps include expansion to
     support a number of configurations, including its current format (stand-alone,
     operating on individual computers at each site), Web-based (allowing linkage of
     data from remote sites into a single database), and wireless, enhancing
     communication within larger care sites.
7.   Initiate a full range of educational programs for medical students, post graduate
     physicians, practicing doctors, clinical officers, and other providers of HIV care.
     Access to the new AMPATH Center will permit didactic sessions on the top floor
     and participation/mentoring in actual ongoing adult and pediatric HIV care on the
     ground floor.
8.   Commit major resources and effort to become an HIV Research Center capable
     of addressing the special questions relevant to Kenya and East Africa. A number
     of Moi University Faculty of Health Sciences faculty members have completed
     formal training in health care research. They are already active in ongoing
     research grants, and are beginning to tell AMPATH’s story in international
     meetings and articles published in peer-reviewed medical journals. Substantial
     capital investments have been set aside by collaborating US medical centers to
      assure the level of onsite mentoring needed to compete in the research arena.
      Moi University Faculty of Health Sciences and Moi Teaching and Referral
      Hospital have invested resources and personnel to scale-up of their own Grants
      Management Office. Success in research by Kenyan investigators is critical to
      finding answers relevant to Kenyan questions.


U.S. academic medical centers have a long history of engaging their considerable
resources in response to underserved populations. Many distinguished academic
medical centers and Large Public General Hospitals in urban America have
demonstrated mutual benefit for underserved populations and the collaborating
academic medical center. 10

Evidence of similar success when U.S. academic medical centers collaborate with
counterparts in the developing world is less evident. During the 1950’s through the
early 1960’s many U.S. medical schools received financial incentives to collaborate with
academic medical centers across the developing world. To a large extent they were
phased out due to problems with sustainability and a disproportionate focus on tertiary
care.11 Most current examples of successful collaboration between U.S. academic
medical centers and their counterparts in the developing world have been limited to
focused initiatives, especially shared research interests. In contrast the fourteen-year
collaboration between Indiana University School of Medicine and Moi University Faculty
of Health Sciences made a comprehensive response to the HIV pandemic through
AMPATH a possibility. 12 The story of AMPATH is the story of an academic medical
center in Kenya [Moi University Faculty of Health Sciences] joining forces with a U.S.
academic medical center [Indiana University School of Medicine] against a common
threat, HIV/AIDS. The broad range of programs initiated by AMPATH was driven by a
shared vision rather than external funding. The fact that so many components of
AMPATH could emerge simultaneously speaks to the enormous potential of academic
medical centers to contribute meaningfully to Kenya’s struggle against its greatest
threat. Patient care was initiated during the same week in both urban and rural sites.
Computerized medical records were developed as the reference lab emerged. Creative
pilot programs such as the HAART and Harvest Initiative and the Family Preservation
Initiative were layered on top of Kenya’s largest and most comprehensive public sector
HIV care program. And, true to the academic agenda, care was taken to assure
teaching and research followed patient care. And finally, AMPATH demonstrated that
academic medical centers united by a common vision can dare to risk together, find
funding, grow and sustain programs.

The current crisis facing sub-Saharan Africa calls for a response from every available
resource within Africa and demands a meaningful response from the full spectrum of
resources that can be brought to bear by developed countries. For African academic
medical centers it means discovering the dormant power that resides in the tripartite
mission of patient care, teaching and research. For U.S. academic medical centers it
means risking far more than collaboration in fully funded research and training ventures.
It is far more likely that African academic medical centers will maximize their
contribution to their countries if they are bolstered by a strong collaboration with
academic medical centers from the developed world, particularly, if that collaboration
represents a comprehensive partnership committed to mustering all their joint resources
against a common enemy.

The degree to which AMPATH succeeds will be best documented in the immediate
years ahead during rapid scale up. AMPATH expects to extend its services to a large
segment of urban and rural western Kenya. If successful, training programs will flourish
and extramural support will distinguish a broad range of research agendas. It is this
interwoven relationship between patient care, teaching and research that has always
defined the power and potential of academic medical centers. When an African
academic medical center steps up to the challenge threatening its society, that
academic medical center has come of age. When a U.S. academic medical center
dares to join comprehensively with its African partner at this critical moment in medical
history, that academic medical center will reach new heights as well.

The development of AMPATH was supported, in part, by grants from the Association
Liaison Office for University Cooperation in Development; the Bill and Melinda Gates
Foundation; the Moore Foundation; and the PVF Foundation.

   1. AIDS Epidemic Update: December 2003. Geneva, Switzerland: World Health
      Association, 2003.
   2. Piot P. Global AIDS epidemic: time to turn the tide. Science 2000; 288:2176-8.
   3. Piot P, Coll Seck AM. International response to the HIV/AIDS epidemic: planning
      for success. Bull World Health Organ 2001; 79:1106-12.
   4. Harries AD, Nyangulu DS, Hargreaves NJ, Kaluwa O, Salaniponi FM. Preventing
      antiretroviral anarchy in sub-Saharan Africa. Lancet 2001; 358:410-4.
   5. MTCT-Plus program has two goals: End maternal HIV transmission and treat
      mother. JAMA 2003; 288:153-154.
   6. Beck EJ. Kupek EJ. Gompels MM. Pinching AJ. Correlation between total and
      CD4 lymphocyte counts in HIV infection: not making the good an enemy of the
      not so perfect. International Journal of STD & AIDS. 7(6):422-8, 1996 Oct.
   7. Rotich JK, Hannan TJ, Smith FE, Bii J, Odero WW, Vu N, Mamlin BW, Mamlin
      JJ, Einterz RM, Tierney WM. Installing and implementing a computer-based
      patient record system in sub-Saharan Africa: The Mosoriot Medical Record
      System. J Am Med Inform Assoc 2003; 10:293-303.
   8. De Cock KM. Fowler MG. Mercier E. de Vincenzi I. Saba J. Hoff E. Alnwick DJ.
      Rogers M. Shaffer N. Prevention of mother-to-child HIV transmission in resource-
      poor countries: translating research into policy and practice. JAMA. 283(9): 1175-
      82, 2000 Mar 1.
9. Perinatal HIV Guidelines Working Group. Public Health Service Task Force
    recommendations for use of antiretroviral drugs in pregnant HIV-1-infected
    women for maternal health and interventions to reduce perinatal HIV-1
    transmission in the United States. Rockville [MD]: U.S. Department of Health and
    Human Services; 2003 Nov 26.
10. Moy E. Valente E Jr. Levin RJ. Griner PF. Academic medical centers and the
    care of underserved populations. Academic Medicine. 71(12): 1370-7, 1996.
11. World Health Organization: The Role of Hospitals in Primary Health Care.
    Karachi Conference Report, 1981. Geneva, World Health Organization
12. Einterz, RM et al, The Partnership Between Indiana University School of
    Medicine and Moi University Faculty of Health Sciences: a Model for US-African
    Cooperation, under review by JAMA.
Projected number of patients to be served by AMPATH over the next five years.

PATIENT                          Year       Year       Year       Year      Year
BASE                              1          2          3          4         5

Moi Teaching and Referral

        Funded from other
        Sources                   1200      2050       3000       3500          3500
        Supported by donor
        community                 2500      4000       6000       6000          6000

Rural Sites - 3
different sites

        Funded from other
        Sources                    125        180       230        260          290
        Supported by donor
        community                  900      2150       3000       3600          4200

TOTAL Patients supported by
donor community                   3400      6150       9000       9600      10200

TOTAL Patients
Under Care                        4725      8380      12230      13360      13990
Appendix C:                     WELCOME TO KENYA and the IU HOUSE
         Kenya is a wonderful and beautiful country with people who are friendly and
eager to meet you. Medically you will see things you have only read about in
textbooks – acute rheumatic fever and carditis, malaria, tetanus and a host of “tropical”
diseases along with endless cases of HIV/AIDS. You will also see many familiar
diseases that are treated a little differently than at home.

          Indiana University School of Medicine and Shawn and Chero Woodin will be
your hosts while you are here. We will endeavor to do everything we can to make your
stay safe and pleasant. Joe and Sarah Ellen Mamlin, who have been here for over four
years, can also answer questions. We ask you to read this letter carefully and ask about anything you don’t
understand. We do not want any misunderstandings to spoil your visit. Don’t hesitate to tell us when you have
frustrations or concerns. Our main goal is that you enjoy and learn from Kenya and her people. You will truly
enjoy your stay here.

         We have a lot to tell you and hope you will read this so you can remember what follows:

                      The Cast of Characters in your IU House Extended Family in Kenya

Shawn and Chero Woodin: Shawn is the IU-Kenya Program Administrator, in charge of daily operations and
employees. Most importantly, Chero is in charge of the daily operations of Kippy and Imani Woodin. Chero also
ensures rooms are ready for guests and assists with issues relating to cleanliness in the rooms. Shawn was in Eldoret
in the 1990s as a Peace Corps Volunteer, and Chero was born and raised in the Eldoret area.

Joe & Sarah Ellen Mamlin: Joe is a lifetime member of the IU School of Medicine’s Department of Medicine with
teaching experience in both Afghanistan and Kenya. He coordinates HIV work for the IU side of the collaboration
and is also an avid birder. Sarah Ellen is an elementary teacher and runs a pediatric recreation and education
program at the hospital. They know everything there is to know about IU House and this area.

John Sidle and Kara Wools come Kenya to oversee IU’s research efforts. They rotate in Eldoret for four month

Jill Helphinstine is here for one year as medical education coordinator. She is a board certified Pediatrician, and
knows physicians in most specialties. She knows a lot about the hospital and how it functions.

Dunia is our business office manager. Her smiling face will greet you in the office in Wanyama House 3 where
she will collect e-mail and other assorted fees. She may also be able to troubleshoot a lot of your computer
problems. Dunia will also help you make safari arrangements and confirm return flights.

Peninah is our head cook. For those of you who thought you might lose weight on this trip, LOOK OUT! Second
helpings of Peninah’s food are hard to resist. Peninah also runs the store in the Miti House 2. This is a major
enterprise for her. Please respect her store and keep it neat. She will give you a fair price. Please buy from her! If
there is anything you would like to take back to the States, make a request. Her bargaining skills are better than a

Yusuf is our assistant and driver. He helps with our shopping and many of our business matters. Discuss your day
to day needs (banking, post office, etc.) with Shawn so he can inform Yusuf of your needs. Yusuf knows best how
to get things done quickly in Eldoret. He is a good advisor on cultural matters and travel needs. Don’t hesitate to
ask. He can also help you arrange transportation out of town for nearby safaris. Yusuf is available to use an IU car
for weekend trips only. Plan in advance.

Bob and Edward do our gardening and has created the beautiful grounds here. He also does minor repairs and
keeps our dogs and cars clean. Ask him about the plants. He enjoys telling guests about them.
Askaris (guards). Sammy, Robert, and Patrick are our askaris at IU House. They rotate shifts throughout the
month. Each has his own personality. Get to know them too. We give the guard at our own gate and the first gate
meals. Silas, Michael, and Nathan are our askaris at Purdue House. Sometimes you will see Kimtai, and others
who sub.

Elisha cleans in House 1 and prepares drinking water for use. You will soon learn his unique and limited brand of
English (“Fine, fine”, “Oh, sorry!” and “you” for all pronouns). Margaret and Lucy are in charge of cleaning in
House 2, House 3, House 4 and House 5. They work very hard; please try to allow them to clean your area when
he is there. Keeping ahead of the dust, dirt and mud (in the rainy seasons) is a lot of work! They also do IU House
laundry and ironing. Elisha will also clean and/or shine shoes for 100/=.

Julius is an invaluable assistant in the kitchen and helps Peninah keep ahead of the dishes and the chopping of
fruits and vegetables. He is a knowledgeable conversationalist and a singer.

Janet is cleaner in Purdue House. She will do laundry for guests there, and for others if Margaret and Lucy are
overloaded when the houses get full. (She gets paid for her help as well!).

Petite and Jack are two important members of the IU Team. They are furry guards for the compound night and day.
Their size intimidates most strangers, but they are very gentle except when they see a leash. Then they go berserk
with joy at the thought of getting some exercise and cannot contain themselves. They will protect you and keep
monetary requests at bay if you go on a walk. Ask for help before walking them. Strength is a plus.

                                            Compound (Boma) Houses

                                     House 1- NDEGE HOUSE of Blue Birds

                         Master Bedroom with
        Great Blue       Double Bed and separate         Blue-eared       Double Bed
        Turaco           bath.                           Starling

                                                         Blue             Family Room with a Double Bed
        Cordon Bleu      Double Bed.
                                                         Swallow          and Twin Bed

                                     House 2- MTI HOUSE of Green Trees

        Acacia                                           Sausage
                         Master with Double Bed and
        Mgunga                                           Tree             Twins
                         separate bath.

        Candelabra       Twins                                            Office and Faculty Work Station

                                     House 3- WANYAMA HOUSE of Brown Animals

        Simba Lion       Master with Double Bed and      Chui             Double bed.
                         separate bath.                  Leopard

        Swara                                            Twiga
                         Twins with trundles.                             Twins with trundles.
        Impala                                           Giraffe
                                    House 4- MAUA HOUSE of Red Flowers

        Nandi Flame     Master with Double bed and      Desert Rose
                        separate bath.                                   Twins
        Kibobakasi                                      Mwandig

        Red-Hot                                         Aloe
        Poker                                           Nyeriensis
                        Mamlin Office                                    Twins.
        Mbamba-                                         Osunguru
        ngoma                                           (Maasai)

        Gladiolis       Servant’s Quarters—Double bed with a separate bath.

                                  House 5- HOUSE OF BLACK & WHITE

        Colobus         Master with Double bed and      Zebra Punda
                                                                         Double and Single beds
                        separate bath                   Milia
                                                        Pied Crow
        Fiscal Shrike   Double                          Kunguru          Twins with trundles.
        Quarters                   Double Bed with a separate bath.

                                                  Purdue House

        Room A          Master Bedroom with             Room E           Twin Beds with separate bath
                        separate bath

        Room B          Twin Beds with separate         Room F           Twin Beds

        Room C          Twin Beds with separate         Room G           Twin Beds

        Room D          Double Bed with separate        Servant’s        Two bedrooms with separate
                        bath                            Quarters         kitchen and bath.

Please note that room setups may change as needed to accommodate IU’s ever growing demands. We have not yet
 found all the Swahili names for the rooms above, but we are working on it; however, most Kenyans do not know
                                 specific names for birds, trees, or flowers either.

 Increasingly the IU and Purdue Houses must be run like a hotel. PLEASE do not switch bedrooms or move
                                       furniture without checking.


        Within our compound we feel the IU Houses are very safe. We are guarded by a double set of gates, dogs,
and askaris (guards) and cared for by a loyal set of helpers, some of whom have worked with us for over ten years.

                   Please fill out an Emergency Form upon your arrival. We have never had to use one, but we ~
         and your Embassy ~ need to know where and whom to call if something should happen. We consider
         having that information as insurance. The embassy has asked us to fax your information to them.
                   Each room now has a drawer that locks where you may put your valuables such as passports,
         return tickets, money etc. during your stay. However, if you would feel safer, there is a box safe in the
Administrative Office. We will be glad to lock up your valuables if you like. You will need passports to cash
travelers checks or use a charge card occasionally. Otherwise a copy of your passport can be sufficient for travel.
          When you go on Safari inside the country, we want to know where you are and how to contact you. Please
fill out an In-Country Safari Form any time you leave to travel inside the country.
          If you plan to travel outside the country ~ even when you return home ~ please fill in the Post- Eldoret
Itinerary Form. It may seem to be a bother, but we have lost a couple of individuals for a few heart-stopping
          We have used these forms as well to get forgotten items to travelers before they leave Kenya. Your
families rest easier if they call and we can tell them where you are.


        Breakfast is self-serve, available when you want it. Just ask us to show you where breakfast items are
normally kept in the cupboards and pantry (but please do not ask at 7:00 a.m.).

         Lunch is the main meal of the day and is served at 1:00 p.m. Monday through Friday. It is often vegetarian.
We try to serve meat 2-4 times a week if most guests are meat eaters. Feel free to invite your colleagues to lunch,
but give us notice by at least 10:00 AM the morning of the meal you would like to have them come.

         Suppers will be prepared by Peninah and Julius on Mondays, Tuesdays and Thursday. Wednesday supper
usually is eaten out. Sunday meals are catered in by local restaurants.

         The local Kenyan diet is rich in fruits and vegetables. Some might be new to you. Be adventuresome!
Find opportunities to taste new things ~ from cultured milk, to termites, to some of the best pineapple and bananas
in the world!
         If you want to keep personal food or drinks in the refrigerator, please mark them with your name in
LARGE letters! Otherwise, they may be eaten by someone else. We do not stand on ceremony when it comes to
eating. Please help yourselves whenever you like. A grocery list will be placed on the fridge. Add any items that
you would like to see. When a staple is finished, please put that item on the grocery list! You are paying room and
board, so please don’t feel the need to buy food items. That is our job!

          Friday evening, all day Saturday and Sunday lunch meals will not be served because most of the time
people are on mini-safaris, therefore you are on your own. You are welcome to raid the fridge and pantry for
leftovers or organize a cooking party where everyone helps prepare a meal. Working with a community of
choppers, cleaners, and experimenters is much more fun. Fridays and Saturdays you must clean up!! We also
encourage you to have dinner with counter-parts at some of the local restaurants. You may also invite guests, but it
is helpful to know in advance so that we might plan ahead.

         When meals are provided, dishes will be washed and dried. Further dishes used in the evening are in the
responsibility of the user/s, so please clean up after yourself. Please help to keep our kitchen clean and sanitary!

Life in IU House

         There will be various activities at the house during the year. All Indiana medical students are invited for
lunch each Thursday to discuss any issues, positive or negative, or just to visit. Other foreign residents and students
can also attend. Sometimes we may have Wednesday afternoon “debriefings”. Request them if you like.

         The living room in Wanyama House 3 is office space for IU House. In Ndege House 1 there is a library
containing textbooks, books on Kenya and Africa, travel books and light reading as well as materials compiled by
previous residents about their travels. Read from it freely and also add to the library if you finish books here and do
not want to carry them home, but please do not take any of the house books with you without signing them out.
Good books are often hard to find here, and we want to maintain the library for future visitors. Hard back books are
expensive and were brought here at the expense of the weight of other items, please do not take them without
          Ndege House 1 also contains a large number of medical books for your use. There are desks available for
reading and study (however, in the dry season there is a hammock (in Ndege House 1's pantry) and chairs in the side
yard just outside on the west side of the compound. You are welcome to light a fire on cold evenings, and play
games here as well.


          Tap water is unsafe to drink. We will try to keep boiled and filtered water available for your use in the
laundry room in Ndege House 1. Some of you (particularly the taller ones) will be asked to help pour clean water
into the filter at the right of the sink. You can help by filling empty water bottles when you see them empty or by
carrying them back from the dining room after meals. Your assistance will be appreciated----this is a quite a time-
consuming job. There should be about 12 full water bottles in the refrigerator at all times.

The water treatment to ensure safety is:
    1.       Boil for 10 minutes. Please help us track the time it after it comes to a rolling boil !!
    2.       After the water cools in holding buckets beneath the sink, it is filtered through ceramic
    3.       The water is then poured into bottles for your use.

         A plastic bottle of boiled water with a plastic cup has been placed in your room for tooth brushing, taking
medications, et cetera. Refill it whenever you need to do so. All empty bottles will be washed with hot, soapy water
and air dried. When you buy bottled water, we will gladly take the empty ones for reuse. You may take the small
bottles on safari, but please return them.


         In the refrigerator in Ndege House 1 are a variety of drinks you are welcomed to
consume. The cost of a soda is Ksh 15/= each and beer is Ksh 60/= each. Coke Light is the
only diet drink available (sometimes) and costs a bit more. We ask that you record each drink
you take. You will be charged for drinks as you leave, but we take weekly payments. This is
on the honor system. Furnishing drinks is not a profit making enterprise! You can help too by
restocking sodas from the pantry in Ndege House 1 when the baridi stock in the fridge gets
low. Thank you!


          Most people opt to do their own laundry in the washing machine. There are now two
washing machines in the compound, and one at Purdue House. One is in the main laundry
room in Ndege House 1, and the second washer is in the kitchen- room in Maua House 4. Please follow the
instructions on each machine and ask Shawn, Margaret, Lucy or Elisha before using so that we might coordinate our
house needs with your private laundry needs.
          If you simply do not want to do your wash, you can arrange with Margaret, Lucy, or Janet to have it done at
KSh 100/= per wash load (that’s less than a laundromat at home!!) and KSh 150/= for ironing. If you leave
laundry in the laundry room to be washed by someone else, please label it with your name.
          Drying clothes is au naturale in the wonderful Kenyan sun. In the rainy season clothes can dry on the hot
water heaters or on hangers in heater closets. There is an iron and ironing board available in the laundry rooms for
your use.
          Color-coded to each house (well, almost), sheets, towels, wash cloths and soap are kept over the water
heaters. If you cannot find what you need, please let us know.
          When you leave Eldoret for the last time, please strip your beds and leave the linens outside your
                                               Onyo = Warning

  All the houses are on a septic system. PLEASE, PLEASE do not put anything down the
                     toilets other than human waste or toilet paper!!!!!
   We would not put this in except that people have put razors, lotion containers, and much more into the
                                     system. It is expensive to repair!!!!

House Cleaning

         Elisha, Lucy, Margaret, and Janet clean the houses on a rotating, regular basis. If you wish for them to
clean your room, please leave the door to your room open. If your door is shut, they will know that you do not wish
that your room be cleaned that day. If you have a particular cleaning need, please let us know. We try to keep
things as clean as possible. Sometimes the rainy season and high traffic defy us.
         If you want your sheets washed, please inform us in the morning. We try to keep toilet paper, light bulbs,
soap cleaning supplies and tissue stocked in each house. Do not hesitate to ask us to replace them if they are
running low.


          The Indiana University School of Medicine Internal Medicine Department plus philanthropic donations
largely support the general funding of the Indiana University – Moi University Faculty of Health Sciences
collaboration. Schools in the ASANTE Consortium also contribute toward some of our overhead. The IU Houses
run largely on the funds of the host family and their guests. For this reason, we have asked our IU guests to
contribute to help defray the costs of meals and utilities, and our non-IU guests are asked a modest additional
amount to help offset administrative costs their presence entails. We hope that most of you have paid Ron Pettigrew
prior to your arrival.

Other Expenses

          Expenses you may incur while you live in the IU House include costs for email, telephone usage, stamps,
laundry, Swahili lessons (approximately $20 per week if you participate on a daily basis ~ and we do encourage you
to do so), your share in costs of weekend trips (lodging and gas), personal travel expenses and personal spending
money. We provide soda and beer to you at cost – 15 shillings per soda and 60 shillings per beer. We will try to
keep it stocked with your available preferences in the laundry room refrigerator in Ndege House 1. Please write
your purchases down on the refrigerator. The money for drinks will come out of Shawn and Chero’s pockets
otherwise and they may not have enough money left to get home. Coke Light is rare and costs more.

Swahili Lessons

         Wycliffe Agesa is the kiswahili tutor. His charges are approximately KSh 300 per hour for lessons for
individual lessons and a sliding rate for group lessons. Check with Wycliffe – rates occasionally change. Again, we
would encourage you to take advantage of this opportunity. Even a few lessons will get you through the basics of
shopping, greetings, bargaining, and basic medical terms you will hear daily, and Wycliffe is a long-suffering

Kenyan Holidays:

Movable Lunar Date     Good Friday and Easter Monday (Christian)
May 1                  Labour Day
June 1                 Madaraka Day (Liberty Day)
October 10             Moi Day
October 20             Kenyatta Day
December 12            Jamuhuri Day (Independence Day)
December 25            Christmas Day
December 26            Boxing Day
Movable Lunar Date     Eid (Muslim)

Your Eldoret address is:
                 Moi University Faculty of Health Sciences
                 c/o Indiana University
                 P.O. Box 4606
                 Eldoret, Kenya

         Mail takes about 14–21 days going both directions. Mail will be picked up and delivered to the IU House.
Please do not send anything important through the mail, e.g., money, checks, credit card information. Incoming
packages are usually charged duty and do not always arrive intact ~ or even while you are in the country; therefore,
we advise against having anyone send you “care packages” while you are here. We usually have stamps in the
Office. Peninah has post cards available in her store. Leave postcards and other things in the office in Wanyama
House 3. Yusuf will pick up mail Monday – Friday morning to post and deliver any incoming mail when he returns
from collecting it at the Moi University FHS.

Postage to the US in shillings is:
                  Aerogrammes                  35.00 shillings
                  Small Postcards 40.00 shillings
                  Large Postcards 60.00 shillings
                  Letters (air mail) 80.00 shillings
These prices can fluctuate. It will not hurt to double check when you send letters.


Please note that you must add your country’s international dialing code (011 for the USA) if placing a call to Kenya.
You must also drop the ‘0’ in front of the city code for these types of calls. For example, to reach the Ndege House
1 Sitting Room from the USA, you would dial 011-254-53-2032484. To call that number from Nairobi, dial 053-

               IU House Main Office                                              +254 (0)53-2061222
               IU House Fax                                                      +254 (0)53-2033512
               IU House Office Alternative                                       +254 (0)53-2033513
               IU House – Ndege House 1 Sitting Room (to contact visitors)       +254 (0)53-2032484
               Shawn Woodin’s Mobile Number/Emergency Contact                    +254 (0)723 942-234
               Joe Mamlin’s Mobile Number                                        +254 (0)722 374 558

Kenya is 8 hours ahead of Indianapolis (midnight in Indy is 8 a.m. in Eldoret). The optimal time to receive calls is
in the morning (7–8 a.m.) or in the evening (7–9 p.m.). Please make sure no non-emergency calls come in the
middle of the night (midnight to 6 AM) as no one may answer the phone at that time. For emergency calls, use
Shawn’s mobile number above.

          Calling the US can be very expensive and variable – up to as much as $3.00 per minute. It is much cheaper
for folks at home to call you. The best rates from the US are from the major carriers with a special overseas rate.
You can get information from any carrier. There are two ways to call the US from the IU house.

         You can use the KENYA POST AND COMMUNICATION network dialing 000-1 (for the US), your
Area Code and then the Number. This is a direct connection and must be logged on the TELEPHONE
CALL / FAX LOG by the telephone in Ndege House 1 for tracking purposes. The IU House telephone bill
is reconciled on a bi-monthly basis. You will be billed for the calls made by you. Logging calls is very
important because we have experienced toll fraud on this line and must be able to account for
every call placed from this number. We will pay for local calls, but you are expected to tally
international calls and Kenyan long distance calls before you leave. You can settle these with Shawn or
Dunia before you go.

        We also ask you record all calls to mobile phones - those beginning in 0721, 0722, 0723, 0733 or
0734 in the Log Book.

          If you do choose to call the US and chat without a calling card, we ask you to pay $3.00 per minute to pay
for the calls. The actual price we are billed fluctuates widely for a minute. Phone bills arrive 2–3 months late, and
we are often paying guests’ bills much later. Unfortunately, the small extra amount is covering for those who do not
log their calls. Again, please use the telephone log and settle up with the office at the end of your visit.

      To save money, we suggest you call the US, give the IU House number, and ask to be called back. It is
MUCH cheaper to call to here from the US.

                     Please do not talk over fifteen (15) minutes on any call.
                Many others are waiting to use the one line we have for e-mail and incoming calls.

Answering the Phone

          The IU House is a five-house compound. Answering the phone may require that you walk to another house
to find the person being called. Please be courteous and take messages for people who cannot be located and/or ask
the caller to call back in five (5) minutes so you have time to locate the person desired. A phone message board is
located next to the computer and telephone in Ndege House 1.


          IU House is now wireless! The compound is (almost) one big hotspot. Anybody with a wireless card on
their laptop computer can access the internet and use their personal emails account for communication.
          For those without a laptop, e-mail is available on the Ndege House 1 computer. This uses the same
network as the wireless service so you can access your internet-based email accounts.
          We have e-mail in the office and will send and receive messages for you in emergency situations if the
Ndege House 1 computer is not working. This is our administrative office, and we regret that we cannot invite you
to use this computer. The amount of administrative work communicating with the U.S. can keep our hours long.
Thanks in advance!!
           Internet-based email can be accessed, but is discouraged, especially when IU House is busy and there is a
lot of demand for the computer. Copy down your friends’ and families’ e-mail addresses and use our e-mail service!
          You also may set up your computer in the visitors office, located in Mti House 2. There are several
workstations for use in that space.
          There are also services in town, ask for directions to these businesses.

         The IU team does its banking at Barclay’s Bank. Yusuf will help you with your banking needs. Guard
your money carefully as pickpockets like to hang around the banks. Large amounts of money, airplane tickets and
passports should be kept in a secure place at all times. We have a safe available where we can store things for you.

          The current official exchange rate falls about KSh 78= per American dollar. This fluctuates on a daily
basis, and it has dropped as low as 71/= and gone up to 81/=. You will always get the best exchange from the bank
machine and the worst from cheques or traveler’s cheques. At Barclays, cash usually is deducted by a commission
of 2 shillings/dollar, while traveler’s cheques are deducted by 4 shillings/dollar.

          Visa and other debit cards are accepted at the ATMs at Barclays and Standard Charter Bank ~ across the
street from Barclay. You will get the daily banking exchange rate if you use the ATM. Uchumi and a few other
stores also accept Visa and MasterCard. It never hurts to ask.


There are many cars at the IU House:
         1)The Toyota Land Cruiser which has government license plates and is, by law, driven only by
         Yusuf and the Administrator. This car came to us two-years-old NEW, which is a long story you
         may hear sometime. We will use it for most long trips and for group outings. In town, it is the
         Administrator’s car.
         2)Two blue Toyota Rav4s are on the compound. The one with the tag number KAS 005U is used
         by the medical education coordinator. The other is used mainly by Chero Woodin, but can be
         assigned to other uses based on demand.
         3)The red Suzuki was acquired for use by The AIM. January, 2003 it will be used to trace AIDS
         patients during the day, but it can be used by people on the compound when it is not required for
         that purpose.
         4)The Toyota Land Cruiser Prado is used solely by the Field Director and/or his wife.
         5)Other vehicles are available, but may be in use. If a vehicle is needed, check with Shawn.

The Land Cruisers may be booked for weekend trips IF they are not scheduled for program or administrative uses.
IU should make sure the tank is full when you leave town. You fill it up on your return to Eldoret. Usually Yusuf is
happy to chauffeur groups to nearby Kenyan parks if his car or our cars are available (for a fee which can be
negotiated with him).

Travel within the country can be arranged through us. We often use Eldoret-based travel agencies. For longer,
more extensive trips at the end of your Kenya visit, you can use either Furaha Travels in Nairobi with Mr. Kassam,
Kisumu Travels, or a variety of others. Check with us. Yusuf is also valuable for setting up reliable Peugeot travel
with safe drivers.

For those of you on one month stays or longer, we can give you each two resident
letters. These may lower your costs for hotels. They may also lower park fees, but
lately have not. If we have failed to give them, ask.

Please see the list of tour companies and contacts that is included in this packet.
Weekend Trips

If you take weekend trips, and we hope you do, please consider the following:
         1-We would like to know where everyone is at all times, so please give us your planned itinerary.
         This is not in order to satisfy our curiosity, but in case we need to reach you for any reason.
         2-Do not take the cooking or eating utensils from the house with you unless you clear it with
         Shawn, Peninah, or Dunia. You may accidentally take something that is treasured, new, or
         needed in the house.
         3-For your travels, please check with Shawn or Peninah before taking any food from the house,
         lest you take an essential ingredient for the next meal! We have a supply of plastic water bottles
         you can fill for travel needs. We also have one tent, one sleeping bag, two coolers and plenty of
         frozen inserts, and one camping stove that we will lend if we are not using them. Please return
         the plastic bottles as well as the equipment.
         4-We encourage you to spend some of your weekends here in Eldoret, learning the town and
         getting to know students. Eldoret has places to explore as well! Often, resident IU faculty will
         invite you to go on a journey with them.
         5-We expect everyone to return from their safaris BEFORE dark!!


          Walking after dark is a very bad idea. Please plan accordingly. We are always happy to come to town to
pick you up, or provide contacts for reliable taxis. We would rather drive you home than see you at the police
station/hospital. Eldoret is a VERY safe town during the day. You can go anywhere that you like. At night, we
ask that you be very careful. Please do not assume that you are inconveniencing us by asking for a ride. We want
you to have a wonderful and busy social life here, and we are happy to accommodate your needs. Call us for rides
after dark.

Baths & Showers

          Please be considerate of your housemates when using hot water. It is an expensive, limited supply, and
your comrades also desire a hot shower! When you are away for the weekend, consider turning off your hot water
heater. It takes a lot of energy. If your water temperature is too hot or too cold, please let us know, and we will try
to adjust it.


         The Administrative Office of the IU/ ASANTE Consortium in Kenya is in Wanyama House 3. Dunia
Karama is our office manager. She or Shawn will be there to answer questions or try to solve day to day problems
which may arise for you. Business hours are 8 a.m. until 5 p.m. Monday through Friday. Often it is open prior to 8
and after 5, but this is not guaranteed.


         We will do everything that we can to make your visit comfortable. Please remember that this is home to
many people. You are welcome downstairs in Ndege House 1 at any time. Also respect the living space of our term
people. Shawn, Chero, Kippy and Imani Woodin are in House 5. The Mamlins reside in Maua House 4, and Jill
Helphinstine is in Wanyama House 3 We will respect your privacy in your rooms at all times as well. Thank you.

         We will do everything we can to make your stay here enjoyable and profitable. Please do not hesitate to
ask us about any questions that you may have.
Checking Out. . .

               1-Strip your bed of linens. Put your sheets and towels on the floor outside your room.
               2-Pay outstanding bills. Check with Dunia or Shawn about any you may have accumulated ~
               such as for using e-mail or making long distance calls and drinks.
               3-Leave any unwanted clothes with Shawn for the street children or rescue centers.
               4-Sign our Guest book in Mti House 2 and add your stories in the Gathering Area notebook.
               5-Confirm your tickets.
               6-Make sure you have your passport/s and tickets!
               7-Return the key to your room’s locked drawer.
               8-Fill out the form that tells us where you will be after leaving IU House and before arriving in the
               United States. We lost a student briefly, thinking he had not returned from a Kilimanjaro climb.
               Our information was incorrect, but we do not want to spend another twenty-four hours worrying
               like we did again!!


If you are returning to Indiana, please, please, please take an IU trunk back with you to be repacked with supplies
(and goodies) for those of us left behind!

                                Thank you for being our guests and becoming our friends!
Revised 1-05
                Appendix E:

           Kenya PharmD Projects

 A copy of previous PharmD project topics
  will be available so that you can see the
 different types of projects that have been
completed on rotation in Kenya. Successful
students have been able to have their work
      published in high level journals.

 The most important aspect of completing a
  project in Kenya is commitment. Projects
that lack this dedication become a burden to
              the faculty mentor.

  SOPs and research opportunities will be
         discussed in the course.
                                       Appendix F:
                                      Kenyan Recipes
Makes 4 servings
2 cups flour
1 teaspoon salt
Oil (or butter)
Sift flour and salt into a bowl. Add enough water to make a fairly stiff dough. Knead well.
Roll out on a floured board into a fairly thick circle. Brush with oil. From the center of the circle, make a cut
to one edge. Roll up dough into a cone, press both ends in, and make a ball again. Repeat that process
2-3 more times. Divide dough into 4 or 5 balls, and roll each out into a thin circle.
Heat a frying pan over moderate heat and dry out each chapati in the pan quickly. Brush pan with oil and
fry chapati slowly until golden brown on each side.
Serve hot or cold with stew or sauce.

Makes 80 servings
1 inch piece ginger root
6 cloves garlic
2 pounds ground lean lamb (or beef if desired)
3 large onions, thinly sliced
1 tablespoon mussala
1 tablespoon curry powder
1 tablespoon turmeric
Salt to taste
2 pounds frozen egg-roll dough, thawed
Process ginger and garlic in blender until well mashed. Combine with meat, onions, mussala, curry
powder, and turmeric. Sauté in a heavy frying pan, without adding any fat, over a low heat 30 minutes,
stirring occasionally and breaking up the meat. Spoon off fat.
Cut sheets of thawed egg-roll dough into strips about 3 by 6 inches. Fold one point up to form a triangular
pocket. Fold over again, and then fill the pocket with some of the meat mixture.
Bring down the top and seal all open sides with a paste made of flour and water. You should end up with
a neat, secure triangle of meat-stuffed pastry.
Deep-fat fry filled samosas, a few at a time, in oil, until golden brown. Drain and keep warm.
After frying and quick cooling, samosas may be frozen. To serve, thaw and place in a hot oven (400 deg.
F) until very hot.
Pilau Rice With Beef Stew
Beef Stew Ingredients
1 lb. beef [not ground] i.e. Cut meat
2 carrots
2 green peppers
4 tomatoes
4 onions
Curry powder
Black pepper
Seasoning salt, Crisco cooking oil, salt
Fry the onions that have been chopped until they turn brown. Add tomatoes and chopped green pepper.
Add carrots, black pepper and coriander. Wash the cut meat and sprinkle it with seasoning salt. When the
carrots have become slightly soft add the cut meat. When meat is almost cooking add some curry powder
and salt to taste.

Pilau rice
1.5 LB rice (water according to rice)
0.5 LB green peas
2 cans pilau masala (type of spice)
3 onions
3 tomatoes
Crisco oil
Wash the rice with cold water. Boil the peas until cooked. Chop onions and then fry them until they turn
slightly brown. Then add tomatoes that have been peeled and cut. Boil some of the rice water with the
pilau masala until it boils. Add some salt to taste. Add the rest of the water to the fried onions and
tomatoes. Then add the green peas when the water starts boiling and the rice. Then let it cook.

Makes about 4 dozen
2 cup flour
2 1/2 teaspoons baking powder
4 tablespoons sugar
2 Pinch salt
2 egg
1/2 cup water
Sift flour and baking powder together. Add sugar and salt.
Beat egg well and add water. Stir egg wixture into flour and mix until soft dough is formed. Add more
water if necessary.
Knead dough in the bowl until smooth but not sticky. Dough should leave the sides of the bowl cleanly.
Cover with a towel and let rise in a warm place about 30 minutes. Roll out dough on a floured board until
1/2-inch thick. Cut into squares, strips, or triangles. Fry in deep fat until golden brown. Drain on absorbent
cupful green grams
cupfuls milk
medium sized onions
spoonfuls ghee or butter 1/2 cupful cooking oil
salt and curry powder to taste
Clean and wash green grams. Place in pot, cover with water and boil until very tender. If more water
needed, add only boiling water.
1. Remove from heat and beat until smooth. It will turn into a paste.
2. Put green gram paste into a bowl and heat cooking oil in same pot.
3. Clean and dice onions. Add onions to oil and fry until cooked and nicely brown.
4. Return the green gram paste to the pot and mix with onion.
5. Add curry powder, salt and milk and simmer for 10 minutes.
6. Add butter or ghee and simmer for another 5 minutes.
7. Remove from heat and place in clean dish with cover.
Serve hot with boiled rice, boiled sweet potatoes, steamed plantain, boiled cassava, or ugali made from
maize flour.

NYAMA NA IRIO (Steak and Irio)
Yield: 8 portions
The Irio:
Drain 1 16-oz. can PEAS and measure the liquid.
Put the peas through a vegetable mill or sieve to make a puree.
Drain 1 16-oz. can KERNEL CORN and add the liquid to that of the peas.
In a 2-quart saucepan:
Prepare 4 cups INSTANT MASHED POTATOES following package directions and using the vegetable
liquors as part of the required liquid.
Add: 3 Tbs. BUTTER
1 tsp. SALT
1/4 tsp. PEPPER.
Blend the puree of peas into the mashed potatoes until a smooth green color results.
Fold in the drained kernel corn.
The consistency should be that of firm mashed potatoes.
The Steak:
In a large skillet:
Cut 3 Ibs. FILET MIGNON (or any steak) in a 2 x 1/2 x 1/2-inch strips.
Saute in 4 oz. MARGARINE OR OIL, until lightly browned.
Remove the steak from the skillet.
Blend in 6 Tbs. FLOUR to make a roux.
Add 2 cups ONION SOUP made from a packaged mix and cook to medium-sauce consistency.
Correct the Seasoning with salt, pepper, and a little Tabasco.
Return the steak to the sauce.
Make a large mound (about 1 cup) of Irio in center of dinner plate.
Form a hole in the center about 2 inches in diameter.
Fill the hole with 1/2 cup of the sauteed steak and gravy.
Smooth around edges of the Irio so it looks like a volcano.
SALADI (East African Salad Relish)
Yield: Relish for 8 salads
This salad relish is added to and mixed with the hot spicy food by the guest a little at a time to "cool" the
spiciness of the dish and change its texture. If the hostess feels that her dinner is not "hot" enough, a
small hot chili pepper is added to the relish.
She may also serve individually or in a bowl additional pilli-pilli or hot red pepper dissolved in lemon or
tomato sauce. See page 128 for Pilli-pilli Sauce and its variations. For your Kenyan dinner you might
have a cruet of a white French dressing on the table for those who might want to add it to their salad.
In a 1-quart bowl:
Combine: 2 cups CABBAGE, finely shredded
1/2 cup CARROTS in very, very thin slices
1/2 cup SWEET ONIONS (Bermuda or Spanish or scallions)
1/4 cup GREEN PEPPER in fine strips.
Fluff the mixture up.
That's it. There is no dressing or seasoning.
Fill small sauce dishes, allowing about 1/3 cup per person.

Matoke is a dish that originated in Uganda but has been adopted by Kenyans
8 plantain bananas (Matoke)
Juice of 1 lemon
1 tablespoon ghee or butter 2 onions sliced
1/2 bunch coriander leaves
1 whole chili
2 cups beef stock
Peel the bananas and soak in lukewarm water with juice of one lemon for 2 minutes. Melt ghee/butter in a
large saucepan. Fry onions, chili and coriander in ghee for 3 minutes. Add bananas and cover with 2 cups
beef stock. Simmer for 30-35 minutes.

Yet another dish that originated from Central Kenya but has been adapted by other communities except
for the fact that they use the vegetables available in their areas.
4 green corn cobs
400 gms beans
4 potatoes
1/2-kg spinach/pumpkin leaves
Salt and pepper
Boil the corn. Cut the kernels off the green corn cob. Boil the corn with the beans until soft. Peel and
wash the potatoes and add the corn and the beans along with the chopped spinach. Boil together until the
potatoes are soft. Season with salt and pepper and mash.

Irio (Method 2)
2 kg. Potatoes (about 4 - 4 ½ lbs.)
2 tbsp cooking fat
1 kg. Green peas (2.2 lbs.)
2 cobs tender green maize
One chopped onion
Salt to taste
Prepare potatoes and peas and remove the maize from the cobs. Cook on a high heat with just enough
water to cover until the vegetables are tender. Mash the peas and the potatoes to a smooth consistency,
adding a little fluid if desired. Fry the onions until brown; add to the other vegetables and fry together on a
low heat. Serve when hot.
Sukuma Wiki
1 lb. Sukuma wiki, kale, or spinach
3 chopped tomatoes
2 chopped onions
Leftover meats (optional)
3 tablespoons oil
Fry onions in oil in large pan. Add tomatoes and any leftover meat. Cook together until tomatoes are soft.
Cook chopped spinach. Add spinach to onion mixture and cook over low heat 20 minutes. Season to
taste. Serves 4.

2 cups maize meal (cornmeal)
4 cups water
Salt and pepper to taste
Bring water to a boil in large saucepan. Stir boiling water as you sprinkle in maizemeal. Cook for 20
minutes or until it is very thick and smooth, stirring constantly to prevent burning. Cover saucepan and
continue cooking 10 more minutes over very low heat. Serves 6.

Akoho Amin-Boanio (Chicken Cooked with Coconut)
Menu Course: Poultry & Game
Preparation time:30 mins to 1 hr
Cooking time:30 mins to 1 hr
   * 10 Pax
   * 1kg rice
   * ¼lt cooking oil
   * 2 chicken
   * 500gr onions
   * 250gr flour
   * 2 coconut
   * Salt
Wash and cut the chicken. Prepare chicken stock. Rap the coconut. Prepare a coconut milk with the rest
of the coconut. Chop onions toss the onions and chicken together. Sprinkle the flour, add the chicken
stock, coconut with the raped coconut. Season and simmer for about an hour. Serve with steamed rice.

Banana Bread
Menu Course: Breads, Cakes, Biscuits & Pastries
Preparation time:10 to 30 mins
Cooking time:30 mins to 1 hr
   * 0.3kg bread
   * 0.5kg bananas (ripe and peeled)
   * 5 eggs
   * 0.4lt corn oil
   * 0.5kg flour
   * 0.015kg bicarbonate of soda
   * 0.01baking powder
Cream sugar and bananas. Add in the eggs. Add in milk and corn oil. Sift flour and baking powder and
bicarbonate and fold in the creamed mixture. Put in baking tin and bake in a moderate hot oven till well
Ginger Beer
Menu Course: Drinks & Cocktails
Preparation time:30 mins to 1 hr
Cooking time:Over 2 hrs
   * 16 ounces fresh ginger
   * 2pcs lime juice
   * 1 stick cinnamon
   * 1tsp whole cloves
   * 1 cup sugar or to taste
Wash the ginger and peel it being careful to remove only the outer layer of skin. Grind or pound to pulp
and place in a large, heat-proof container that is enamel or made of glass or stainless steel. Cover with ½
gallon of boiling water. Set the mixture aside in a warm place. (You may want to protect it from dust by
covering the container loosely with a cloth). After an hour or so, strain the liquid through a cloth,
squeezing pulp to extract all flavour. Stir in lime juice, cinnamon, half the cloves and ½ gallon of cold
water. Let liquid sit for another hour, in the sun if possible. (Rebecca dyasi in the book of good tastes in
Africa says this is done to allow the starch from the ginger to settle). Pour the mixture gently through a
cloth to strain it, trying not to disturb any sediment at the bottom strain again if necessary. Stir in the
remaining cloves if transfer the ginger beer to a jar and refrigenerate.

Ginger Soup
Menu Course: Soups & Starters
Preparation time:10 to 30 mins
Cooking time:1 to 2 hrs
  * 2lts bouillon – beef
  * 0.4kg ginger
  * Salt
  * Pepper
  * 0.1kg butter
Peel the ginger and chop them finely. Melt the butter and sweat the ginger. Add the bouillon and let it
cook for 1½ hours in a simmering point. Add salt and pepper. Pass the soup through a conical strainer
and check the seasoning. It should be served hot.

Kuku wa kunukia
Menu Course: Poultry & Game
Preparation time:10 to 30 mins
Cooking time:10 to 30 mins
2pcs chicken
  * 2tbs curry powder
  * 2pc onion sliced
  * 2tbs mixed spices
  * 2tbs corn flour
  * 0.2lt cooking oil
  * Salt
Portion the chicken and season. Brown the chicken meat. Add two cups of water and simmer until
cooked. Stir the curry powder and corn flour in a frying pan with oil. Pour these over the chicken and
cover to simmer for 10 mins. Serve hot with Iro or Rice.
Kuku wa mayai
Makes 10 portions
Menu Course: Poultry & Game
Preparation time:10 to 30 mins
Cooking time:10 to 30 mins
2 ½ whole chicken
   * 5 eggs for boiling
   * 5 eggs well beaten and seasoned
   * 2 large onions chopped
   * ½ bunch spring onions cut into cubes
   * 0.320kg large fresh tomatoes
   * 0.1kg tomato ketchup
   * .6lt oil
   * ½ tsp taragon
   * ½tsp thyme
   * 2tsp curry powder
   * salt to taste
   * pepper
Cut the chicken into quarters. Saute the chicken to brown in a little oil, put inside. Put oil in a heavy
bottomed cooking pot. Put in 2dl of oil heat when ready. Start frying the onions till light brown. Add in the
spices, fry a little. Add in the fresh tomatoes, continue frying till the tomatoes are tender. Add in tomato
ketchup, mix well. Now put in the sauteed chicken and fry it together with the mixture till well mixed. Cover
and leave to cook for 1-2 minutes. Add in the chopped coriander and the spring onions. Mix well. Season
and using the ovenware dish, arrange the chicken in the dish together with hard boiled eggs sliced

Makes 10 portions
Menu Course: Breads, Cakes, Biscuits & Pastries
Preparation time:30 mins to 1 hr
Cooking time:10 to 30 mins
   * 0.5kg flour
   * 0.01kg yeast
   * 0.2kg sugar
   * 0.1kg butter
   * 1 egg
   * 0.5lt oil
   * salt
   * water
Mix flour, yeast, sugar, salt, butter, eggs with water to a thick runny paste. Let it rise for a long time. Cook
in deep fat fryer until golden brown. Best served warm.

Mkate wa ndizi
Menu Course: Breads, Cakes, Biscuits & Pastries
Preparation time:30 mins to 1 hr
Cooking time:30 mins to 1 hr
  * 1.5kg sugar
  * 0.25kg ripe bananas
  * 25pcs eggs
  * 2lt milk
  * 0.5kg flour
  * 0.015kgbicarbonate
  * 0.05kg baking powder
Mash the bananas, add sugar and whip until creamy. Add eggs one at a time as you continue whipping.
When all the eggs are incomporated, add the milk. Sieve the flour, bicarbonate and baking powder
together and the fold into the mixture. Bake in a moderate oven.

Fried Ripe Banana Plantains
Makes 10 portions
Menu Course: Side Dishes
Preparation time:10 to 30 mins
Cooking time:10 to 30 mins
   * 3 doz bananas
   * Cooking oil
Peel the plantains and cut them into nice shapes. Heat some oil then put the banana plantain into it. Turn
them to make sure they do not burn and that they are golden brown on both sides. Take out of the frying
pan and place them on paper serviettes to absorb excess oil. Serve hot. NB: ⋅ The oil should cover the
plantains and should be hot enough to avoid the plantains absorbing too much oil. ⋅ Use a frying pan big
enough or simply deep fat fry them.

Simsim (Sesame Seeds)
Menu Course: Puddings & Desserts
Preparation time:Less than 10 mins
Cooking time:10 to 30 mins
  * 2kg simsim
  * 0.75kg sugar
Wash the simsim, cook in the dry pan and in cook until they start sticking to each other. Roll into small
balls for serving.

Steamed Matoke
Makes 10 portions
Menu Course: Vegetarian
Preparation time:10 to 30 mins
Cooking time:30 mins to 1 hr
  * 1 bunch matooke – 50 pieces
  * Big banana leaves (for wrapping)
  * 2 small banana fibers (for wrapping)
  * 4 big bunches assorted of traditional green (makati dodo sunsa)
  * Vegetables steamed
Wrap the peeled bananas in the banana leaves and tie with the fibers. Using a saucepan (cooking pot)
containing with ¼ its capacity of water + banana leaves stalks, place in the banana and cover with a thick
volume of banana leaves . The banana stalks prevent bananas getting sogged by the water while the
banana leaves trap the escaping steam which in turn cooks the banana. Bananas are cooked when the
water dries up, so mash and repeat the above process with less and hot water This gives the food its
aroma and texture. The vegetables are steamed together with the bananas.

Tende cake
Menu Course: Breads, Cakes, Biscuits & Pastries
Preparation time:10 to 30 mins
Cooking time:30 mins to 1 hr
  * 0.25kg sugar
  * 0.25kg butter
  * 0.45kg flour
  * 0.01kg baking powder
  * 0.1kg dates
  * Tende
Cream sugar and butter. Add eggs one after the other. Fold in flour, baking powder, tende (chopped) and
knead to the fest mixture. Bake until well cooked.
Menu Course: Side Dishes
Preparation time: Less than 10 mins
Cooking time:10 to 30 mins
  • 5kg fermented maize flour
Boil the water. Add flour. Allow to simmer for 10-15 minutes. Add again the flour to make it thick. Allow to
simmer again for 3-5 minutes. Serve the food using wooden spatula.

Ugali wa maziwa
Makes 10 portions
Menu Course: Side Dishes
Preparation time: Less than 10 mins
Cooking time:10 to 30 mins
   * 2kg maize flour
   * 1.5lt milk
   * 1lt water
   * 0.3lt cream
   * 0.01kg salt
Sift the flour. Put milk and water in pot over fire and let the liquids boil add in salt. Take some of the flour
and make a paste. Mix it with the boiling liquid to make porridge. Let it boil sufficiently. Add the cream.
Add in the flour all at a go while stirring to make ugali. Not too hard, should be soft. You can serve with
any stew or curry.

Waaky (Rice & Beans with Pepper Sauce)
Makes 10 portions
Menu Course: Vegetarian
Preparation time:10 to 30 mins
Cooking time: 30 mins to 1 hr
  * 2kg red beans
  * 2kg rice
Pepper sauce:
  * 0.25kg hot red peppers (dried)
  * 1pc dried fish
  * 0.25kg onions
  * 0.25kg tomatoes
  * 0.25kg tomato paste
  * 0.05kg curry
  * 0.05kg cloves
  * 0.005kg thyme
  * 1pc beef cubes
  * 0.15kg dried shrimp/prawns
  * 0.05kg salt
  * 0.1lt oil
Boil rice and beans together until done.
                        Appendix G:
                       SWAHILI GUIDE
Please sit - tafhadali keti

Did you finish your medicine - Ulimalisa dawa yako

It is important to take these everyday without missing doses. - Ni muhimu kutumia hizi,

kila siku, bila kukosa.

Tell me how you take your medicine - Niambie unatumiaje madawa yako

Tell me again how you will take this? - Niambie tena utatumiaje madawa yako?

Do you have your medicines from the last time? Can I see it? - Una madawa yako ya

wakati uliopita, au una madawa yoyote? Ninaweza kuona?

Come back on day, month. -Rudi tena tarehe day/month –

Do you understand? - Unaelewa?

Mon – jumitatu, Tue – jumanne, Wed – jumatano, Thu – alhamisi, Fri – ijumaa

Take this to the pharmacy. - Peleka hii kwa duka la dawa

Take this to lab - Peleka hii kwa lab

Take this to xray - Peleka hii kwa eksirei

Please bring back your medication even if it is finished - Tafadhali rudisha dawa yako

au pakiti au bahasha tupu

Drink plenty of water - Kunywa maji mengi/sana

But this medicine will help you - Lakini dawa hii, itasaidia wewe

We are finished, - Tuma malisa

every hours # -kila kwa masaa –
It doesn’t matter - Hakuna shida

Why? - Kwa nini?

day -siku

week - wiki

month - mwezi

year - mwaka

continue - endelea

Take this medicine instead of these - utatumia dawa hii badala ya dawa hizi

You have # medicines - Una dawa #

You have one more medicine - Una dawa moja zaidi

Do you have any questions? Una swali lolote?

Return after # weeks - Rudi tena baade (after) ya wiki #. .

Because I’m sick - kwaheri sabada mimi ni mgonjwa

I’ll see you next time. - Kwaheri mpaka wakati ijayo

Do like this - fanya hizi

Shake before using - Tingiza kabla hujatumia

Press here - Finya hapa

Hold your breath - Shika pumzi yako

Then breathe – halafu pumoa

Wait for one minute – ngoja dakika moja

Repeat one more time – udia tena mara moja

Wash your hands after using this medicine – osha mikono yako baada kutumia dawa hii

You may take acetaminophen - Unaweza kutumia paracetamol.
Avoid drinking alcohol/beer (without EtOH) - Usitumie dawa hii, na pombe (bila pombe)

Take on an empty stomach - Usitumie na chakula

Take with food - Tumia baada ya chakula/ tumia na chakula

Keep medication in original container - Weka dawa katika chombe kawaida

Avoid exposure to moisture/ Keep in a dry place - Weka mahali palipo pakavu

Take with plenty of water - Tumia na maji mengi

Keep medication in refrigerator or in a cool place - Weka dawa katika chombo cha

barafu au mahali pacipo na moto

How many times - Rudia mara ngapi

Take at morning, afternoon, evening, bedtime (end of day) - Tumia asibui, mchana,

jioni, usiku yote

Notify the doctor (medical officer, clinical officer) if you develop problems - Kama kuna

shida ya ngozi kufura, julisha daktari

Apply a little to affected area – paka kidogo mahali pameumia

This drug may cause:

- rash - Dawa hii Inaweza kusababisha vipele

- muscle pain - Dawa hii inaweza kusababisha maumivu, ya musuli, na viungo

- headache - Dawa husababisha maumivu ya kichwa

- sedation/drowsiness - Dawa hii inaweza kusababisha kiu.

- insomnia/ vivid dreams - Dawa hii husababisha kutokulala

- nausea/vomiting/diarrhea - Dawa hii husababisha kusikia, kutapika na kuhara

- tingling/ numbness of extremities - Husababisha maumivu kwa miguu na mikono

- gas/ stomach pain - Husababisha gasi na maumivu ya tumbo
                         Appendix H:

 Potential Weekend Travel and Estimated Costs

The following handout was compiled by the students in Kenya during
2009-2010. Cost will vary based on accommodations, number of people
traveling, and mode of transportation.
           Appendix I:

                       Appendix K:




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