By Chrissy Dideriksen
It’s nearly two months to the day since I began the Global Health master’s program here at Duke. My classmates come from a variety of backgrounds, but all of us have dipped our toes in international waters as students, volunteers and even doctors. Each week in our “Global Health Challenges” class. guest lecturers — the best in their field — cover a wide variety of topics and we continue the discussion on our blog. Our discussion swings from grand ideals of naive optimism to an unending cycle of questions — who, how and when. We are all working through the complex issues discussed in our classes in small groups and independent reflection. As a global health student, I often feel daunted by the oniony layers that surround caring for the world’s underserved, so listening to Dr. Joe Mamlin talk this week was both an inspiration and a challenge.
Dr. Mamlin almost came to Duke as a cardiologist fellow, but it is a good thing he didn’t. Instead, Mamlin ended up at Indiana University with a keen interest in international care. He helped build a medical school in Afghanistan and then a partnership between IU and Moi University in Kenya. It was through this partnership that Mamlin witnessed firsthand the devastation of the HIV epidemic in sub-Saharan Africa. As he described, his clinic in Eldoret saw about 85 deaths a year, then suddenly they saw a jump to 1,000 deaths per year. Mamlin responded to this crisis by helping establish AMPATH, the Academic Model for Prevention and Treatment of HIV/AIDS, now the most comprehensive HIV program in sub-Saharan Africa.
AMPATH’s impact on the epidemic in Kenya cannot be overestimated. What I find most impressive about Mamlin’s approach is the way he confronts each new obstacle head-on. He spoke about one patient, a young woman who couldn’t seem to gain weight and get healthy despite her HIV medication. He asked her about her diet and the woman told Mamlin that she hadn’t had any food to speak of. So he fed her. And he continued to find a way to feed her, and others, until AMPATH built a farm that today sustains 31,000 people everyday.
Mamlin urged us to “move out of the hospital and into the home and village.” We cannot treat disease in a vacuum. While efforts toward HIV, malaria and TB have expanded capabilities in the developing world, they haven’t done enough to treat Mamlin’s three-headed monster: Disease, Hunger and Poverty.
AMPATH is currently using what they call the FLTR method of care: Find everyone, Link them to care, Treat and lower viral load, and Retain in care. Mamlin emphasized that we cannot sit and wait for those in need to come to us, either in the hospital or in the community health center. We must go door to door if we are to “break the back of the pandemic.” This commitment and strong in-country partnerships are the ingredients that Mamlin and AMPATH believe will help spur the first Kenyan generation free of HIV since the epidemic began. He believes this can happen within five years.
At first glance, AMPATH’s goals seem overly ambitious and Mamlin’s approach outrageous in scope. However, he has proven that setting your sites beyond what is expected does not lead to impossible outcomes and that health and well-being for all is an attainable future. This is a lesson that we, especially early in our careers, must not forget.