Magazine

Karibuni

The Indiana University-Kenya Partnership develops leaders in healthcare on two continents and has created a miraculously successful model for battling HIV/AIDS in Africa. Co-founder Dr. Bob Einterz ’77 says its deeper mission "transcends medicine.

by Doug McInnis and Steve Charles

IT’S A WARM AFTERNOON IN JUNE, storm clouds rumble on the western horizon, and Lea Anne and Bob Einterz’ Zionsville, Indiana home is buzzing with conversation.

Adam Paarlberg ’03 and three other Indiana University medical students are out on the covered patio recalling their weeks last summer working in Eldoret, Kenya as participants in the IU-Kenya Partnership.

Ron Pettigrew, program director of the Partnership, coaxes a smile from Einterz’ two-year old daughter, Abigail.

As Violet Yebei, her husband, Philemon, and their two daughters step inside, Philemon glances at the familiar word above the front door—karibuni, "welcome" in Kenya’s national language, Swahili. Their oldest daughter, Ann, recently recovered from cochlear implant surgery at Riley Hospital in Indianapolis, kneels down to play chess with Einterz’ son, Zach.

Paul Muganda, a Kenyan emergency room doctor currently recuperating in the Einterz home after a mitral valve replacement, gets over his initial shyness and joins one of a several conversations taking place on the deck.

A beautiful African woman in her late 20s with her hair in cornrow braids, Carolyne Jepkorir-Kitonyi walks in with her husband, Timothy. Einterz greets her with a hug. He met Carolyne in 1991 when she was 12 years old and Einterz was on one of his first trips to Kenya. Herfather, a driver for the Partnership, asked the physician to examine her.

Einterz didn’t like what he heard.

"I put the stethoscope to her chest and—boom!—heard this bad mitral stenosis," Einterz recalls. "She sounded like she wasn’t going to live another six months."

Einterz and his colleagues arranged to have her flown to Indiana and "snuck her into Riley Hospital," where they replaced a heart valve.Then Bob and Lea Anne took her into their home, where she lived for several months. At 18 she returned for a final repair to the valve and lived with the Einterz family while she completed her degree at Marian College. She’s now a third-year medical student at IU. She calls the Einterz residence "my home away from home."

The threatening storm finally lets loose, forcing the gathering inside as they sprawl onto the sofas and the floor. Einterz calls out over the laughter of his friends that they have just figured out what everyone in the room has in common: They’ve all spent at least one night in the upstairs guest room here. Some have spent years in this house. All have worked with or been served by the IU-Kenya Partnership.

Bob Einterz will tell you that the deeper mission of the IU-Kenya Partnership "transcends medicine."

"Medicine is just the medium," he says. It all comes down to what he calls "individual counterpart relationships—one person from Kenya, one from Indiana." The sorts of relationships thriving in this room. The former Wabash chemistry major seems completely at ease, even joyous in the midst of it all.

It’s a way of looking at the world shaped by Einterz’ Catholic upbringing, an immersion experience in France during his high school years, his liberal arts education at Wabash, and service work on a North Dakota Indian Reservation during medical school.

But for the Einterz family, the journey to Kenya began in the Caribbean.

"A wonderfully difficult year"

IT WAS 1986 when Einterz took a leave of absence from his comfortable faculty job at Indiana University’s School of Medicine to take an unpaid post practicing medicine in Haiti. He also swapped the comforts of an American home for one without running water, electricity, or screens in the windows.

An evening’s entertainment might consist of Scrabble by the light of a kerosene lantern. When the game was over, Bob and Lea Anne would dive under the mosquito netting. Once the light was out, bats zoomed through the open windows and careened about the room.

He took up practice in a local clinic, where Einterz began tackling the sort of basic medical problems that not so very long ago killed large numbers of Americans—diseases that could be easily solved by public health initiatives.

"It was a wonderfully difficult year," he recalls. "I felt an obligation to work as a volunteer.With privilege comes responsibility. We’re given gifts to benefit not only ourselves, but others."

He recalls one of his youngest patients.

"He was three years old and suffering from malnutrition and whooping cough," Einterz explains. "I can remember him like it was yesterday."

When Einterz returned to Indiana, he didn’t want to leave the developing world behind. He took an idea to three other faculty members—to combine the assets of a Big Ten medical school with the goals of an up-and-coming medical school in a developing country. They supported the concept, and IU formed a partnership with Kenya’s Moi University School of Medicine that has lasted 16 years.

Moi was Kenya’s second medical college and had a faculty of four. Today it has more than 100 faculty members. Einterz was IU’s first representative. He has been going back ever since, making three or four trips a year, and now serves as director of the partnership between the two schools, and as associate dean for international affairs at IU’s medical school.

The two institutions developed a relationship which allows IU faculty and students to work at Moi, which is on the front lines of the battle to contain Africa’s AIDS epidemic. It is an experience that transforms the lives of many of those who go through it.

Einterz had seen in Haiti how the biggest gains in health and life expectancy could be achieved through relatively inexpensive public health measures.

"Assuring clean drinking water would in many ways be more important and would save more lives than building a new hospital with a high-tech intensive care center," Einterz says.

So Moi was chosen, in part, because of its emphasis on public health. "The ideawas that the medical school we selectedwould have a very strong medical outreachprogram rather than just trying toproduce the typical doctor who focuseson cures. At Moi, they wanted to produce a doctor who could simultaneously wear a public health hat."

Refusing to let them die

But it took awhile to get the project off the ground. Einterz and his colleagues soon discovered that even the simplest initiatives could prove difficult to implement. They realized they would have to deal with underlying social problems before they could make medical progress. They started with the medical school.

"In Kenya, the students are very bright, but some of them are exceedingly poor," Einterz says. "On some days, they go without eating. They don’t have the resources to both pay their tuition and get a square meal every day."

So Einterz and his colleagues at IU began raising cash for needy students.

"Ordinary Hoosiers have since funded more than 40 full-tuition scholarships," he explains. "With their tuition paid, the students can spend their limited resources on food, shelter, textbooks, and supplies."

That same pervasive poverty is one of the root causes of the country’s staggering mortality rate. "Young children die of diabetes," Einterz says. "They can die from something as simple as pneumonia or as complicated as HIV.These are diseases that usually do not cause death in the United States. But in Kenya, there’s a shortage of absolutely everything."

Sometimes the only way to save lives was for IU’s contingent to dip into their own pockets and buy the needed supplies.

"When we initiated the partnership in 1990, we committed ourselves to work within the Kenyan system and not to come in from the outside and try to change it," Einterz says. "Then we had an epidemic of meningitis, easily treatable by penicillin, but potentially fatal without it. In this hospital serving the poorest of the poor, you had to buy your own medicine. They couldn’t afford it.

"I was seeing 10 to 15 patients a day with meningitis, and I decided I could no longer stay there and watch people die. We made the commitment that no one would ever die for lack of penicillin. So we went out and bought penicillin from our own pockets."

A similar response from Einterz’ colleague Dr. Joe Mamlin to the AIDS epidemic was the catalyst for AMPATH (Academic Model for the Prevention and Treatment of HIV/AIDS), the partnership’s remarkably successful HIV/AIDS prevention and treatment program.

In September 2000, Mamlin met Kenyan medical student Daniel Ochieng, who was in the advanced stages of AIDS. He was grossly underweight and unable to eat. "A skeleton," Mamlin says.

Up to that time, IU’s program had focused on prevention, seeing treatment as too expensive, given the scarce funding available. But like his colleague Einterz years earlier, Mamlin refused to let the Kenyan die. He scraped together the money to buy the medicine, the drugs worked their well-known "Lazarus effect," and Ochieng was saved.

Ochieng’s recovery was "the turning point for us," Einterz says. The IU doctors were convinced that treatment has to be a component of the global AIDS struggle, and today AMPATH treats more than 33,000 adults and children with HIV.

A deadly silence

In Kenya, the prevailing culture can cost lives, especially from AIDS. The disease had just begun to take off when IU arrived 16 years ago and has since become the scourge of Kenya and much of southern Africa.

"In many areas of Kenya, a woman is not allowed to talk about such things as AIDS," Einterz says. "When we first became involved with fighting the HIV epidemic, we saw women whose husbands had died from the disease. The women were infected too, but they would not come in for treatment while their husbands were alive. Had they done so, their husbands would have kicked them out, even though it was the husbands who had infected them. There was a stigma attached to having the disease. People would say that this person died of diarrhea or pneumonia. No one acknowledged that HIV existed."

"One of the things we’ve done is work to reduce the stigma of HIV so that everyone will come in and be treated and tested. There’s still a stigma, but more people are willing to come forward now that they’ve realized the disease is treatable."

While the Partnership is helping to bring about profound changes in Kenya, it has also had an effect on the young IU medical students who have taken part in the program.

"By working in Kenya, our students get a better understanding of the human condition," says Einterz. "They learn bedside skills, how to work with colleagues, and how to understand cultural issues in health care. I don’t want to suggest that a two-month experience in Kenya will change your whole personality. But it does begin to change it."

Beth Gates, who participated in the program in 2005, concurs. Not unlike Einterz’ experience in Haiti, she has vivid memories of many of her patients.

"A little boy came in with a very serious infection in his leg—a really cute kid, big eyes, big smile. There wasn’t any peroxide to clean out his wounds, no IV or antibiotic, and no working x-ray machine at the clinic. So our team of Kenyan medical students and the teacher chipped in to get this little boy some treatment. Spent the better part of a day tracking down antibiotics in the next town miles away.

"Still, we had to clean out his wounds without any anesthetic. He was so brave, he didn’t try to pull away. No child in the U.S. would ever have to experience that kind of pain."

THE RAIN LETS UP at the Einterz home in Zionsville and this contingent of the IU-Kenya Partnership—doctors, patients, colleagues, friends, and family—break off their conversations and step outside for a group photo. It’s a snapshot of lives from two continents intertwined. Lives enriched, even saved, by each other.

Einterz insists that the ability to develop relationships like these is at the heart of the IU-Kenya Partnership.

"I ask my students, ‘Can you have compassion? Can you become a person who can dignify relationships? That’s where it all begins, people meeting face to face."

Like the faces Einterz remembers from his days in Haiti. Or Carolyne Jepkorir- Kitonyi in Kenya, or the children with meningitis he just couldn’t allow to die.

Einterz would gladly trade his commute from Zionsville to downtown Indianapolis for daily rounds in the Kenyan village of Eldoret. And he’s counting on that opportunity someday.

"I sometimes joke that what I’d like to be when I grow up is a doctor," Einterz says. "I mean, which is more rewarding—interacting with a computer and paper all day, or interacting face to face with people?"

But he is betting that his work with the Partnership can have more impact as it shapes the next generation of physician/ leaders.

"What we’re really trying to do is develop leaders of compassion and integrity," Einterz explains. He’d be heartened to read what his fellow Wabash man, Ahmad Paarlberg ’04, wrote about his experience in the program:

"I realize now what this trip has been all about. Not about safaris, infectious disease, or international politics, but about goat roasts and good conversation over bread and water. It has been about human experience and interaction, and that is what I will remember about my time here.

"This is what I believe Bob and Ron had in mind when they set up this partnership, and this is what I believe medicine is all about; it is not about surgeries, drugs, or procedures, but about the human spirit.

"Experiences such as these are great for medicine, and they bring out the best in people. They remind us why we devote nearly a decade of our lives to long days, sleepless nights, and agonizing study—we do it not for prestige, for wealth, or even for science, but for each other."

Bob Einterz couldn’t have said it better himself.

ONE LIFE AT A TIME PHOTO ALBUM

Read more about the IU-Kenya Partnership at http://medicine.iupui.edu/kenya/

Contact Bob Einterz at reinterz@iupui.edu