AMPATH-UofT Program

Vision, Goal & Objectives

Vision
Academic health centres linked to all citizens have a critical role as a foundation of a sustainable health system able to address the health needs of a community.

Goal 
The goal of our partnership is to improve the quality of women’s and reproductive health care in Western Kenya through the development of a sustained partnership between the Medical School of Moi University and the Faculty of Medicine of the University of Toronto focused on improving maternal and gynaecological services, continuing medical education and research.

Objectives 

• Reduce maternal mortality and morbidity
• Prevent and treat gynecologic cancers
• Improve maternal and infant nutrition

Guiding Principles

• Lead with Care
• Reciprocity
• Equity
• Peer support
• Integration with the Ministry of Health

Leadership Team 

Dr. Rachel Spitzer
Vice Chair, Global Women's Health and Advocacy
Associate Professor, Department of Obstetrics & Gynaecology, University of Toronto

Dr. Jenny Yang
Team Leader, AMPATH-RH (2022-23)

Dr. Barry Rosen
Section Lead, Gynaecologic Oncology, Beaumont Health System

Dr. Nan Okun
Head, Division of Maternal-Fetal Medicine
Associate Professor, Department of Obstetrics & Gynaecology, University of Toronto

Dr. Michael Milosevic
PMH Lead
Associate Director, Radiation Medicine Program, Princess Margaret Cancer Centre
Professor, Department of Radiation Oncology, University of Toronto

Joe George
Administrator, Fellowships and Global Health
Department of Obstetrics & Gynaecology, University of Toronto

AMPATH-RH Activities 

As academic health centers, the North American partners who form the AMPATH Consortium are guided by a tripartite mission that includes patient care (service), education (training), and research. While education and research are critically important to achieving our goals, AMPATH is determined to lead with care. All members of AMPATH believe beginning with service is crucial since we work with populations that are terribly underserved in health. In addition, leading with care often helps to instill a belief that the health conditions of populations can be improved. In addition, service is the foundation upon which the necessary training and research is conducted.

Research

Research is critical to improving medical care and sustaining a health system. A robust medical information system is required to provide data for research. The AMPATH medical record system (AMRS), originally conceived by the AMPATH Informatics team, is a centerpiece of AMPATH Informatics and is a cornerstone of the AMPATH initiative.

Current research projects are ongoing in the focus areas of our collaboration, such as maternal, newborn and child health, gynecologic oncology, and public health. Much of our research is programmatic, focusing on evaluating our clinical care programs to assess and improve the health outcomes for women in western Kenya. Many of our findings though are relevant in other regions of Kenya and sub-Saharan Africa.

Click here to access the most current list of research publications by AMPATH that includes UofT authors.

Education

Faculty and trainees from Moi University and the University of Toronto have the opportunity to participate in placements in reproductive health in Toronto and Eldoret, respectively. If you wish to participate, visit the Get Involved page.

Since 2005, faculty members from the University of Toronto’s Department of Obstetrics & Gynaecology have participated in placements at Moi University’s School of Medicine/Moi Teaching and Referral Hospital (MUSOM/MTRH), supporting undergraduate and faculty education. This included important core development of both Maternal-Fetal Medicine and Gynaecologic Oncology, two reproductive health subspecialties that are lacking in Kenya.

Several Kenyan Department of Reproductive Health (DRH) physicians from MUSOM/MTRH have visited the University of Toronto, conducting observerships in cervical cancer care. Each year two senior Kenyan undergraduate medical students from MUSOM completed a six-week medical rotation at Mount Sinai Hospital, St. Michael’s Hospital and Sunnybrook Health Sciences Centre in Toronto. Kenyan postgraduate OBGYN residents also conduct electives in Toronto. This allows for the development of both personal and professional relationships, a broad exposure to high-quality medical care, and a vision for Kenya’s potential. You can read about our latest Kenyan students here.

Current Objectives for Educational Activities 

Improved Maternal Health

• Support the implementation MUSOM Master's of Medicine postgraduate training programme in Reproductive Health, including third-year elective placements in Toronto; 
• Training and support for Community Health Workers;
• Involve medical and MPH students and residents from UofT, and MUSOM and other Kenyan universities in maternal health program;
• Continue to support maternal-fetal medicine training and fellowships.

Treatment and Prevention of Cervical Cancer

• Provide continuing medical education and clinical support for cervical cancer screening, treatment of precancerous abnormalities and treatment of cancer with surgery and chemotherapy;
• Involve medical and MPH students and residents from UofT, MUSOM and other Kenyan universities in the oncology program;
• Continue to support gynaecologic oncology program at Moi University.

Service

Current services provided through AMPATH-UofT include:

• Advanced care in maternal-fetal medicine
• Cervical cancer screening
• Surgery to repair obstetric fistulas
• Advanced care in gynaecologic oncology
• Outreach maternity services at community level
• Mother's support groups

Programs

AMPATH-UofT runs many programs in conjunction with the Moi University School of Medicine and the Moi Teaching and Referral Hospital, including training and teaching programs in gynaecologic oncology, maternal-fetal medicine, radiology, immunology, and others. 

Maternal and Child Health

About 99% of maternal mortality deaths occur in developing countries. Kenya’s maternal mortality rate, like many countries in sub-Saharan Africa, is extremely high. It is estimated that there are 400 maternal deaths per 100,000 live births in the East African country (The World Bank 2014). In comparison, there are 11 per 100,000 maternal deaths in Canada. The main causes of maternal deaths include: haemorrhage, sepsis, hypertensive disorders, unsafe abortions, and obstructed labour (UNICEF 2015). A Kenyan woman has a 1 in 39 lifetime risk of maternal death and an even higher risk of suffering from disease or disability after pregnancy. As a consequence of obstructed labour, obstetric fistula are very common in this region and lead to devastating consequences for women, not only physically but emotionally as a result of the fistula and being ostracized by their families and society.

The root causes of Kenya’s high maternal mortality lie in access to health care and quality of care. Access to care is affected by the widespread poverty in which many Kenyan women live, a culture of gender inequality that requires a husband’s permission to leave home, and the long distances that need to be traveled in order to see a health care worker. Less than 50% of Kenyan births take place in a health facility (public health facility, mission health facility or a private facility). The majority of births take place at home or a non-hospital setting in the absence of a skilled health professional (defined as a midwife, nurse trained as midwife, or doctor).

Gynaecologic Oncology

By 2020, there will be 16 million new cases of cancer worldwide; 70% of them are expected to occur in the developing world. In Africa, many of these cancers will be gynaecologic in origin with cervical cancer being the most predominant. In contrast to Canada where cervical cancer is only the 11th most common and where cure rates are high (>90%), in Kenya, cervical cancer is almost never cured and kills more women than any other type of cancer.

Many Western countries have substantially decreased cervical cancer mortality rates with the implementation of screening programs (i.e. Pap smears), which identify abnormalities before they become cancerous. Patients who present with abnormalities receive early treatment and are frequently cured. Later stages of cervical cancer are treated aggressively with radiation and chemotherapy.

Such prevention and treatment programs are rare in Sub-Saharan Africa. Due to the lack of screening programs in Kenya, most women present cervical cancer that is already matured to its later stages and is difficult to treat, even with high quality medical care. Radiation and chemotherapy are common treatments for these stages of cancer yet there is only one radiation machine in all of Kenya.

Cervical cancer kills women in the prime of their lives, devastating the families and communities that are left behind.

The substantial number of cancer cases in Sub-Saharan Africa is largely due to a lack of cancer awareness, knowledge of prevention, and diagnostic and treatment expertise. The Gynaecological Oncology representatives of AMPATH-UofT are working in partnership with Moi University representatives and other representatives of the AMPATH Consortium to address inequalities in gynecologic cancer care and improve the health of women in western Kenya.

Public Health

The University of Toronto's Department of Obstetrics and Gynaecology partners with the Dalla School of Public Health in working with the Moi University School of Public Health.

AMPATH took a population-based approach to developing one of the most successful anti-retroviral therapy (ART) programs in sub-Saharan Africa. Since 2009, we have been building on this success to bring primary health care to the entire population of western Kenya, 3.5 million people.

Public health expertise in biostatics, epidemiology, occupational and environmental health, social and behavioural health sciences and public health policy is helping to AMPATH support the development of a robust primary health care program throughout western Kenya.

As with all AMPATH programming, we strive to integrate care (clinical public health) with education and research.

Radiology

Our radiology team has been introducing and encouraging improved gyneacological imaging (endovaginal ultrasound approach) and teaching sterilization and disinfection techniques for a number of years now.

New and well-functional used ultrasound machines have been donated to Moi Teaching and Referral Hospital (MTRH) and rural hospitals. Training has been conducted when these donations have been made to ensure the potential benefits of the equipment are realized and the equipment is well maintained.

Current and future activities in this area include:

• Basic ultrasound instruction to medical officers
  • Fetal assessment / Fetal lie
  • Evaluation of amniotic fluid volume
  • Placental position
  • Fetal activity
  • Cervix
• More sophisticated instruction for radiology residents
  • Obstetrical imaging
  • Gynecological imagine
  • Other
• Supporting interaction between OBGYN and radiology professionals
• Taking basic ultrasound to villages

Partners

WE'RE FAR MORE IMPACTFUL TOGETHER.

AMPATH is a perfect example of what happens when people come together with a shared mission. Multiple North American academic institutions join together to make up the AMPATH Consortium, which in turn partners with the Moi University and Moi Teaching and Referral Hospital in western Kenya. Together, we exchange knowledge, share resources, train medical professionals, and expand our reach beyond patients to whole communities.

The following are the AMPATH Consortium members:

• Indiana University School of Medicine - Indianapolis, Indiana
• Brown University School of Medicine - Providence, Rhode Island
• Duke University Medical Center/Hubert-Yeargan Center for Global Health - Durham, North Carolina
• Icahn School of Medicine at Mount Sinai / Arnhold Institute for Global Health - New York, New York
• Johns Hopkins University - Baltimore, Maryland
• University of Alberta - Edmonton, Canada
• Purdue University - West Lafayette, Indiana
• University of California, San Francisco - San Francisco California
• University of Texas at Austin Dell Medical School - Austin, Texas
• University of Toronto Faculty of Medicine - Toronto, Canada
• Stanford Centre for Innovation in Global Health - Stanford, California
• NYU Langone Health - New York, New York

Partners in Toronto

In the core of Toronto exists an incredible number of organizations involved in health care. Walking up University Avenue and along College Street one passes numerous organizations involved in the Toronto Academic Health Science Network (TAHSN). This is an impressive network providing health care, conducting biomedical research, and teaching undergraduate, postgraduate, medical, and healthcare professional students. AMPATH-UofT draws on this vast expertise in health for its success.

Major Toronto-based partners include:

• Dalla Lana School of Public Health, University of Toronto
• Faculty of Medicine, University of Toronto
• Princess Margaret Cancer Centre
• Mount Sinai Hospital
• St Michael's Hospital
• Sunnybrook Health Sciences Centre

Partners in Kenya 

Our partners in Kenya include: 

• Moi University College of Health Sciences (MUCHS)
• Moi Teaching and Referral Hospital (MTRH)
• Government of Kenya
• Kenya Obstetrical and Gynaecological Society (KOGS)

 Map of Clinical Sites

Contact Us

Medical students and residents who are interested in completing an elective with AMPATH should contact:

Dr. Rachel Spitzer
Vice Chair, Global Women's Health and Advocacy and Associate Professor
Department of Obstetrics and Gynaecology, University of Toronto
rachel.spitzer@sinaihealth.ca

Joe George
Administrator, Fellowships and Global Health
Department of Obstetrics and Gynaecology, University of Toronto 
joseph.george@utoronto.ca