October 2016
Table of Contents
Enhancing patient discharge process shows positive results in health outcomes 
Almost five years ago, Indiana University received grant funding from the National Institutes of Health Fogarty International Center to develop a Kenya-based clinical research training curriculum and support eight Kenyan research fellows to conduct research focused on non-communicable chronic diseases. Each Kenyan research fellow was mentored by both Kenyan and North American leadership, with research topics relevant in Kenya, but also impacting the health of vulnerable populations globally. As the grant cycle comes to an end, the researchers have already begun to see the impact their projects have made on patients.
For example, Betsy Rono-Cheriro is investigating how patient health can be improved by enhancing the discharge process at Moi Teaching and Referral Hospital in Eldoret, Kenya. In the study, patient outcomes with an enhanced nurse discharge advocate were compared to those with the standard discharge process. The enhanced nurse advocate introduced new discharge instructions that were more comprehensive regarding follow-up care and written in the local language. Co-study professors helped to develop these instructions that summarized the patients' overall condition and history.
“Before the study, patients were going home with one page of scientific medical language,” said Betsy. “Now they are saying things like, ‘I’ve never known anything because people just talked around me. This is very interesting information I am now finally getting!’”
The new interventions also include encouraging the patient to ask questions, a call from a discharge nurse within 72 hours, and patient contact again after 30 days to evaluate how their care is continuing. Diabetes currently has the highest incidence among chronic diseases for the enhanced nurse advocate follow-up, with asthma and cardiovascular disease following. It is Betsy's hope that the enhanced nurse advocates can eventually be incorporated into the hospital discharge processes permanently.
Improving trauma care in Kenya
Trauma accidents are a major cause of death worldwide, with more than 90% occurring in low- and middle-income countries such as Kenya. Further, deaths from road traffic accidents have doubled over the past 40 years in Kenya with the majority being vulnerable road users such as pedestrians, motorcyclists, and cyclists. Despite the Kenyan government's recent efforts to improve safety with speed-detection cameras and a “No Helmet, No Ride” social marketing campaign, road traffic accidents continue to increase. One reason for the high number of deaths is limited access to trauma care such as triage, transportation, and infrastructure. Working with the American College of Surgeons, AMPATH began an Advanced Trauma Life Support training program for faculty at Moi Teaching and Referral Hospital. 
“It’s a very exciting program to bring to a country for the first time,” said Gary Dunnington, MD, Chair of the Indiana University School of Medicine Department of Surgery. Dunnington said once the preparation is complete next year, Advanced Trauma Life Support training will be available for everyone involved in trauma care at Moi Teaching and Referral Hospital.
October: Breast Cancer Awareness Month 
Breast cancer is the most common form of cancer in women worldwide, and in Kenya it tends to occur more frequently in younger women (aged 40-49 years) compared to the west where peak prevalence is between 50-59 years. With screening and detection and timely treatment, breast cancer is associated with a good prognosis. Unfortunately in Kenya, 70-80% of cancer cases are diagnosed in late stages due to lack of awareness, inadequate diagnosis facilities, lack of treatment facilities, and high cost of treatment in a poverty-stricken country. 
Today, with the new Chandaria Cancer and Chronic Diseases Centre now open on the Moi Teaching and Referral Hospital campus, more than 1,000 breast cancer screenings occur per month. AMPATH and the government of Kenya have joined forces to help overcome the burden of cancer in Kenya.

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