Partnering with Academia: Visioning Church Hospitals Towards Educational Excellence

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Partnering with Academia Visioning Church
Hospitals Towards Educational Excellence
Bruce Dahlman MD Director, Institute of Family
Medicine (INFA-MED) African Christian Health
Association Conference Kampala,
Uganda 25 February 2009
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Objectives

• 1. One human resource challenge physician
  leadership retention in your hospitals
• 2. Discuss the strengths and issues of forming
  partnerships between universities and
  faith-based health institutions towards Family
  Medicine development in Africa

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Medical Leadership Is it a Crisis in Your
Hospitals?

• Who is the leader of the medical staff at your 70
  150 bed hospital(s)?
• How long do they serve?
• Specialization?
• Think of yourself as a new Medical Officer

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Your Career ladder

• Internship 1 year
• Assigned Government service in rural District
  Hospital or your smaller church hospital which
  often
• Is in the Remotest place
• Has Poorest working environments
• Little or no clinical back-up
• Poor professional advancement opportunities
• Meanwhile . . .

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Your medical school classmates . . .

• Who landed at larger hospitals have been working
  under a surgeon/ obs-gynae/ paediatrician for
  2-3 years
• They have their referee letter to apply for
  speciality training
• Look forward to consultancy position university
  lecturer post secure future

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What would you do?

• Ask for sponsorship for speciality training from
  your church hospital?
• Join the PEPFAR project in your area?
• Join a friends private practice?
• Continue serving joyfully year after year in the
  lowest paid Medical Officer cadre with no
  professional rank?

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Family Medicine Training Who is a Family
Physician?

• Definition from Kenya Ministry of Health
• Family Medicine Policy (2007)
• A family physician is a medical doctor
• providing competent and comprehensive clinical
  care (usually in a primary care consultancy
  role)
• over a wide range of patient conditions
• considering the persons physiologic,
  psychological, socio-economic, cultural and
  spiritual dimensions
• within the context of their family and community
  and
• not limited by the persons age, gender, organ
  system or disease entity.

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Roles of a Family Physician

• Provide continuous, comprehensive, cost-effective
  and coordinated care to individuals, families and
  communities primary care consultant
• Engage in life-long learning to improve health
  care delivery
• Teach effectively members of the health care
  team, the patient and the community
• Act as a team player and a leader
• Manage health care resources

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Why Family Physicians?

• Given the need to provide primary care services
  to the entire population, as well as the family
  doctors ability to manage most medical problems,
  it makes sense that a majority of physicians
  should be trained to practice as family doctors.
  This may be even more important in developing
  countries, where it may be prudent to limit the
  utilization of costly hospital-based technology
  (WHO, 1994).

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Why are Family Physicians Needed?

• National Health Strategic Plan (2005-2009)
• To contribute to the reduction of health
  inequalities and to reverse the downward trend in
  the health related impact and outcome indicators,
• To achieve Millennium Development Goals to
  reduce child mortality, improve maternal health
  and reduce communicable diseases like malaria,
  HIV/AIDS TB,
• Medical Officers are currently not sufficiently
  trained to provide general, comprehensive care to
  the Kenyan people.

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Family MedicineEspecially important to achieve
improvement in equity of access

• The Family Physician will
• Improve quality of care, particularly for
  the underserved Kenyans
• Improve patient satisfaction and
  continuity of care
• Provide comprehensive specialist care
  at District and Sub-district levels
• Improve preventive care From Kenya Ministry
  of Health Family Medicine Policy
  Document (2007)

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Kenya MoH Family Medicine Policy(Echoing WHO)

• The MoH recognizes that the Family Physician is
  the most appropriate person to respond to the
  challenges of the Kenyan health care delivery
  system.

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The African Family Doctor A summary

• Clinical specialist in Primary Care leader of
  the medical team
• 3-4 year Master of Medicine training
• Competent emergency surgeon
• Bridge to the primary care team
• Gains the professional respect of peers as the
  primary care consultant specialist
• Equipped to stay build your hospital

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Where Is This Doctor Mentored?

• Probably will not do this training in the
  National Referral Hospitals
• Because they will need mentoring by dedicated
  doctors who have the same call to service and in
  a place where the greatest needs are
• That place would be?

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Your rural church hospital!
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Why Does Your Hospital Need to be a Teaching
Hospital?

• Because these hospitals are serving in the places
  where Family Medicine training needs to exist
  in the rural areas
• Because they contribute a significant portion of
  the clinical care in most sub-Saharan African
  countries and will continue to do so
• Because they are often already well-respected by
  patients

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Church Hospitals Role in Education

• Your church hospitals likely already have a
  nursing school to meet the needs of nursing
  staffing . . .
• Can there be a corollary in the medical education
  realm?

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Church HospitalsAre You Ready for Prime Time?

• Objections . . .
• Were not big enough
• They dont need us . . .
• What would we have to offer?
• We couldnt pay for it

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But what if . . .

• You step
• outside . . .

of the box
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Africa Inland ChurchKijabe Hospital - 265 beds
outside view of inpatient wards
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Educational Resource From Rural Church Hospitals
Example of AIC Kijabe Hospital

• 1916 - Hospital started as infirmary to a
  boarding school for missionary kids
• 1959 Separate facility built to serve the
  community 30 beds 1 doctor
• 1970s Expanded to 120 beds 2 doctors
  Expatriate medical student rotations
• 1980 210 beds, 3 doctors KECHN nursing
  school Kenyan medical student electives

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AIC Kijabe HospitalBecoming Part of the Answer

• 1995 Medical staff of 7 No Kenyans Govt
  medical internship started
• 2005 Medical staff of 16 2 Kenyan Family
  Medicine residency started with Moi University
• 2006 - Agreements with Pan-African Academy of
  Christian Surgeons and University of Nairobi -
  general and paediatric surgery externships
• 2008 COSECSA orthopaedic residency
• 2009 Medical staff of 27 11 Kenyan

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But How to Begin?

• Take First Steps . . .

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The Kenyan Case Towards Family Medicine Training

• March 1995 MAP Intl. consultation with
  hospitals from Kenya and Zaire resolves to start
  family medicine post-grad. programme
• 1996 2000 Kijabe, Chogoria and Tenwek
  Hospitals begin College of Family Medicine
  (COFAMED) and pursue accreditation with
  Commission for Higher Education

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But . . . in most sub-Saharan contexts

• The model for post-graduate education requires
  partnership with a medical degree-granting
  academic institution
• Master of Medicine Degree
• Includes Masters research thesis

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Kenyan Family Medicine Development

• Sept. 2003 Moi University Senate approves the
  curriculum that had been through numerous
  revisions over 3 years.
• January 2005 Moi University Family Medicine
  begins with three registrars
• July 2008 First class graduates all take
  teaching positions

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Your Partner is TheUniversity Medical School

• You need to partner with your University that
  does medical training Dean, Comm. Med.
  department
• You may be suggesting something new to them
• You may need to engage Ministry of Health,
  Professional Boards

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Resource on how to engage the process

• Improving Health Systems the Contribution of
  Family Medicine A Guidebook
• WONCA World Org. of Family Doctors
• www.globalfamilydoctor.org

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Africa Christian Health Associations
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African Family MedicineExpansion

• 1980s - Nigeria and South Africa
• 1988 Uganda 1996 DR Congo
• 2004? Ghana
• 2005 - Kenya, Tanzania
• 2009 - Rwanda, Lesotho
• Investigating - Ethiopia, S. Sudan
• Interest Malawi, Mozambique

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Institute of Family Medicine (INFA-MED)

• Support and assistance organisation to assist the
  development of the community-based church
  hospital teaching sites for the Moi programme
• Faculty development
• Integrating continuing medical education with
  post-graduate needs
• Scholarship support

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Institute of Family MedicineMission

• INFA-MED is committed to advancing family
  medicine in the developing world by training and
  mentoring doctors to be clinicians, teachers,
  leaders and life-long learners, who will provide
  comprehensive and wholistic health care, relevant
  to community needs

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Institute of Family MedicineStrategic Goals

• 1. To establish and expand family medical
  education in developing countries
• 2. To facilitate the sharing of evidence-based,
  relevant primary health care information
• 3. To actively engage church congregations to
  become healing communities
• 4. To promote and support continuing
  professional development and life-long learning
• 5. To build the capacity of INFA-MED as an
  institution, and mobilize resources for the
  advancement of family medicine in developing
  countries

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Institute of Family MedicineAccomplishments in
Kenya

• 2000 Assist Moi University to start Kenyas
  first Family Medicine program
• 2002 Helped launch KAFP
• 2003 Brought Advanced Life Support in
  Obstetrics course (ALSO) to Kenya contributing
  to Global ALSO refinements
• 2005 Assist with initial Moi Univ. lecturer
  salaries
• 2006 Began small group CPD courses with KAFP
• 2009 - Adapting Comprehensive Advanced Life
  Support (AfriCALS) to East Africa
• 2010 Digital African Health Library Health
  information tools to use at the point of care

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Questions and comments?

• Bruce Dahlman MDInstitute of Family Medicine
  (INFA-MED)bdahlman_at_aimint.net
• 254-736-450-915
• Pan-African College of Christian Surgeons
• Dr. Bruce Steffes
• bruce_at_brucesteffes.net

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Kenya The People