Introduction
Day four of our journey brought us deeper into the world of healthcare innovation and public health research in East Africa, offering a firsthand look at the groundbreaking work being done in hospitals and academic institutions. We had the privilege of meeting with distinguished faculty members from Aga Khan University’s Nairobi campus – including Dr. Mansoor Saleh, a cancer specialist who completed his residency at UAB and led the development of the hospital’s Cancer Centre; Drs. Kendi Muchingi and Zul Merali with the Brain Mind Institute; and Dr. Rosebella with the Population Health Department – who shared insights into their respective fields and the advancements shaping modern medicine in Kenya. Through these conversations, we witnessed the power of medical education, data-driven public health initiatives, and groundbreaking research aimed at improving patient care. From cutting-edge technology in medical simulation to community-based health programs, the day provided a comprehensive view of how healthcare is evolving to meet the needs of diverse populations.
Several of us were particularly moved by two of the initiatives we learned about: the Centre for Innovation in Medical Innovation (CIME) and the Kaloleni/Rabai Community Health and Demographic Surveillance System (KRHDSS). CIME demonstrated how simulation-based training is revolutionizing medical education, streamlining medical training by equipping professionals with practical experience before they step into real-world clinical settings. Beyond treatment and acute care, the KRHDSS shed light on the role of community health promoters in Kenya – an approach vastly different from public health surveillance in the United States. These experiences highlighted the intersection of technology, education, and grassroots health initiatives around the world, prompting meaningful discussions about how healthcare systems can adapt and innovate to better serve communities.
Centre for Innovation in Medical Education
Our tour of CIME at the university was a fascinating journey into the future of healthcare training. As one of the most advanced medical simulation facilities in East Africa, CIME offers a cutting-edge environment where healthcare professionals refine their skills through realistic, hands-on experiences. One area that particularly stands out is the Birth Training Room. This space is dedicated to simulating obstetric and gynecological procedures. This is where medical practitioners exercise emergency obstetric care to enhance their ability to handle high-risk births and improve maternal and neonatal health outcomes. This facility also houses a simulated endoscopy room, where medical students practice endoscopic and bronchoscopic procedures. This gives trainees the chance to master minimally invasive techniques with precision.
CIME features an array of simulation labs, covering fields such as neurosurgery, ophthalmology, urology, angiography, laparoscopic surgery, and ENT procedures. Each lab station is designed to provide a high-fidelity training experience that ensures each healthcare professional develops confidence and expertise before working with actual patients. The facility also includes mock emergency and surgical wards. This is where students can engage in patient care simulations, disaster response training, and critical care procedures – all within a lifelike hospital setting. Building on innovation is the Dental Simulation Lab, equipped with state-of-the-art dental mannequins, which allows students to refine their technique in a controlled, yet realistic environment. These advancements reflect CIME’s commitment to simulation-based medical education, ensuring that professionals graduate with practical, hands-on experience that directly translates to improved patient care. CIME stands as a testament to how technology and innovation can revolutionize medical education, bridging the gap between theoretical learning and real-world application. This eye-opening visit showcased the future of healthcare training in Kenya, where precision, practice, and cutting-edge technology combine to create exceptional healthcare providers.
Data Surveillance and Population Health
In Kenya, community health promoters are local community members recruited by health departments at the sub-county level who regularly visit with assigned households in their vicinity to discuss health topics. Their work ranges from health education and promotion to referring someone to formal care, if needed. These individuals are trusted community leaders, known well by the communities they serve. They are trained in culturally- and resource-sensitive health promotion practices and share these with their designated households. They are able to spot risk factors, illnesses, and injuries and encourage families to seek care for issues that may otherwise go unnoticed.
In 2017, the Population Health Department at Aga Khan University launched KRHDSS in partnership with the Sub-County Health Management Offices in Kaloleni and Rabai, two sub-county divisions in Kilifi County in eastern Kenya. Through this partnership, community health promoters receive additional training on data collection and management, then survey their households to track risk factors over time. In addition to the standard set of about 40 questions included in KRHDSS, other questions are sometimes included. The data collected may then be used to identify trends in exposures, behaviors, illnesses, and more throughout the communities involved. This information is brought back to community members through periodic report-backs, where community members themselves may identify root causes of these trends and propose solutions.
The information collected in KRHDSS may be used to inform community-level health interventions. One example of this is an ongoing food systems mapping exercise, in which the KRHDSS included questions about crops grown, livestock raised, and dietary patterns. While many people grew fruits and raised chickens, goats, and other animals, their diets often lacked these very foods. In the report-back event, community members described the reasoning behind such decisions: certain fruits and livestock are considered assets to be saved and sold when monetary needs arise, not as sources of sustenance. With this new understanding, future nutrition interventions may be tailored to more appropriately meet the needs of these communities.
Surveillance systems like KRHDSS are a key tool for the public health profession, as data is a critical tool in advocating for community health. The data collected identifies and contextualizes public health concerns; these data can prompt additional research, indicate the successes and shortfalls in health promotion efforts, and inform policy decisions. This is the first surveillance system in Kenya to collect household-level risk factor data in a systematic way. Already, researchers at Aga Khan University have leveraged this data to explore the impacts of climate change on mental health, identify cancer related knowledge among community members, and pilot measures for a longitudinal study on ageing.
In the United States, we utilize what we call the Behavioral Risk Factor Surveillance System (BRFSS). Every year, the CDC leads a nation-wide survey with several questions around different behaviors and environmental conditions. While there is a standard set of questions, additional questions may be added by states’ health agencies. The major difference: BRFSS is conducted by phone and KRHDSS is conducted in person by community health promoters. In fact, such a role does not exist in the American public health system, at least not in such a systematic way. Learning about the structure of the Kenyan public health system, with community health promoters playing a key role at the local level, made us wonder what a greater level of community engagement would look like in the United States.
Do the Good that You Can
At the end of our visit, one of the students asked Dr. Saleh how global health professionals persevere in the face of challenges, especially with regard to shifts in political will in settings which are already resource-constrained. His answer: Do the good that you can wherever you are, one person at a time, one day at a time. Dr. Saleh highlighted this by sharing the story of one woman with advanced breast cancer and how she was able to receive treatment through a clinical trial under his supervision. In Kenya, only about 20% of women receive a mammogram at any point in their lifetime. In contrast, about 80% of women in the United States undergo breast cancer screening annually. So those coming to seek treatment are usually in more advanced stages that what we see in the U.S. This is due to the lack of community-level knowledge of cancer identification and prevention as well as barriers in access to care. By the time this particular individual was referred to Dr. Saleh, the cancer had advanced to a debilitating degree. However, she was able to undergo experimental treatment at the Cancer Centre thanks to innovative funding mechanisms through research studies, and now her life has been extended and she is thriving. Had he not done all he could to facilitate the development and growth of the Cancer Centre at Aga Khan, this woman would not have received the care that she needed.We witnessed innovative approaches, from the cutting-edge training at CIME preparing skilled healthcare professionals, to the dedicated community health promoters of the KRHDSS making a tangible difference in their local areas, to the community-level work that was highlighted by Drs. Kendi and Merali that the Brain Mind Institute is doing to reduce stigma for those suffering from dementia. These experiences underscored that meaningful progress in global health often lies in consistent, localized efforts driven by a commitment to individual well-being.
