By Jamie Hansen, Global Health Communications Manager

A recent visit to the Stanford School of Medicine by two top medical students from Moi Teaching and Referral Hospital in Eldoret, Kenya cultivated cross-cultural learning and the bilateral sharing of medical knowledge.

MTRH and Moi University maintain a unique collaboration and partnership with the AMPATH Consortium. AMPATH, the Academic Model Providing Access to Healthcare, was founded by Indiana University 35 years ago to support Kenyan physicians working to improve healthcare for those living in Western Kenya. The program shares knowledge and cultivates bidirectional medical learning between a global network of 16 university partners, which Stanford joined in 2019.

AMPATH ensures an equitable knowledge exchange by requiring its overseas partners to host two medical students per year at their institutions. This was Stanford’s first time doing so, largely due to delays from the COVID-19 pandemic.

Mutual learning between institutions was evident as students Hazel Mwazonga and Monicah Kitonga spent six weeks rotating at Stanford’s closely affiliated Palo Alto VA in August and September, participating in different rotations and meeting with various Stanford faculty and potential mentors. Mwazonga arrived planning to build a career in obstetrics-gynecology, while Kitonga plans to pursue radiation oncology.

“These were exceptional women – the top of their class. They were not passive learners, but constantly engaged, curious, and contributing their ideas and insights,” said Cybèle Renault, MD, Stanford Clinical Associate Professor of Medicine – Infectious Diseases, Deputy Associate Chief of Staff for Education at the Palo Alto VA, and the leader of the partnership between Stanford and AMPATH.

Mwazonga and Kitonga said their six weekly rotations at the Stanford VA offered new insights into key differences and similarities between medical care in the U.S. and Kenya – while broadening their ideas of what is possible in medicine.

This included witnessing the use of advanced robotic surgery techniques while on a surgery rotation, noting the high prevalence of skin cancers in the U.S. compared with Kenya, observing more targeted approaches to prevent antibiotic overprescribing, and appreciating the comprehensive, holistic approach to patient care made possible by a smaller patient- to- physician ratio during internal medicine rotations.

Perhaps the greatest takeaway was a new appreciation for the value of primary and preventive care, witnessed during their general medicine outpatient rotation. In Kenya, Mwazonga said, the concept of primary care is virtually nonexistent.

“At some point, I was like, wow! This is what most of our patients need because it keeps very many patients out of the hospital,” said Mwazonga. “Many of our patients might be living with things like diabetes and hypertension, and not become aware of it until they present to the hospital in an emergency.”

Strong primary care, she realized, could help prevent the high patient burden in Kenyan hospitals through early detection and care of health concerns such as diabetes and cancer. She said the experience has motivated her to consider a career in this discipline, or to advocate for the government to fund primary care.

Kitonga, meanwhile, left with a sense of possibility regarding the ability to save lives through cancer screenings and other preventive measures after noting the higher survival rates among cancer patients at Stanford.

“With rising cancer incidence in Africa, many of them presenting late, patients often end up just receiving palliative care,” she said. “I was surprised that that’s not the case in the U.S. Yes, there are lots of cancer patients, but the mortality rates are quite low because primary care catches cancer at an earlier stage.”

AMPATH is one facet of a growing effort by Stanford to create more equal global health partnerships in which practitioners on both sides learn from each other. This contrasts with the one-sided historic practice of wealthy institutions sending trainees overseas to gain knowledge and provide services, without offering reciprocal opportunities. Other recent efforts to create more equitable exchanges at Stanford include the Stanford Center for Innovation in Global Health’s new Stanford African Scholars in Global Health program and an ongoing partnership with the University of Global Health Equity.

In this spirit, the faculty said they learned and gained much from the students’ visit.

Baldeep Singh, MD, a Stanford Clinical Professor of Medicine, hosted Kitonga and Mwazonga at his home — something he described as a wonderful experience for his family.

“As the weeks unfolded, our home became a tapestry of cultures. Monicah and Hazel brought the warmth of Kenyan hospitality, sharing stories about their families, their medical training, and the vibrant traditions of their homeland, as well as the political tensions in Kenya,” he said.

The cultural exchange included swapping recipes in the kitchen, visiting the Santa Cruz Beach Boardwalk and San Francisco, and eating at In-and-Out — along with serious discussions about medical care in the U.S. and Kenya.

“They were both passionate and tenacious, and my wife, Rachel, and I, were inspired by their maturity and poise… I hope Stanford can do this again in the future,” he said.

Renault emphasized the program’s benefit to Stanford. AMPATH uniquely offers a chance for partners to have system-level impact thanks to how deliberately the Kenyan leaders and Indiana University have structured the initiative. Renault said: “It’s program development, it’s teaching at a large scale in a relatively high-resource hospital system in a lower middle-income country.”

Over the past few years, 1-2 Stanford infectious disease fellows have rotated each year at MTRH. While there, they’ve helped develop curriculum while supporting the development of the institution’s infectious diseases consult service and their antimicrobial stewardship program. Renault said the fellows receive a remarkable career development opportunity to support Kenyan partners as they teach antimicrobial stewardship principles at MTRH — gaining valuable experience addressing the growing, global threat of antimicrobial resistance.

To ensure that Stanford’s role in AMPATH is sustainable, Renault hopes that other training programs at Stanford Medicine support the partnership by connecting trainees and faculty with the program and contributing to the annual dues. The program is currently funded through September 2025 by the Division of Primary Care and Population Health, the Department of Medicine, and the Division of Infectious Diseases and Geographic Medicine.

“Involvement in the AMPATH Consortium offers a tremendous opportunity for trainees – there are no partnerships as developed as this anywhere else,” Renault said, emphasizing that AMPATH is considered the model of how high-income partners can support the development and success of a hospital system in a low- or middle-income country.

Acknowledgments

Stanford Medicine’s Division of Primary Care and Population Health, under the leadership of Associate Dean Sang-ick Chang, first initiated and paid for Stanford’s participation in AMPATH. The Stanford Center for Innovation in Global Health supports the fellows’ travel to AMPATH and funded Mwazonga and Kitonga’s travel to Stanford. Staff from the Stanford Department of Medicine, including Erica Zuniga-Lumidao and Loto Reed, organized the logistics to make the students’ visit possible, and Dr. Renault organized the students’ clinical rotation schedule and meetings with potential mentors. At VA Palo Alto, the students rotated with Dr. Sherry Wren and Dr. Cara Liebert on General Surgery, Dr. Peter Johannet on Plastic Surgery, Dr. Cybèle Renault on Infectious Diseases, Drs. Rachel Najafi, Conor Holton-Burke, Ryan Satovsky and Chris Millhouse on General Medicine wards, and Dr. Matt Stevenson in the General Medicine Clinic.