Major Exchange Programs

Moi University Faculty of Health Sciences - Eldoret, Kenya

Lead with Care, follow with Education and complete the circle with Research

Website: http://brownmedicine.org/Kenya/

In 1977, faculty at the Warren Alpert Medical School at Brown University initiated collaboration with faculty from the Moi University School of Medicine in Eldoret, Kenya as part of a medical exchange program. Moi, Indiana University and Brown developed - and were awarded - a Gates Prevention grant to fund AMPATH (Academic Model for Prevention of Treatment of HIV/AIDS. AMPATH has expanded across western Kenya, supporting over 23 major treatment sites with a cumulative enrollment of well over 150,000 persons living with AIDS. AMPATH recognized that care is not limited to the provision of medicine but extends to the alleviation of poverty and food inequity as well as the development of social equity programs; with this recognition a comprehensive care program has been developed with includes encompassing clinical care, social service, legal aid, food equity and economic empowerment programs. With maturity of the HIV care program. AMPATH Program returned to its roots in building a primary care program, maintaining its Acronym but now standing for the Academic Model for Providing Access to Healthcare. AMPATH has been cited by the WHO and UNAIDS as a model program and was nominated for the Nobel Peace Prize in 2005*. Funding comes from philanthropic donations, PEPFAR, USAID as well as program-specific NGO grants.

AMPATH has been nominated multiple times for the Nobel Prize, most recently 2010 (I think).

In the spring of 2009, the Riley Mother and Baby Hospital opened, anticipating 12,000 deliveries per year. The facility has a 50 bed neonatal unit and is the referral and training site for healthcare providers in obstetrics and neonatal care in western Kenya.

Brown faculty are also con-investigators in the NHLBI funded Cardiopulmonary Center of Excellence in Clinical Research at Moi University. Rapidly expanding research awards exist to look at the health effects of Indoor Air Pollution on women and children as well as the nation-wide roll-out of the WHO PAL strategy and Kenya National Asthma Guidelines.

As part of the backbone of the program, Brown faculty, residents and medical students regularly participate in month long rotations on the inpatient wards and ambulatory outpatient settings. Moi University medical students rotate to Brown annually for a six-week ward rotation in Internal Medicine while Moi University Resident physicians rotate to Brown for subspecialty training. The Brown Kenya Program is located within the Department of Internal Medicine and supported as the Chairman's Program under the auspices of Dr. Louis Rice.

Hospital Cabral y Baez - Santiago, Dominican Republic

In 2004, the Brown Department of Medicine entered into an educational exchange agreement with the Department of Internal Medicine at Cabral y Baez hospital in Santiago, Dominican Republic. In choosing Cabral y Baez as an educational exchange site, the Department considered the relevance of an experience in the Dominican Republic to our patient population in Providence, the relative ease of travel to Santiago, and the desire of many Brown internal medicine residents and medical students to gain international experience in a Spanish-speaking country. At Cabral, we found internal medicine colleagues eager to partner with us in a mutually-beneficial educational exchange program. In addition to faculty-led PBL sessions, the Brown Internal Medicine. Dominican Republic month-long clinical rotation involves three complementary clinical experiences:

• Cabral y Baez Hospital: During time scheduled at Cabral y Baez, Brown students, residents and faculty members spend time attending morning rounds with Cabral internal medicine residents, morning teaching rounds in the UCI (intensive care), and rounding with specialist teams, including hematology and nephrology.

• CEDI: The CEDI (Clinica de Enfermedades de Immunologia) is the HIV center that is supported by a joint program between Brown and Cabral y Baez internal medicine departments. Dr. Claudia Rodriguez sees patients in the clinic and visiting Brown representatives assist with clinical encounters.

• A Mother's Wish Foundation: A Mother's Wish supports a clinic for mothers and their children in the mountainous region outside of Santiago comprised of the towns Los Pinos, Las Pajones, El Llano, Arenoso and La Tinajita. When Brown Internal Medicine visits the clinic opens its doors to all adults. On Fridays during the rotation Brown students, residents and faculty conduct home visits with Jim Pickard. This offers the rare opportunity for Rhode Island residents to view the rural living conditions and gain perspective on additional health concerns engendered by these living situations.

The Brown AIDS International Training and Research Program (AITRP)

The Brown AITRP trains and mentors scientists in developing countries to address the AIDS epidemic primarily through advanced degree training, along with long term and short term training tracks in prevention research, biomedical and behavioral interventions. Brown University, Tufts University and the Miriam Hospital jointly operate this AITRP. The program supports established research training programs at partner sites in India, Cambodia, the Philippines, Kenya and Ghana. The training program is directed by Susan Cu-Uvin, MD and is supported by mentoring faculty from multiple Brown departments and institutes. These collaborations have opened up opportunities for research and training for Brown faculty and trainees.

Brown AITRP Collaborating Training Sites

INDIA

YR Gaitonde Center for AIDS Research and Education (YRG CARE), Chennai, India
http://www.yrgcare.org

YRG Care is the largest community-based AIDS service organization in India and currently cares for more than 13,000 people living with HIV. The Brown AITRP has been collaborating with YRG Care since 1999. More than a dozen of their laboratory, clinical, behavioral and nutritional investigators have received advanced training via the Brown-Tufts AITRP. YRG CARE is funded by the NIH to conduct therapeutic and prevention research trials through the HPTN and ACTG, and also has funding from NIDA to study substance use and sexual risk taking, as well as the natural history of HIV. YRG CARE investigators have also been funded by the NIH to conduct basic laboratory studies, and to develop low-cost clinical monitoring schema (e.g. CD4 and plasma HIV RNA testing).

Christian Medical College, Vellore
http://www.cmch-vellore.edu

Christian Medical College is one of the oldest medical schools in India and a major tertiary referral center for the country. The Brown AITRP, along with partner Tufts University, has been collaborating with CMC since 2001. Under the leadership of Dr. Gangadeep Kang, CMC investigators are leaders in obtaining NIH funding and independent clinical research in India. Their trainees have conducted basic laboratory investigations of mucosal immunology and the natural history of cryptosporidiosis and other water-borne parasitic infections in the HIV-infected populations in southern India. They have also done large field studies to understand the impact of HIV and tuberculosis in large census tracts in the communities surrounding Vellore.

National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre)
http://www.icmr.nic.in/pinstitute/trc.htm

NITR is the Indian Council for Medical Research's (ICMR) premier basic laboratory and clinical research center for all studies related to TB in India. The Center is also well positioned and funded to examine the nutritional and metabolic complications of HIV. Laboratory scientists at the TB Research Center have NIH funding to conduct studies of basic HIV immunology, virology, nutrition and metabolism, pharmacology, as well as clinical research studies.

PHILIPPINES

University of Philippines, Manila
http://upm.edu.ph/upmsite

Brown faculty have been working with clinical investigators from the University of the Philippines for over two decades. More than 20 trainees have come to Brown for HIV/AIDS training under the AITRP program, including physicians, and other clinicians, social and behavioral scientists, administrators, as well as basic scientists. A number of former AITRP trainees now occupy key positions in the University and the major hospitals and have continued to be active leaders in the HIV/AIDS research within the Philippines.

GHANA

University of Ghana, Accra
http://www.ug.edu.gh

The University of Ghana in Accra is the premiere medical school in Ghana and home of the largest clinic taking care of people living with HIV. Brown faculty member, Dr. Awewura Kwara, and Dr. Marget Lartey lead the AITRP collaboration, beginning in 2010. Short term and long term degree training is provided by the AITRP, with a focus on Nursing, Pharmacology and Nutrition related to HIV. The Brown AITRP works closely with the Ghana-Brown Academic Partnership to Address HIV/AIDS, funded by HED/USAID to ensure the biggest impact at the University of Ghana.

KENYA

Moi University/Moi Teaching and Referral Hospital, Eldoret
http://www.mu.ac.ke

Moi University School of Medicine (MUSOM) opened its doors as Kenya's second medical school in 1990. In 2001 MUSOM opened AMPATH, the Academic Model for Prevention of HIV/AIDS, in partnership with Brown. The AMPATH Training Institute is the major HIV training center for the western half of the country. The medical exchange program between Brown and MUSOM has existed for over 10 years; in its bilateral exchange over 150 students, residents and faculty have worked at MUSOM and over 25 Kenyan students and 6 residents have trained at Brown. The Brown AITRP began collaborating with Moi in 2006, led by Dr. Jane Carter and have trained fifteen faculty and staff, including eleven advanced degree trainees.

CAMBODIA

National Center for HIV/AIDS, Dermatology and STDs (NCHADS), Phnom Pehn
http://www.nchads.org

National Center for HIV/AIDS Dermatology, and STD (NCHADS) under the leadership of Dr. Mean Chhi Vun, is the Cambodia Ministry of Health body responsible for HIV surveillance, diagnosis, treatment and prevent in Cambodia. Trainees from NCHADS have returned to develop pivotal surveillance projects and participate in development of the national program.

Sihanouk Hospital Center of HOPE, Phnom Pehn
http://www.sihosp.org

Sihanouk Hospital Center of HOPE is an NGO hospital funded by HOPE Worldwide and has one of the largest ambulatory programs providing HIV care in Cambodia. They provide primary care services for 2700 adults living with HIV and 2200 who are on active antiretroviral therapy. Brown/Tufts AITRP trainees have returned to conduct independent studies of the spectrum of disease in newly diagnosed patients, gynecologic complications in HIV-infected women, and response of plasma and genital tract virus to antiretroviral therapy.

Other Brown Collaborations

UKRAINE

The Brown University Ukraine Collaboration is a joint venture between the Brown University Center for AIDS Research (CFAR) and HIV health and service providers in Ukraine through the support of the Elena Pinchuk ANTIAIDS Foundation. The collaboration engages the resources of Brown University to work with Ukrainian health providers to address the challenges of the HIV/AIDS and tuberculosis (TB) epidemics for children, women and their family members in Ukraine.

HAITI

Medical Education and Leadership Development Project (MELD)
Over the past two years, the Warren Alpert Medical School of Brown University (AMS) has developed a relationship with St. Damien Hospital in Tabarre, Haiti (outside of Port-au-Prince), to collaborate on developing a pediatric medical education curriculum for Haitian medical students. The collaboration, called the Medical Education and Leadership Development (MELD) Project, aims to address the unmet need of providing domestic pediatric clinical rotations to Haitian medical students.

China Rotation

The Brown - Nanjing Partnership, begun in 1993, was recognized by the International Society of Nephrology with the Sister Renal Centers Award for this major collaborative effort in the study and treatment of Kidney Disease between Rhode Island Hospital and Jingling Hospital, the major teaching hospitals of Brown and Nanjing University, respectively. Beginning in the current academic year, we plan to open this opportunity to internal medicine residents. Initially, we plan to focus on clinical and research experiences in kidney disease. In the future, we anticipate opportunities for rotations in other areas of internal medicine. The Nanjing University program is one of the premier programs in China, with over 40 faculty based at a 200 bed renal hospital performing over 100 renal biopsies weekly, a Lupus Nephritis clinic with 2000 patients, an IgA Nephropathy program with over 1000 patients, and many other high quality clinical and academic programs.

Nanjing University. Nanjing University is comprised of three campuses and the Nanjing Medical School. Jingling Hospital, a large public hospital in Nanjing, is the major academic hospital of the medical school and is widely recognized as having the best kidney program in China.

Kidney Program. The renal program is impressive on many levels, in large part due to the scope and volume of disease. The renal division at Jingling is comprised of over 40 faculty based in a 200 bed renal hospital. The hospital sees regional referrals and includes a renal ICU and stem cell unit. The institution sees approximately 200,000

Nanjing is a modern city of approximately 8/5 million people in Southeastern China with excellent mass transit and cultural opportunities.

This rotation is directed by Dr. Lance Dworkin, Director of Nephrology and Hypertension.

Other Programs

Many residents have international experience prior to beginning residency and may continue with an independent study rotation even if Brown has no formal arrangement.

Global Health at Home ("Glocal" Health)