Eldoret is a city of about 250,000 in western Kenya, at an elevation of 6500 ft. It is home to the Moi Teaching and Referral Hospital and the Moi University School of Medicine. For the past several years, Duke has been working to establish a cardiology Center of Excellence there. I responded to a DUCCS newsletter about this effort. My wife Jean and I spent October and November, 2014 there.
The experience was both heartwarming and heartbreaking. The Kenyan people are friendly and welcoming, hardworking and eager to learn. I did a lot of teaching, most directly related to patients on the cardiac unit. The spectrum of heart disease was very different from the USA. Rheumatic valve disease is frequent, aggressive, and causes severe stenosis and regurgitation early. The youngest patient I saw with severe valvular disease was 8 years old. Pulmonary hypertension is also common, and seems due mostly to indoor air pollution from cooking with small fires in small, poorly ventilated homes. Ninety percent of the population outside of major urban areas still cooks this way. Needless to say, this problem affects women mostly, and the severe elevation in pulmonary pressures causes profound right heart failure among women in their 40’s. Congenital disease, either unrecognized or untreated, was also frequent. I saw only 2 STEMIs, 2 NSTEMIs, and no one with a bradyarrhythmia requiring a pacer. [Perhaps the shorter life span does not allow for the conduction disease to develop.]
The available drugs were adequate, thanks to the large number of generics in most classes. Urgent surgery is impossible to achieve now. Elective surgery can be arranged but takes weeks or months to accomplish. There is lots of interest in improving that situation over time.
There is a huge amount of work to be done. We saw ourselves as part of an effort that will take decades to achieve the goals of prevention, early detection, and appropriate treatment. It was fun to work alongside our Kenyan colleagues to move this process along.