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Dr Mutugi Ex - Director ITROMID |
INTERVIEW WITH DR MUTUGI- EX. - DIRECTOR OF INSTITUTE OF TROPICAL AND MEDICAL INFECTIOUS DISEASES (ITROMID)
When was ITROMID established and what were the reasons within the society that needed to be addressed by the establishment of the program?
It was established in 2003 with the goal of developing capacity of medical and paramedical centers in Kenya to deal with Tropical and infectious diseases. We recognized that the schools of Tropical medicine at that time were outside the tropic and so they depended on the local people from the tropical country for their information.
What are the main fields taught at the program?
All are post graduate programs with emphasis on Public Health, Parasitological and entomology. virology, myco-bacteriology, molecular medicine, phyto- chemistry and popular program of epidemiology, lab management and epidemiology, medicinal chemistry
What has the program managed to accomplish thus far?
We have achieved our goal of developing capacity of scientist and medical workers in the area of tropical and medical diseases. We have graduated over 50 masters and 10 PHD’s and many are currently in the system.
What are the current challenges being faced by the program?
Mainly financial support of our students– the program is oversubscribed but since it’s a self sponsored program, the tuition is quite stiff Kshs. 350,000 /year for training and research. Many try to find programs that can sponsor them, where they can fit in, but this is not enough.
What types of positions has the program managed or is aiming to fill in the health sector?
Currently we have filled positions in both the private and public health sectors. Most of those in the program were already working with various health programs and took time off from work or trained simultaneously as we have evening programs especially in public health. Thus all the students have identified a need/s that arise in their capacity within their scope of work. There also those who have filled the international systems, NGO and various private sector organizations that deal with health and research.
Does the program collaborate with other organizations and how has this benefited it in terms of the quality of work carried out?
Yes, the quality of our training has increased because of our partnership. Among many others, there is the support from US government through Center of Disease Control (CDC), University of Georgia, Columbia University in New York, and the regional governments that sponsors students from Kenya, Uganda, Tanzania, Congo, Malawi, Zimbabwe, Ghana, and New Sudan. The agreement with New Sudan is to build the capacity of the southern Sudan as they built their infrastructure. We have an active partnership with them to rebuild that capacity to deal with infectious tropical diseases.
One of the Millennium Develoment Goals is the reduction of child mortality rates, how does the ITROMID program target surveillance in cubbing with infections and vaccine preventable diseases?
The issue of prevention is the key and in order to prevent and intervene in the case of infectious diseases we need to have a good surveillance system which must be all the way from the health centers to the national structures in the ministry of health. Thus each country must have good surveillance systems, so that they are able to detect emerging and re-emerging infectious diseases, then we can avoid national epidemics by nipping them in the bud. So this program has contributed to the increase of the capacity of the various ministries of health in regional countries. Because we recognize regional diseases surveillance training as vital in controling diseases found within various regional borders we have 2 classes of epidemiology and lab-management, funded by CDC and USAID, and so far have graduated 2 cohorts from Kenya, Tanzania, Uganda, Ghanaian and southern Sudanese students coming through this year.
It’s important to note that we have a taught course to develop the skills of the students and to refresh their memories in their specific areas. An important element is for them to be able to develop their research skills to be able to have an analytical mind in terms of correlating and collecting information from the ground, analyzing it and putting out recommendations. Many of those working in the ministry of health scope are curative clinicians, and yet the data that flows through them daily is so important and they need to be able to have an analytical and research mind, to tease out information so that they can identify trends, odd events, and quickly pick up an upsurge of e.g. malaria cases and others. Some of our students have done retrospective studies of data maintained in the files in the various health centers and one of the things observed is that the incompleteness of data, very critical detail is left out, because the questions asked do not have the analytical approach and so recorded data is of socio-demographic characteristics. The critical details are necessary, so that as they put together information for the ministry of health, the clinicians will already be in the know on the kind of things that are happening on the ground and make their comments useful as they give their opinions in terms of looking at the data, not just raw data, they can raise the flag on issues that are important.
Since the programs targets are in tropical diseases that are common in the region, are there any particular orientations to the diseases of most interest e.g. malaria, HIV and the neglected diseases like meningitis?
When the students come in, they do their projects in the areas they are interested in which largely depends on where there working. There are areas that the national level is interested because of the prevalence in the country, e.g. HIV, Malaria, Tuberculosis (3 big ones) the trend will be for students to go towards these areas and in areas where there is funding. However there are students working on various topics / projects.
So the program provides more of a guideline for the particular line of interest?
We not only strengthen the students to develop the capacity in their area, but sharpen their research skills to be able to collect relevant data, analyze, draw conclusions and give recommendations which are a critical area of this program.
To manage infectious and preventable diseases and achieve better quality surveillance data, effective strategic control measures are needed to enhance the skills of medical personnel who form an integral part of disease surveillance. Various training programs for medical personnel have been set up in different countries and we interviewed two core contributors of such training programs in Kenya. Click on the links below to read their respective comments.
Institute of Tropical and Medical Infectious diseases (ITROMID) - interview with Dr. Mutugi
The Field Epidemiology and Laboratory Training Program (FELTP) - interview with Dr. Muchiri
INTERVIEW WITH DR. MUCHIRI OF FIELD EPIDIMIOLOGY AND LABORATROY TRAINING PROGRAM (FELTIP)
When was FELTP established and what were the reasons within the society that were the main reason for the establishment of this program?
FELTIP was established in 2004 with the goal of training Ministry of Health Staff on a regional scale in applied epidemiology. From the issues of the Ministry of Health (MOH), there were certain gaps that needed to be filled in terms of disease control and surveillance. The program that was there previously for disease control had several gaps in terms of validity and capacity of doing this activities so the ministry knew that it had this gaps in personnel who could effectively do epidemiological surveillance and who could do disease control as well as getting data that could be used by policy makers for various initiatives so the inadequacies in the MOH led to it looking for ways it could correct this inadequacies in particular on surveillance and disease control.
What are the main fields taught at the program?
Field epidemiology training program has got 2 components. One is to train MOH staff in applied epidemiology i.e., epidemiology that is more oriented to the field. Epidemiology that would give the trainees more skills in terms of how to involve themselves in epidemiologic investigations.
What are the current challenges being faced by the program?
Any program will have its successes and challenges. One challenge that we recognize very well is how the MOH sustains this program, in view of the fact that there are so many organizations and institutions that would want to have a program like this. This is a sponsored program through CDC and is very expensive to run. The key challenge that we have is the sustainability of the program after the major funder, CDC steps out. We’ve spent a lot of time working on this because we know that we need to make the ministry create a budget time line for the continued training of the residents. Secondly we know that in order to retain this people, in the ministry, we must have a career pathway for the epidemilolgists. Previously this has not been achieved because we did not have enough mass of epidemiologists
The third challenge is for us to have a local faculty that can train the epidemiologists. From the start of the program to the first class graduates, the ministry has had less than 5-10 epidemiologists in the ministry. A few years ago, we had no well trained epidemiologists; however, we have other disciplines like public health masters who are not specifically epidemiologists.
Were any of the trainees involved actively in the management and surveillance of meningitis during their coursework?
In West Pokot (Kenya) just a few weeks ago there was an outbreak of meningitis and these are the people who spearheaded all the surveillance activities, besides the gradate trainees of this program, we also had our own students who joined hands with everybody else in investigating and make a rapid assessment of the situation in the areas that had meningitis, we have reports indicating clearly where this problem was and who was affected.
Are there any success stories of former students who have key positions within the ministry to assist in policy making?
We have those in the first graduate class of 2006 who have been ploughed back into the ministry and all of them are involved in the national programs. We have two of the graduates deployed to the Division of Outbreak Management Unit (DOMU), one resident trainee who is heading the Division of Health Management and Information System, one graduate of the program who is in malaria and is in charge of monitoring and evaluation, one who is the deputy manager in charge of he Division of Vaccine and Immunization that was previously Kenya Epidemiology Program of Immunization (KEPI), one graduate in charge of the HIV reference lab, one graduate brought back here to be the field coordinator for the FELTIP program, we have another graduate who has been posted to the North Eastern Province in charge of surveillance activities in the area, we have one of the students who now is in charge of the National Public Health Laboratories.
We have now actually now moved to the national level and we anticipate that the next class of six students who will graduate next year are going to get to be deployed to the provincial level. It’s up to us to come up with very clear surveillance descriptions required for the provincial level. After we do that, we will construct the necessary structures for the epidemiological investigations, for the outbreak investigations, public health surveillance evaluation, for program evaluation of whatever they are doing there. And there will be a centralized system for this information that they are going to be getting from the periphery health facilities.
Is there a target goal for the program?
Yes, we do have a target goal, if we had enough resources, we really want to have all the provinces, the districts and at the national level to have an epidemiologist at the senior level. The district will need to have a district epidemiologist, a provincial epidemiologist and at the National level we believe that once we create the critical level , we will create the central epidemiological unit that will be coordinating all the activities of the epidemiologist that is the plan that we have. When we were talking with CDC, our target was to have at least 74 epidemiologists trained who can work with the ministry and the reason being that we knew we could cover most of the districts and would still have another group operating at the national level.
Is the program targeting only countrywide or does in integrate other regions?
Initially when we started this program on 2004, we wanted it initially to be wholly for Kenyans because of limited resources. However, looking at the various needs that we’ve got at the regional level, it was felt that we needed to bring in other countries into the fold and it became a requirement that in order for us to secure resources, we needed to make it a regional program. It is only the first cohort that started in 2004 that did not have people from the neibouring countries but from the class of 2005,Tanzania has trained here, Zanzibar has got someone training here, Uganda, we have some people training with us, Sudan now in their 2nd year of training and we are training Ghanaians in order for them to go and start a program like this one in their country. So this really is a regional program and we hope that if we could secure more resources, we would open up to more people being trained in order for us to realize our targets of at least having an epidemiologist at the district level.
Does the program collaborate with other organizations and how has this benefited it in terms of the quality of work carried out?
Various partners have worked with us, the primary partner being Center for Disease Control (CDC) who introduced this program for us to see how we can train people who can work in the Ministy of Health in this aspect of epidemiology. We have been working with CDC for a long period of time and whenever we had any problem we used to turn to CDC for assistance. For instance when we had the Rift Valley Fever back in 1997-98, we had to look for the capacity as well as the assistance of various institutions to come and assist in doing the investigation, so CDC has always been a very handy partner that has been working with us in various fields of health to see how we can improve on our facility.
However, there are other partners coming in, we have KEMRI as our significant partner, we have JKUAT which is an important partner in this goal in the sense that it awards the degrees for the students who go through this 2 year course. And the MOH is of cause a partner as well as a customer in the sense that it provides the employees and also benefits from the services that the trainees provide after their training.
To read more on FELTIP please visit CDC's website at www.cdc.gov/about/stateofcdc/everywhere/kenya.htm
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