Friday, July 1, 2011

Clinic visits with Dr Mamlin

I got a pretty cool opportunity to go with Dr. Joe Mamlin (founder of AMPATH and Nobel Peace Prize Nominee) to a satellite clinic and observe as he treated patients.  Each week he goes to two towns called Turbo (where we built the new pharmacy) and Mosoriot to treat patients.  I joined him on Wednesday for his trip to Mosoriot.  Right off the bat, he impressed me.  I was waiting for Dr Mamlin with a PharmD candidate who is a Korean American .  When Dr Mamlin walked out, asks us who we are and then busts out with formal greetings and small talk in Korean.  We come to find out he has never been to Korea but had a friend who taught him Korean some 50 years ago.  Along the 30 minute ride to the clinic, he was telling us bits and pieces of his life. He has been married 53 years to Sarah Ellen who has joined him along on all of his travels.  12+ years in Afghanistan, 20+ years in Kenya, staying in Eldoret and saving 250 minority tribes people from the election violence in 2007/08.  Telling the US ambassador to Kenya to go pound sand when he told Dr Mamlin to leave during the election violence.  Having 12 automatic weapons pulled on him during his time in Afghanistan.  Adopting a Kenyan son and Afghan son who are now Harvard educated PhD and IU educated MD.  3 other children that are wildly successful and that he has no plans to live permanently back in the US despite being “retired”.  Did I mention that this was a 30 minute conversation in which he asked us most of the questions?  Pretty remarkable guy.  I can only imagine we just scratched the surface.
So we pulled off the road and into a small village where Dr. Mamlin’s church back in Indiana had built a shelter to house patients who live too far from the rural clinic.  In fluent Swahili, Dr Mamlin greets each patient and the shelter director.  Piles 5 patients in the Land Cruiser with us and off we go to the clinic.  After a tour of the grounds, Dr Mamlin introduces us to the staff and tells us how this was the first clinic he opened with AMPATH in Kenya, sarcastically points to the sign that says “This building was built with support from the US Government  – 1967” and says ‘that’s the last time the US government had anything to do with this clinic.’  He told us about his first time treating patients there, with one nurse and himself and enough money/drugs to treat 15 patients.  After meeting with village elders and having been told his services were not needed, he had a line of patients over 200 people long that continued for 3 days nonstop.  Now the hospital has a men’s, women’s, maternity and childrens ward, OB/GYN clinic, family planning clinic and they are starting a dentistry clinic soon.  We sat down and listened as Dr Mamlin consulted with about 10 patients.  A few patients in particular stick out.  One was the daughter of a woman Dr. Mamlin treated 20 years ago.  The mother was HIV positive while her daughter was not.  The mother apparently injected her blood into her daughter so they would die at the same time and not be alone when the mother died of HIV.  Long story short, the daughter has survived and is now a (relatively) healthy 19 year old woman that Dr Mamlin has sponsored through primary, high school and now into college.  She is a budding journalist and sends Dr Mamlin copies of her most recent novel every few months.   
Dr Mamlin told us that rarely uses what he learned in med school and instead treats each consult like a problem solving exercise.  “How do I get the patient to take antiretroviral (ARVs) and come to appointments with no money and little family support?”  Each patient was treated the same; young, old, positive, negative, TB patient, prisoner.  He talked to them all like a friend.  Although asked almost every time for money to support the family or new business, he referred them to a social case worker.  However, he did commit to sponsor a few women’s children through school and gave the prisoner 30 Ksh for a soda.  With the exception of the young college girl mentioned above that he refers to as his ‘daughter’ who he gave about 10 bucks to, he handled all of the requests with an air of professionalism and tact.  He really is an impressive man.  Although I had not really spoken much with him in my time here, on the way back to Eldoret he told me how much he appreciated the work we (me and Ryan) were doing with the businesses and that he had heard we were really making a big contribution.  He asked to talk with us about sustainability and alternative ways to cut costs in case AMPATH ever lost PEPFAR funding.  It was an honor to have him ask for my advice.    

Work Update

This week has been really busy, I had inventory at Imani Workshops and yearly budget due for Watalamu.  It is amazing how similar a US business with $5 Million+ in revenue is compared to a business with only $10,000 in annual revenue.  You still start with income take away expenses and hope to have something at the end.  Capturing these measures and utilizing appropriate data to make the right decision is what makes the difference.  We have so much information in the US and still don’t get it right every time.  I am beginning to understand why the enterprise managers have such a difficult time reaching profitability.  At Imani, we have nearly 50% of total 2010-2011 FY revenue in our inventory, not a very good inventory situation to find oneself in.  It basically means, we have so much inventory that we hypothetically would not have to make a single product the rest of the year and still have enough to meet customer demand.  This week was the first time Imani actually took an appropriate inventory and it caught many people by surprise.  But hopefully this will have a lasting impact on the business managers and help them see clearly how their decisions are affecting bottom line performance.  

I was pleasantly surprised that the pharmacy project with Watalamu Repair and Maintenance actually turned a profit.  Labor is so incredibly inexpensive.  43 total working days (8-9hrs per day) for the technicians only costs about $225 USD all together.  As I mentioned in an earlier post, this experience is really great for me in that I am forced to adjust to an entirely new business model.   I haven’t fully adjusted yet and am still shocked by some of the numbers and business practices/decisions made here but it really is an incredible learning opportunity that will hopefully make me a better manager back in the US.   

One of my advisors here, Naiomi (ND MBA ’06), has an extremely positive outlook on the businesses and on life in general.  When I get to complaining about how bad inventory at Imani is or how much work there is to do in developing employees at Watalamu, she chimes in with “O well that doesn’t sound too bad” or “We have to start somewhere, I think that’s a pretty good start”. Hopefully I shake some of my cynicism and put that energy to helping solve the problem instead of being overwhelmed.  

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