It’s a consequence, perhaps, of growing up a “poor hillbilly” (his words) in western North Carolina. He tells stories about going out west as a young man to work as a lumberjack; about making money for college by selling Bibles—and being good at it; about meeting tobacco scion R.J. Reynolds Jr., who founded the scholarship that paid for Mamlin’s medical school. He talks of being in the Peace Corps, teaching at a fledgling medical school in Afghanistan and writing the first medical textbook in Pashto, which his students treasured as if it were dropped from heaven. Yet, Mamlin’s greatest reservoir of stories—involving death and life, generosity and mischief, bravery and beauty—stem from his central role in what might be Indiana University’s noblest endeavor, the School of Medicine’s initiative to help build a health care system in western Kenya and its fight there to turn the tide against AIDS.
For 19 years, Joe and his wife Sarah Ellen lived in Kenya almost exclusively, returning to Indiana two weeks a year and spending another two with family in North Carolina. This April, they said a series of goodbyes to their friends in Kenya, were feted by speeches from dignitaries, and lavished with songs and dances from patients in far-flung communities. They returned to Indianapolis to try retirement—for a second time—and to see grandchildren they’ve seen too little of for too long. But Joe’s not sure how to label this next phase. “There’s a little bit of discovery there,” he said.
JOE MAMLIN’S story is so densely intertwinedwith the story of IU’s miraculous work in Kenya that they cannot be told separately.
Mamlin was there—along with fellow IU School of Medicine faculty members Bob Einterz, Charlie Kelley and Dave Van Reken—when the idea for the project first formed in the late 1980s. Each physician had had memorable experiences delivering medical care in developing countries. Each thought IU medical students would benefit from something similar. Mamlin insisted IU partner with another academic institution. They found it in the nascent Moi University School of Medicine in Eldoret, Kenya.
The plan was for an exchange program. IU faculty would rotate into Kenya, assist their Kenyan colleagues in delivering much-needed patient care and train future Kenyan doctors. IU students would go to learn the resourcefulness, creativity and compassion needed to deliver care in a developing country. Kenyan students and faculty would visit IU for training. They would also collaborate on research.
Einterz and Kelley each served a year as field director in Kenya. Then Mamlin began his first tour in 1992. He taught students. He treated patients at Moi Teaching and Referral Hospital with cases ranging from cancer and heart disease to malaria and tuberculosis, and everything in between. There were also a few patients with HIV/AIDS. But it was untreatable at the time, even in the United States. Opportunistic illnesses were treated, but the patients were essentially there to die. After a year, Mamlin returned to Indiana.
Through the 1990s, Moi’s medical student enrollment grew, as did the student and faculty exchange. Other North American universities joined the partnership. IU surgeon Dave Matthews completed a five-year stint in Kenya and his church, Second Presbyterian in Indianapolis, provided money for a surgical suite.
By 2000, Joe Mamlin was 64 and edging toward retirement. For 29 years, he’d served as chief of medicine, first at Marion County General Hospital and then at Wishard Memorial. He’d served IU School of Medicine as Chief of the Division of Internal Medicine for 28 years. He was president and CEO of IU Medical Group Primary Care, a forerunner to IU Health Physicians. And he wanted a break. Joe and Sarah Ellen decided to head back to Kenya for one last tour, if for nothing else than to give his successors room to take over. “I thought we were going for two years and that was going to be it,” Sarah Ellen said. “But just like all of life, it evolved.”
WHEN THE Mamlinsarrived in 2000, Kenyafaced a public health emergency. Across Africa, AIDS was killing millions. In Eldoret, the wards at Moi Hospital were brimming with HIV-infected patients, most in their 20s, simply wasting away. During his visit in the early 1990s, Mamlin had seen about 100 patients die at Moi Hospital. Now, he was watching 100 die every month. From AIDS. “The whole aura of it at that time,” Mamlin said, “was that, ‘Oh my God, the world’s coming to an end.’”
The tragic irony was that, by 2000, AIDS was treatable. The problem for Kenya was that the necessary anti-retroviral drugs were too costly. Even if available, skeptics doubted the drugs could be effective for people living in such poverty, with limited access to medical care.
Mamlin’s anger came to a boil one night on rounds at the hospital. He saw a medical student seated by a withered patient who was obviously dying from AIDS. As Mamlin stepped closer, he was surprised to see that the dying man was also a Kenyan medical student: Daniel Ochieng.
If IU couldn’t save a medical student, Mamlin wondered, what was the point of being in Kenya at all?
What we’ve been able to do in partnership in Kenya—through the leadership of Joe Mamlin and others—is nothing short of remarkable. This life-saving and community-enhancing work should be a source of pride for our entire state.
Jay Hess, MD, PhD, MHSA, Dean, IU School of Medicine
He shared the situation with Joe Wheat, an IU School of Medicine infectious disease expert. Quietly, Wheat sent Mamlin the money to pay for a year of Ochieng’s HIV treatment. Wheat also directed Mamlin how to administer the drugs, as he had never done it. Over six weeks, Mamlin saw Ochieng come back to life. Watching his vitality gradually return, Mamlin said, “changed both Daniel’s life and mine.”
Mamlin was convinced IU had to “bomb its agenda” in Kenya, putting the treatment of AIDS at its core. How to do it was the question. To treat a single HIV person was a lifelong commitment—and costly. To do it for an entire population was beyond any resources at IU’s disposal.
One of Mamlin’s great gifts, Bob Einterz said, is persuasion. He credits Mamlin’s colorful Carolina vocabulary, his absorption of the words of so many philosophers and theologians—and something else. “Some people are doers, some people have great capacity for vision, and some people are both,” Einterz said. “Joe happens to be both.”
Einterz, who was by then coordinating the IU-Kenya program, now known as AMPATH, from Indiana, began knitting together a patchwork of grant money to fund the flow of AIDS drugs. “In a sense,” Einterz said, “we didn’t have a playbook.”
In 2003, as Einterz’s funding patchwork was wearing thin, President George W. Bush announced that the United States would pump billions of dollars into Africa to fight AIDS through the President’s Emergency Plan for AIDS Relief (PEPFAR). As the money began flowing into AMPATH—and demand for testing and treatment grew—it became obvious that AMPATH needed an HIV clinic. But the only infrastructure grants available were for renovation projects.
This was a turning point for IU’s role in Kenya—the fulcrum between what came before the AIDS crisis and what came after. It also transformed AMPATH’s relationship with the Kenyan people. Previously, an HIV diagnosis had been a death sentence. For that reason, many Kenyans resisted testing. Once infected, many kept their HIV status secret to avoid being shunned. But IU doctors had restored Daniel Ochieng, who was now taking his story—and the imperative for testing and treatment—to his people. “He became the voice,” Mamlin said, “of the people we’re caring for.”
Mamlin had learned much from navigating the Kenyan bureaucracy. And, in dealing with the United States Agency for International Development, he executed what may be a quintessential Mamlin maneuver—now the subject of one of his favorite stories.
Mamlin threw a brick out into an open field. “I’m going to renovate around that brick,” he said. And $2 million later, AMPATH had an 80,000 square foot building.
The details of this maneuver were left to Einterz to smooth out, but he said the episode is a perfect example of Mamlin’s philosophy that forgiveness is more easily won than permission. When navigating American red tape or obstacles created by the Kenyan government, Mamlin said he had two simple rules.
“Rule No. 1 is that it is ethically okay to lie, cheat, and steal on behalf of HIV-infected Kenyans,” Mamlin said. “The other one is similar: If people are not sharp enough to help you, they’re not smart enough to stop you.”
In the years that followed, AMPATH’s network of clinics grew to become the largest in Kenya. It also built some key new facilities: the Riley Mother and Baby Hospital; a 10-bed cardiac care unit; and the Chandaria Cancer and Chronic Diseases Center, just to name a few. Much of the work was fueled by philanthropy.
Today, AMPATH’s HIV program is one of the largest in the world. It cares for more than 150,000 HIV-infected patients. AMPATH has broadened its role, too, screening women for breast and cervical cancer and helping Kenyans develop greater income and food security. Best of all, Kenyans now lead the endeavor, with Sylvester Kimaiyo serving as executive director. As such, AMPATH has become a health care model touted internationally, and one soon to be replicated in Ghana and Mexico.
“What we’ve been able to do in partnership in Kenya—through the leadership of Joe Mamlin and others—is nothing short of remarkable,” said IU School of Medicine Dean Jay Hess, MD, PhD, MHSA. “This life-saving and community-enhancing work should be a source of pride for our entire state.”
Jim Morris, an IU alumnus and current IU Board of Trustees member, served as executive director of the United Nations World Food Programme when AMPATH leaders realized malnourishment was hindering the effectiveness of HIV treatments. To improve the situation, the UN agency partnered with AMPATH to get more food to the Kenyan people. Morris said it was an example of AMPATH, and Mamlin, understanding the community’s needs.
“This is the best face of the state of Indiana stepping forward to do something really, really important,” he said. As for Mamlin, Morris says, “He is truly one of the most remarkable people in the world.” Others who agreed nominated Mamlin and AMPATH for the Nobel Peace Prize—more than once.
In Kenya, the highest honors came in other forms. The Nandi people made Mamlin a tribal elder. Several families touched by the HIV treatments named children “Joe” or “Mamlin.” One who did so was Daniel Ochieng, the first HIV survivor treated by AMPATH.
The kinship and accolades were hard earned.
In 2008, post-election violence broke out in Kenya. Roving gangs wielded machetes, hacking people to death if they were from a rival tribe. Roads were blocked, churches burned and gunfire frequent. Most IU students and faculty evacuated. Joe and Sarah Ellen Mamlin stayed. An American embassy official told Mamlin he shouldn’t shelter locals lest he be considered taking a side. “I normally don’t say to people, ‘Go to hell,’ Mamlin said. “But you can’t turn your friends away.”
The Mamlins welcomed more than 120 Kenyans into the IU compound. The act revealed more than selfless bravery, said Dino Martins, a Kenyan-born naturalist and now Princeton University researcher who developed a special relationship with the Mamlins, becoming their foster child as a teen.
“Because of their presence and personality and respect and love for people, no one would have dared enter that compound and threaten anybody because Joe and Sarah Ellen were there,” Martins said. “That would still stand today. In Kenya, part of it is very big respect for older people and people who have given to communities.”
There’s a whole new generation of Kenyans who now understand they can dream, they can vision and they can make important things happen And when you contaminate any society with a few folks like that, that society transitions into a developed society.
Mamlin remained deeply involved in the work right up until boarding the plane for home.
In April, Mamlin, 83, was still making the rounds five days a week in the crowded wards at Moi Hospital and in three local clinics. He was training residents and lecturing students. On Tuesdays, his 14-hour days involved a 3-hour car trip (one way) to rural clinics along Kenya’s border with Uganda. During the visits, he treated upward of 30 HIV patients a day and examined other patients with cases too complicated for local health workers. But in his final months there, Mamlin said he began to wonder if his presence was helping or getting in the way, as the Kenyans became more able to handle matters themselves. Mamlin is optimistic about AMPATH’s future. And he says surviving the AIDS crisis—with IU’s help—has meant much to Kenya’s psyche.
“There’s a whole new generation of Kenyans who now understand they can dream, they can vision and they can make important things happen,” Mamlin said. “And when you contaminate any society with a few folks like that, that society transitions into a developed society.”
For Mamlin, letting go won’t happen overnight.
Two days after returning to Indianapolis, Mamlin was back in the AMPATH offices at 7 a.m. Via email, he was trying to promote the cause of universal health care in Kenya. He was advising his successors on navigating the Kenyan bureaucracy. And he was trying to raise money to help Ochieng pursue his doctorate in public health at IU. He and Sarah Ellen plan to make periodic visits back to Kenya.
The impact of their retirement detour, which stretched 19 years, is evident in several ways. In talking about Kenya, Joe sometimes lapses into referring to it as “here.” Arriving back in Indianapolis, the Mamlins realized they didn’t own a car. The retirement home they built near Eagle Creek Park when Y2K was still a thing appeared on the cusp of being swallowed up by the wilderness. Visiting Kenyans and assorted church groups used it, but the Mamlins themselves had scarcely rested their heads there.
And, except for sporadic visits, Joe and Sarah Ellen missed the years when their grandchildren were young.
Mamlin has no regrets about his journey. The Kenya venture was risky for him, for IU and the School of Medicine, he admits. But a healthy risk. “It reminds us that, at our best, we can do two or three things at once. It’s been good for Indiana. It’s been good for Indiana University.”
In this second go at retirement, Joe may write about these and other adventures.
After all, he’s a storyteller.
To learn more about AMPATH’s critical mission or make a gift to support its work, please contact Teresa Rhodes at email@example.com or 317.278.0840. You can also visit ampathkenya.org for more information.