A series of ‘firsts’: How a former U of T professor helped establish gynaecologic oncology training in Kenya
Barry Rosen launched East Africa’s first gyn-onc fellowship program through the University of Toronto–AMPATH partnership with Moi University in 2012
Barry Rosen remembers the Kenyan gynaecologist who, in 2009, first alerted him to the situation in East Africa. Hillary Mabeya had come to Toronto for a visit in the middle of February wearing two ski jackets.
“He told me cancer was a really big problem, and they didn’t know what to do about it,” says Rosen, at the time a professor and head of the gynaecologic oncology division in the department of obstetrics and gynaecology at U of T’s Temerty Faculty of Medicine.
Three months later, Rosen traveled to Moi University in Eldoret, Kenya, to see how he could contribute to a solution alongside its faculty physicians.
The outcome was the first gynaecologic oncology fellowship program in the sub-Saharan outside of South Africa — based at Moi University School of Medicine and certified to Canadian postgraduate standards — which today has trained 18 specialists, all of whom practice in Africa, the majority in Kenya.
But it took a few years to get the program on its feet.
They started to discover things they’d never seen before — like early-stage cervical cancer. All they had ever seen was advanced stage.”Barry Rosen
When Rosen first landed in Kenya, he represented both of U of T and AMPATH, a long-standing global health program based in the U.S. that provided primary health care throughout the western part of the country. The two institutions had recently entered into a memorandum of understanding, with a formal partnership in the offing.
Rosen saw that cancer was a bigger problem than he imagined. Moi University Teaching Referral Hospital, associated with the school, had a full obstetrics and gynaecology department but no cancer specialists.
“When we would go on rounds, we’d see a gynaecology patient, maybe they had infection or endometriosis or a fibroid, and we’d spend a good five to ten minutes talking about them,” says Rosen, who plans to retire from clinical practice next year. “Then we’d go to the next bed, somebody with advanced cervical cancer, and they’d say, ‘Oh, she has cancer, let’s go on to the next person.’”
Oncology was not a major part of local training. If a cancer patient arrived bleeding and severely anemic, “they’d transfuse the patient and send them home to die,” Rosen says.
Rosen suggested they establish an oncology clinic so patients could be seen in one location rather than sporadically through the week, which accelerated the learning process for on-site gynaecologists.
He helped organize a cancer screening study that was led by Susan Cu-Uvin, professor of obstetrics and gynaecology at Brown University, alongside U of T representative Astrid Deb Christopherson, now an ob-gyn at B.C. Women's Hospital. The study required two nurses to relocate to Kenya, and whom they secured through AMPATH. The plan was for the nurses to run the study at the gyn-onc clinic for one year to screen 150 women; they hit their target in two months. The study’s success paved the way for Rosen to petition the CEO of the hospital to continue funding the nurses indefinitely, a huge win for the clinic.
“With the screening study, they started to discover things they’d never seen before — like early-stage cervical cancer,” says Rosen. “All they had ever seen was advanced stage.”
Early-stage cervical cancer can be treated with surgery, and the screening program had identified seven candidates for a radical hysterectomy. But the local surgeons did not have the training. Rosen stayed in Kenya to teach them the procedure, beginning with gynaecologists Elkanah Omenge and Peter Itsura.
The seven patients were scheduled for surgery over a two-week span. Rosen worked side-by-side with the trainees for the first week. By the end of the second, he didn’t even scrub up.
“If you’re a gynaecologist in Kenya, if you’re already a practising ob-gyn, you’re already a capable surgeon. You see a lot of very difficult things, and you do a lot of difficult surgeries,” says Rosen. “They just took off.”
To continue their studies, Omenge and Itsura applied to gyn-onc fellowships in South Africa, the only place on the continent that offered this specialized training. Such a move followed a well-established pattern of trainees going abroad to study and then obtaining more attractive jobs either there or elsewhere. They rarely if ever returned to Kenya.
To keep the surgeons where the need was greatest, Rosen was approached with the idea to set up a fully certified gyn-onc fellowship program at Moi University School of Medicine. Rosen was skeptical that it could be done, given the university had no other subspecialty training programs of any kind, and credits the University of Toronto for its commitment and guidance through the process. The key was to aim for longevity and sustainability — for Rosen and his U of T ob-gyn colleagues to develop a detailed curriculum that met the requirements of Canadian postgraduate medical education.
Rosen pitched it to Moi University administration for certification as “not a Barry Rosen program, but a Moi University program.” It worked.
Once the program launched, a lineup of Canadian doctors wanted to participate — including Allan Covens, a professor of obstetrics and gynaecology at Temerty Medicine, who has visited Eldoret every year since 2012 (excluding the Covid years). The surgeons who travelled to Kenya would spend several weeks training fellows on surgical techniques, decision-making and patient care. The Kenyan fellows would come to Toronto for a six-week observership to study pathology, palliative care, radiation and other areas that Moi University didn’t have the capacity to teach.
In 2014, Omenge and Itsura — the first two trainees — graduated. Today, Omenge practises and teaches at Aga Khan University Medical College in East Africa, and Itsura is head of the department for reproductive health at Moi University.
“We try to develop the fellows’ leadership skills, because wherever they go in Kenya, they’re going to be a leader,” says Rosen. He notes the success of the gyn-onc fellowship also inspired Nan Okun, a professor of obstetrics and gynaecology at Temerty Medicine who is on staff at Sunnybrook Health Sciences Centre, to develop a parallel fellowship in maternal-fetal medicine.
While Rosen will step away from clinical work in January 2026, he plans to continue holding weekly virtual teaching sessions with the Kenyans.
“Ten years ago, I didn’t think I’d still be doing this,” he says. “It’s right up there with any other highlight of my career. It changed my life.”
Support U of T-AMPATH with a gift in honour of Barry Rosen
The fellowship program’s funding faces an uncertain future. To help ensure this important program’s continued impact, we are asking community members to consider supporting U of T–AMPATH with a gift in honour of Barry Rosen and his work over the last two decades.
Tax-deductible donations can be made online via U of T’s secure giving form, or by contacting Samantha Correia at samantha.correia@utoronto.ca or 416-662-5975.
