Sometimes, we wind up exactly where we are meant to be in life. For Dr. Francis Aho, DNP (Class 37), CNM, that place has been with Africa Mission Services (AMS) in Kenya since 2008. She recently opened the Africa Mission Services Women’s Health Center, an 11,000-square-foot building that includes both inpatient and outpatient services, as well as a labor and delivery wing. The birth center provides an extremely rural and underserved population with vital services that were previously administered as a small component of the AMS Community Health Clinic, which serves the Maasai tribe of the Maasai Mara National Reserve in Kenya.
“This is major for us,” Aho said. “We have an outpatient department, an inpatient maternity wing, and then an OB labor and delivery wing. We started out in a little clinic building with just an exam bed, no electricity, no running water.”
In 2016, Aho and her team renovated an area of the AMS Community Health Clinic to provide more space for maternal health services, but the need for a larger, dedicated space is evident. In 2023, Aho and her team of four Kenyan midwives delivered 612 babies in a community with an estimated population of 11,000.
“It is really hard to know the actual population,” Aho said. “We are on dirt roads. If you drive down the road, it looks like nobody is around here, but they are all in little huts and homes in the bush. We also have women from farther away who come for ultrasound or specialty care such as infertility.”
What might seem overwhelming to some is exactly the environment Aho craves. Born in Switzerland, she and her family came to the United States when she was 4, moving around a lot before settling in rural western Tennessee when she was 10. She grew up in a very religious family and often read about mission trips and mission work. Her passion for serving led her to become an ER nurse, where she found that she also thrived on the adrenaline rush of providing urgent care. She thought of becoming a flight nurse, which would be both exciting and fulfilling, but the idea of mission work was also in the back of her mind. She did some mission work in Honduras and sought a more permanent position. That’s when she found AMS. She moved to Kenya in 2008.
“At that time, there was a clinic – just a little building – and visiting doctors would open it up,” Aho said. “It would be open for a week and then shut down. I asked Africa Mission Services if I could come and open up the clinic full-time. I was 24 and thought I could change the world. A Kenyan provider, thank goodness, asked if he could help open it up. We came the same week. That was December 2008.”
Aho recalls losing a 5-year-old patient with malaria just three days into her time at the clinic and hiking into the village to treat pregnant women while the Kenyan provider treated the men.
“I was an ER nurse and knew nothing about women’s health,” Aho said. “I was just kind of feeling around their bellies and talking to them about nutrition. I had no clue what I was doing. That evening we delivered our first baby with a little mini Maglight. The girl who is now in charge of my office was holding the mini Maglight, and I delivered the baby.”
Despite the uneven start, Aho was hooked. Aside from a two-year hiatus from the clinic after the birth of her twins in 2014, she has remained at the clinic along with her husband, Andrew, who is the founder of AMS.
After the birth of her children, Aho’s awareness of the need for maternal care was heightened. She needed to learn more in order to better care for these women and their babies.
“I think my maternal instinct kicked in. I had to change things,” she said. “I ended up going to Frontier Nursing University and decided to become a midwife. We did a big fundraiser, got equipment, and renovated a whole area at the clinic, and that’s where we set up the birth center. I hired Kenyans who were more specialized midwives and knew maternity, and we became the Women’s Health Center.”
After earning her CNM at Frontier, Aho went on to get her DNP from Frontier as well. Her DNP project led to the establishment of a prenatal class at the clinic.
“I have learned basic OB ultrasound and taught two of my midwives,” she said. “As I was doing my DNP, I decided, as part of it, I would ultrasound all the women. I did ultrasounds on hundreds of women for my DNP project. That’s what made me learn OB ultrasound.”
Aho’s enrollment at FNU coincided with the university updating its policies to disallow clinicals being completed internationally. Aho feared she might not be able to continue.
“I was all gung-ho and ended up going to Frontier Bound that week they announced online that they were not allowing international clinical,” Aho said. “They worked with me. I went and did three months, then I flew back to Kenya for two months, and then I flew back and finished. I did my clinical in Chattanooga. For my DNP, they allowed me to do my project at my clinic. Being able to do it somewhere where I have autonomy and leadership, I was able to choose something that was very impactful for my population and clinic.”
Like many others, Aho was drawn to FNU’s mission to provide care to rural and underserved communities and populations.
“I chose Frontier because of their mission,” Aho said. “Their mission is really to give back to rural areas and underserved populations, and that really hit home with me.”
Without question, Aho certainly serves a rural and underserved area. Not only are healthcare services limited, but so are travel and overall access to care. AMS has modified a Landcruiser to serve as an ambulance able to traverse the rough and muddy dirt roads. It is over an hour’s drive to a facility that can perform a C-section and two-and-a-half hours to get to the nearest NICU.
“We are the first line for anything emergency-related in the area,” Aho said. “We deal with a lot higher risk than a birth center should, considering we don’t have C-sections, but we see patients that we will never see for prenatal care who will show up at our door ready to deliver. We have a population of HIV-positive moms, we deliver twins at least once a month. We have done triplets. We have done breach delivery. When we do an ultrasound and know that they are twins, we do the counseling and tell them they should go into town and deliver where there is a backup for C-section, but at the end of the day, they can afford to come to us, and they are going to show up.”
They can afford the care Aho and her time provide thanks to AMS being aligned with the Kenyan government’s insurance program. The government provides payment for rural women, even if they are uninsured.
“The majority of people don’t work, and they don’t have insurance,” Aho said. “They can come to our clinic, we sign them up, and then they get four prenatal care visits, the delivery, four well-baby checkups, and the immunizations that the government will pay us for. We get about $20 for the delivery. It’s not big money, but it’s more than we could charge the locals. It does help cover our payroll, but we haven’t been paid since March of 2023.”
AMS, which is a nonprofit with no religious affiliation, relies on donations, fundraisers, and volunteers to help serve its mission. Volunteer medical teams, construction teams, and even landscaping teams provide much-needed physical support.
“When I have a medical team, I will go out with them, and we will set up mobile clinics in the villages that don’t have a healthcare facility, and we do free clinics under a tree,” Aho said.
With the opening of the AMS Women’s Health Center, Aho will do so with a 12-person staff, including four midwives, a lab technician, a pharmacist, and social workers who are birth assistants. Together, they are committed to providing excellent healthcare while respecting the culture and values of their patient population.
“Having a birth here is a woman’s event completely,” Aho said. “They are polygamous in general, so they come either with a co-wife, a sister, mother, some other women – and we will often have a room full of women supporting one mother. We will let mothers come into the room if women are giving birth and they want their mom or another woman to give them strength. They have certain practices like blowing air into the mom’s mouth that give them strength, conveying strength from one to the other. I try as much as possible only to educate and change things that are not healthy for the baby or mom.”
“I don’t want them to feel judged when they are giving birth,” Aho said. “I feel like I empathize with the women here. They have a tough life, and if I can make their childbirth experience safer and give them a place where they can rest and feel treated with respect and their cultural values respected, it gives me a high sense of fulfillment.”
The opening of the Women’s Health Center this summer figures to be equally fulfilling. She hopes that it will grow beyond providing maternity care to addressing other needs, such as breast cancer and cervical cancer testing and treatment.
“I never came in with the idea that I could raise enough funds or start this big women’s health center,” Aho said. “My dream is that this women’s health center way outlasts me. I will feel like I have been successful if I have trained the locals to know what I know and if the center doesn’t shut down when I leave.”
Much of Kuo’s committee work involves ensuring that APRNs are working within their scope of education, certification, and licensure. This, he says, ultimately leads to a better overall healthcare system.
“As I became more involved in the mental health world, I needed to make sure I had the education and training to back that up,” Kuo said. “That’s when I decided to go back to Johns Hopkins. Once I was done with that program, then my work in mental healthcare catapulted. I worked on ways to improve mental healthcare in the workplaces that I was in. I just grew to embrace mental healthcare.”
“I started in 2015 with myself and a front desk person,” Hicks said. “By 2020, I had a front desk person and a part-time nurse.”
Hicks’ real mom was also a nurse but encouraged her to become a physician. “I told her I wanted to become a nurse because I had watched her and how her colleagues and patients loved her,” Hicks said. “She loved her work. She made me promise that if I wanted to be a nurse, I would go to the top and make an impact.”
Part of refining her clinic to meet the community’s needs included the establishment of C-Trilogy Outreach, a non-profit branch of C-Trilogy, in 2020. This came in response to a growing number of patients, both insured and uninsured, who were presenting with more complex issues during the pandemic.
Understanding that C-Trilogy cannot fix the state’s mental healthcare needs alone, Hicks has become a vocal leader in advocating for increased awareness and funding. As a presenter and speaker, she addresses the importance of the social determinants of health in providing individualized and holistic care on a broader scale.
The experience only strengthened her resolve to become a nurse. Once she had her driver’s license, she would go to the hospital and watch the babies, nurses, and doctors through the nursery windows.
“I was in class number 22,” Bovée said. “What a fabulous experience that was! The two trips to Hyden for the 
“The hospital where we had privileges was happy with our service,” Bovée said. “The administrators and physicians at the hospital came around to understanding the benefits and qualities of nurse-midwifery care. It involved years of persuasion and persistence. It involved countless revisions of nurse-midwifery documents involving policy, procedure, and delineation of privileges. I consistently worked to be present at the table or at decision-making events. It took us 13 years to get permission for us to have student nurse-midwives in the hospital. I consider this my legacy. My colleagues call me the ‘Pioneer Midwife’ in the east valley, and I am honored to have this title.”
Frontier Nursing University is excited to announce the launch of our Continuing Education Program.