Building a surgery program in Malawi

February 2009

By Myron S. Cohen, MD, Director of the Institute for Global Health & Infectious Diseases

Among the challenges to improving health in resource-constrained countries are a limited health care infrastructure and inadequate workforce. Malawi has one of the lowest physician-to-population ratios in the world: 2 per 100,000 people. For the past 20 years UNC has been working to improve health care delivery at its research, care and training facility UNC Project-Malawi, located at Kamuzu Central Hospital in the Malawi capital of Lilongwe. UNC Project has always focused on treatment of infectious diseases, and especially HIV, but recently we have launched some exciting and promising activities in surgery, another area of great need in Malawi.

jonathan-samuel

UNC surgical resident Dr. Jonathan Samuel

Our surgery program consists of a partnership among several UNC faculty: Carol Shores (ear, nose and throat), Claire Lee (plastic surgery), Anthony Charles (trauma), Jonathan Samuel (general surgery), and Andres Villaveces (injury prevention). In addition to IGHID, support for these faculty efforts has come from the UNC Department of Surgery, North Carolina Jaycee Burn Center, and Center for AIDS Research (CFAR).

This team is strongly committed to service and training and spends much of its time in the operating rooms, working and instructing local surgeons on difficult sub-specialty cases. At the same time, these surgeons are all engaged in research projects designed to improve the health of the people of Malawi.

Trauma—particularly trauma caused by traffic injuries—is one of the leading causes of death in Africa. Not only is there a lack of skilled surgeons and emergency care, there is a dearth of data to support improving care. As a result, Drs. Charles, Lee, and Samuel have developed a trauma registry in Malawi. “After less than a year on the ground, the trauma registry is capturing an extensive data set on injuries treated at Kamuzu Central Hospital, says Dr. Samuel, a senior surgical resident. “We are comparing our registry data to police reports, which provides us with a better estimate of road traffic injury epidemiology,” he says. Jon moved to Malawi in 2008 accompanied by his spouse, Lillian Brown, an MD/PhD student completing her dissertation on Malawi-based research.

Jon and the team are also working on a national plan for training and action. They are assisting with the development of a surgery residency program for Malawian doctors and strengthening the surgical instruction of clinical officer students who administer the majority of surgical care in Malawi, especially in rural areas. “Directly providing clinical care is certainly rewarding,” Jon says, “but providing training and education will have a more lasting effect.”

By any measure, Jon has already been very successful. He has just been awarded a nationally competitive fellowship from the Fogarty International Clinical Research Scholars Program (FICRS). This award will allow him to spend a second year in Malawi. Jon is now assisted by a third-year medical student, Adesola Akinkuotu, who is supported by a prestigious Doris Duke Fellowship.

“Being involved in these activities with such a dedicated group of individuals from UNC is incredibly rewarding, says Jon. “I look forward to continuing to be part of UNC’s active presence in Lilongwe.”

When we started the UNC Project-Malawi 20 years ago, I never dreamed how large it would become. I certainly didn’t imagine that it would expand to involve UNC surgeons, and yet here they are, leading one of the most exciting and creative parts of our program.

You can read more from Jon Samuel on our blog, http://uncglobalhealth.wordpress.com/2008/12/18/a-surgeons-perspective/

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