Burns, Trauma, Surgery

Globally, burns are a significant public health problem, and fire-related deaths are a leading cause of death among children and young adults. Ninety-five percent of fatal fire-related burns occur in low- and middle-income countries. Prevention efforts fall far short of those in high-income countries, and treatment for burns is both costly and lengthy. Similarly, road traffic injuries are the leading cause of death among young people aged 15–29 years.

A child on the burn unit at Kamuzu Central Hospital, Lilongwe, Malawi. Photo: Caitlin Kleiboer

A child on the burn unit at Kamuzu Central Hospital, Lilongwe, Malawi. Photo: Caitlin Kleiboer

Research

Injury Surveillance and Trauma Registry at Kamuzu Central Hospital

Trauma registries are an integral part of injury surveillance, but are rare in resource-constrained countries. UNC surgeons in Malawi have developed a hospital-based trauma registry in partnership with Kamuzu Central Hospital in Lilongwe. KCH is the tertiary care center for Malawi’s central region, serving a population of about five million. The registry can be used to determine the burden of injury in Malawi, establish norms for trauma outcomes at KCH, and implement a foundation for quality improvement. Contact: Jon Samuel

Clinical Care and Training

Malawi Surgical Residency Program (Malawi)

Many injuries in Malawi require surgical care, but there are only 25 surgeons in Malawi, and very few of them are Malawian. Training Malawians to be surgeons, teachers and leaders has the potential to provide and improve surgical care for years to come. The Malawi surgical resident training program at Kamuzu Central Hospital is the largest training program in the region. Established in 2009, it is designed for general practitioners and leads to fellowship in the College of Surgeons of East, Central and Southern Africa (COSECSA).  Through curriculum development, clinical and didactic training, and career mentorship, this effort continues to grow. The residency program is a partnership of KCH, the Malawi College of Medicine in Blantyre, Haukland University Department of Surgery (Norway) and the UNC Departments of Surgery and Otolaryngology/Head & Neck Surgery. Contact: Carol Shores or Anthony Charles

Burn Unit at Kamuzu Central Hospital (Malawi)

UNC is home to one of the premiere burn units in the U.S., the UNC Jaycee Burn Center. Since 2010, UNC Surgery has supported burn unit at KCH by providing training to Malawian staff, equipment and infrastructure development and research.  Burns predominately affect children—the majority of burn victims are under the age of 5. The burn unit sees about 2,000 patients per year. Among the most recent improvements is a new treatment room with a tub and shower to assist with wound care.  Future plans include building a dedicated operating room within the burn unit.

Jeff Wilkinson repairs a fistula at Bwaila Maternity Hospital in Malawi.

Jeff Wilkinson repairs a fistula at Bwaila Maternity Hospital in Malawi.

By training local health care providers, using mobile technologies for burn triage and consults, and improving treatment protocols, we have begun to improve burn care delivery in the central region of Malawi. Contact: Anthony Charles

Fistula Repair (Malawi)

Obstetric fistula is a devastating condition that occurs in girls and women almost exclusively in low-resource settings. It is usually caused by obstructed, prolonged labor and leaves women incontinent and therefore socially stigmatized. In June 2012, UNC Global Women’s Health partnered with Freedom from Fistula Foundation to open the only dedicated Obstetric Fistula Center in Malawi at Bwaila Maternity Hospital, at a ceremony headed by Malawi President Joyce Banda. As of that time, more than 450 women had been screened for fistula and 265 surgeries had been performed. UNC is collaborating with the foundation to prevent and treat fistula and help women reintegrate into society, often after years, or even decades, of isolation and shame.

Pediatric Cardiac Care and Training at Mulago Hospital (Uganda)

Since 2003, under the leadership of Keith Kocis, UNC faculty in pediatrics, surgery and anesthesiology have worked at Mulago Hospital in Kampala, Uganda, to deliver compassionate and competent cardiac care to infants, children, and adolescents. Through in-country training initiatives and a physician exchange program, we have worked to improve the medical knowledge of the Ugandan health care workforce. Contact: Keith Kocis.

Who’s Involved

Bruce Cairns

Anthony Charles

Keith Kocis

Michael Mill

Jon Samuel

Carol Shores

Selected Recent Publications

Haac BE, Charles AG, Matoga M, Lacourse SM, Nonsa D, Hosseinipour M. HIV testing and epidemiology in a hospital-based surgical cohort in Malawi. (World Journal of Surgery, 2013)

Kendig CE, Samuel JC, Tyson AF, Khoury AL, Boschini LP, Mabedi C, Cairns BA, Varela C, Shores CG, Charles AG. Cancer Treatment in Malawi: A Disease of Palliation. (World Journal of Oncology, 2013)

Tyson AF, Boschini LP, Kiser MM, Samuel JC, Mjuweni SN, Cairns BA, Charles AG. Survival after burn in a sub-Saharan burn unit: Challenges and opportunities. (Burns, 2013).

Qureshi JS, Ohm R, Rajala H, Mabedi C, Sadr-Azodi O, Andrén-Sandberg Å, Charles AG.  Head injury triage in a sub Saharan African urban population (International Journal of Surgery, 2013).

Qureshi JS, Young S, Muyco AP, Borgstein E, Charles AG, Mulwafu W, Shores CG, Banza L, Cairns B, Viste A, Mkandawire N. Addressing Malawi’s surgical workforce crisis: a sustainable paradigm for training and collaboration in Africa (Surgery, 2013).

Tomlinson J, Haac B, Kadyaudzu C, Samuel JC, Campbell EL, Lee CN, Charles AG. The burden of surgical diseases on critical care services at a tertiary hospital in sub-Saharan Africa (Tropical Doctor, 2013).

Kiser MM, Samuel JC, Mclean SE, Muyco AP, Cairns BA, Charles AG. Epidemiology of pediatric injury in Malawi: burden of disease and implications for prevention (International Journal of Surgery, 2012).

Samuel JC, Sankhulani E, Qureshi JS, Baloyi P, Thupi C, Lee CN, Miller WC, Cairns BA, Charles AG. Under-reporting of road traffic mortality in developing countries: application of a capture-recapture statistical model to refine mortality estimates (PLoS One, 2012).

Samuel JC, Msiska N, Muyco AP, Cairns BA, Charles AG. An observational study addressing the anatomic basis of mesosigmoidopexy as a rational treatment of non-gangrenous sigmoid volvulus (Tropical Doctor, 2012).

Samuel JC, Qureshi JS, Mulima G, Shores CG, Cairns BA, Charles AG. An Observational Study of the Etiology, clinical presentation and outcomes associated with peritonitis in Lilongwe, Malawi (World Journal of Emergency Surgery, 2011).

Samuel JC, Campbell EL, Mjuweni S, Muyco AP, Cairns BA, Charles AG. The epidemiology, management, outcomes and areas for improvement of burn care in central Malawi: an observational study (Journal of International Medical Research, 2011).

Akinkuotu A, Samuel JC, Msiska N, Mvula C, Charles AG. The role of the anatomy of the sigmoid colon in developing sigmoid volvulus: a case-control study (Clinical Anatomy, 2011).

Martin TD, Samuel JC, Routh ED, Der CJ, Yeh JJ. Activation and involvement of Ral GTPases in colorectal cancer (Cancer Research, 2011).

Samuel JC, Akinkuotu A, Msiska N, Cairns BA, Muyco AP, Charles AG. Re-examining treatment strategies for sigmoid volvulus: An analysis of treatment and outcomes in Lilongwe, Malawi (Global Journal of Surgery, 2010).

Samuel JC, Akinkuotu A, Baloyi P, Villaveces A, Charles A, Lee CN, Miller W, Hoffman IF, Muyco AP. Hospital-based injury data in Malawi: strategies for data collection and feasibility of trauma scoring tools (Tropical Doctor, 2010).

Samuel JC, Akinkuotu A, Villaveces A, Charles AG, Lee CN, Hoffman IF, Miller WC, Baloyi P, Hoffman M, Brown LB, Muyco AP. Epidemiology of injuries at a tertiary care center in Malawi (World Journal of Surgery, 2009).

Samuel JC, Muyco AP. Ward Round—paediatric bowel obstruction: a surprising and rare cause of a common problem (Malawi Medical Journal, 2008).