In Malawi, where fewer than 50 pediatricians serve millions of children, there is little margin for delay—and even less margin for error.
For Dr. Elizabeth Fitzgerald, that reality has shaped her latest work, to help expand a Malawi-designed pediatric emergency training program at Queen Elizabeth Central Hospital (QECH) in Blantyre, to give healthcare workers the confidence and skills to act quickly when critically ill children arrive at their doors. Blantyre is the second largest city in Malawi, while Lilongwe, the home of UNC Project-Malawi, is the largest.
Her focus is the Advanced Malawi Pediatric Life Support course (AMPLS), a national training initiative modeled after the pediatric advanced life support certifications used in the United States but built specifically for the realities of Malawi’s healthcare system. The course was designed and implemented by Dr. Josephine Langton, a pediatric emergency medicine physician and associate professor of pediatrics at Kamuzu University Center for Health Sciences.
The program focuses on what healthcare workers can realistically do when a critically ill child arrives at a facility with limited staff, equipment, or medications. Its goal is simple, to help providers act quickly, stabilize children effectively, and prepare them for higher levels of care when needed.
Working with Dr. Langton and colleagues at Queen Elizabeth Central Hospital in Blantyre, Fitzgerald will help implement and expand the program, to address pediatric emergencies in resource-constrained settings.
“This program was developed by nurses, physicians, and community healthcare workers,” explained Fitzgerald, associate professor of pediatrics. “And it will be collaboratively taught to healthcare workers across different settings.”
Fitzgerald’s role will focus on training instructors and helping manage the logistics required to scale the program over the next five years. Ultimately, organizers hope the training becomes a national competency supported by Malawi’s Ministry of Health.
“The goal is for clinicians to feel more confident and prepared when children with emergencies show up,” she said. “To be able to stabilize them and prepare them for transport to a tertiary care facility or a higher level of care.”
A Connection That Became Personal
Fitzgerald’s commitment to the country of Malawi is not only professional—it is deeply personal. She first traveled there in 2011 and spent two years living and working in Lilongwe, caring for some of the country’s sickest children. The experience exposed her to both the tremendous healthcare challenges facing Malawi and the resilience of the people working to overcome them. She returned with two seven-month-old boys, twins from a Malawian hospital where children were being treated for severe malnutrition. Later, the twins’ half-sister Malawi would also join the Fitzgerald family. This connection has remained central to her work and perspective.
In 2016, Fitzgerald became UNC’s lead for PACHIMAKE—the Pediatric Alliance for Child Health Improvement in Malawi at Kamuzu Central Hospital and Environs. The partnership united Baylor College of Medicine, The University of Utah, Cincinnati Children’s Hospital Medical Center, UNC-Chapel Hill, and Malawian healthcare leaders around a shared mission: improving care for critically ill children. It was named for a Chichewa phrase meaning “heart of the matter.”
Programs were built collaboratively, and investments in training and infrastructure were designed to strengthen Malawi’s healthcare system long after visiting physicians returned home.
Together with Malawian partners, the alliance supported a pediatric residency training program on the Lilongwe campus at Kamuzu Central Hospital, creating a pathway for physicians to receive specialty training and remain in country. In-country members such as Dr. Tisungane (Tisu) Mvalo supported consortium residents.
Today, the pediatric residency program continues under Malawian leadership—something Fitzgerald views as one of the partnership’s most important accomplishments.
The Malawi Children’s Initiative
Fitzgerald has also found ways to remain closely connected to the work in Malawi. In 2017, she and her then-husband Dr. David Fitzpatrick, co-founded the Malawi Children’s Initiative (MCI), a nonprofit dedicated to supporting child health, healthcare education, and nutrition programs in Malawi.
“We’re a conduit,” said Fitzgerald. “There are generous people who want to help, and there are needs in Malawi. We have provided a trusted way to connect the two.”
Through MCI, Fitzgerald has helped fund pediatric residency scholarships, supported medical and nursing students, provided salaries for social workers, strengthened nutritional rehabilitation programs, purchased equipment and supplies, and facilitated specialized training opportunities for healthcare professionals. And the organization’s role often extends beyond fundraising.
“There are people who worked in Malawi who want to support someone there,” she said. “We can provide the mechanism to make that happen.”
Fitzgerald has also worked to address financial sustainability. One example emerged when a donor contributed $100,000 to support pediatric care. Fitzgerald asked local leaders what they needed most. Their answer was a private pediatric ward.
A resulting renovation created a ward where families with financial means could pay for upgraded accommodations and services. Revenue generated through the ward is returned directly to the pediatric department to support medications, staffing, and care for children whose families cannot pay.
Looking Forward
The Advanced Malawi Pediatric Life Support course represents a blueprint for how global health partnerships can evolve, shifting from external support to locally owned expertise and leadership.
Fitzgerald is looking forward to training nurses and physicians to become AMPLS instructors, while coordinating implementation efforts and helping to build the systems needed to bring the program to additional hospitals and healthcare facilities throughout the country. The program’s reach is expected to grow over the next five years, with ambitions extending into district hospitals throughout Malawi and increasing collaboration with the Ministry of Health.
“Every skill that stays, every clinician who is trained, every program that continues—that’s what changes outcomes.”
Visit the Malawi Children’s Initiative to learn more or make a donation.