I am planning to go to Lilongwe, Malawi to work at Kamuzu Central Hospital (KCH) for 6 weeks between March and April, 2024. I first went to KCH as a Texas Children's Global Health Corps (https://www.texaschildrensglobalhealth.org/globalhealthcorps) in 2019-2020. Since then, I have been working to improve pediatric care at KCH by partnering with local pediatricians in research (https://pubmed.ncbi.nlm.nih.gov/37339764/), education, and clinical care.
The goal of my trip is to continue to grow the partnership I have with KCH in direct clinical care, education, and research. I will provide direct clinical coverage 4 days a week for 6 weeks for a pediatric department that evaluates 100,000 patients per year and only has about 1-3 fully-trained pediatricians available. I will teach the 4 MMED candidates (i.e. pediatric residents) that my institution has helped to sponsor this past 2 years. I will also teach up to 10-12 interns who are rotating through the department. Finally, I have received approval from departmental leadership to begin building a local team to investigate nursing and physician attitudes and practices towards reassessment with vital signs.
This trip will help me maintain the relationships I have built with KCH pediatricians over the past 5 years and help strengthen and empower these local leaders to improve their health system.
KCH evaluates approximately 100,000 patients per year. The mortality rate for inpatients is approximately 4%. Unfortunately, there are few fully-trained pediatricians in Malawi and at KCH. Therefore, my trip will help more of these patients to receive care from a fully trained pediatrician like myself.
I will provide direct clinical supervision for about 20-30 patients per day while, at times, providing indirect clinical coverage for a department whose census ranges from 60-150 patients. I expect to teach multiple Malawian medical learners.
I also expect to create a local team for our research project that will include nurses and physicians. We are planning a qualitative study to investigate the attitudes of clinicians towards vital sign reassessment. The general outline of this project was approved by leadership because the department is prioritizing triage and reassessment in its quality improvement initiatives to improve care. My goal is to finalize our team and submit an IRB to my local institution and the Malawian governing body through this trip.
For 5 weeks, I was one of only about 2-3 fully trained pediatricians available to be responsible for the 300-400 children admitted to Kamuzu Central Hospital (KCH) every day. I helped teach about 20 different medical trainees through bedside teaching and formal lectures, including one on anaphylaxis (see picture). I also mentored a medical officer in developing a research proposal to determine the beliefs and behaviors of nurses and clinicians at KCH, which we proposed to physicians and nurses representing KCH and the 4 US institutions that support KCH.
