I am currently a 2nd year Pediatrics resident at UNC. We have a partnership with a hospital in Lilongwe, Malawi that allows residents and faculty to serve and treat patients in the hospital. We work our of Kamuzu Central Hospital which houses one of the few pediatric hospitals in the entire country. As residents, our responsibilities will be to similar to our responsibilities in America. There is an attending physician who oversees the hospital, and we are tasked with helping them care for the patients using the resources and staffing available.
Ideally the children of Malawi will get the most benefit. As previously stated, it is a country without many Pediatric hospitals, so healthcare is limited. The number of Pediatric providers is also limited, so residents being available to help with patient care and management benefits the healthcare teams as well. UNC has other sites as well, but I chose this one, because I'm originally from West Africa, so my Global Health ambitions lie in the African continent. Malawi is a country that has significantly less resources than my mother country of Ghana. I feel like I'm in a good place in my training at this time to be able to be helpful and make an impact on the people.
My hope is that my trip is impactful on patients and their families. Patients have to be transported from far distances to get the help that they need, and the goal is to be able to be part of that mission. As previously stated, resources and manpower is limited in some of those settings. I want my presence to be able to help mitigate some of that burden and reduce the bandwidth of the faculty and staff that are providing care for the patients. I have never done a Global Health trip before, so this would provide me with a good foundation for future endeavors. I want Global Health to be part of my future practice, and this will hopefully be an ideal introduction to the field and the clinical work. I think there will be plenty of clinical pears and lessons that I will pick up and can incorporate into my career domestically as well.
This was my first Global Health trip ever, so I wasn't too sure what to expect. It was an incredible learning experience but definitely eye opening in some of the processes that I have gotten accustomed to. In terms of impact, I feel like there were patients that I was able to be of real benefit too. Language barriers were as present there as they are in other places, but there isn't quick access to translators like I am used to. Thankfully, I had opportunities to be able to be the bridge and speak to some patients where that was an issue. There was one family especially that had low literacy that I spent extra time with and even personally walked them to get the supplies they needed for treatment (the patients had to go pick up their own medication, fluids, lab vials, etc spread across the hospitals campus). I also got several opportunities to directly teach some of the House Officers and Medical students I got to work, since they weren't as tuned into Pediatric medicine as the Residents. Overall, though, I think I was able to impact the efficiency of care for several patients by being the extra presence and extra pair of hands in a very busy unit. Of course, though, I think the biggest impact was on myself. Not having so many tools as readily available as I do in my home institution, I had to learn to be very precise about diagnoses in the absence of extensive work-ups. There were several different pathologies that I have not been exposed to that I got to learn how to make quickly and in a cost-effective manner. It definitely gave me a n appreciation for the resources available to me as well as valuable lessons in not having to rely on them.
Going through the pictures, the first one was a patient with suspected septic emboli. However, due to unavailability of resources and monetary limitations, we weren't able to readily get a Doppler or other imaging work ups that would be standard in the US. The second image was a hemangioma on a patient who also had bilateral congenital ectropion. The Ophthalmology team was able to reduce the eyes individually and she was started on B-blockers. The third image was in their singular PediatricCardiology unit that had 2 ECHOs. The patient had an AV canal defect, which I found out wasn't operable in the country. During the discussions with the parents, the Pediatric Cardiologist had told them that usually they allow the patients some time to grow, then will often send them to India (or elsewhere) to get cardiac surgery.