I plan on spending one month working in the pediatrics department in Lilongwe, Malawi at Kamuzu Central Hospital (KCH), one of two teaching hospitals in the country. This will be through UNC hospital’s Project-Malawi program, which is a collaboration between UNC and the Malawi Ministry of Health. The majority of my time will be spent engaging in clinical activities on the pediatrics wards at KCH and in the Emergency Department, working side by side with Malawian trainees and physicians to treat acutely ill children with conditions ranging from malnutrition and dehydration to malaria and HIV.
The goals of this project are to provide much needed medical care to the children in Lilongwe and surrounding areas and to help the ongoing mission at UNC Project-Malawi to decrease pediatric mortality by improving practices and standardizing care for the major causes of death.
I also want this project to make a difference in my own medical practice. As a combined Internal Medicine and Pediatrics resident, I have learned how to take care of a wide variety of medical conditions in adults and children, though my training has largely been in a resource-rich large academic center where advanced medical interventions are widely available. By spending this month in Malawi, a country ranked among the least developed nations, I hope to gain skills and knowledge to treat diseases I have yet to be exposed to and to learn how to treat patients in limited resource settings. I will use this going forward in future experiences in global health and in general as a physician regardless of where I am working.
Malawi is a resource-poor nation in sub-Saharan Africa with more than half of its people living below the international poverty line. Its inhabitants suffer from food insecurity and malnutrition, dehydration from diarrhea, and a variety of infectious diseases. Malaria is endemic to Malawi, accounting for a significant number of admissions to the hospital. Kamuzu Central Hospital is a tertiary referral center serving about 5 million people. Anywhere from 40 to 120 pediatric patients are admitted per day depending on the season, and the mortality ranges from 2-5% per month based on recent estimates. The most common causes of death include malaria, malnutrition, HIV, and sepsis. While Malawi’s pediatric mortality rate is improving, there is still work to be done to decrease this further. By helping provide more standardized medical care for the more common medical conditions afflicting the Malawian children, there will hopefully be continued improvement in survival rates of pediatric patients at KCH.
The impact of this project will be in fostering continued collaboration between pediatrics residents from UNC and physicians and trainees in Malawi. This collaboration is important because it allows for physicians practicing in very different circumstances to work together and learn from each other. This exchange of knowledge helps both sides improve their understanding of medicine so as to better take care of patients in the future. This project will be invaluable in helping me become a well-rounded physician and in teaching me how to identify and manage conditions that I have yet to be exposed to as a doctor in North Carolina. These include the management of severely malnourished children, the treatment of infectious diseases such as malaria, HIV, typhoid, and others. I will also learn how to manage common pediatric conditions (such as dehydration or respiratory distress) with limited resources and technology, which will help me better take care of patients on future global health trips.
In addition, as stated above, I hope that part of the impact of this project is continued improvement in the application of more standardized medical therapy to the pediatric patients at KCH. Over months and years of the continued partnership between UNC and Malawi, the ultimate goal will be continued improvement in the pediatric mortality rate throughout Malawi, and in particular, the millions of people served by Kamuzu Central Hospital.
I spent one month working in the pediatrics department at Kamuzu Central Hospital in Lilongwe, Malawi. This was a challenging and amazing experience and I am so incredibly grateful for the opportunity to learn from the medical professionals at KCH and from the people and children of Malawi. We worked in a very busy medical ward, side by side with medical students, Malawian residents and consultants, and other international residents and doctors. We all worked together to provide medical care to the patients and problem solve with each other to help treat incredibly sick kids.
During my time at KCH, I learned how to treat children with the limited resources we had available to us and to rely more on my physical exam skills rather than medical tests and imaging. It was amazing to see how much we could do, sometimes with so little. I feel so thankful for the things I have learned this month and the people I have met. It was a privilege to take care of the children of Malawi and I hope I have the opportunity to return in the near future to continue this work.