I am planning to work in the Pediatric Emergency Room at Kamuzu Hospital in Lilongwe, Malawi where I will act both as clinical learner and educator alongside the local health care team. One of my primary goals is to gain insight into the local burden of disease, available resources, and knowledge gaps in the field of pediatric emergency medicine in order to broaden my own clinical education and conduct a needs assessment of the facility. Additionally, I plan to begin the design of a sustainable project focused on improving the use of limited medical resources and their triaged distribution in the Emergency Center. Only after I’ve spent time working with the team, discussing their needs and current projects, will I be able to begin work on a project centered around the appropriate resource for study design and implementation. My time will also be spent providing pediatric education to local students and residents through morning rounds, didactics, and clinical case sessions.
Malawi is a landlocked country in southeastern Africa considered a low income country according to the World Bank with a significant health burden including a high under-five mortality rate and prevalence of malnutrition, malaria, TB, typhoid, and HIV/AIDS. The general population of Malawi is estimated to be 18 million, with ~46% of those children under the age of 15. Malaria alone is estimated to be the cause of 40% of hospitalizations for under-five children. My scope of practice will be limited to the pediatric ward of Kamuzu Central Hospital in the capital city of Lilongwe, Malawi where I will act a pediatric emergency medical provider and instructor. The hospital admits more than 27,000 pediatric patients a year, sometimes caring for over 100 acutely ill children a day in the close quarters of their one-room emergency center. Villages and clinics across Malawi send families to Kamuzu for emergent care needs as it is one of the few centers in Malawi to offer pediatric specialty and subspecialty care.
The overall expected impact of my time in Lilongwe is to provide pediatric emergency medical services alongside the health care team in order to better understand local practices and institutional needs. Clinical time will serve as an adjunct to the medical care currently being offered by local practitioners, and educational time will be a collaboration with other in-hospital staff to improve sustainable pediatric care. One of the WHO’s strategic agendas for Malawi within the scope of strengthening health systems is to promote evidence-based decision making. My hope is that over time the joint learning endeavors with local provides will become a platform for this evidence-based clinical care across Malawi. I also hope to bring case presentations and shared experiences back to my Pediatric Emergency Medicine fellowship program and colleagues in the U.S. as a chance to expand our understanding of global health care needs.
I recently returned from Lilongwe and have been sorting through my experiences, trying to understand and process the incredible opportunity and patient care I was invited into by families and staff.
As with most global health trips, I was saturated with learning offered by the many gracious and knowledgeable providers I interacted with on a daily basis. One of the highlights was teaming up with the group of medical students and interns rotating through the Pediatrics ward. They taught me so much about humility and compassion, as well as cultural practices in Malawi, and their "typical" pediatric diagnoses. For example, bronchiolitis is a typical diagnosis in both the States and Malawi, whereas Malaria is one of the most prevalent and therefore "typical" diagnoses in Malawi.
The children's guardians were especially impactful though: Their selflessness in staying day-in and day-out with their children on crowded beds in a crowded ward, along with their patience for a foreign physician just learning her way around a new system and new wealth of knowledge was remarkable and inspiring.
My pictures illustrate the hospital and children's ward where I worked, along with a few "tricks of the trade" I picked up from the health care team. The nurses were always willing to demonstrate troubleshooting methods - like an 18G needle in a bag of Normal Saline fluids to equilibrate the pressure and improve the drip rate for the patient. I also learned that the primary role for the ambulance is to transport patients between hospitals rather than respond to roadside accidents or medical emergencies at this time. And plastic bottles are everywhere, recycling them as spacers for inhalers provides the perfect device for asthmatics who need a spacer for their albuterol!