In March 2020, I will be returning to Kamuzu Central Hospital (KCH), a referral hospital in Lilongwe, Malawi, to work in the pediatric wards. This project will be a predominantly clinical rotation. I completed my first clinical rotation at KCH in April of 2019 and plan to return this upcoming spring as well as the year after. The pediatric wards have about 215 beds and collectively admit more than 27,000 patients per year.
The majority of my time at KCH will be spent in the Emergency Zone. In the Emergency Zone, residents work alongside local medical officers, interns, and medical students to care for often critically ill patients. Residents take vital signs, document clinical encounters, administer breathing treatments, set up nasal cannulas and positive airway pressure, administer medications at times when nurses are unavailable, and retrieve blood from the blood bank. We predominantly communicate with and educate patient families through the assistance of medical students who translate for us. While working with medical students, we are able to teach components of history taking, physical exam skills, diagnosis and disease management. In the months leading up to my clinical rotation, I will also be working with a mentor at my institution as well as a local mentor to start a research project likely related to quality improvement.
Resident rotators help more patients be seen at KCH each day than may otherwise be evaluated. We are also able to escalate the care of more patients to a higher acuity of care than would happen in our absence. We educate medical students who will likely continue to care for pediatric patients in some capacity, and I hope that we influence some students to go into pediatrics for their careers. I plan to additionally identify a research area before and during this trip in an effort to improve the care that children at KCH receive.
As detailed above, the pediatric wards collectively admit more than 27,000 pediatric patients per year. The children hospitalized at KCH benefit from additional physicians being present because it improves quality of care. By performing the tasks detailed above, patients are able to get respiratory treatments, blood, medications and other treatments more readily. This pediatric patient population is important to me. Most of the children I will see are critically ill in a low resource environment, and I want to do my best to make a positive impact in their lives.
Additionally, medical students benefit from resident rotators being present because it increases education they receive on rounds and during the afternoon lectures that we prepare. I look forward to teaching medical students and have also been very grateful for the students with whom I worked for teaching me language and local culture.
I hope to positively impact the care pediatric patients receive at KCH and also to add to the medical education that students receive at KCH. Furthermore, I know that this project will have a profound impact on me. I am at this time strongly considering a fellowship incorporating Hospital Medicine and Global Health. This rotation allows me to continue learning how to deliver care in a low resource setting, diagnose and treat a wide array of pathologies I am less likely to encounter in my current practice setting, and conduct research; it will also help me further decide what I want to do in my career. The experience I gain from returning to KCH will help me to better care for patients in the United States and abroad.
Unfortunately, my time at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi was cut short by the pandemic. I was only able to spend two of my anticipated four weeks working on the pediatric wards. Because my time was cut short, my work on this trip was solely clinical. It was an honor to work with the children and parents at KCH as well as learn from and work along side with local residents and medical officers. I look forward to returning in the future!