UC Global Surgery program expands horizons

Traumatic brain injury, intestinal perforation from typhoid fever, appendicitis, severe burns from motorcycle accidents, infant hydrocephalus, and advanced tuberculosis leading to paralysis and pressure sores. Those are just a few of the cases seen on a “typical” Friday morning at Mzuzu Central Hospital in Northern Malawi by visiting surgical resident Young Kim. 

Kim, a current University of Cincinnati resident who completed a global surgery rotation in Malawi in 2018, calls his two month experience at Mzuzu Hospital in a word, “humbling.”

“Malawi has a completely different breadth of treatment modalities compared to the American population. CT scans are rare, interventional radiology doesn’t exist, and blood tests are limited to complete blood counts and some electrolytes. Anticoagulation is too expensive for most Malawians, and sterile technique is often restricted by lack of soap and running water,” says Kim. 

He adds though, that most residents are prepared to hit the ground running in their new environment because of the advice from those who have been involved with the program before them.

In the 350+ bed Mzuzu Central Hospital, upwards of 100 patients may be admitted for surgical conditions, divided among the five surgical wards. To meet this surgical need, residents operate three full days a week, while also managing the care of patients already in the hospital and evaluating new patients who present to the surgical clinic or come by referral to the hospital on any given day from health clinics or district hospitals throughout northern Malawi. There is an opportunity to make a significant impact on dozens of lives on a daily basis.

“If a patient presents to the hospital with an emergency condition, that patient takes top priority, and we mobilize our team and resources to get that patient to the operating room as soon as possible,” says Park.

“In Malawi, people tend to present very, very, late—they have waited so long, maybe because the village has had to raise money for the transportation to the hospital.  Getting one patient from their rural home to the district hospital can devastate the funds of an entire village. Everybody will work to support that family,” says Jocelyn Logan, MD, a graduate of the UC general surgery residency program (2010), who founded the UC Global Surgery Program.

“It’s no surprise therefore that by the time they arrive to their local district hospital, they can be very sick, and it may be up to the clinical officers at the district to see and treat these complicated and advanced cases. But they are such strong tight-knit communities they make tremendous sacrifices for one another,” Logan says.

As a point to Logan’s intent to make the experience bi-directional, visiting residents to Malawi provide educational sessions to nursing students, clinical officer students, medical interns, and junior staff members. In Malawi, there are so few trained physicians that clinical officers make up the backbone of the health care delivery system. Similar to a physician assistant, clinical officers receive three years of health sciences and hospital training. In Malawi, they are expected to function as general practitioners in the outpatient and inpatient settings, as well as perform procedures such as cesarean sections, aligning fractured bones, and hernia repairs.

Logan recalls one resident asking the clinical officers to provide a list of topics to talk about while there. “They were so excited, and they came back with four pages of ideas,” she says. “The hunger for knowledge is powerful there, and it's very inspirational; you realize it’s such a blessing to have what we have here and how much they value their work.”

 “What we’ve built up now is an amazing experience for these residents,” says Logan, “and not just because of the surgical cases, but also because of the people of Malawi. It’s a culture of generosity and sharing, gentleness, and that gets passed on in the experience.”

Kim says, “Over my two months there, I truly believe that we did everything we could to care for these patients and educate the clinicians. But, in the end, I think it is us that walk away with the greatest benefits from this humbling experience.” 

All photos in story provided by Young Kim and Charles Park.