In the Center for Heart and Vascular Care, we are proud to have vascular surgeons, cardiothoracic surgeons, cardiologists, interventional radiologists, electrophysiologists…and the list goes on and on. In total, there are more than 42 faculty physicians treating patients under the umbrella of UNC Heart and Vascular.
Let’s compare that to the impoverished southeastern African country of Malawi, which has a population of 14 million people. They have 25 surgeons total. In the entire country. Most of whom are not Malawian.
Just try to imagine that.
In July 2009, the UNC Departments of Surgery and Otolaryngology/Head & Neck Surgery partnered with Kamuzu Central Hospital in Malawi, the Malawi College of Medicine, and the Haukland University Department of Surgery in Norway to establish a new surgical resident program at Kamuzu Central Hospital.
Called the UNC Malawi Surgical Initiative (MSI), the mission is to train Malawian medical school graduates to be surgeons in a COSECSA-approved General Surgery Residency Program. The graduates will be supported by the MSI program throughout their surgical careers and will learn research methodology, grant-writing skills, and research implementation.
Joseph Fulton, MD, Assistant Professor, Division of Vascular Surgery, is one of the faculty involved in the initiative, training and educating the surgical residents at Kamuzu Central Hospital.
Having recently returned from a two-week trip to Malawi, Dr. Fulton says, “This was my second excursion to Malawi, and I’m already looking forward to going back.”
Dr. Fulton began his work with MSI in May 2011. During that four-week trip, his wife and three children, who were 11, 9, and 8 years old, accompanied him. While Dr. Fulton was working at the hospital, his family was spending time with local children and volunteering at an orphanage.
Photo courtesy of Dr. Fulton
“There is certainly a paucity of general surgeons in sub-Saharan Africa, and particularly in Malawi,” explains Dr. Fulton. “There are even fewer surgeons possessing sub-specialty skills.”
For example, he says, “Malawi has four dialysis centers, each with four dialysis machines. Two of these centers are in Lilongwe and the other two are a four-hour drive away in Blantyre. There are no surgeons in Lilongwe currently capable of creating an arteriovenous fistula for dialysis. Few patients can afford to travel to and from Blantyre for an operation, therefore there is an alarmingly high mortality rate due to catheter sepsis.”
“One of my principal reasons for going to Malawi has been, and is, to perform these procedures and to gradually train the surgical residents to be able to do likewise,” says Dr. Fulton.
As sub-Saharan Africa grows and develops with an improved economic potential, the people face an increase in non-communicable diseases, many of which are surgical conditions that if treated in a timely and effective manner, can return people to a normal, productive life.
Dr. Fulton says, “While dialysis access brought me to Africa, I found myself doing a majority of general surgery cases, such as hernias, bowel obstructions, trauma laparotomies, amputations, and tumor resections. It is amazing how much surgical pathology exists in Malawi and at what late stage they present. “
“One of the greatest challenges for me was transitioning from a resource-rich health care system to one that is resource-poor,” he states. “Aside from the lack of imaging modalities (no CT or MRI) and laboratories, there are the frequent obstacles such as a hospital-wide lack of IV fluids, loss of running water, no pediatric ventilators, etc. It forces you to be flexible and creative in both diagnosis and treatment.”
Along with operating, Dr. Fulton participated in a daily educational case conference for the residents and medical students, ran suturing labs, presented medical student lectures, and routinely led ward rounds on more than 60 patients.
Photo courtesy of Dr. Fulton
To go along with his clinical and educational work, Dr. Fulton is also collaborating with other international physicians in clinical research dealing with end-stage renal disease in Malawi.
After their training at Kamuzu Central Hospital, the surgical residents will be able to spend their lifetime providing surgical care in Malawi, where surgeons are desperately needed. They will also become the faculty for the self-sustaining program, training generations of surgeons and leaders.
In a country where only $14 per person is spent each year on healthcare, the UNC Malawi Surgical Initiative is providing training and leadership where it is needed the most.
“We are working alongside other international surgeons to help provide a sustainable, self-reliant health care system in Malawi, in which surgery is becoming more and more vital,” says Dr. Fulton.