Introducing Carolyn, Global Health Fellow!

Carolyn Schafer is a Global Health Fellow working with Access Health Africa and World Altering Medicine based in Lilongwe, Malawi. Carolyn's fellowship started as of August, 2018. 

Hi! I am so excited to be working with Access Health Africa and World Altering Medicine as a Global Health Fellow. I am coming to Malawi from Cleveland, Ohio. I earned my Bachelors of Science in Biology from Saint Mary's College (Notre Dame, IN) and went on to receive my Master's in Public Health from Saint Louis University where I concentrated in Global Health and Epidemiology.

I have worked and lived abroad many times over the past few years in South Africa, Belize and most recently Burkina Faso where I was a Peace Corps Volunteer. This is my first time in Malawi and I am very excited about the work that AHA and WAM are doing and how I can create a lasting impact with both organizations.

Over the next year I hope to improve upon the many amazing programs that these organizations are making possible. My goal is to create sustainability through the monitoring and evaluation of these programs and by working with our Malawian community partners.

Since being on the ground in Malawi, I have created all of the data collection instruments for our Medical/Surgical trip that is beginning August 17 and will run through August 25. I have been working closely with Angela, the other Global Health Fellow to finish any logistical tasks needed to prepare for the trip. I have also met with all of our community partners throughout the country and am excited to work more closely with them. I am excited to use my skills and build upon new ones through this Fellowship and the programs that AHA/WAM have already created.

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Surgical Week Wrap Up

Today wraps up our week in Malawi which has by all accounts been a huge success.  Dr. Henson and myself were able to exceed our surgical case goal with over 60 procedures performed in just 5 days.  This volume could not have been accomplished without the excellent planning of the AHA staff, exceptional OR personal and assistance of the Kabudula staff.  Power outages and limited supplies were daily challenges that required creative problem solving.  Head lights and generators were a most to keep the day moving.  Operating in Malawi has been a chance to step outside of my comfort zone and learn how to work with the resources at hand. 

 The opportunity to provide care for many people has been the highlight of our experience.  Regardless of the country, surgery is a scary event for patients.  The language barrier made comforting and reassuring patients a challenge, especially in our pediatric patients.  Despite their anxiety, the Malawian patients showed a strength not commonly seen in the United States and trusted that we would fix their ailment.  The hardest part of the week was turning patients away simply because there was not enough time in the day. 

So, as our week ends it has been an honor to be a part of the Access Health Africa team.  Our team quickly formed a small family.  Our days have been filled with work in the village followed by eating dinner while drinking local beer and chatting in the evening.  The group will be missed but not forgotten and we leave planning to return in the near future.

 

Thank you to Dr. Sean Martin, one of our volunteer surgeons for writing this blog! 

CPR/BLS Training in Ukwe, Malawi!

(Written Tuesday, August 21, 2018) What an amazing training experience today, in the village of Ukwe, Malawi! The participants from the women’s/children clinic were both receptive and excited to learn the components of C.P.R. The initial apprehension quickly turned into enthusiasm. Practicing the steps of B.L.S. and working together  demonstrating how to save a life, gave participant confidence that each of them is capable of making a positive impact in an emergency situation. The instructors and interpreter all agree that the knowledge gained will be an asset to this rural community.

Thank you to Dr. Francine, our volunteer CPR/BLS Trainer for writing this blog!

First day in the OR!

This trip has been an experience like no other (this coming from someone that has never left the U.S. before). Mostly, I’ve felt completely out of my element. It’s been a hard adjustment, but it has been one of the most rewarding experiences of my life. I’ve really enjoyed learning about Malawian culture and spending time getting to know our team. We spent the weekend screening patients for surgery and getting accustomed to our new surroundings.

Today was the first day of surgery. I work as an operating room nurse, so being in the OR felt like home. Our team consisted of 2 surgeons, 1 CRNA, 1 surgical tech and 1 OR nurse. The staff at Kabudula worked along with us, so we were able to see their methods in the OR. The schedule started out with 8 surgeries. With added on cases, we did a total of 12 surgeries. We worked non-stop all-day, taking only a moment to grab a snack or water. We didn’t mind the hustle and bustle because we were so absorbed in our work. Overall, the day was a great success. The dental team saw 70 patients and the CPR class had 47 attendees. After today, I am so excited for the days ahead. We have an awesome team doing some majorly awesome things here in Malawi.

Thank you to Allyson, our volunteer operating room nurse! 

Surgical Team Arrival!

Day 1: August 17, 2018

As the plane landed in Lilongwe, Malawi I felt every emotion, especially pure excitement.  Walking down the steps of the plane, looking across to the airport buildings, I spotted the Access Health Africa sign hanging from the banister and saw the AHA Fellows waving. Finding 6 large duffel bags of medical supplies and 3 small suitcases amongst 300 people’s luggage was actually much easier than I thought. All bags were present and accounted for so off to the customs officer to have the bags checked.  We were extremely blessed they didn’t confiscate any of our bags.  We had two very friendly ladies, Carolyn and Angela, waiting on us from Access Health Africa to welcome us and take us to the house.  After loading all the bags on top of a 15 passenger van we headed to the house.  It was a 30 min ride on the opposite side of the road and CRAZY driving but we made it safely.  We spent the next hour or so unloading and organizing all the things we needed to make our week doing surgery a success. We took a trip to the grocery store to purchase snacks.  I was amazed that the grocery store was not much different from the ones in the US.  Great pizza was served from a local Malawi pizza restaurant.  We were advised to stay awake until 9:00 so we would be able to sleep all night due to the time difference.  So after checking in back home I took one of the hottest showers I have ever had and go into my bed surrounded by the mosquito net and fell asleep.

 

Day 2: August 18, 2018

The alarm goes off at 7:30 and it’s time to start day 2.  After everyone fixed themselves breakfast and got dressed we left for Kabudula Hospital.  It was a 45-minute drive, and a CRAZY one.  Some of the road is paved, some are not. On the drive we did get to see different villages where the homes were built of self-made bricks and mostly straw roofs.  After arriving to Kabudula hospital we started the pre-op process.  We split up into vitals, anesthesia approval, examination by the doctor, and surveys.  After having their vitals and anesthesia work up, Dr. Henson and Dr. Martin did an exam and decided if the patient was eligible for surgery.  We saw 18 patients and scheduled 15 for surgery, a very successful day.

 

Day 3: August 19, 2018

In the morning, we packed the van with enough supplies to accomplish 2 days of surgery and headed to Kabudula Hospital to pre-op more patients.  We saw 19 patients but scheduled 15 for surgery.  Some of us went to the maternity ward to see if there were any patients in labor.  Its not like laboring at home.  These ladies are lying on a cement floor in active labor and not making a sound.  After they get to a certain point in labor they are moved to the delivery room where they lay on a delivery bed but it is far from the luxury beds in the US.  There is one nurse to take care of the laboring mother and the baby.  She is responsible for all laboring patients.  Today there were 3 in labor and 2 in active labor.  We also went to the pediatric ward.  There were 12 patients.  It is the family’s responsibility to take care of their child while at the hospital. After setting up the OR for our day tomorrow we headed back to the house.  Tomorrow we have planned for 8+ surgeries, wish us luck!

 

Thank you to our wonderful surgical tech, Tyra for writing this blog! 

Updates from Malawi

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Surgical week is almost upon us! Staff in both the US and Malawi have been preparing for weeks to treat and see over 80 surgical patients, 120 dental patients, and provide CPR/BLS trainings  and fluoride treatments for Malawians in Kabudula Community Hospital and Dzaleka Refugee Camp.

Access Health Africa has recently hired two Global Health Fellows who are on the ground in Malawi working on various arrangements that have involved a close partnership with the Kabudula Hospital Staff to recruit patients, ensure there are the correct supplies and medications and equipment for the various activities that will be occurring over the next week. We are lucky to have such a close partnership with the staff in Kabudula that has lasted over 9 years and are looking forward to improving upon our past surgical trips with their inputs. They are also excited to be in partnership with us and look forward to working every year with their friends and colleagues from the United States! 

Introducing Angela, Global Health Fellow!

Angela Quashigah is a Global Health Fellow working with Access Health Africa and World Altering Medicine, based in Lilongwe, Malawi. Angela's fellowship started in July of 2018. 

I am a U.S. citizen, born and raised in a suburb outside of Philadelphia, PA. I am the first member of my family to complete a higher education and the first to travel outside of the Eastern U.S. I completed my undergraduate studies at Central Washington University (Ellensburg, WA) and my Master’s degree in Sustainable Development at the University of Florida (Gainesville, FL).

I have now lived and worked in rural Malawian villages for the past 3 years, starting out as a Peace Corps volunteer near Liwonde National Park, and continuing on as the founder of a nonprofit community-based organization near Malingunde called the Mustard Seed. Prior to coming to Malawi, I served aboard a hospital ship called Mercy Ships along the coast of West Africa for a year.

I am proud to be the first Global Health Fellow in the WAM/AHA partnership, and I am looking forward to working with both organizations and their local partners to accomplish common goals for the improvement of health in Malawi. My goal in this position is to combine my academic background with my local experience to contribute to the missions of reducing preventable deaths/suffering while increasing access to health services, education, and resources at the community level.

I am currently helping to organize the upcoming surgical trip in August, during which a team of doctors from the U.S. will come to Malawi to perform necessary surgeries for 40-60 patients in 1 week, while training local surgeons on the procedures. There will also be a Basic Life Saving Skills/CPR training for local clinicians and community health workers. The visiting team will be working at both Kabudula Community Hospital and Dzaleka Refugee Camp. Throughout my time with WAM/AHA, I will also be assisting with monthly distribution of essential medicines to community hospitals which would otherwise lack these supplies. I also plan to support and enhance the ongoing scholarship program, as well as continuing to link needy patients with necessary funding for their surgeries through a Watsi partnership.

Meet Chipingo, our Country Manager!

 Chipingo Phiri, AHA Country Manager

Chipingo Phiri, AHA Country Manager

Solomon-Chipingo Phiri has been Access Health Africa's Country Manager for several years, so we're long overdue on introducing Chipingo and all his amazing work to our blog. 

Chipingo, who was born and raised in Malawi, came to AHA with a background in education and Mass communications and experience in resource mobilization, HIV/AIDS and gender programming, advocacy, networking, behavior change communication, and workshop facilitation. 

Of working for AHA, Chipingo says, 

"AHA serves not only people in towns or suburbs, but it reaches people in hard to reach areas...deprived of the basic health services because they do not have facilities or personnel. AHA reaches out to these vulnerable people. Hence, through AHA's work people of Malawi are seeing the light in the access to quality and equitable health services, education, and resources. It is from this background that I find working with AHA so fulfilling. AHA hears the voice of the people, it follows tenets of "empowering development" as compared to passive development whereby people are passive recipients. AHA believes in people having a voice in what they want, how they feel they need to do it and the support that they need." 

 Chipingo, far right, working hard with leadership staff to prepare for Camp Hope's 2017 sessions 

Chipingo, far right, working hard with leadership staff to prepare for Camp Hope's 2017 sessions 

One of Chipingo's greatest accomplishments is managing and growing the impact of Camp Hope, which we have operated since 2011 as part of our partnership with Serious Fun and other private partners. Camp Hope is a week long camp for adolescents that provides HIV knowledge, peer support, decisionmaking, nutrition, hygiene, and other important topics for PLWHA and ALHIV (Adolescents living with HIV). Chipingo is incredibly passionate about Camp Hope, which he describes as intentional programming "cross cut with fun" that "focuses mainly on the building blocks of love, safety, and respect..we provide a forum for ALHIV to work through their challenges and create peer networks for support. Camp helps to decrease a sense of isolation and helplessness and allows our participants to build their self-confidence they need to manage life time treatment as they grow in society." 

 Chipingo, second from left, goofs around with Camp Hope leadership house at AHA offices 

Chipingo, second from left, goofs around with Camp Hope leadership house at AHA offices 

Chipingo helped Camp Hope expand from the first year, where there were 40 campers in one session to 320 across four sessions this past year. Chipingo specializes in training Camp Hope's extensive staff roster in child focused and therapeutic recreation using a loop model of challenges, successes, reflections, and self-discoveries. Chipingo is especially proud of the 64 Leaders in Training, former camp graduates and peer educators, who have been trained and have facililtated camp since 2014. 

AHA is incredibly lucky to have such a dynamic, up-for-anything, passionate Country Manager. Please join us in thanking Chipingo for his contributions so far and follow along for more of his great work! 

 

reflections on a somber day

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reflections on a somber day

By Dr. Baker Henson, written on July 19, 2017

As  medical providers, we strive to both increase the quality and extend the lives of our patients. Recently, we had a clear reminder of the fine line between life and death. We were reminded that this fine line is much more delicate in Malawi than what we are accustomed to in the United States.

 lone ambulance at Kabudula Hospital, July 2017

lone ambulance at Kabudula Hospital, July 2017

Yesterday, a pregnant mother of two, who had presented to the health care center the night before in labor, was brought into the operating theatre for an emergency cesarean section. Right away it was apparent that something was wrong based on her vital signs and clinical presentation. Upon initial examination, we noticed the baby’s head appeared to be protruding from her upper abdomen where it shouldn’t have been. We suspected a uterine rupture. The c-section commenced and we quickly discovered that her uterus had ruptured and the baby had died. There was a large amount of blood in her abdomen and the woman would not have survived much longer had the team not been there to intervene. After the procedure was completed, the mother was wheeled to the women’s ward to recover and grieve the loss of her child.

 Women's ward at Kabudula Hospital, July 2017

Women's ward at Kabudula Hospital, July 2017

To say that this experience left many of us shaken is a tremendous understatement. In Malawi, we are constantly reminded of the fragility of life. If this mother had access to better health care throughout her pregnancy, perhaps things would have turned out differently.

Thankfully, the next day we had a pleasant surprise. We assisted in another emergency c-section, and this time a young first-time mother delivered a full term, healthy baby boy. She named him Chisomo, the Chichewa translation for Grace.

 a young mother waits outside of Kabudula Hospital, July 2017

a young mother waits outside of Kabudula Hospital, July 2017

Repeatedly we are reminded that we are not here to transform the healthcare system in Malawi into our own, and yet even in a short time we can provide services that help and change lives.  While it is impossible to help everyone, we are steadfast in our commitment to make a difference in the lives of those we can reach.

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Reflections from a first-time AHA volunteer

by: Lilian Nagle, medical/surgical team volunteer

Hi! My name is Lilian Nagle and I am currently a pre-med undergrad at the University of North Florida. This is my first time in Africa and it has been an experience beyond anything I could have imagined. From observing and assisting surgeries in the rural Kabudula hospital to being able to experience a day in the casualty area of Lilongwe’s main hospital, Kamuzu Central Hospital (KCH), I have learned and gained incredible world experience in the span of the week.

 Lily stands outside of the Trauma unit at Kamuzu Central Hospital, July 2017.

Lily stands outside of the Trauma unit at Kamuzu Central Hospital, July 2017.

I was most struck by the people and the community in Malawi. Everyone was friendly and open and would genuinely ask how you were doing when you talked to them. Everyone we interacted with would consistently express their gratitude for the healthcare they were receiving from the Access Health Africa physicians.

Our translator for the week, Chipie, was an incredible person to get to know and is representative of the soul of Malawi. She is interested in what the AHA team is doing and she was proactive in making sure the patients felt comfortable and were able to communicate with us, and that they understood what their procedures entailed. She also assisted in our interviews with the patients, who gave us valuable insights into the health of everyone in the surrounding villages. With her help, we learned that many patients were traveling over 2 hours by foot to receive procedures that would hopefully change their lives for the better.

On Friday I had the opportunity to accompany Dr. Newell to KCH. We first sat in on the medical resident’s morning check in where they discussed patient cases from the previous night. One of the most difficult and sad cases involved a newborn in critical condition whose twin had already passed away. We then went to help out in the casualty area of the hospital, which had few beds and plenty of patients with a various range of complaints. Very critical patients with emergent issues were in the direct vicinity of patients with kidney stones and each patient was seen by first year medical residents and medical students. The medical students and residents we met were all incredibly bright, motivated individuals who clearly care about their patients.

 Lily outside of an operating room at Kabudula Hospital, July 2017

Lily outside of an operating room at Kabudula Hospital, July 2017

            Overall I am taking away memories that will stay with me forever and will motivate me to work towards my own goals of becoming a physician. I look forward to one day returning to Malawi and I also look forward to following Access Health Africa and the work that they do for the people here.

 

 

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Time passes in the blink of an eye

by Dr. Amber Newell, AHA Board Member

I awoke this morning to the roosters. It's 5:30 a.m. and light is starting to creep through the darkness. I get dressed and ready for my last run in Malawi - it's my last run of this trip at least, but many more are in the future.

I step outside and fill my lungs with the Malawian air. The streets are already flooded with our Malawian neighbors on their way to work.  There is a genuine beauty to the people and landscape.  They are our patients but we learn so much from them.  Each breath in, each stride on the pavement, I'm reminded of our patients this week and our cases. 

 Dr. Newell and Dr. Henson operate on an AHA patient at Kabudula Hospital, July 2017 

Dr. Newell and Dr. Henson operate on an AHA patient at Kabudula Hospital, July 2017 

I'm reminded of the gentleman who thanked us for his surgery, alleviating the pain he had experienced for over a decade, and for providing the transportation funds required to get to the hospital. After surgery we exchanged a handshake, and a gentle smile. I don't want to leave.  The time between trips here is too long.  I will hold on to that moment and the others until my next return.  

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Day Two at Dzaleka Refugee Camp!

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Day Two at Dzaleka Refugee Camp!

by Kristin Hendricks, dental volunteer 

 Dr. Jenn Mullarkey treats a patient at Dzaleka Refugee Camp on July 20, 2017

Dr. Jenn Mullarkey treats a patient at Dzaleka Refugee Camp on July 20, 2017

   Today at Dzalaka Refugee Camp, Dr. Mullarkey and her team treated 23 patients.  The patients ages ranged from 6  up to 72 years old.  The refugees are from various countries and backgrounds, with over 30,000 people living in the camp.  The majority of the refugees are from the Congo and make up over 17,000 of the total population.  At Dzalaka, there is no dental clinic so the access to treatment is limited. They must travel over an hour by ambulance to the dental clinic that's located at the hospital in Lilongwe. Many of these patients avoid seeking treatment at the hospital because they are responsible for their own transportation home after receiving dental care. 

   There's only one medical doctor living in the camp and only minor illnesses can be treated.  The health facility has limited resources and relies heavily on volunteers to help treat patients.  Any major medical procedures or treatment must be done at the public medical hospital, which is also over an hour commute.  Part of AHA's mission is to help improve access to health care for the refugees by directly visiting and providing care at the camp.

 AHA Dental team prepares to hold Dental Clinic at Dzaleka Refugee Camp on July 20, 2017

AHA Dental team prepares to hold Dental Clinic at Dzaleka Refugee Camp on July 20, 2017

    The power was still out in Kabudula, but with a generator up and running, Dr. Henson and his team completed six surgeries today. The surgery's included two hernia cases, a hydrocele case, as well as cysts and lipoma surgeries to round out the day. 

   AHA's public health consultants, Katie Sacca and Sadie Bazur-Leidy, spent today traveling to Chikowa and Ukwe regional health centers to meet with their center directors and learn more about how the referral process for surgical care at the Kabudula AHA clinic this week went.  The centers serve between 30,000 and 60,000 patients each per year!  They traveled 50 kilometers on dirt roads from Kabudula's district hospital to the regional health centers.  Despite being staffed by only one nurse and one medical assistant each, they are highly respected in their communities.  Many of the patients are then referred to Kabudula Community Hospital for more extensive treatment.  AHA's goal is to help provide more medical support in these distant health centers in Malawi.  

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Wednesday: Dentistry at Dzaleka Refugee Camp!

By Dr. Jenn Mullarkey

Today, the dental team spent their first day at Dzalaka refugee camp. With only a small medical clinic and no dental clinic, the residents were in great need of dental treatment. We were able to treat 27 patients today and anticipate seeing many more tomorrow. The members of Dzalaka were eager to help us coordinate patients and assisted us in translating the many languages spoken at the camp including French, Chichewa and Swahili. 

 AHA Dental team Kristen (L) and Dr. Jenn Mullarkey (R) visit Dzaleka Refugee Camp in Dowa, Malawi 

AHA Dental team Kristen (L) and Dr. Jenn Mullarkey (R) visit Dzaleka Refugee Camp in Dowa, Malawi 

 

The surgical team had another successful day at Kabadula! For the first time this week the power went out in the village and at the hospital. Despite the power outage, Dr. Baker Henson and Dr. Amber Newell performed 6 complex procedures including multiple hernia repairs and a c-section. Our public health consultant Katie Sacca spent the day interviewing patients to gain insight into the access to healthcare throughout Malawi. We learned that most patients have to travel 2-4 hours by foot to arrive at the hospital and that many of these patients fear the hospital may not have the resources to treat them. Access Health Africa aims to identify these issues with patient access to care and help to reduce them throughout Malawi.

 

Reflections on Day 2 at Kabudula Hospital

by Katie Sacca

 Kabudula Hospital 

Kabudula Hospital 

Today was another very busy day at Kabudula Hospital! We have been so fortunate to work with the medical staff at Kabudula, including head Clinical Officer Aubry, with the partnership and support of World Altering Medicine (WAM) and Watsi. We had another great day helping to relieve patients of their pain and discomfort through surgery and other medical interventions.

The morning started out very eventfully, with all hands on deck to assist with an emergency c-section for a patient in distress. The medical staff at Kabudula are extremely adept at managing obstetric conditions, and are tireless in serving their communities to the best of their ability. The rest of the day continued at a rapid fire pace, with Dr. Jenn Mullarkey performing close to 40 dental extractions and handling a few larger dental cases as well.  The surgical team performed 15 surgeries, focusing on lesion and mass excisions. The patient registration and procedures went extremely smoothly, and patients and their families left with relieved, smiling faces.

Here are some reflections from our staff, volunteers, and partners on the day:

“today went really well, we were really efficient and it went smoothly!” – Hannah, a travel nurse based in L.A. who has been a tremendous asset to the partnership

“there was an interesting variety of (things) today, starting with the c-section. Getting to see how medical officers did their jobs compared to American doctors was interesting” – Lily, assisting in the OR as a volunteer scribe

 Dr. Newell and Aubry prepare to jointly perform a mass excision. 

Dr. Newell and Aubry prepare to jointly perform a mass excision. 

“we’re evolving in a sense that we’re exploring how we can optimize our success within the confines of our work environment”  -Dr. Newell

“Everything went really efficiently with dental, I was surprised to see a second child with Ludwig’s angina (when the swelling from a tooth infection affects the patient’s ability to swallow and breathe) in two days. We admitted both patients and are managing the swelling” – Dr. Jenn Mullarkey

“I really liked meeting the dental therapists today, I thought they were really efficient and I liked how they interacted with the patients. It was fun to learn more about the culture in Malawi from them too!” –Kristen, assisting Dr. Mullarkey with dental extractions

“Seeing medical officers working in their environment was really interesting!” – Peter, assisting in community outreach and the OR

“I was really impressed with how well everyone worked together, including the staff at Kabudula and everyone who came, given everyone has different levels of expertise and training… I was very impressed by how everyone came together.” – Sadie, WAM manager and liaison with Kabudula Hospital

As for me, this was my first full day spent in a hospital in Malawi and it was extremely eye-opening to see how different hospital care is in Malawi than the United States. There was a lot that was hard to see and process because it’s so different from how things work at home. I was inspired to see the motivation of Kabudula’s staff and our staff to provide the best possible patient care, and how we were able to harmonize and work together and learn from each other.

Zikomo for reading, and stay tune for more tomorrow: our Dental team will be heading to Dzaleka Refugee Camp and our Surgical team is heading to a jam-packed day 3 at Kabudula Hospital.

Tionana mawa!

Katie & the AHA Team

 

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First Day Working in Malawi

By: Peter Harrill

Hey everyone! My name is Peter Harrill, and I am a recent graduate of UNC-Chapel Hill. I'm applying to medical school this summer and am extremely excited about being part of this medical mission trip! This is my first time traveling to Malawi with Access Health Africa.

After arriving yesterday, it has been an incredible two days thus far. The people of Malawi have been very welcoming and the country itself is beautiful. Today was our first day providing medical care and it was a busy one! We traveled to the Kabudula Community Hospital and saw a variety of patients with differing needs. We are currently working in coordination with the non-profit organization, Watsi, which helps support medical treatment and surgeries for people in need by using a crowd-funding platform. More specifically, this organization helps fund 15 of our OR patients as well as 100 of our dental patients over the course of the week, while compensating those patients’ transportation costs as well.

In total, we had 10 patients treated in the OR today for a variety of bumps and lumps, including several ganglion cysts and lipomas. This patient total is actually a 67% increase from the number of patients seen in the OR last year on the first day. We also had the unique opportunity to observe a circumcision being conducted on a young teen. Additionally, Dentistry received 16 patients overall and the Casualty Department treated 5 patients by the end of the day. Most of the dental patients were there for extraction of damaged or decaying teeth. In the casualty unit, a two-year old child came in with a lacerated gluteus and it was uncertain whether he would be able to withstand treatment under local anesthesia. Luckily, local anesthesia did the job and he was able to receive care without having to undergo surgery. Dr. Newell did a great job helping this patient get the treatment he needed!

I would like to give an additional shout-out to the donors for helping us buy a new generator! This has helped ensure that we have electricity for the entire trip, making it easier to treat as many patients as possible.

Overall, the differences in the health care systems of Malawi and the United States are glaring, providing more perspective to the countless resources we have available back at home. So far we are off to a great start and hopefully that trend continues throughout the week!

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Off to Malawi!

 Dowa, Malawi. Photo by K. Sacca

Dowa, Malawi. Photo by K. Sacca

And we're off! 

Hailing from North Carolina, Chicago, New Orleans, and Florida, the AHA team is en route to Malawi!

We have a packed schedule ahead of us, from dental work at Kabudula Hospital and Dzaleka Refugee Camp, to dozens of surgical cases at Kabudula Hospital, to trauma care, staff training, and on-call nights at Kamuzu Central Hospital. We'll work alongside the hard-working medical staff at all of these health care centers and more to decrease the backlog of surgical cases, ease the suffering of many patients, and train the next generation of Malawian health professionals. On top of that, this year we'll have supplemental power and electricity to ensure that we can give our patients the best care possible in limited resource settings.  

 

Thanks to generous donations from our many supporters, we beat our goal, raising $11, 211!

$4,656 was raised by our Dental team and $5,690 by our Medical team. Zikomo Kwambili (thank you) to all of our supporters! 
 

There's still time to get your donation in if you missed the chance: Click here to donate! 

Stay tuned for more updates from our team on the ground. Tionana (see you later!) 

 

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Learn more about our team: Dr. Amber Newell

Dr. Amber Newell is an ER physician who is traveling to Malawi for her fourth time in just a few short weeks. Read an interview that Katie conducted with Dr. Newell below to hear about her work in Malawi and what motivates her to keep returning to Malawi. 

Katie: Approximately how many emergency department patients are seen per day over how many days?

Dr. Newell: It varies, because it depends on how many traumas they have. I’m in the casualty area, which sees traumatic injury, so car accidents, motorcycle accidents and burns, any sort of violent crime. It really just depends -- the first year I was there were protests and we were packed full with patients in the hallways and we saw 30 in a day. A base estimate is anywhere between 10-30 per day in the trauma area.

Katie: What type of cases do you typically see in the emergency department?

Dr. Newell: Casualty area is all ages. [There are a lot of] newborn babies with burns-- there’s a huge campaign to try to [prevent] women carrying babies on their back when cooking on the fire…[they are] falling out of the swaddles and getting burned.

We see dog bites, from the dogs running around and [kids] play with them and get bitten. We do unfortunately see kids from bike accidents and vehicles, they’re often unrestrained. The lack of regulations...you see a lot of traumatic injury of all ages. Burns, bicycle vs. auto, person vs. auto, dog bites.

Katie:  What is your role?

Dr. Newell: My role has changed a little bit throughout the years, the first year I went there were so many patients because of the protests, there were a lot of extra personnel, I did some supervision of the nurses and some folks that were with us, functioned as a practitioner taking care of patients. Getting an idea of things that were available, things I could do.  I trained in a level 1 trauma center, so I wanted to be familiar with what they had available and that environment. [I did] some supervision and teaching of folks we brought, and operated as a physician. I thought it would be more beneficial for me to have residents.

 The following year [Hospital administrators] said, “hey, you should be in charge down here.” I took a more teaching role. Supervised, offered some hints and stuff. Now, with more of a teaching and supervising (position) at Kamuzu Central, residents are applying book knowledge to practical cases and I help when they need it but mostly supervising in that arena.

I’ve done that the past two years, and last year started to lecture to the residents on trauma as well. Apparently on their boards, they’re heavily tested on critical care, but they don’t get any experience in that.  No one in Malawi  is on a cardiac model, so that was very well received. All the senior residents came to that lecture because it was on their boards.

[Other things I do are] helping Baker turn over OR rooms, getting patients out, teaching, supervising, education residents and staff, assisting Baker on cases.

Katie: How many people do you train in classes?

Dr. Newell: Medical students were gone, but it would be about 20 in the lectures, including 5-8 senior graduating surgery residents.  

Katie: Tell me about the trainees. Where do they come from? What drove them to medical school? 

Dr. Newell: A lot of them are from Malawi, various parts, a lot from Blantyre and Lilongwe.  The common thread is that they want to help their community. Interestingly, talking to residents about to graduate, a lot of them say the government jobs are maybe not good or well paid, they work crazy hours for minimal reward.

 They want to stay in their community. A lot of them want to take care of their community and serve them. The education program is very long, it starts out of high school, so they have to make that commitment when they’re relatively young and they have their mind made up. Genuine, altruistic factors to help their community.

 Katie: Tell me about needs for Emergency medicine and trauma in Malawi.

Dr. Newell: Tremendous. Just the limitations are hard, the quality of everything, people have to get around on bikes, they’re dependent on cars with no air bags, etc. As a result of that, we see horrendous traumas, burns, things that could in large part be prevented. The mechanisms of trauma and severity could be limited. The needs are tremendous.

The golden hour...all of us adhere to it, when you’re taking care of an ill patient from trauma you only have one hour to really ID what is going on with the patient. That level starts in the field with pre-hospital care. Because of a lack of prehospital care, ambulance services, car accident victims are driven by a family member or they die en route, so we don’t see the patients anywhere near the golden hour, [which has] a huge impact on mortality and morbidity. We see patients within 20 minutes, whereas within 10 minutes [we would be] sending them to get a CAT scan [in the United States].

[In the U.S. we have] dedicated resources and teams versus there (In Malawi), there is one person taking care of a patient, one physician, one nurse, and there is no CAT scanner, a broken x-ray machine, [medical staff are] relying upon their physical exams to formulate whats going on with the patient, the patient is not [comprehensively] monitored, [they get] one initial set of vitals, assumptions about what is going on are made. There are no set statuses, it’s based on clinical judgement and evaluation. And the lack of resources, no bedside ultrasound, no ventilator, transfusion…

Patients die. It happens every year. 5 or 6 people i’ve seen would have had perfect outcomes if we were in the US. Last year it was 3 or 4. It is very difficult.

When we’re there we don’t tell them what we would do it’s what can we do for this person. Every year i’m finding out more and more. It is very difficult...i’m still learning to function within the confines of the system, but the patients are so grateful and beautiful and vulnerable that i want to do anything and everything that we can. The patients are just...if there’s any question, if it’s difficult, you find your motivation with the people who come in.

Katie: What do you want to accomplish on this trip?

Dr. Newell: Whether assisting Baker (8-10 cases with him, being an extra set of hands), continue to educate, within the confines of what is available. [Training and lecturing] with the surgical residents, I will be lecturing again this year now that I know the need is tremendous for critical care...they study about it, they’re studying all the time, on their day off they’re studying...their dedication is very impressive.

They’re not putting it to practical use, so my lectures are based on the application of this to help them with their boards and give them a foundation of understanding for these things. Then applying things while providing care, giving the residents specific information. For example, I supervised an intern on his first day and helped him put in a chest tube. The level of satisfaction he got from alleviating someone from their discomfort and potentially saving their life was inspiring.

Katie: What do you want to accomplish with AHA over the next 5 years?

Dr. Newell: Eventually I would like to work on exploring the possibility of developing emergency medicine. [In Malawi it is] not a residency program at this time as it is in most parts of Asia and Africa. [Others that have implemented this are] observing tremendous decrease in morbidity and mortality just having prehospital care and knowledge about emergency in the hospital setting.

Eventually I'd love to look into developing prehospital care and having Emergency medicine as a residency program for the [hospitals]. Right now the surgeons run the casualty area, but [specialists in Emergency medicine] offer specific knowledge, it offers an element to the patients that can really make a difference as well in morbidity and mortality.

 Katie:  What makes your day when you’re working?

Dr. Newell: Definitely the experience when a young or new physician asks a question or wants to do a procedure, watching them learn and apply new skills, is rewarding. Seeing when I start to do the lectures, when I go through and ask them questions and they answer them with confidence when they didn’t have any before.

Most important, the smiles of the patients, the gratitude, their words...an older woman [giving thanks and praying] waiting outside for her family. A woman who smiles when a young child is treated…the patients have always been my primary motivator so the reward comes from my interaction with them.

 Katie: Describe one full day of your work.

Dr. Newell: When we get there about 7:30, specifically to the casualty area -- there’s 2 beds and a nurse waiting room, people are lining up in the waiting room, some mornings are busy with patients. In the morning, staff are readying and getting blood supplies and everything organized for the day, getting ready. Residents have sign out, they listen to their cases overnight to hear about the patients in the casualty area and in the OR, where I observe their methods and offer help. We start our day, typically there’s a patient either waiting or comes in shortly thereafter. We function in the casualty center, pretty much do patient care until 4:30 or 5:00. 

 Katie: What is your motivation?

 Dr. Newell: It’s the people and the sense of community...the main motivating factor for young physicians is not to make money and get out of the community from which they came, it’s to help and be a public servant. I always view physicians as public servants and they really embody that. They’re from the community they want to improve and empower the community, the dedication to that is absolutely phenomenal.

Plus Malawi is naturally beautiful, from the people to the terrain, it’s a beautiful place, and I start my day running on the golf course, listening to the roosters, everybody up getting on the buses, everyone’s waving, lots of smiling faces, people are becoming familiar, it feels like home away from home.

 Thanks Dr. Newell for sharing your experience. Stay tuned for more interviews! 

A day in the life...Bwaila Hospital Dental Clinic

Walking up to the entrance of the Bwaila Hospital dental clinic, I was greeted by a line of over 60 patients eagerly waiting to receive dental treatment. Some had severe tooth pain, holding onto their faces tightly and fighting off tears. Others had large swollen masses, most likely severe dental infections, protruding from their cheeks. Once the doors opened at 8:30am, the patients were first sent to the diagnosis room where they were screened and examined by a dental therapist. Next, they went to the injection room and were anesthetized for their upcoming procedure. Lastly, they were sent to us in the treatment room, also known as the “extraction room.” In the treatment room were 4 cracked and severely worn dental chairs and a small table covered in old and broken dental instruments. These limited resources made it difficult for us to treat patients, but we were up for the challenge! With the help of 4 dental students from UNC we were able to treat 75 patient in just 3 hours! As soon as one patient’s treatment was completed, the next was seated seconds later. Despite the limited resources, it was a well-oiled machine designed to efficiently treat as many patients as possible. This experience highlighted the need for dental instruments and materials at many clinics throughout Malawi. With proper instruments, the patients would be able to receive a higher quality of care and the dentists and dental therapists would be able to work more efficiently. 

Smile...

Our planning paid off. We eagerly pulled up to our first medical outreach location at Kabudula Hospital. Upon our arrival, we were gratefully greeted by the staff at KH and quickly saw the vast array of patients waiting, hoping to schedule for surgical procedures this week. Foremost, this will be there only opportunity for surgery or to be evaluated and treated by a surgeon. In Malawi there are only approx. 40 surgeons for 16 million people. After evaluating over 30 patients with surgical concerns, Drs. Newell and Henson quickly got to work in the operating room. Despite a late start, they were able to complete 6 successful surgical cases. The appreciation was evident as many of these patients have been waiting several years for treatment.

Dr. Mullarkey spent the day at Kamuzu Central Hospital working with a small group of dental students from UNC – Chapel Hill. At the hospital they performed fillings, extractions and assisted on larger trauma cases. One patient came to the dental clinic after getting into an altercation in which his friend bit half of his upper lip off. Needless to say they are no longer friends. There is no dental school in Malawi and there is great need for dentists and dental treatment throughout the country. In the absence of a dental school in Malawi there is a three year training program for “dental therapists.”  These dental therapist make up the majority of dental providers throughout Malawi. At Kamuzu Central Hospital there are only 2 full time dentists and the remainder of providers are dental therapists, volunteer dentists and students. The need for dentists throughout Malawi is evident and Dr. Mullarkey is excited about growing the dental outreach project with Access Health Africa.