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!