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 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 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. 


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. 


Social Entrepreneurship in Africa

Access Health Africa co-founderJesse Pipes, director of the Holland Fellows Program in the Walker College of Business and entrepreneurship lecturer in the Department of Management, recently presented on Social Entrepreneurship­­ and Seeing Opportunity: the Unity between Needs and Solutions.

The participants are members of the Mandela Washington Fellowship for Young African Leaders, comprised of 25 individuals who were competitively selected from an applicant pool of more than 40,000. Each fellow has an established record of accomplishment in promoting innovation and positive change in their organizations, institutions, communities and countries. The fellowship, begun in 2014, is the flagship program of President Obama's Young African Leaders Initiative (YALI) that empowers young people through academic coursework, leadership training, and networking. In 2016, the program will provide 1,000 outstanding young leaders from Sub-Saharan Africa with the opportunity to hone their skills at a U.S. higher education institution with support for professional development after they return home.

During the workshop, Pipes shared how social entrepreneurship is about applying practical, innovative and sustainable approaches to benefit society in general, with an emphasis on those who are marginalized and poor. The concept of social entrepreneurship captures a unique approach to economic and social problems, an approach that cuts across sectors and disciplines grounded in certain values and processes that are common to each social entrepreneur, independent of whether his/her area of focus is education, health, welfare reform, human rights, children's rights, workers' rights, environment, economic development, agriculture or whether the organizations they set up are non­-profit or for profit entities.

"Developing a workshop for the Mandela Washington Institute supports my own vision of creating Malawi's first center for collaborative learning and impact making," said Pipes. "The spirit of the Mandela Washington Fellowship mirrors this vision. With Access Health Africa we want to contribute to the growth of a new type of philanthropy by developing a community solutions hub that responds to specific needs on the ground in Malawi by placing a special emphasis on the spirit and ambition of Malawi’s youthful population who are creative and adventurous.”

Pipes explained why Malawi's first technology and collaboration center could facilitate access to vital information and resources, and strengthen engagement between local communities, global citizens and government.

"It will include and elevate local change makers, and underpins modern education for advancements in quality of life," said Pipes. "The Access Health Africa Collaboration Hub in Malawi will build upon human capital, focus on strengthening existing interventions, and allow the global community to participate in a community solutions program connecting the best and brightest in an effort to empower youth, cultivate leaders, strengthen healthcare institutions, and extend access to quality health services, education and information."

"With more than 15 years of experience designing public health impact curriculums, Access Health Africa is uniquely positioned to become a mission-driven organization at the intersection of health, education, and social sectors," added Pipes.

About Appalachian's MWF Institute

Appalachian's Office of International Education and Development are responsible for implementing the program in collaboration with the university's Academic Civic-Engagement Program. Dr. Jesse Lutabingwa, associate vice chancellor for international education and development directs the program, and Dr. Brian MacHarg, director of academic civic-engagement at Appalachian serves as co-director. While at Appalachian, program fellows will participate in seminars and workshops conducted by with faculty and staff as well as leaders from local nonprofits. They will be mentored by several young leaders in the Boone/Watauga area to learn from each other. They will also volunteer with local organizations to experience volunteerism first hand. Appalachian was selected to participate in the program following a rigorous national competition. The University is one of 40 public and private institutions countrywide that have been selected to host the 2016 Mandela Washington Fellowship Institute and the only one in North Carolina. 

About the Mandela Washington Fellowship program

Each Mandela Washington Fellow takes part in a six-week academic and leadership Institute at a U.S. university or college in one of three tracks: Business and Entrepreneurship, Civic Leadership, or Public Management. This year, there will be a pilot Institute on Energy. Following the academic component of the fellowship, the fellows visit Washington, D.C., for a Presidential Summit featuring a town hall with President Obama. During the three-day event, fellows will take part in networking and panel discussions with U.S. leaders from the public, private and non-profit sectors. For more information, visit the Young African Leaders Initiative site.s



Today, at Access Health Africa, we dedicated the majority of our day organizing our detailed outreach plan for the upcoming week.  This week, we will be providing medical outreach care in four very diverse locations.  On one end of the spectrum, we will be working at the large public hospital, KCH.  In addition, we will venture out to the rural hospital in Kabudula. Here, we will perform much needed operative procedures, many of which have been prolonged due to lack of available surgeons as well as lack of available hospital resources.  Our ability to provide health care in these forgotten communities exists, in large part, as a result of the generous donations of a vast number of private donors, health care providers and hospital systems. Their contributions have helped transform our dream of expanding access to health care throughout Malawi into a reality. In addition to traveling to KH, we will also visit both Dzalaka refugee camp and the village of Mchezi. In these locations, we will switch gears, focusing largely on patient education and preventative medicine in hopes of empowering a community to flourish in the future. 

Malawi Dispatch_1


Malawi Dispatch_1

Dr. Amber Newell, Dr. Baker Henson, and Dr. Jenn Mullarkey arrive at the Access Health Africa Hub in Malawi.

After stepping off the plane in Malawi we were quickly reminded of the disparity between the living conditions in United States and those in Malawi. With such limited resources and very few health care providers, the tremendous need for medical volunteers in Malawi became apparent.

Drs. Amber Newell, Jennifer Mullarkey and Baker Henson are traveling to Lilongwe Malawi, East Africa, for the first official outreach trip as Access Health Africa. For the next 2 weeks we look forward to getting the new World Camp, now called Access Health Africa off the ground.

Dr. Amber Newell will dedicate her efforts to providing much needed medical care in the emergency room/casualty area. In addition to volunteering in the clinical setting, she will also provide trauma education and focused hands on training to medical residents, interns, nursing staff and students of Kamuzu Central Hospital. She will also be assisting Dr. Baker Henson in operative procedures performed in a rural village with our surgical team.

Dr. Jennifer Mullarkey will also provide a multifaceted approach in her involvement with AHA. Not only will she care for patients in desperate need of emergent dental care, she will also focus her efforts on the establishment of a dental outreach program which will provide ongoing treatment of Malawi residents. Dr. Mullarkey will mentor dental students from UNC-Chapel Hill to serve patients at KCH. Lastly, she will visit a rural refugee camp to provide much needed oral health education and preventative measures.

Dr. Baker Henson will be providing surgical care at both a rural village hospital as well as the operating room at KCH. He plans to perform much needed operative interventions on patients whose surgeries have been postponed due to lack of available local recourses and staff. He will also provide training focusing on minimally invasive operative techniques to the surgical residents and staff of KCH.

We look forward to providing you with periodic updates regarding our progress for the duration of our medical outreach trip. Thank you in advance as we understand that it is your continued support and generous contributions which make projects like these possible.