Three years ago I first came to Zomba Malawi to begin to try and understand the impact that the lack of access to surgical care has on the lives of so many people around the world. The Lancet Commission on Global Surgery estimated that up to 5 billion people do not have the access to surgery that we take for granted in developed countries. More people die from this lack of access on an annual basis than HIV, malaria and tuberculosis combined. Think about that for a minute. Addressing the challenges of global surgery is essential if we hope to make gains in the broader discipline of global health
There is so much we can specifically do as urologists. Urinary retention from prostate enlargement, urethral stricture and the presence of prostate and bladder cancer is an immense challenge in Africa and a source of tremendous disability. Surgical expertise in our field is both necessary and sorely lacking. Furthermore, establishing an infrastructure to work safely, invest in nursing and anaesthesia is at least as important. In 2016 I first came to Zomba and began the process of trying to understand this better. I quickly realized that coming for a week or two to perform some cases will never lead to a path of sustainability. Most of the surgical work done throughout much of Africa is done by specialty clinical officers. I have described this in detail before. Teaching common surgical techniques to clinical officers, investing in talent and working with other international partners is the only way to hope to improve surgical care for so many people and leave something more permanent behind.
To date a number of things have been achieved and I will highlight three.
1. A clinical officer, Duncan Goche conducts some common urological procedures in Zomba and contacts myself and others regularly for advice on encountered challenges.
2. In 2017 we identified and have funded the training of a Malawian surgeon to gain specialty certification through the College of Surgeons of Eastern Central and Southern Africa (COSECSA) in urology. He will complete his training at the end of this year, write his exams and then arrive full time as a urologist in Zomba to build on our efforts in January 2020.
Meet Dr Wanangwa Chisenga:
3. We funded a pilot project through the University of Toronto in partnership with an NGO on the ground to run a prostate outreach camp. Led by local surgeons to work through a backlog of patients with long tern indwelling catheters (many for years) and perform prostatectomy. Data on this project has been reviewed and a publication is planned for submission shortly
Finally, a delegation from Germany has been coming in parallel to Zomba the last several years to work to improve surgical care following similar principles. Dr Henning Mothes in particular has been an extraordinary force and leads their efforts. A German surgeon, he served as the Head of Surgery at Zomba from 2003-2006 and has come regularly since then for short visits. He understands the local infrastructure well and has built valuable relationships within the broader Malawi healthcare system. While not a urologist, he has quickly come to see urologic surgery as a grossly neglected service in Malawi. With the overwhelming need to manage more acute, life-threathening problems such as C Section, trauma as well as acute abdominal emergencies such as appendicitis and bowel obstruction, men with indwelling catheters are forgotten. Dr Mothes has also engaged urological colleagues from Germany to support the Zomba effort. Dr Christian Weidemann, a urologist and two anaesthetists have also joined us. Furthermore, my German colleagues have secured funding for the trainee of a second Malawian surgeon under COSESCA that we will together identify this week.
Dr Heimrath, far left. Dr Mothes, third from right, Dr Weidemann second from right
As I arrive in Malawi today I are very excited to coordinate a “Zomba Urology Week” with my German colleagues and new friends. It is a great pleasure to see how far Zomba urology has evolved from my first trip in June 2016. There is so much more to do. I have also brought our recent MGH fellow, friend and now colleague Olivier Heimrath with me to build on our efforts to date and work with our new colleagues. He has been to Zomba with our support once before and has also worked in Rwanda. In addition to performing surgical cases this week, an entire itinerary that includes colleagues from the University of Malawi, healthcare officials and Zomba Central Hospital administrators awaits us. There is an opportunity for Zomba Central Hospital to seize a lead role in providing good urological care throughout this country and in doing so improve the health of men more broadly.
Welcome to Zomba Urology week 2019! Further updates to follow!