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Published: October 3rd 2008
So here is a brief breakdown of the work experience in Malawi. Since I've been here (2 weeks) I have been exclusively at Queen Elizabeth Central Hospital in Blantyre. It is the biggest hospital in the country and home to the medical school. The medical school has only been in existence for a few years, initially the graduating classes were 20-30, now it's closer to 100. Regardless, these graduating doctors are meant to see to the needs of the entire country of 12 million, a difficult task given the current numbers. Because of this Malawi relies heavily on foreign doctors, specifically surgeons. One guy asked me if I would be willing to stay for a year if they could get approval for it. I have a feeling that, when I said no, he asked some dude selling phone cards if he would want the spot. As a side note, there is only one orthopaedic resident currently training in Malawi. Not because they can't afford or couldn't use more residents, but because no one wants to go into it. Given the competitiveness of surgical subspecialties in the western world, I was very surprised. The reason seems to be twofold: there are still
so few doctors that they are filling primary care positions and there are more opportunities in other fields. Specifically everyone wants to go into public health and HIV. There is a multitude of NGO funding, resulting in a greater salary, and more opportunity for travel and possibly living and practicing abroad. Interesting.
What I have been doing is much the same theme as South Africa. Some mornings I will go on ward rounds, some days will operate, etc. The pace again is like a county hospital, with many breaks and struggles to get three not-very-big cases done in a day. The teaching here of medical students is good and it reminds me of my schooling to see them answering questions in the morning and trying to stay awake in the back of an OR.
The hospital seems more advanced in some ways compared to South Africa (the trauma service is good, one of the guys does big spine cases, there are computers and and MRI) and in some ways more archaic (they have not been fixing certain fractures because they ran out of implants). The pathology has been interesting. More TB spine than is imaginable - before getting
here it is just something I had read about, here it seems like there's one a week. I have seen a couple tumors as well. The diagnostics are much harder as usually it is just an XR and maybe a biopsy. Honestly it doesn't matter much because if it's anything bad the story always ends the same as chemotherapy essentially doesn't exist and most get palliative amputations. Today I treated a kid for crocodile bites. That was a new one.
I definitely like Malawi as a country. It has the reputation of warm people ready to smile. That's not absolutely the case, I'm not giving hi-fives and singing Disney songs on the way to work, but everyone at least greats each other with a "how are you" and undoubtedly I feel more welcome than I did in Mozambique. It is just three more weeks here and I am going to start going to the district hospitals next week. More to come...
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Stephanie and Scott
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Glad to hear you are enjoying Malawi. The lake looks beautiful...your living condition sounds somewhat undesirable tho...a grumpy old man and bats...I only live with one of the two thankfully...maybe he will take the bats with him when he leaves...we can live in hope! I had a great chat with my sister this a.m. and she said Noor is very soon on her way to be with you...we are all happy that you two will get to be together...take good care, love Stephanie Scott, Max, Caroline and the motley k9 crew