At the mid-point of registrar training, I spent 6 months with the Plastic Surgery Department at Queen Elizabeth Central Hospital, Blantyre, Malawi. My first interest in healthcare in low and middle-income countries developed during my medical school elective in Tanzania and India, and academically through authoring a book chapter for the World Health Organisation, on the evidence behind clinical indicators of HIV infection in children in resource poor settings.
QECH is the largest hospital in Malawi, ranked as one of the poorest countries in the world. It has the country’s only medical school, which opened 25 years ago. The hospital has approximately 1000 beds, receiving patients from throughout Malawi. The hospital grounds accommodate many families while relatives are an inpatient, and they are required to provide food and give out medication.
QECH has a range of medical and surgical specialties and has two Plastic Surgeons in the department, one trainee and a clinical officer. There are a team of hugely dedicated nurses, and physiotherapists within the burns unit. The case mix consists of large numbers of patients with burns, cleft lip and palate, skin oncology of the head and neck, and trauma. Breast cancer and head and neck cancer patients are managed with General Surgery and ENT.
Patients with burns frequently presented late, and there were many reconstructive cases to release contractures of the limbs, neck and facial structures. Cleft lip and palate cases were performed each week, and a range of pedicled flaps used to reconstruct head and neck skin oncology defects and following trauma - cases which are seen less and less in the UK with use of free tissue transfer.
A typical week consisted of consultant-supervised operating lists on 3 to 4 days, burns / general plastic surgery clinic, hand clinic and an oncology MDT. Small group teaching sessions would take place two mornings per week prior to the ward round. During my time in the unit, a week long educational course was provided for nurses and clinical officers from around Malawi, in conjunction with Mr Stuart Watson from Glasgow and Interburns.
Malawi is a beautiful country of friendly people, and working there was a hugely rewarding, challenging and enjoyable experience. I learnt a considerable amount from the experience and managing patients in a resource-poor setting, developing general plastic surgery skills, in addition to providing an excellent basis for a career in skin oncology and facial reconstruction. I continue to support the development of the Plastic Surgery and Burns service and hope to maintain involvement in educating the Plastic Surgeons of the future in poorly resourced settings.