Malawi, Africa - March 2013

"In my third year of training I spent a month as the Orthopaedic Surgery Resident Traveling Fellow through Health Volunteers Overseas in Malawi, Africa. My trip was additionally supported by our departments Baril Award. Africa is home to about 11% of the world’s population, owns 24% of the global burden of disease, and is incredibly short of supply of providers with just 3% of health care workers. Malawi is a landlocked country surrounded by Mozambique, Tanzania, and Zambia. It is a former British colony and is a poor country reliant on agriculture and whose struggles are not limited to the effects of HIV/AIDs with a large orphaned population, famine, and economic instability. Of the 266 practicing physicians in the country, nine are orthopaedic surgeons. This roughly requires one surgeon to provide care for 1.8 million people versus 11,000 in the US. My home base was Queen Elizabeth Central Hospital in Blantyre, where in addition to training 2 Malawian Orthopaedic surgeons a year, is houses the Orthopaedic Clinic Officer (OCO) training program. OCO’s are medical technicians who are trained in basic orthopaedic care including some standard surgical procedures. They bridge the gap and in most hospitals and can provide care here independently.

My job was to teach residents and clinical officers and did many offsite visits to other district hospitals in Chickwawa, Tholyo, Mulanje, Zomba, Mwanza, and Machinga allowing me to get really good at driving on the “other” side of the road and see the spectrum of life in the southern region of the country from the flatlands to the plateaus and the enormous and beautiful Lake Malawi. I was a visiting primary consult at the district hospitals where I was the only orthopaedic surgeon in the building and helped to advise, assist, and relay information to the larger central hospitals. I also assisted in daily activities at Queens including surgical, clinical, and rounding activities. As a guest, I visited local private and children’s specialty hospitals. Patients presented with basic and neglected orthopaedic problems including trauma, oncologic issues, congenital deformities, and infections. The perspective I gained by teaching and learning the adaptive techniques of their local practice was invaluable and has affected my approach to patients and problem solving and seriously makes one consider what is necessary and efficient back home in the US. In the future I am considering doing an international fellowship after completion of my Pediatric Orthopaedic Fellowship and hope to incorporate a long term relationship to assist in teaching in a developing country throughout my career." Dr. Sarah Nossov, Orthopaedic Resident