click to enlarge
John Thorp and Stephen Kaliti, director of maternal health services at Bwaila Maternity Hospital
This has been an exciting and informative trip to Malawi. I have worked with Jeff Wilkinson, assisting at elaborate fistula surgeries including ureteral reimplantations and other procedures. He recalls that I attended his first total hysterectomy during his residency, so this was actually quite nostalgic. We tell stories, sing, and relive our youth, and amazingly, we are seeing women dry after surgery. Jeff’s skill set is astounding. We are the second operating room for a labor and delivery ward that does more than 15,000 deliveries. So uterine ruptures, C-hysterectomies, etc. abound. We are busy.
On the obstetrics front, Dr. Sumera Hyat is winding down an intense course in OB emergencies for Malawian health care workers. This includes hands-on evaluation, team-building exercises, and more. Her instructional skills rival Jeff’s surgical prowess, and it’s amazing to watch the learner’s knowledge swell. The big “training the trainers” session is tomorrow. UNC OB-GYN and Women’s Primary has another outstanding medical educator on its team!
Fortunately, this trip has coincided with visits from important partners to our efforts. I have been able to meet with the top leaders at the Freedom from Fistula Foundation, the chair of OB-GYN at the Medical College in Blantyre, officials from UNC Project, chair at Kamuzu Central Hospital, Kevin Assimi from Fresno whose family’s foundation has helped to renovate the new unit, and the Ministry of Health of Malawi.
Jeff and Sumera have formed an awesome and dedicated team. Margaret Moyo is his administrative leader and can get just about anything you would need in a bureaucracy that can make UNC look efficient. She accomplishes all of this with a wry smile and laugh that brightens everyone’s day. Jeff is also aided by two great anesthesia technicians (Johan and Melvis) who make the clinical care work. I hope that all of them can visit Chapel Hill in the next year. Fanny Mtambo, an administrative assistant at UNC Project-Malawi, helps Sumera with the instructional work and is quite effective. Dr. Stephen Kaliti, who heads maternal health services at Bwaila Maternity Hospital, continues to provide clinical leadership to the OB unit.
We have had numerous Chapel Hill trainees and teachers on site. Gretchen Stuart was here the first week, and Tom Ivester will be here at the end. Kacey Eichelberger, a second year maternal-fetal medicine fellow, and Jason Franaziak, a fourth year resident in OB-GYN, were there on rotation, and their visits overlapped with mine in the middle. They led the effort to teach clinic officers and midwives practical ultrasound and did a lot of hands-on instruction. Jason loaned me clogs for the OR! Kathryn Stein has been working on a photo and audio documentary for the fistula patients, and the brief glimpses I’ve seen suggest it will have huge potential for sharing their compelling stories with a wide audience.
The new unit is handed from the contractor to the UNC-Freedom from Fistula Foundation team tomorrow. We have a new OR table, anesthesia machines, and equipment to move and set up. One really has to wear a lot of hats to do something as complex as surgery in the developing world.
We have also visited villages with community groups working in health education. The focus has been augmenting their maternal and child health messages with knowledge about fistula. Joe Carol, who is my wife and a nurse at UNC’s Horizons Perinatal Substance Abuse Program, and Sloane, a recent UNC Women’s Studies graduate, have spent a lot of time working along these lines. Sloane captured it best when she said, “My women’s studies degree has gotten a real slap in the face. Women in Malawi face a constant struggle to maintain health and hygiene and cannot afford the modern conveniences I take for granted.”
All said, this experience has been a real privilege. I am grateful to my team at home which has functioned flawlessly in my absence and the Malawian team that works miracles in the most difficult of situations.