OverviewDr. Janey Phelps first visited Kamuzu Central Hospital (KCH) as part of a surgical trip in 2014 and she quickly realized the need to partner with the anesthesia clinical officers at KCH to enhance the peri-operative anesthesia care. Anesthesia clinical officers have 18 months of training after which they are the anesthesia providers for all ages, surgical cases, and provide all the medical care in the intensive care unit. Due to the profound shortage of medical doctors in low to middle income countries (LMICs) clinical officers are used in every specialty field in the majority LMICs. There are only 4 anesthesia physicians in the country of Malawi with a population 18 million and none are in the city of Lilongwe. The main focus of this partnership is to provide continual medical education to the anesthesia clinical officers and to assist in the training of the anesthesia clinical officer students. An International Resident/Fellow rotation was developed to help fulfill this mission and provide UNC anesthesia trainees with a robust Global Health experience.
The resident/fellow clinical experience is to provide focused, individualized education in the areas of global health, anesthesia in low resourced areas, and to offer continuing medical education opportunities for the anesthesia clinical officers and students through the residents. The Anesthesia International elective focuses on both clinical exposure and on providing education to the Malawian clinical officers and students. The collaborative relationship with the anesthesia clinical officers at Kamuzu Central Hospital offers a meaningful opportunity for the residents to make a lasting and positive impact through education and quality improvement research.
MalawiUNC Project Malawi (UNCPM) is a collaboration between UNC and the Malawi Ministry of Health that was established in 1999. UNCPM employs ~375 Malawian staff, including clinicians, nurses, laboratory staff, pharmacy technicians, data officers, and administrative staff. In addition, UNCPM has ~15 permanent Malawian and expatriate resident faculty in infectious diseases, hematology-oncology, women’s health, pediatrics, and epidemiology. UNCPM serves as a training site of the Fogarty International Center, and as the site of many ongoing research studies, including protocols implemented by the NIH. Several international protocols have been chaired by the UNC faculty. Annually, UNCPM receives ~500,000 USD for infrastructure support from UNC, ~11 million USD in grants for clinical research and training, and ~5 million USD in grants for implementation and service delivery. Much of this support comes from the NIH; additional support comes from the Bill & Melinda Gates Foundation and private donors. Currently, UNCPM leadership is housed in the UNC Institute of Global Health and Infectious Disease (IGHID). Historically, UNCPM research has focused on communicable diseases. With the arrival of new faculty, there has been substantial growth and diversification, including major activities in cancer, surgery, women’s health, pediatrics, anesthesia, and sickle cell disease.
UNCPM has been sponsoring physicians who have supported pediatric inpatient clinical care and research at Kamuzu Central Hospital (KCH) since 2009. In 2014, UNC Anesthesia began a partnership with the KCH Anesthesia Clinical Officer group and through this partnership an International Anesthesia elective was developed.
KCH is the national referral hospital in the capital city of Lilongwe, serving the central region of Malawi and has a catchment area of 8 million. It is an 800-bed hospital that will flex to over 1,000 beds during the busy season. KCH is overseen by the Ministry of Health and is affiliated with the Malawi College of Medicine with on-site facilities for the third-year Malawian medical students.
Our department has sent numerous anesthesia residents, 1 pediatric anesthesia fellow and 5 anesthesia faculty members to KCH. There have been two peer reviewed journal articles published by UNC anesthesia faculty on Global Health at KCH as of 2020. There are 2 IRB approved ongoing research projects in anesthesia at KCH. Unfortunately, the electives planned for the Spring and Fall of 2020 were canceled due to the COVID19 pandemic. Residents and faculty have received travel scholarships through Doximity. Residents and fellows have received scholarships and a research scholar grant through UNC Office of Global Health Education (OGHE). Faculty have been the invited external visiting Professor examiner for the Anesthesia Clinical Officer Student final clinical exams. UNC Faculty have received national awards for their Global Health Advocacy.
Other Sites and Resources
UNC Office of Global Health and Education
UNC Malawi Initiative
UNC School of Medicine
Global Health Scholars Program
Institute for Global Health and Infectious Disease
The UJMT Fogarty Global Health Consortium