This has been an exciting and informative trip. I have worked with Jeff [Wilkinson,director of UNC Malawi Fistula Unit] assisting at elaborate fistula surgeries including ureteral reimplantations, etc. He recalls that I attended his first TVH [Total Vaginal Hysterectomy] in residency so this is quite nostalgic. We tell Droeges' stories, sing, relive our youth, & amazingly are seeing people dry after surgery. Jeff's skill sets are astounding. We also are the second operating room for an L&D that does more than 15k deliveries. So uterine ruptures, C-hysterectomies, etc. abound.
On the obstetrics front, Sumera Hyatt is winding down an intense course in OB emergencies. This includes hands on evaluation, team building, etc. Her instructional skills rival Jeff's surgical prowess and one watches the learner's knowledge swell as they participate. The big "training the trainers" session is tomorrow. UNC OBG and Women's Primary has another outstanding medical educator!
Fortunately, this trip has coincided with visits from important partners to our efforts. I have been able to meet with the upper echelons of the Freedom from Fistula Foundation, the chair of OBg at the Medical College in Blantyre, officials from the UNC project, chair at the Kamuzu Central Hospital, Kevin Osimi from Fresno whose family foundation has helped renovate the new unit, and the Ministry of Health.
Jeff and Sumera have formed an awesome and dedicated team. Margaret Moyo is his administrative leader and can get just about anything one needs done in a bureaucracy that makes UNC look efficient. She accomplishes all of this with a wry smile and laugh that brightens everyone's day. He has 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 helps Sumera with the instructional work and is quite effective. Dr. Khalita continues to provide clinical leadership to the OB unit.
We have had numerous Chapel Hill learners and teachers on site. Gretchen was here the first week and Tom I will be here at the end. Kacey and Jason's visits overlapped with mine in the middle. They led the effort to teach clinic officers and midwives practical USD and did a lot of hands on instruction. Jason leant me clogs for the OR and his wife Kate helped me typed my editor's choice article for the BJOG. Cat Stein has been working on a photo and audio documentary for the fistula patients that my brief glimpses at have seemed to have huge potential for sharing their stories with a Western audience.
The new unit is handed from the contractor to the UNC-FFFF team tomorrow. We have 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 and Sloane (UNC Women's Studies graduate) have spent a lot of times along these lines. Sloane captured it best in her commentary," 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 has been a real privilege. I am grateful to my team at home who has functioned flawlessly in my absence and the Malawian team that works miracles in the most difficult of situations.
The University of North Carolina Project-Malawi (UNC Project) is collaboration between the University of North Carolina at Chapel Hill and the Malawi Ministry of Health. It is based on the campus of Kamuzu Central Hospital in Malawi's capital, Lilongwe. The mission of UNC Project-Malawi is to identify innovative, culturally acceptable, and affordable methods to improve the health of the people of Malawi, through research, health systems strengthening, prevention, training, and care.
John M. Thorp, Jr., MD is Professor and Director of Women's Primary Healthcare in the Department of Obstetrics and Gynecology. He is an expert on preterm birth, cervical insufficiency, clinical trials, nutrition in pregnancy, health disparities, alcohol and drug abuse research, and outreach education.