Recently in Lilongwe, UNC Project-Malawi leaders welcomed UNC Chancellor Carol L. Folt and other dignitaries to celebrate decades of accomplishment and mark the formal opening of new research and library facilities.
By Jamie Williams
UNC’s work in Malawi began more than 20 years ago with a small team working out of a single rented office on the second floor of the Dulux Paint Building in Old Town Lilongwe. From those beginnings, the dedicated scientists and staff at UNC Project-Malawi have led research studies that changed the course of global health, trained a generation of Malawian physicians and scientists, provided transformative learning experiences for UNC students, and helped to improve the health care infrastructure of the southeast African nation.
UNC has over time expanded from that single small office to around 75,000 square feet of research and clinical space, spread across the campus of Kamuzu Central Hospital as well as other locations in Lilongwe. From labs in Lilongwe, UNC Project-Malawi researchers helped lead the HIV Prevention Trials Network’s 052 study, which showed that early treatment of HIV with antiretroviral therapy could reduce sexual transmission by 96 percent. That international study led by Myron Cohen, MD, Associate Vice Chancellor for Global Health, and Director of the Institute for Global Health and Infectious Diseases, was named Breakthrough of the Year by Science in 2011. Further work has greatly reduced the rates of mother to child transmission of HIV. Now, overall rates of new infection in Malawi are way down, and antiretroviral therapy adherence has greatly increased.
From the foundation of groundbreaking and life-changing infectious disease research, UNC now supports clinical care and education in disciplines including cancer, surgery and women’s health.
“The people we have in place in Malawi and the work that they are doing are amazing,” said Irving Hoffman, PA, MPH, professor of medicine in UNC’s Division of Infectious Diseases and UNC Project-Malawi’s international director. “I’d say that we have never been in better shape with regard to research and clinical cooperation and collaboration in the country.”
Hoffman first traveled to Malawi in 1992, working with Cohen on early studies of HIV in the country. Discoveries made in those early years built the early momentum that led to the formalized launch of UNC Project-Malawi. Francis Martinson, MB ChB, PhD, MPH, was brought on as country director in 1999. Looking back, he recalls telling Hoffman he could commit to one year. He stayed 18 and is now preparing to retire in early July back home to his native Ghana.
“In those early years, we were foreigners; we had to build trust with the government,” Martinson said. “But we made progress; we did good work and things continued to build. Now, everyone in Malawi knows UNC.”
Two physical manifestations to that tremendous growth were dedicated in June honoring Martinson and Hoffman at a celebration that included remarks by UNC Chancellor Carol L. Folt, the United States Ambassador to Malawi Virginia Palmer, and representatives from the Malawian government. The trip was Folt’s first visit to the country.
A new UNC Project Annex building houses the modern laboratory space needed for UNC to lead and participate in multiple clinical trials for infectious diseases and cancer. The facility’s pathology lab was dedicated to Martinson for his decades of service. A striking, silver sign spans the building and helps tell the story of UNC’s work in Malawi.
From the facility’s pathology lab, UNC staff will conduct research to improve the treatment of cancer in the developing world, an emerging global health crisis. UNC’s cancer program in Malawi is led by Satish Gopal, MD, MPH, a member of the UNC Lineberger Comprehensive Cancer Center. Gopal works closely with a team of Malawian physicians and researchers, including Dr. Tamiwe Tomoka, the first female pathologist in Malawi. The team in Malawi maintains a close connection with colleagues in Chapel Hill, connecting often via video conference to review pathology slides and discuss diagnoses. The new UNC Project library, which is dedicated to Hoffman for his years of exemplary leadership, offers learners the same resources available at the UNC Health Sciences Library in Chapel Hill, including technical assistance, journal access, scientific search engines, and an ever-expanding collection of medical reference books.
UNC Project-Malawi has been providing library services since 2000 and the training and education of Malawian students and staff has always been a key component of UNC’s presence in Malawi and will continue to be a guiding principle.
“Research training and mentorship has prepared the Malawians on our team to now help to set the course for our work,” Hoffman said.
The current research and care capabilities at UNC Project-Malawi are built on a foundation of infectious disease research. That work continues, with UNC Project-Malawi’s ongoing participation and leadership in the HIV Vaccine Trials Network and research into the most effective means of HIV prevention, under the leadership of UNC Project-Malawi’s Scientific Director Mina Hosseinipour, MD, MPH. In addition, UNC Project-Malawi is participating in the next phase of clinical trials for a malaria vaccine, a project being led by Hoffman.
UNC Project-Malawi has expanded into areas including cancer, surgery and women’s care, and has added a strong clinical training component to its research mission.
Anthony Charles, MD, MPH, of the UNC Department of Surgery has overseen the development of a resident training program for surgeons. The Malawian Surgical Initiative aims to increase the quality and availability of surgical care, which is severely lacking in the country. He has also helped establish a burn unit at Kamuzu Central Hospital. Burn care is a vital clinical need in a country where fire remains a primary method of heating homes and cooking food.
Jennifer Tang, MD, of the Division of Global Women’s Health, leads a residency training program in the area of obstetrics and gynecology, also helps to oversee maternal health and family planning services at outlying facilities including the Bwaila District Hospital and Area 25 Health Center. Tang and colleagues are working to improve women’s health in a country with one of Africa’s highest maternal mortality rates.
Malawians trained and mentored through the UNC Project also hold leadership roles and will help to guide the future of the work. Dr. Tamiwe Tomoka works side by side with Gopal and will help shape the future of cancer care. Dr. Lameck Chinula is the only surgeon in Lilongwe capable of performing the surgical procedure required to treat cervical cancer, which occurs at high rates throughout the country. He’s active both in OB-GYN training and HIV care and research. Dr. Cecilia Kanyama has been working at UNC Project-Malawi since 2003 and now works closely with Hosseinipour on HIV and other research projects. These are only a small number of the Malawians now involved in the site’s research and clinical care efforts.
In all of these areas, UNC sits poised to continue making the research and health advances that will spread far from this small nation in southeastern Africa.
“The discoveries made in Malawi have made an impact across the whole world,” said Cohen. “We have shown that the work done here in this small country can have a disproportionate impact on our entire species.”