“When Dr. Charles Mabedi came to UNC as a visiting professor in 2017, having then just finished his urologic surgery training in Tanzania, I was immediately struck by the daunting task he had before him. As the sole urologist in Malawi, he aimed to start a residency training program to provide care to the over 18 million Malawians. Through a generous funding opportunity from the Southeastern Section of the AUA, I was able to join him in Malawi for two weeks during my chief year.”
Benjamin McCormick, MD
After 4 flights and 30 hours, I arrived at Kamuzu Central Hospital in Lilongwe, Malawi, where I was housed in a beautiful communal space with 12 other US and international researchers, medical students, residents, and fellows. We soon bonded over our various projects, and during my time there I met lifelong friends and future collaborators.
On the first day in the hospital, I was in awe of the extreme lack of resources. Basic supplies such as gloves, gowns, and hand sanitizer are only intermittently available. It is difficult to obtain labs and often even vital signs. The beds on the wards are positioned so close to each other that it is difficult to walk between them, and frequently there are more patients sleeping on the floors. The 6-bed intensive care unit serves a population of 6 million people. There is one CT scanner (which is not operational at night or on weekends), and no physician anesthesiologists, not to mention the lack of urology-specific supplies and tools.
Despite this, I was exceedingly impressed with the quality of the care the patients received. Lack of lab and imaging tests is compensated for by rigorous history taking and physical examinations, more often than not leading to the correct diagnosis without wasting time or cost on further testing. I admired how adeptly Dr. Mabedi navigated the system, and how skillfully he performed a wide array of cases, often with awake patients and staff not familiar with urologic procedures.
I found my role in educating the interns and medical students about a variety of urologic problems, and assisting Dr. Mabedi in the OR, with consults, and in clinic. As busy as we both were, I am truly astonished that he is able to keep up with all of his responsibilities. Despite how much work we had, he was always quick to teach me and the other residents, and offer kind words and reassurance to patients.
For two days during my time in Malawi, Dr. Mabedi suggested I visit the Fistula Care Center on the other side of Lilongwe. The center is run in part by Dr. Ennert Chipungu, a Malawi-born surgeon who received her training in OB/GYN in South Africa. When she returned from residency, she was offered further training under a UNC-trained surgeon, Dr. Jeff Wilkinson. Now, Dr. Chipungu performs about 300 fistula surgeries per year. More than that, she accepts patients into the center 24/7, 365 days per year, offers them work opportunities, nutrition supplementation if needed, and starts them back on a path towards feeling human again. The care her patients receive is world-class, and the difference she is making in her patient’s lives can not be overstated.
In reflection, this experience will have a profound impact on my career and my practice. In a time where healthcare costs are higher than ever, my visit reinforced that attention to physical exam findings and a good history can provide an accurate diagnosis in a large percentage of cases without the need for expensive tests. In addition, I have started to think about a time when I can return to a resource-limited setting to have a more meaningful and long-term impact on the patients and trainees there. I left Malawi with a deep and humble appreciation for the work being done there by Dr. Mabedi, Dr. Chipungu, and all the trainees and staff, and a drive to pay the experience forward in some way during my career.