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A Regional Exchange at the University of Malawi College of Medicine

Filed under: GEMx Regional Exchanges, GEMx Student Reflections

a smiling student

Post by John Baptist Ssenyondwa
GEMx exchange student from Makerere University School of Medicine 

John standing outside of the Queen Elizabeth Hostipal

My first day at Queen Elizabeth
Hospital

Medical school without a clinical rotation outside the teaching hospital environment of one’s training is not comprehensive enough. Through elective rotations, medics are exposed to the different experiences that come with working in a different setting from one’s training facility. I was one of the students that got the opportunity to take part in the GEMx Electives program this year. It was last semester for me and not only was I looking forward to completing medical school but also engaging in a clinical rotation for the weary holiday prior to internship. I had tried to apply for several programs that I could enroll in before I started internship but in all in vain.

As I walked through the busy schedules of school, the call for applications by GEMx Electives came to my notice and so came the interest to apply to take part. I had always wanted to travel as a student to a different medical school for an exchange program that would contribute to building my future career as a doctor. I immediately logged into my new GEMx account to find out the available universities for elective applications. I also found out that I was under the GEMx- South to South program which included University of Witwatersrand in South Africa;  College Medicine in Malawi, Makerere University and University of Rwanda. The days passed by and three weeks later on, I received the good news that my application had been accepted for the elective rotation at Malawi University College of Medicine. Filled with joy, I shared my good news with friends who were happy for me.

Malawi is divided into the central, northern and southern regions with 28 districts. The college of medicine is located in Blantyre, which is found in the southern region of Malawi. Having been established in 1992, it is the only medical school in the country with four undergraduate courses offered which include the five-year-long Bachelor of Medicine and Surgery (MBBS), and the four-year-long programs of Bachelor of Medical Laboratory Sciences (BMLS), Bachelor of Physiotherapy (Hon) and Bachelor of Pharmacy (Hon). For a greater portion most of my rotation, the College was on holiday and therefore I had appropriate contact time with the senior lecturers however limited interaction with the other students.

surgery being performed

Assisting surgical theater at Mercy James Centre for Paediatric Surgery and Intensive Care

The first official day of my elective found me at Queen Elizabeth Central Hospital in the Surgical Annex for the handover meeting held daily. Queen Elizabeth Central Hospital is the largest government tertiary unit and main teaching hospital for the College of Medicine. The hospital handles the referrals from the districts surrounding Blantyre. I was oriented through the facility ends and corners so that I could get my bearings well thereafter. I was introduced to the head of department, Surgery and each individual on the team I was joining in paediatric surgery. I rotated through paediatric surgery for first three weeks and one week at Beit Cure International Hospital.

Cure Malawi is a 58 bed teaching specialized in treating orthopedic needs of children and adults opened in 2002. The hospital also has special expertise in total hip and knee replacement surgery, making it one of the few places where this surgery is available in Sub-Saharan Africa. The hospital treats a wide range of orthopedic conditions including clubfoot, burn contractures, osteomyelitis, and other acquired or congenital conditions. In addition, CURE Malawi also provides physiotherapy and chiropractic services.

Table of Metrics

Table I. The cases observed and assisted in Paediatric Surgery rotation at the MJC theatre

 

Table of Metrics

Table II. The different surgeries participated in at Beit Cure International Hospital

While at Queen Elizabeth Central Hospital, I attended the handover meeting first before heading out for the day’s work each day. At these sessions, a 24 hour recap of the cases handled by the department was held and these cases discussed by the resident doctors together with the respective surgical teams of General Surgery, paediatric and orthopedic surgery.

Ward rounds were conducted daily by a senior consultant and residents on the different wards. The wards included: Paediatric Surgical Ward at the Mercy James Center; Chatinkha Neonatal Unit; Paediatric Nursery Ward; Paediatric Oncology Ward.  At the ward rounds, I was able to see several of the common conditions in paediatric surgery most of which I hadn’t seen during my school rotation. Additionally, we were able to discuss the conditions with the consultants and learn the approach to managing the ailments.

While in paediatric surgery, I was able to attend 3 ward rounds in a week. At the ward rounds, I was able to see several of the common conditions in paediatric surgery most of which I hadn’t seen during my school rotation. Additionally, we were able to discuss the conditions with the consultants and learn the approach to managing the ailments.

The OPD [Out Patient Department] ran every Monday afternoon after the rounds. While at the clinic I participated in eliciting history from the patients, examining and discussing with the consultants the different cases. This was a special learning experience as we saw several patients with a variety of conditions and therefore I always had various conditions to study. I had assignments to do every clinic and this facilitated my learning throughout the rotation. It was exciting to be in theatre and take part in the management of patients. I worked in theatre on Tuesday till Thursday for about seven hours each day.

surgery being performed

Assisting through the operations at Beit Cure Hospital

The rotation at Cure hospital was one week during which I rotated through the OPD clinic, theater and the wards. The OPD clinic also ran on Monday the entire day. I attended one clinic day of which we saw 30 patients with various orthopedic conditions. I was well facilitated by Dr. Lubega Nicholas, an orthopedic surgeon at cure who always discussed and ensured I followed through the activities at the facility.

I also attended teaching seminars at Cure hospital with the resident orthopedic students. Much as the cases discussed at these seminars were beyond my scope, I was able to learn the basic concepts on how to diagnose and know who to refer to. I learned the basic surgical skills employed generally in the field of surgery. I also took part in the general surgical management of the patients admitted at Cure, assisting in the various operations at the facility.

natural waterfall and pools

At Dziwe Lankhalamba Waterfall

While in Blantyre, I toured several beautiful places around the town during the weekends which also rejuvenated me throughout the rotation. I hiked Mulanje Mountain the highest peak in Malawi and visited several other sites like Mandala historical site among others. I met so many people and made quite a number of friends both within the medical field and other fields.

During my stay in Blantyre, I was able to work in a different environment with warm people eager and committed to improving the health of their patients. Despite the fact that the setting was much similar to my training hospital, I was able to achieve the objectives of my rotation.

I was able to develop and build my confidence in proper approach to pediatric surgical cases. My diagnostic acumen depending on history taking from the patients without need to depend on newer imaging diagnostic modalities was greatly improved. I was trained by highly qualified surgeons in the basic surgical skills and technique employed in the operation theatre which is a lifelong skill obtained.

group of young people

With new friends

The rotation greatly supplemented my prior curricular clinical rotation in which some concepts and topics had been unsatisfactorily taught. I was able to deeply appreciate and understand some of the topics clearly through the ward round discussions with my supervisors and mentors. Throughout the rotation, I had ample time to read up the cases I saw on the ward and in theater. I was also able to identify the deficiencies associated with our African health systems and how these impact on the health of our patients. I met different individuals practicing in the medical field and made friends throughout my rotation and stay in Blantyre. It was great interacting and socializing with people from all over the world but with similar goals and interests. I was able to share several ideas and experiences with my new friends and establish career building relationships.