Post by Onthatile Thusi, a medical student from University of the Witwatersrand Faculty of Health Sciences [South-South] who recently completed an elective exchange at the University of Malawi.
The plane cut through the clouds to reveal the first views of Malawi from the sky. The land was patterned with areas of green and brown and scattered housing. The scene was a great contrast to the landscape of Johannesburg which is populated with housing. As the plane began to fall towards the earth the exhilaration rose in my body while the thought of stepping my feet onto to a foreign land soon became a reality.
Queen Elizabeth Central Academic Hospital found in the city of Blantyre, Malawi is the largest referral health facility in the country of Malawi and was the setting of my 4-week elective along with 4 other students from South Africa. I was in the Department of Medicine under the supervision of Dr. Mallewa. I was placed in the male medical Ward 3b and was welcomed by the team responsible for Bay 2 which consisted of Dr. Lester, an experienced consultant, Dr. Basami a proficient intern, Dr. Pink an enthusiast registrar, and Allan Masapi a friendly and helpful final year medical student. The only directive we were given for the elective was to follow the final year students timetable and we were given the freedom to attend any of the lectures or teachings carried out by the Department of Medicine.
“You are responsible for your own learning”.
This was a statement repeated to us throughout our second year of study and it is now in this elective experience, that I have come to grasp the significance of this statement. There are numerous opportunities to learn from patients whilst in the wards. The team working in Ward-3b, Bay 2, and the members of the Department of Medicine was willing to impart their knowledge onto the students. However, it was my responsibility to take hold of the learning opportunity and initiate engagement and discussion with every source of knowledge at my disposal. Other than the scheduled final year student lectures, and the bedside teachings carried out during the ward rounds twice a week, learning was often self-directed.
My day at Queens began with student case presentations which I found very valuable. In these case presentations, I saw the theoretical knowledge acquired in medical school come to life through practice. It is in the discussions of these cases where I learned the value of the art of medicine in a resource-limited setting. Each investigation was challenged for its relevance and utility. The principles imparted in these discussions are some that I hope to apply in my personal practice of medicine in my home country of South Africa that face a number of resource limitations with a similar HIV burden. Following case presentations, were morning ward rounds often done with the intern and joined by the student and consultant twice a week. It is in these ward rounds that I was inspired by the extremely knowledgeable intern Dr. Basami and had the privilege of seeing the art of medicine practiced with efficiency and great proficiency despite the many limitations. Under the patient guidance of interns and final year students, I was able to carry out a number of my clinical skills and acquire new skills with the encouraging consent of the patient. It was often that the ward round and ward work was completed before 13:00, and I would find myself with nothing to do the rest of the day. I attempted to shadow an intern in the medical admissions in the Emergency Department or searched the wards for a doctor to have discussions surrounding patient’s cases.
One of the very exciting experiences was at the Grand Ward round which took place once a week. It is in this ward round where ongoing studies at the hospital were presented. Exhilarating discussions were had on the clinical relevance of the study and conclusions were made from the study. Active conversations between departments would take place on how the challenges and recommendations brought forward by the study could be mitigated and implemented. It was exciting to hear the dynamic interactions between professionals that bring tangible change in public health and ultimately improve patient care.
Malawi the warm heart of Africa. The pulse of this heart is felt through the people of Malawi. The patients I encountered were willing to engage with me and consented to my intention to learn new skills with welcoming eyes. The language was a great obstacle, as most of the patients speak Chichewa, there were very few patients that spoke English. I felt that my opportunity to gain crucial experience in clerking and presenting patients was hindered. This language barrier limited my ability to perform procedures and examinations using a patient-centered approach, as all communication was done through a third party.
The pulse of this warm heart of Africa extended outside the hospital confines. The owners and staff at Home Up guesthouses, our accommodation for the duration of the elective, welcomed our arrival with expectant and cheerful spirits. Throughout our stay, they created a friendly and cozy environment. The staff was eager to help in any regard and provided valuable information to make the most of our experience in Malawi.
The vibrant and energetic spirit of Malawi is reflected in its landscape. We had the privilege of exploring some of the great sites in Malawi. We trekked through the majestic Mount Mulanje, trudged the lush green forestry of Zomba plateau and strolled through the tranquil fields at Satemwa tea plantations.
The friendly people, the warm culture and the exposure to a number of new medical experiences made these 4 weeks greatly fruitful. Despite the delays during the application process and the challenges in securing the funding before my departure, thanks to the diligent work of Mr. Motlhabani and all involved this elective experience was made possible. Each moment has been a true privilege. I have obtained valuable exposure to a wide range of medical conditions, although ideally, I would have enjoyed the chance to rotate through the different medical wards and engage with different doctors. Similarly to South Africa, Malawi has a large HIV burden and through this elective, I learned crucial principles concerning the monitoring of HIV in a resource-limited setting. The greatest personal revelation that I have taken from my 4 weeks in the Department of Medicine, is that true learning comes with an eager and earnest attempt to acquire it. I have retained a great amount of information due to a personal growth desire to gain a greater understanding of the patients I encounter and I hope to continue to grow into an experienced and proficient doctor.