UNC at Work in Malawi

I spent today at the Malawi College of Medicine, seeing lots of interesting and impressive things.

My host was Dr. George Kafulafula, the vice-principal of the COM. The principal, who is analogous to a U.S. dean, was out of town. George is an Ob-Gyn, and former head of that department here. His principal research interest is the prevention of maternal to child transmission of HIV. He is a young doctor, in a very responsible position, with obvious commitment and dedication.

The College of Medicine is located on the grounds of Queen Elizabeth Central Hospital, a sprawling institution of 1,500 beds. It is made up of many buildings, all one floor, connected by covered walkways.


I had visited QECH in 1991, when I was CDC Director, as part of a US Government delegation. They have made progress in many areas, but it is still a stark contrast to a hospital in America. The doctors, nurses and others are struggling to care for a huge burden of illness, with inadequate facilities and limited supplies and equipment. One image that will stick with me in the children's ward an IV pole was not tall enough to hang an IV for a high bed, and so it was extended, with a whittled branch that was taped to the pole. It did the job, but was still jarring.

We met with Dr. George Chithope Mwale, the director of QECH. He is himself a graduate of the COM, and formerly was a district health officer. He talked about the challenges he faces to try to care for the teeming numbers of patients who come to his hospital. The wards were jammed full, with more beds than they were built for. In one of the men's medical wards, for example, I counted 60 beds all full, with many family members as caregivers in one large open room.

We went to the pediatrics wards, and for me, a pediatrician, it was particularly poignant. In the children's malaria research unit, we saw where they care for the most severely ill patients, including those with cerebral malaria and meningitis. A young registrar (resident) gave me a tour, along with a clinical officer (like a physician's assistant). I was really taken with their enthusiasm, despite the huge challenges.

I saw the facilities of many other collaborating institutions the Gates Foundation funded Malaria Research Center, the MLW Malaria Research Facility (Malawi-Liverpool-Wellcome Trust), and the Johns Hopkins Research unit.

UNC and Hopkins are major partners in many of our studies, and it is a very cordial and fruitful relationship on both sides.

Steve Meshnick, of the UNC School of Public Health, has long done malaria research here, and he is now leading the UNC Summer Institute of Public Health here. He and others are assisting the Division of Community Health of the College of Medicine in their Masters of Public Health program, which they have now launched, very successfully. They aspire to create a School of Public Health here for Malawi, within the College of Medicine.

I have visited with Dr. Victor Mwapasa and Dr. Linda Kalilani, both with UNC ties, who are playing major roles in the MPH program here.

They are interested, as well, in collaborating with UNC's School of Public Health, in a joint doctoral degree in public health, for Malawi and the entire region.

I am pleased that UNC has done and is doing so much here the opportunities are very great. Again I make the point that we should work in global health for many reasons, surely including the benefits of this work to the people of North Carolina.

More to come tomorrow in Lilongwe, and I still need to describe Will and Jessica's day with the Street Kids Project.

Bill

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