Projects
1. Tools & Skills
The Problem
Conducting the Clinical Officer training in surgery - Project in the years 2005 - 2009 a situation was found where both expertise and equipment to properly carry out essential and emergency surgical procedures and �management was lacking or at least insufficient at the average hospital in the district in the whole country.
In consequence, this lead to
1. poor results, in terms of outcome (morbidity and mortality)
2. high costs (referral)
3. poor motivation of the staffs concerned.
Adressing the problem
Following a comprehensive survey in 2007 of all (17) hospitals in the Southern Region and in 2008 and 2009 in the Central and Northern region, a shortlist was compiled of the most urgent problems regarding surgical treatments (SKILLS), materials, instruments and equipment (TOOLS) necessary for surgical care in a broader sense.
To address the shortage of tools and skills in the region, two lines of action were planned.
1. To bring (or make available) the tools and to teach the associated skills in a number of workshops to be organised at each hospital separately.
2. To bring technicians and health care professionals to the hospitals. The technicians for repair and (teaching) maintenance of equipment, the health care professionals to assist in logistic and maintenance issues.
Project activities
1. Provide or make available those items of materials, instruments and equipment which are essential but lacking or not functioning.
2. Organise workshops at the Hospitals in the District pertaining to the most essential and as yet insufficient treatments and techniques mostly directed at the surgical- and trauma patient.
3. Arrange for technicians and health care specialists, expatriate as well as Malawian, to work and teach at a selected number of these hospitals, directing their activities at tools, logistics and maintenance.
The programme TOOLS & SKILLS has been officially assigned to CHAM, the Christian Health Association of Malawi. To this end a formal contract is signed in February 2009.
The project started with a successful series of workshops in the District and Mission Hospitals on Bone pinning in January 2008 followed by workshops on Sutures+suturing, Burns and Skin transplantation, Basic Trauma Life Support and Local Anesthesia in Surgery. The concept of TOOLS & SKILLS clearly proved to fill a need.
Apart from a recommendation letter by Dr. Dzowela, Deputy Director Clinical Services (Ministry Of Health) the project manager of T&S received the very positive recommendation below from the Medical Council of Malawi.
Medical Council of Malawi received a Tools & Skills Project that Dr. Charles
Boissevain is implementing in conjunction with Christian Association of Malawi(CHAM).
Council is impressed with the project and supports its implementation as it will:
1. significantly increase the knowledge, skills and motivate health care workers in our district hospitals where the need is greatest
2. augment Council's efforts in providing Continuing Professional Development (CPD) to our practitioners and earn them credit points - important for renewal of registration.
We wish Dr. Boissevain and his team all the best as they improve surgical skills amongst our health care workers.
Regards,
KM MKANDAWIRE
ASSISTANT REGISTRAR(PROFESSIONAL PRACTICE)
From 2010 workshops on Sutures+suturing, Burns and Skintransplantation, Basic Trauma Life Support and Local Anesthesia in Surgery are also being organized in the District and Mission Hospitals in Central and Northern region of Malawi .
2. Queen Elizabeth Central Hospital (QECH) Support Program
Materials and Equipment
From the start in 2008 Malawi.kom supports the Department Of Surgery of teaching hospital QECH in Blantyre by delivering medical equipment and supplies.
Clinical Officer Surgical Training (COST)
The surgical / urological specialists of Malawi.kom support the Bachelor degree COST program by supervision and training the candidates during the hospital visits.
3. Support Kalemba Hospital Bangula
In July 2004 Kalemba Hospital in Bangula, Lower Shire, was scaled up to a Community Hospital, but could by no means fulfill its tasks, due to lack of treating and nursing facilities, medical equipment and qualified manpower.
Following a request of the Congregation Sisters of Our Lady Malawi.kom helped to construct a mortuary, a theater and a wall fence around the hospital area. The construction of a much needed surgical ward is intended for. Essential medical equipment is still lacking. A program to training the hospital workers has been started.
4. Urology
There are many people in Malawi with urological disease including benign prostate hyperplasia, urethral stricture disease, urinary fistula after prolonged labour, stone disease, bladder-, prostate- and penile cancer. Moreover there is a fair amount of paediatric urological conditions. Often patients present with advanced stages of disease. In the district hospitals urological service is offered by clinical officers and medical docters. Their urological expertise is limited resulting in the majority of patients ending up with a urinary catheter or palliative care. Some female fistual patients are cared for in so called �fistula camps� organized by visiting surgeons. As a result many urological patients are referred to surgical departments of the four central hospitals in the country. Due to the high numbers of other referred patients, not rarely requiring acute surgical care, the capacity in these centres is small. The diagnostic facilities are limited and endoscopic instruments are abscent or malfunctioning. At present there are two qualified malawian urologists in the country. In 2018 a COSECSA certified urology training centre was started at Kamuzu Central Hospital in Lilongwe.
From 2014 urological consultancy- and training missions were undertaken two- or three times a year visiting both central- and district hospitals. In 2015-2016 malawi.kom urologist Gert J Montagne worked in the surgical department of QECH Blantyre two periods of three months to assist in upgrading the urological care and to train surgical residents and clinical officers. This project was supported by the US Physicians for Peace. In 2016 the practical urological training of COST Africa Bsc. clinical officers in six district hospitals was taken care of. Likewise urological workshops were organized in other district hospitals reaching as far north as Chitipa. In the following years in Nkhoma CCAP hospital a promising twice yearly urological workshop was set up. The local surgeon and clinical officers were trained in doing cystoscpy and BPH surgery, TURP was introduced. Feb 2020 marked the start of the close co-operation with freshly qualified malawian urologist Charles Mabedi, the proud leader of the COSECSA urology training centre at KCH Lilongwe. Both Nkhoma CCAP and the Urology Training Centre in KCH Lilongwe greatfully received large volumes of urological (endoscopic) instruments including two ultrasound machines. Covid travel restrictions forced us to put the planned visits temporarely on hold. In 2021 and 2022 two successfull TRUS prostate biopsy workshops could be organized at KCH urological training centre. In addition several district hospitals in the southern region were visited for urological teaching. Malawi.kom joined the two malawian urologists in their invited presentations at the 1st �Malawi Surgical Oncology summer school� August 2022.
Over the years urology malawi.kom has been supported by Astellas, Stichting Medic, Stoppler, BK-Ultrasound, Olympus Nederland.
|