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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,

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 is a large burden of urological pathology in Malawi. The main problems are BPH, urethral stricture in men, fistula disease (prolonged labour) in women and malignancy of bladder (schistosomiasis related) and prostate. Besides there is a fair amount of paediatric urological pathology. Apart from one trained urologist in Kamuzu CH in Lilongwe urological care in other hospitals is provided by general surgeons, medical officers and or clinical officers. There are private hospitals in the country providing somewhat more up to date urological services. Urological care in the district hospitals is at a very low level. In general diagnostic facilities are poor and endoscopic instrumentarium is non-existent or malfunctioning. As a result there is a serious shortage of treatment facilities for the many urological patients. At the same time there is a great need for teaching and training of doctors, clinical officers and nurses. Malawi.kom aims to answer this need focussing on the district hospitals. Exciting news is the intended opening early 2018 of a Cosecsa urology training at Kamuzu Central Hospital, Lilongwe.
Over the recent years bi-annual clinical visits to Malawi were undertaken with clinical consultations and workshops on urological subjects in several central and district hospitals in Malawi. In 2014 Malawi.kom urologist Gert J Montagne worked for 3 months at the surgical department of the Queen Elisabeth Central Hospital (QECH) in Blantyre. On the department’s request he assisted in upgrading local urological care and in training of surgical residents and clinical officers. The project was generously supported by Physicians for Peace (PfP) from the USA.
With the aim of upgrading the urological care at district hospital level Malawi.kom was happy to contribute to the practical training of clinical officers (COST Africa Bs. training programme). Early 2015 covering six district hospitals in the Southern and Central Region clinical officers were trained in the (surgical) management of BPH. Nov 2015 and march 2016 a similar training was given at Chitipa district hospital (Northern Region). Since Nov 2015 malawikom urology is focussed on Nkhoma Mission Hospital (Central Region). This well managed mission hospital is visited regularly for a 2 week urological workshop. In these visits many local patients and patients from Lilongwe area are seen and operated. Clinical officers are trained in cystoscopy and BPH surgery. In Oct 2016 Dr Meinhardt, former Malawi mission docter, joined this malawikom - Nkhoma urological initiative. In 2018 a COSECSA certified urology training was started at Kamuzu Central Hospital, Lilongwe. A major step ahead for urology in Malawi.
Malawikom's urology work is generously supported by Stichting Medic, Stöpler en bk-ultrasound