University of Cincinnati Global Surgery Rotation

UC News Article on Global Surgery Program

The Need

Five billion people in the world do not have access to emergency and essential surgical care due to insufficient training of local clinicians, lack of safe anesthesia, and transport/financial limitations.

Our Response

Since 2015, we have addressed this underpublicized global crisis of avertable deaths and disability through the UC Global Surgery Program, which offers an 8-week elective General Surgery Rotation for senior residents at Mzuzu Central Hospital (MZCH) in Malawi, Africa.

Through the support of a full-time faculty member on staff in Mzuzu and the rotating senior resident, we provide free surgery and train dedicated, promising local clinicians in Malawi, one of the world’s poorest countries with one of the lowest surgeon to population ratios in the world [Lancet Commission on Global Surgery, 2016].

Malawi has long been known as the "Warm Heart of Africa"

See this recent ‘virtual tour’ of Malawi in the New York Times! https://www.nytimes.com/2020/08/31/travel/malawi.html

Our Partner

MZCH is the safety net referral hospital for the people of the Northern region of Malawi, a catchment area of 2.5 million people. Our goal is to enhance surgical care and capacity by supporting the infrastructure in place at MZCH. Surgical residents become a core component of a team of attendings, clinical officers and physician medical officers that manages patients in the emergency room, inpatient surgical wards and outpatient clinic setting who suffer from surgically treatable disease.

Residents participate in endless bidirectional educational opportunities with local clinicians including surgical attending staff, clinical officers, medical officers, nurses and other trainees on tropical disease, the pathophysiology of surgical disease, the technical and perioperative management aspects of surgical care, and the ethics of providing the best care possible in a low resource environment.

Our Opportunity

Working with our partners at Mzuzu Central Hospital, residents learn to apply basic principles of surgery and leadership in a limited resource, tropical practice setting in a culturally and resource-adaptive way.

Residents hone their clinical evaluation and physical examination skills as they diagnose and treat basic and complex surgical diseases in an austere environment with no readily available CT scan and limited laboratory investigations and medications. They are frequently challenged by the wide breadth of pathology and advanced stage of disease presented.

Residents perform approximately 100 major cases in a two-month period of time. Emergency laparotomies are frequently done to treat patients with delayed presentations of intestinal perforation from peptic ulcer or untreated salmonella typhi infections as well as intestinal ischemia from volvulus of both small and large intestine. Pediatric surgeries for anorectal malformations, palliative surgeries for biliary obstruction, procedures to manage obstructive uropathy, and management of large burns – are a small fraction of the clinical challenges to be managed.

In the operating room, there is an emphasis on efficiency and economy, to avert premature death and disability for the greatest number of patients possible. Residents adapt to operating without surgical instruments such as complex self-retaining retractors and surgical staplers.

Through advocacy, service, and education, we are able to support our friends in Malawi who provide the best surgical care they are able to, under very difficult circumstances, with the knowledge that without them there would be no surgical service available at all.

Mission

• To enhance surgical care and capacity in Malawi by utilizing senior U.S. surgical residents and consultants to support the infrastructure in place at Mzuzu Central Hospital.
• To provide shared learning experiences and unparalleled educational opportunities in an austere environment.
• To inspire a transformative approach to global health.

Core values

• Excellence in clinical services provided.
• Respect for colleagues and staff at all levels.
• Compassion for patients and their families.
• Advocacy for those who are dedicated to improving healthcare in Malawi.

Dr. Emily Midura (4th year surgery resident) managing a sigmoid volvulus with a Malawian clinical officer in training.

Dr. Elizabeth Dale (Burns/Plastics attending) working on a lower extremity skin graft with Augustine Chilongo, Malawian surgical clinical officer.

Dr. Ryan Earnest, trauma/critical care, leading ICU rounds with surgical clinical officers in training.

Jylos Chitenje, Malawian clinical officer, operating on a midgut volvulus with Dr. Charles Park.

Dr. Phylicia Dupree (4th year surgery resident) helping Mr. Francis Masoo (head of anesthesia) to prepare an infant with ruptured omphalocele for surgery.

Child with pre-auricular cyst examining the mouth of Dr. Winifred Lo (4th year surgery resident).

Clinical officer students, operating room nurses and surgical clinical officers with Dr. Jocelyn Logan (co-founder of the Global surgery program), Dr. Peter Jernigan (4th year surgery resident) and Mr. Masoo.

Nkhata Bay.

The Global Surgery Program requires significant financial investment to cover program, housing, and travel expenses. To help make our program sustainable, please donate now.

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