DISPARITY

I have been attending the Thursday morning Morbidity and Mortality conference of the surgery department at Kamuzu Central Hospital, which is the largest hospital in Lilongwe.  The surgery residents present the cases and we discuss them.  What I have discovered is that there is a certain level of underlying frustration among the attending staff surgeons there.  The hospital is large and has a pretty impressive infrastructure, but there is a certain level of dysfunctionality in the place.  Surgeons have been complaining that they have cases scheduled that get cancelled because there are no sterile drapes, or maybe no IV fluid.  This last Thursday there were two cases of femoral neck fracture that were presented.  Ordinarily such cases should receive internal fixation and be mobilized early on crutches.  But the two orthopedic surgeons told me they don't have the hardware to do the operation.  So these patients will end up lying in skin traction for several weeks, and probably end up with some disability.  Very sad.

Three weekends ago I was down at Malamulo Hospital covering for the weekend so their surgeons could take a little time away.  While there a patient was referred down from Lilongwe (Partners in Hope Clinic) for gall bladder disease.  She ended up needing a common bile duct exploration along with her cholecystectomy, which the fourth year resident from Loma Linda was quite excited to do with me.  The point is, though, that she was referred from the capital city to a rural hospital five hours away because the referring doctor felt that was the best option for her.

So the need for reputable surgical care in Lilongwe is quite stark.  We need a hospital that can provide reliable, attractive, modern service to the wealthy, and use the financial stability to be able to offer services to the poor, as well.  This is always a challenge to set up and sustain, but the needs are great and I think we need to face this challenge for the sake of the people of Malawi.  This is one of the poorest countries in the world, and one of the lowest per capita health care providers.  Malawi has just two physicians per 100,000 population.  The U.S. has about 265 per 100,000.  A great disparity.