BEGINNING ENDOSCOPY IN LILONGWE

This week was another milestone.  We inaugurated our endoscopy equipment with the first colonoscopy performed at Adventist Health Centre.  All went well, The equipment functioned well, with good resolution.  We still have a few things to work out in terms of protocols, but we are functional as an endoscopy center.
 

Our medical director, Dr. Chibaka, checking out our endoscopy setup.

This week at the surgery morbidity and mortality conference I learned of a head injury patient that looks like he may need a tracheostomy.  However there are no tracheostomy tubes available at that hospital (the largest hospital in the city).  Fortunately, we have received a box of them in the shipment that came with our household goods.  So we are able to share with them.  The other unfortunate situation there is that their CT scanner is broken down and the technicians who do the repair are employed by a competing organization, so there is a conflict of interest.  Very sad for a country that needs all the help it can get.

Some people have asked for pictures of our house, so here it is.  A fairly nice place to live.  Parked in front is our little Toyota Raum, which gets us around a bit.

CHIANGMAI, THAILAND

During the last two weeks of April and first week of May we attended the Institute of World Mission session that was held in ChiangMai, Thailand.  We had actually attended a session in the Fall of 1993 prior to going to Nigeria.  Both times we have found it a good time for reflection on the how's and why's of what we do, discussion on cross-cultural interaction, and great fellowship with new friends, many of whom are heading for an extended cross-cultural experience for the first time (though there were a few experienced ones).  The weather was quite warm, the food was good, and we did get some free time to explore northern Thailand a bit.  Here are some pictures.

Entrance to the ChiangMai Zoo and Aquarium

One of many statues of deities around the area

View on a Sabbath afternoon hike

Ready to take us for a ride

Trying to keep our balance in a wobbly elephant saddle

Rafting on a rainy afternoon

Part of our group cooling off in a waterfall at the end of a hike

 At the mountaintop.  It was cooler up there.

One of the beautiful pagodas we visited.

 Agape feast the final Friday evening of the Institute.

Sabbath lunch at ChiangMai Adventist Academy.  Never-ending mango sticky rice.  Awesome!!

Family

This picture is a bit out of place chronologically, having been taken last September, but I wanted a more recent picture of the whole family on the blog site.  Taken at Sunriver, Oregon.

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.

IN LILONGWE

We arrived in Lilongwe on May 21.  The Adventist Health Centre Lilongwe here has been a reputable place for primary care, dental care and optometry in this, the capital city of Malawi.  But now we're trying to upgrade and add surgical services, as well as Ob/Gyn services.  Dr. Lolita Largosa, an Ob/Gyn from the Philippines, is due to arrive (with her husband) in a couple months.

The thought was that we could remodel the pharmacy store room into an operating room.  That was the original intent in the design of the building.  But the way things are now, it would be difficult to make that into a reputable operating room with good sterile precautions.  Not to mention there is a paucity of storage space and it would be difficult to find a good place to put the pharmacy store.  So it seems best to try to build a reputable surgical suite as an extension onto the current facility.  We have some plans on how that could happen, but little money.  So we are in fundraising mode.

Adventist Health Centre Lilongwe

The photo below shows where we would like to build the surgery extension.

Meanwhile, the container with our household goods has arrived, and with it some hospital equipment and supplies.  This means that I can now set up to do upper and lower endoscopy.  Should be up and running within the next week or two.  For actual surgical procedures requiring anesthesia and sterile set-up, I go to the MASM (Medial Aid Society of Malawi) Hospital which is a about a ten minute drive from AHCL.  It is not ideal, but we are working with it for now.

Here is a drawing of the surgical suite we would like to add onto the Health Centre.

More on Malawi, and Lilongwe in particular, another day.