Factors Involved in Selection of a Career in Surgery and Orthopedics for Medical Students in Malawi

AimsThere is a critical shortage of Orthopedic Surgeons in Malawi as well as all countries in sub-Saharan Africa. To date, there is no published literature that has investigated surgical or Orthopedic career selection amongst African medical trainees. With the goal of facilitating recruitmentinto Surgery and Orthopedics in Malawi, we explored the key aspects of Malawian Medical Students’ choice of careers in surgical disciplines.MethodsAn on-line survey of all students in clinical years at the College of Medicine in Blantyre, Malawi was performed. The survey was anonymous and constructed de novo by a stringent process including Item Generation, Item reduction, Survey composition, Pre-testing, Assessment of Validity by a recognized survey expert, Pilot testing in on-line format byseveral Malawian Medical Students, and then formal survey testing.ResultsSurgery was the most popular specialty choice among the medical trainees (46%). General Surgery was the popular surgical specialty (27%), followed by Neurosurgery (22%) and Orthopedics (19%). The majority of students (67%) feared occupational exposure to HIV but this did not appearto be a factor in specialty choice (p=0.9). Students with Orthopedic mentors were significantly more likely to choose Orthopedics as their first choice surgical specialty (p = 0.01). Despite limited resources and surgeons in sub-Saharan Africa, surgical specialties are desirable career choices.ConclusionsThis is the first evaluation of factors involved in surgical or Orthopedic career selection in any African context. Future initiatives to improve exposure and mentorship in Orthopedics are fundamental to recruitment into the specialty

The impact of long term institutional collaboration in surgical training on trauma care in Malawi

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Background Attempts to address the huge, and unmet, need for surgical services in Africa by training surgical specialists in well established training programmes in high-income countries have resulted in brain drain, as most trainees do not return home on completion of training for various reasons. Local postgraduate training is key to retaining specialists in their home countries. International institutional collaborations have enabled Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, to start training their own surgical specialists from 2009. Results and discussion The direct impact of this has been an increase in Malawian staff from none at all to 12 medical doctors in 2014 in addition to increased foreign faculty. We have also seen improved quality of care as illustrated by a clear reduction in the amputation rate after trauma at KCH, from nearly every fourth orthopaedic operation being an amputation in 2008 to only 4 % in 2014. Over the years the training program at KCH has, with the help from its international partners, merged with the College of Medicine in Blantyre, Malawi, into a national training programme for surgery. Conclusions Our experiences from this on-going international institutional collaboration to increase the capacity for training surgeons in Malawi show that long-term institutional collaboration in the training of surgeons in low-income countries can be done as a sustainable and up-scalable model with great potential to reduce mortality and prevent disability in young people. Despite the obvious and necessary focus on the rural poor in low-income countries, stakeholders must start to see the value of strengthening teaching hospitals to sustainably meet the growing burden of trauma and surgical disease. Methods Annual operating data from Kamuzu Central Hospital’s Main Operating Theatre log book for the years 2008–2014 was collected. Observed annual numbers were presented as graphs for easy visualization. Linear regression curve estimations were calculated and plotted as trend lines on the graphs

Africa's quest for food security : what is the role of urban agriculture?

The history of urban agriculture in Africa dates to the colonial era when farming flourished in urban areas, largely to meet consumption needs of bureaucrats, settlers, and other elites. Today, urban agriculture is becoming increasingly significant as a source of household food, a trend that is closely linked to declining incomes of vulnerable urban households in the wake of neoliberal economic restructuring, high rates of urbanisation, and the need to serve an emerging niche market in African cities. Urban agriculture is generally viewed as a potentially viable policy response to the complex challenge of feeding a burgeoning mass of urban residents amidst decline in food production in rural areas. Also, recent concern regarding climate change and the need to reduce the environmental footprint that comes from transporting food over long distances has given impetus to the need for urban agriculture. The aforementioned notwithstanding, the balance of evidence from existing literature on urban agriculture indicates that the practice faces varying degrees of opposition from urban authorities and policy-makers, who generally underestimate its actual value and contribution to urban poverty and food insecurity. The apparent lack of political will necessary to promote African urban agriculture over the years is reflected in weak or absent policy frameworks over the years, resulting in an enormous capacity deficit. Policy makers and planners need systematic information for planning and managing capacity development centered on urban agriculture. Such a focus on urban agriculture will unlock its potential to address the growing urban demand for food and to alleviate urban poverty. Key words: Africa, food security, Ghana, livelihoods, Malawi, urban agricultur

Avascular necrosis of the femoral head in HIV positive patients-an assessment of risk factors and early response to surgical treatment

26 consecutive patients (37 hips) with avascular necrosis (AVN) of the femoral head treated surgically at our institution from 1999 to 2008 were reviewed . The aims of the study were to evaluate the risk factors associated with AVN in HIV positive and HIV negative individuals, and assess early response to total hip replacement (THR) surgery in HIV positive and negative patients. There were 15 male and 11 female  patients in total. The mean age for all patients was 47.1± 8.0 years  (range, 33 to 66 years). 12 patients were HIV positive, 11 patients were HIV negative and 3 patients had unknown HIV status. Excessive alcohol intake was the most common risk factor for developing AVN .15 patients (58%) had more than one risk factor for AVN and only 2/12 (17%) HIV positive patients had no other risk factor apart from HIV infection. There were no early postoperative complications in 34 arthroplasties in both HIV positive and negative patients. The aetiology of AVN seems often to be multifactorial, even in the presence of HIV infection. Early response to arthroplasty surgery in AVN of the femoral head is equally good irrespective of the HIV serostatus of the patients

Ward Round - Crocodile bites in Malawi: microbiology and surgical management

We present a case series of 5 patients admitted over 5 months to Queen Elizabeth Central Hospital who had sustained injuries from a crocodile bite. Three patients required amputation of a limb. The severe soft tissue injury associated with a crocodile bite and the unusual normal oral flora of the crocodile create challenges in treatment. Progressive tissue destruction and haemolysis are complications of such infected wounds. An antibiotic regime is recommended that covers gram negative rods, anaerobes and may include doxycycline, as well as the need to have a low threshold for early amputation. Malawi Medical Journal Vol. 21 (1) 2009: pp. 29-3

Providing surgical care in Somalia: A model of task shifting.

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Two 'transitions': the political economy of Joyce Banda's rise to power and the related role of civil society organisations in Malawi

This is an Accepted Manuscript of an article published by Taylor & Francis in Review of African Political Economy on 21/07/2014, available online: http://www.tandfonline.com/doi/abs/10.1080/03056244.2014.90194

Addressing Inequity to Achieve the Maternal and Child Health Millennium Development Goals: Looking Beyond Averages.

Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs

What Mismatch Challenges are there between What Teacher Education Institutions Teach and What is Expected at Work Place? Retrospective Views of Secondary School Teachers from Tanzania and Malawi Studying in China.

This study sought to establish what mismatch challenges, contradictions and tensions novice pre-service teachers faced as they started teaching in secondary schools in Tanzania and Malawi. Using the qualitative approach, through snowballing methodology, 19 teachers were interviewed using purposive non-random probability sampling in universities in Chin. These were students who had gone through pre-service teacher education and had been teaching in Tanzania and Malawi. All the participants had their first degrees in teacher education and were then studying in China. The results from their retrospective reflections revealed that these teachers experienced lots of perceived mismatches, contradictions and tensions as beginner teachers. The mismatches include different expectations between the schools and the college supervisors, difficulty to apply theories learned, and dissatisfactions with restrictions on the courses they were compelled to learn as education students.The study suggests that there should be a‘re-think’ about what happens to pre-service teacher education with reference to when novice teachers enter into teaching in order to help them smoothly ‘initiated’ and adapt to the teaching profession.