AAO-HNSF Humanitarian Travel Grant Report: Malawi

Ian D. Bowers, DO, MBA, Chief Resident Otolaryngology-Head and Neck Surgery
McLaren Oakland Hospital, Pontiac, Michigan

Dr. Bowers visits with his patient on postoperative day one following a superficial parotidectomy.During the stress of residency, it can be easy to lose sight of the big picture. We have to take time to remind ourselves of how lucky we are to be able to learn these skills and how being a competent and caring surgeon can change the lives of the people we treat. One of the best ways to put this in perspective is through medical humanitarian outreach trips. Ever since starting medical school, I had always dreamed of taking part in such a profound experience.

Dr. Bowers working under the operating microscope to repair a stenotic ear canal secondary to an accidental auricular avulsion.Malawi is one of the most impoverished nations in the world. According to the World Bank, it has the eighth lowest gross domestic product (GDP) in the world and relies heavily on a rural population working mainly in agriculture. Health outcomes are poor, with the life expectancy in 2020 estimated at 65 years and only one doctor for every 20,000 citizens. This stems from a high rate of HIV and other infectious diseases and little access to clean water and proper sanitation services. This creates a situation of extreme need, where a little can go a long way. The Madgy Malawi Foundation was created to help provide the needed expertise of otolaryngologists for this community.

As a PGY-5, my responsibilities included screening patients to assess their need for surgery, performing surgical procedures under the supervision of board-certified otolaryngologists, providing immediate post-op care, and helping to provide education to the local residents who assisted in the outreach trip. Prior to the trip, I helped in the organization process and collected supplies from local hospitals and vendors. This process was a great learning experience in and of itself.

Dr. Bowers meets with a pediatric patient suffering from recurrent respiratory papillomatosis and his mother to discuss the procedure.For some patients the pathology was readily apparent: a large necrotic neck mass or a massive goiter. Others were more difficult to see. I was introduced to a two-year-old child who, on closer inspection, was actively stridulous. His disease was progressive, and he could no longer participate in active play. On his day of surgery, direct laryngoscopy revealed extensive papillomas obstructing his airway, which is a common finding with recurrent respiratory papillomatosis. Using the skills I learned in residency I was able to clear his larynx of disease and open his airway once more. Following his recovery, I witnessed him running around with the other children with a smile on his face. This case was a perfect example of how much good can be accomplished by medical outreach trips and how gratifying an experience it can be for a resident physician.

Dr. Bowers excising respiratory papillomas in a pediatric patient.I'd like to thank the AAO-HNSF for its generous humanitarian travel grant that made this mission possible. It provided an unparalleled learning experience and gave me a much-needed motivational boost as I approach the end of my residency. I hope the Academy continues to provide these grants in the future so residents can continue to participate in humanitarian outreach trips.