Stories from the Road: Blantyre, Malawi

Steven R. Engebretsen, DO

Steven R. Engebretsen, DOThe Madgy Malawi Foundation is a U.S.-based nonprofit that aims to support the local training program in Blantyre, Malawi. The original invitation to start a surgical mission experience was organized through Michigan State University, which has a long-standing relationship with Blantyre, Malawi. It was through these connections that David N. Madgy, DO, a U.S.-based otolaryngologist-head and neck surgeon, partnered with Wakisa Mulwafu, MBBS, FCORL(SA), the only local otolaryngologist in Blantyre.

In 2019, Dr. Mulwafu was able to start formally training local physicians. After Dr. Madgy’s passing, the mission trip grew into The Madgy Malawi Foundation in 2021. The goals of the Foundation include primarily supporting the local residency training in Malawi. The Madgy Malawi Foundation’s ongoing expertise on complex patients, support for infrastructure and training, and collaborating with other surgical mission groups improves the educational breadth of Malawi-based trainees.

Bo Pang, DO.The training model in Blantyre is to train local otolaryngologists to stay in the country or the surrounding countries of need. The local residency is sponsored through the University of Malawi College of Medicine and the College of Surgeons for East Central and Southern Africa. Through the expansion of the Foundation’s existence over the past few years and the efforts of those in Malawi, there has been an entire unit built at the Queen Elizabeth Hospital in Blantyre dedicated to ENT care. One of the recent graduates of the otolaryngology residency program in Blantyre, Tabeh Freeman, MD, has returned to his home country of Liberia with hopes to one day do exactly what Dr. Mulwafu has done in Malawi. 

Map of Malawi and nearby Blantyre.

About Malawi and Otolaryngology

Malawi, as it is known today, did not become independent from Great Britain until 1964. Since that time, there have been many sociopolitical changes in the country. Malawi was widely affected by the HIV/AIDS crisis due to a lack of resources, education, and medical access.

Otolaryngology care in Malawi is in high demand because of the overall low access to medical care in the first place. According to the World Health Organization’s most recent assessment, there are only 0.49 physicians per 10,000 people in Malawi, which is one of the lowest on the continent. Blantyre is the only location in the country that provides consistent surgical ENT care. All patients in the clinic and most of the otolaryngology inpatient unit are walk-in only. In the early hours of the day, there are crowds lined up.

Many of these patients’ only mode of transportation is walking. Some walk for days to obtain care. The conditions vary from pediatric respiratory disorders and diseases to stage 4 cancer. Some still cannot be treated because of the complexity of their care and the limited resources regarding chemotherapy, radiation, or even diagnostic modalities. Despite the challenges they face in coming to the ENT unit, the friendly and patient attitude is common among the people treated in Blantyre. This is perhaps why Malawi has been deemed the “Heart of Africa” for the warmth of the people.

“The need is eye-opening, but taking care of patients in such need one by one provides some of the most rewarding experiences in my professional career. Continuing with the program brings me much more than I give!”

– Kyle Robinette, DO, CEO, The Madgy Malawi Foundation

The Madgy Malawi Foundation and the Experience

The 2022 Malawi team. Dr. Wakisa Mulwafu is the third from the left.The Madgy Malawi Foundation currently leads two mission trips per year. Those in the traveling group have included subspecialty-trained head and neck, otology, and pediatric otolaryngologic surgeons. Additionally, three to six trainees in their senior years of residency or fellowship attend. The addition of highly skilled certified anesthetists and other support staff make the trip possible. The staff locally in the OR support the surgeries and are willing to both learn and teach.

Shant A. Korkigian, MD, a head and neck surgeon based in Michigan, started with The Madgy Malawi Foundation in 2022 and describes his impressions returning to Malawi with the Foundation after working as a medical student years prior. “It is so impressive to see what a difference The Madgy Malawi Foundation made with the help of Michigan State University. When I came as a medical student (before the organization existed), there was no public dedicated ENT facilities for nearly 20 million people. Now, where once a football field stood, there is a fully operational ENT clinic, inpatient ward, and operating theater!”

Jake Sims, DO, working with one of the Malawi-based residents.Landing in Blantyre, the group is immediately met with the host physician Dr. Mulwafu and his staff. Thanks to the generous donations of prior patrons, there is a guest house adjacent to the ENT ward where the visiting trainees stay. This guesthouse allows the residents to frequently work with the staff and do both early morning and evening rounds on all the ENT patients in the ward, usually about 25-30 patients. A lead visiting resident is designated to work with the Blantyre-based chief resident or managing staff to arrange the OR schedule, coordinate care, and distribute team members for surgical cases. Passing out candy, toys, stickers, and coloring books is also one of the favorite activities between cases.

Dr. Mulwafu is the local champion who makes the collaboration with the local hospital and government possible. His knowledge of conditions and experience show the many years he has been caring for challenging patients with limited resources. It is obvious that his trainees glean as much as they can from his mentorship. He also is instrumental in coordinating what his trainees want to learn from visiting surgeons such as those in The Madgy Malawi Foundation.

At the conclusion of the trip, the visiting staff continue to engage in daily updates/recommendations on the cared-for patients. The involvement of Dr. Mulwafu and the staff in Blantyre makes this a truly bidirectional learning experience.