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Reports

Urology visit to Malawi, November 2018

Amsterdam December 2018

Dear friends,

After my six week visit to Nkhoma Hospital in July-September this year in which I was asked to assist in re-opening the surgical services at Nkhoma I returned home with mixed feelings. Nkhoma surgical staff had been reduced to one single clinical officer, nursing care was below standard and chances for improvement at short time were grim. In fact, according to my impression Malawi in general fails to cope with basic problems like population growth, water and electricity supply, healthcare and education.

It is therefore with great pleasure that I introduce to you my dear friend and collegue-urologist, Wim Meinhardt, who was willing to join malawikom in our effort to contribute to the build-up of urological services in Malawi. Read and enjoy his enthousiastic and interesting report.

Gert Jan Montagne

Urology visit to Malawi, November 2018

In Zomba General Hospital a clinical officer is responsible for the urologic cases many of which are referred from the southern part of Malawi. I visited this hospital for the third time. Government hospitals are not well stocked with equipment or medicines and are overcrowded with seriously ill patients. CT scanning is not available in Zomba and the laboratory facilities are rudimentary. The urologic interventions are limited to scrotal surgery and prostate operations for men who are unable to pass urine. In Malawi there are thousands of patients that have a urinary catheter for the rest of their lives, because surgery is not possible in the amount needed. In this context a visit of a urologist is mainly moral support of the clinicians confronted with a large number of patients. After discussions on problems such as how to deal with bladder cancer patients (palliative care), patients with urethral strictures (without urologic intervention in need of a catheter the rest of their lives) we made decision rules how to handle such cases. And of course we operated on the odd cases that were told to come to the hospital because of the urologist visit. Such as the 4 year old boy with the pelvic fracture and the prostate that was torn of his urethra.

It will be a long road before urology service in Malawi will be more than doing some prostate operations on the fortunate males with a catheter who happen to come to a place where this basic surgical procedure can be performed.

Mr Goche, c.o. responsible for urology, doing rounds
Mr Goche, c.o. responsible for urology, doing rounds

 

Climbing Nkhoma mountain.
Nkhoma has been a mission site for more than a hundred years. The hospital is 103 years old and has always been one of the better hospitals in the country. It provides service on many different fields of medicine. The compound is also the site of the presbyterian synod and the site of primary, secondary and even tertiary education. For several years malawikom urologist Gert Jan Montagne, locally known as doctor Phiri, has improved the urologic service to an extent that is rare in Malawi. The nearby Lilongwe Central Hospital (Kamusu Central Hospital) is the only hospital in Malawi with a fulltime (Cuban) urologist, his waiting list is > 2 years however. He refers patients to Nkhoma when he is informed that dr Phiri is around. On my second visit to the place many patients with urethral strictures were referred. Unfortunately the contrast medium for X-ray’s was out of stock, which made it more of a challenge than it normally is. The hope is that when Lilongwe will become a well staffed COSECSA urology training centre (expected to start in two years) the KCH-Nkhoma cooperation can be intensified and may result in a urological service which is more than ‘just’ relieving patients of their emergency problems. In the past cooperation between these two hospitals has been very successful for example in the eye department.

Nkhoma Nkhoma
The village is a beautiful place and the mountain is worth hiking. It also illustrates the problems the subsistence farmers and their family face.

Nkhoma Nkhoma Nkhoma

 

Climbing Nkhoma Mountain you come to these huts, where 1 family lives. After 15 more minutes a pond is reached, that is the only water supply of this family. The women have just finished washing clothes and the baby and will take water down to their house for cooking and drinking.

Nkhoma Nkhoma
I doubt if it was a student who was responsible for this gravity The top of Nkhoma mountain

In short the government hospitals are overcrowded and not well supplied. Cooperation between Nkhoma and Kamusu Central was fruitful in the past, especially in supplying the country with a good quality eye care. We hope that likewise such a cooperation could be established within the much needed urology care in this beautiful country.

Dr Wim Meinhardt, urologist.