Abstract
There is a significant lack of surgeons in the developing world. Malawi Africa is one of the poorest and medically underserved countries in the World, with surgical care particularly lacking. Providing surgical services has numerous barriers, such as availability of well-trained surgeons, infrastructure, continuity of care, and access to care. There is currently one otolaryngologist in Malawi who provides complete access to this subspecialty. The development of the otolaryngology department was successful through institutional, local, national, and international collaboration, with a long-term goal of sustainability. An established department can train the next generation of surgeons for the preservation and growth of the surgical workforce. Once the department approaches independence, the role of outside collaboration transforms primarily from financial to a bi-directional partnership encompassing education, training, and leadership.
More than two-thirds of the world’s population lacks access to safe, timely, competent, and affordable surgical care, leading to significant morbidity and preventable mortality. One of the poorest and medically underserved nations based on gross domestic product and physician density is Malawi, Africa. 1 Public health challenges are compounded by poor access to medical care, with an estimated physician density of 0.02 physicians/1000 population (United States: 2.45 physicians/1000 population). 1
Providing health care in a country with limited financial resources and a significant rural population creates many challenges. Regardless of location and economic status, sustainability within a health care system is imperative for both short- and long-term health care goals. A sustainable health system is affordable, acceptable to patients and health professionals, and adaptable, resulting in a healthy populace who is provided superior and just health care. 2 The framework for identifying and responding to limitations within a health care system has been well described. 3 Collaboration at the institutional, governmental, and global level assists with managing these constraints and allows the system to trend toward sustainability.
Infrastructure is often the first hurdle to overcome toward providing health care to a new region. There is one practicing senior surgeon providing otolaryngology care in the country of Malawi; upon his arrival, there was little infrastructure for consistent otolaryngology surgical care. With a goal of eventual sustainability in mind, the appropriate infrastructure required for an otolaryngology practice was built, through institutional, local, and international partnership. The next step in long-term sustainability is the training and education of staff. Due to the high quality of otolaryngology care being delivered, a residency program through the University of Malawi College of Medicine was recently developed. Training residents in-country increases the probability these residents will remain in Malawi or the surrounding area, thereby providing otolaryngology care to new locations. 4
Once departmental stability is achieved, global collaboration need not end; though the focus of the union may change. Bilateral mentorship through relationships developed during humanitarian efforts is mutually beneficial. Participation in international short-term medical service trips is often not considered cost-effective; however, humanitarian outreach effectively improves cultural competence and attitude toward leadership in those who participate, which increases the desire to contribute to future volunteer-based programs. 5 Visiting surgeons provide valuable didactics, educational material, procedural training, ancillary staff training, and the ability to perform more advanced surgical procedures.
In conclusion, independence, sustainability, and the education of future providers must be achieved for continuity of health care. The otolaryngology department in Blantyre, Malawi is an excellent example of how institutional, local, government, and global collaboration generated sustainable, long-term, subspecialty surgical care. This philosophy of collaboration with a goal of sustainability should serve as a model in both the developing and developed worlds.
