International Child Health Section: Articles
Ngodzi, Malawi 2007
Submitted by Vishal Avinashi
From both an educational and a personal point of view, I was most pleased with my recent international elective experience in Malawi, the “Warm Heart of Africa.” The one month elective was based in an outpatient clinic in the friendly fishing village of Ngodzi. My short clinical experience likely did not result in any significant changes within the country or even the village, but in being realistic, a short experience serves more to shape the learner as opposed to his/her surroundings. The experience took me outside my usual comfort zone and resulted in my feeling more skilled, adaptable and certainly more appreciative.
The humble set-up of the Ngodzi clinic lacked the usual infrastructure of a western tertiary care centre inclusive of diagnostic imaging, laboratory services and subspecialty support. What it did have is a hard-working team dedicated to offering the best possible care within their given resources. Relying on histories and physicals is what allowed the clinical officer and the four nurses to get through the usual 250-350 patients per day. I have gained tremendous respect for the nurses who work in an extended capacity, not only prescribing but performing procedures such as suturing, conscious sedation and incision and drainage! The harsh reality is that the country of more than 10 million people is functioning with fewer than 150 physicians, so ALL help comes greatly appreciated.
In the local context of twenty five per cent of the clinic population being HIV positive and malaria being the diagnosis to rule out, cases termed “bread and butter” became greatly redefined. There was much irony in that the sickest patients presented to the outpatient clinic instead of to the regional hospital. This was a result of the clinic being the region’s ARV distribution centre and being the only nearby facilities with reliable pharmaceutical stock beyond Quinine and Paracetamol.
The Malawian people were amazing. One very memorable moment helps illustrate the kindness of the locals: At the end of the day after an outreach clinic, I was thanked emphatically and sincerely by a local farmer for visiting the region and providing services. It was later that I was informed that this local gentleman had walked several kilometres from his neighbouring village, waited in the sun for more than six hours, only to be told that he would not be seen that day and to come back the following week when the outreach team would return.
A few of the ways the clinical experience has been beneficial include gaining exposure to a new variety of conditions and circumstances as well as building confidence in my previously acquired knowledge and general decision making. Although I encourage others to do an international clinical elective, I fully appreciate and recognize the limitations of acute clinical medicine without empowering the local people and addressing the underlying social causes for the medical problems.
Posted: June 2007
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