Africa, Take II by Dr. Devang Patel

Two Docs in Lake Malawi

Patel is back.

I last stepped onto African soil 4 years ago with Eric in Uganda. And now Patel has returned to Africa to work with his med school buddy in Malawi.

Eric has been working with Pediatric AIDS Corps (PAC) since graduating from residency last summer and I’ve wanted to meet up with him ever since. As medical students in Uganda we were more observers than practioners. Now we actually have the training to do some good in this country. Malawi is one of the poorest countries in the world. There is one pediatrician employed by the government in the entire nation of Malawi. In contrast the Baylor PAC program employs 13 pediatricians in Malawi to provide HIV care. It’s a sobering thought to be sure. One of the physicians here described to me the breakdown of each medical school class in Malawi. The class starts with 30-36 students. 4-6 of them die of AIDS before completion of school. Another 4-6 are lost to poor academics. Half of the remainder will end up going abroad to complete their training and most do not return. That leaves only a handful of Malawian doctors in the country each year. This dearth of physicians is readily apparent in Kumuzu Central Hospital (KCH).

Children's Ward A

How do I describe hospital conditions at KCH in Lilongwe? Remember that this is the tertiary care referral center in the capital city of Malawi. As you walk from the Baylor clinic to the gates of the hospital, you catch a pungent odor that just may induce vomiting. Walking further you enter Ward C. 150-200 malnourished children along with their caretakers occupy this dingy, musty, dark room separated into bays. You smell sweat, feces, urine, vomit, and rotting food that cooks inside this concrete oven during the afternoon heat. And this may actually be an improvement to the adult ward where at least half the patients are laying in an outdoor corridor that runs the length of the building. There are obviously no private rooms here. 6-10 children die every day on the peds wards and the numbers are even worse on the adult wards. X-rays are often not performed because the hospital runs out of water at least 1-2 days per week. For the past 2-3 weeks, no CBCs have been performed because the lab does not have the necessary supplies. These are the conditions under which medicine is practiced KCH. On one particularly busy morning I discovered that I was the only physician caring for about 70 patients on the adult ward. Who would have seen those patients had I not shown up?

Dr. Eric McCollum + Translator in the C Ward

The physicians working for PAC in Malawi should be commended for the work they do here. They have all given up at least one year of their professional lives in the United States to come and tend to the children of Malawi. Eric, Saeed, Maria, Anjalee, Kebba, John, Jean, Amy, Nader, Ellie and all the rest serve as an example for the rest of us. They make a difference in the lives of countless children everyday. My brief experience here has shown me that the work can be tiring, frustrating, angering, and saddening but you always want to return the next day because you know you’ve made a difference.