Surgically-treatable conditions kill close to 17 million people each year, and worldwide, five billion people do not currently have access to safe surgical care and anesthesia. In low- and middle-income countries, 9 out of 10 people cannot access even the most basic surgical services.
Dr. Bela Denes, a general surgeon who has been teaching in Malawi for the last year, is dedicated to closing the gap in safe surgery and saving lives. As a Seed Global Health Volunteer, Bela has been teaching young medical students at the University of Malawi, College of Medicine, equipping them with the essential skills to perform lifesaving surgeries, even with limited resources.
We asked Bela to reflect on his time as a surgeon and educator in Malawi and share his thoughts on improving access to safe surgery.
What are the biggest challenges facing safe surgery in Malawi?
The biggest challenge has been the lack of resources. We often do not have appropriate antibiotics, adequate drapes to create a sterile field. Additionally, we often have to operate without adequate stores of blood for resuscitating the patients. Operating room staff – surgeons, anesthetists, nurses – all want the very best outcome for the patient, and want to uphold best practices, so we do the best we can.
A small example is the use of chest tubes. Placement of a chest tube is a simple procedure that saves lives when someone has a pneumothorax or hemothorax from trauma. But unfortunately, our hospital, Kamuzu Central Hospital, has not had chest tubes in stock for months. We have improvised with resources we do have on hand, and while we are doing our best, the outcomes are not optimal because of the lack of resources. People have died because the hospital ran out of appropriate sutures required for a given operation.
What is essential to improving access to safe surgery?
I have been amazed at the skills of my Malawian surgery colleagues. They can do so much with so little. But safe surgery requires an investment in appropriate resources. We need adequate surgical resources to provide the best care for our patients.
What has been your proudest moment during your year of service?
The highlight of this year has been working with the surgical registrars, doctors who have completed medical school and are completing their specialty training. They are a bright group of young surgeons. This year, three of the registrars sat for their College of Surgeons of East, Central and Southern Africa (COSECSA) membership exam. It is an oral exam given annually that is fraught with a lot of anxiety and a low pass rate. The registrars studied diligently for this exam, and I was able to help them prepare with weekly tutorial sessions. All three of our residents passed the exam.
Additionally, I have had the privilege to work with Dr. Vanessa Msosa, a senior registrar. Over the course of the year, she has flourished in the development of her surgical skills and decision making. A small example has been working with her to perform inguinal hernia repairs with mesh, which she is now capable of doing independently. She will be a great asset to Malawi, when she finishes her training. I am so proud that I was able to work with her.