How Providence supports family medicine training in Malawi

Sunday, April 2, 2023

[5 min read]

At Providence, the Global & Domestic Engagement department serves areas outside the U.S., including Malawi, a largely rural country in southeast Africa. Malawi has one of the lowest ratios of physicians to population in the world.
Since 2018, Providence has partnered with Seed Global Health and Kamuzu University of Health Sciences (KUHeS) to help advance global health equity in Malawi by supporting the buildout of a strong pipeline of family medicine physicians.
Since 2018, Providence has funded two U.S. physicians to manage bi-directional training rotations of U.S and Malawian family medicine registrars.

Health equity through partnership: Providence and Seed Global Health in Malawi

At Providence, we believe in health for a better world. And while we support critical partnerships in our local communities to improve health and well-being, our commitment extends globally, too. Each year, our Global & Domestic Engagement department (GDE) partners with communities beyond our borders, including in the southeast African country of Malawi.

Since 2018, we’ve developed a deep partnership with Seed Global Health (Seed) and Kamuzu University of Health Sciences (KUHeS). The partnership helps advance global health equity in Malawi. It focuses on supporting the work of KUHeS and the Ministry of Health through bi-directional clinical training and health system infrastructure improvements to build a stronger pipeline of family medicine physicians.

Addressing health care shortages in Malawi

In Malawi, there are only two physicians for every 100,000 people — one of the lowest rates of physicians in the world. This shortage of providers, along with poor access to health care, leads to countless preventable deaths each year.

Currently, most Malawian people access their health care services from primary care health centers and district hospitals. These facilities are designed for higher volumes of patients, but they often struggle with having enough trained staff to keep up with demand. Each facility needs, at a minimum, a pediatrician, an internist, a surgeon and an obstetrician. But, with the shortage of physicians in Malawi, most facilities either can’t afford to fill these roles, or the doctors aren’t available.

A focus on family medicine

One way the Ministry of Health is helping Malawi’s physician shortage is by focusing on developing a population of family medicine doctors. These physicians bring a versatile skillset. They can accommodate about 80% of the cases a district hospital might see. Not only can they treat cholera, but also help deliver babies during a difficult birth, diagnose COVID-19, administer vaccines and treat a broad range of medical issues.

Family doctors are known to deliver the best outcomes at the lowest cost with the greatest patient satisfaction — focusing on the person more than the disease. Research shows that family doctor-led primary health care teams, when well-trained and resourced, can help countries in Africa achieve Universal Health Coverage.

Learn more about how Providence is partnering to support the development of family medicine in Malawi. Listen to our live event: US-Malawi Exchange: Advancing Health Equity through Family Medicine.

Seed Global Health has developed a ten-year plan with Malawi’s Ministry of Health and institutions to train two family medicine doctors for each of the 28 district hospitals across the country. Through our collaboration with Seed and KUHeS, we support the Ministry of Health to build a growing cadre of family medicine physicians numerous enough to serve the whole country. In so doing, we all advance global health equity in Malawi- together.

To manage training of both Malawian and U.S. family medicine learners while mitigating burden to the local hospital created by hosting learners, Providence has funded two faculty members managed by Seed since 2018 — Anna McDonald, M.D.(Swedish), and Jacob Nettleton, M.D.(Healthpoint). Both Dr. McDonald and Dr. Nettleton spend four months of each academic year in Malawi to strengthen clinical training for Malawian undergraduate and postgraduate students at KUHeS, the only medical school in Malawi. Family medicine has existed for decades in the U.S. but is less than a decade old in Malawi. As more Malawian family medicine physicians graduate, local physicians will take over the training.

To further bolster local FM learning at the 500 bed, rural, Mangochi District Hospital, Providence funds up to 14 U.S.-based family medicine residents from our network to do four-week rotations there. These rotations simultaneously teach Providence Family Medicine residents about tropical disease and resiliency in a low resource setting.

By design, this program was always intended to be bi-directional: providing the reciprocal opportunity for Malawian Family Medicine registrars (residents) to come to the US for an immersive Family Medicine experience. Providence has done this since 2017, by co-hosting a six-week family medicine experience for two-three Malawian FM registrars each fall. The experience, called the Collaboratory, includes a four-week observational rotation through the Swedish Family Medicine residency, co-presenting at an international family medicine conference and earning a certificate from the UW Certificate in Global Health Leadership course. Seven of Malawi’s first Malawi-trained FM doctors have all come through the Providence Collaboratory program.

Family medicine program progress so far

Providence and Seed Global Health have made progress in transforming the way care is delivered for Malawians. Here’s what we accomplished together in 2022:

Set up a first-of-its-kind family medicine clinic at Mangochi District Hospital

Seed and its Malawian partners established this clinic, which is open twice a week. It’s staffed by family medicine faculty or post-graduate trainees (under faculty supervision).

Built a medical skills lab on Mangochi District Hospital grounds

Providence funded the construction of this lab. Here, over 200 learners per year can practice clinical skills in a simulated environment.

Provided new high-tech, low-cost technology and training

To increase clinical capacity at Mangochi District Hospital, Providence provided four Point of Care Ultrasound (POCUS) machines, and Seed provided an additional device. The devices allow for quicker diagnosis and treatment planning. Their portability means they are small enough to fit in a clinician’s pocket and that providers can use ultrasound in more remote areas.

Providence Global & Domestic Engagement also funded a training of trainers that will happen in the spring of 2023. It will focus on training 30 registrars and clinicians on how to use the POCUS technology. They will each train another 20 clinicians. Having both the technology and the training will create a team of hundreds of clinicians who can use this game-changing technology.

Future-focused and beneficial for all

The dream of this program, which is already unfolding, is that while deepening the family medicine learning of trainees in Mangochi it also strengthens the U.S. residents’ care delivery skills for underserved populations in the U.S.

“No matter where I am, I can learn something, and I can teach something,” says Akosuah Agyei, M.D., a third-year Swedish First Hill FM resident, who attended the Malawi rotation in 2022. “That structure of how to be of service — there is something I can give and something I can learn.”

Third year Sea Mar Marysville-Providence Everett FM resident Pedro Ayau Aguilar, M.D., also attended the Malawi rotation in 2022, “I was really impressed by how the whole system is geared to treat very complex pieces. Even despite resource limitations, there were things they did very well. I learned a lot about HIV, malaria and other infectious diseases that I am not exposed to here as much.”

Our work has already started having an impact on health care in Malawi and in the ways that returning US residents see their patients and their career paths. The key to this success is investing in the health workforce. A well-trained, well-distributed and well-resourced health workforce is the foundation of any health system. By supporting providers, both locally and abroad, we can make a difference. And truly promote health for a better world.

At the end of the first Collaboratory, Malawian participant, Dr. Modai Mnenula said, “I have learned so much, but this program is not about me or any of the doctors: this is about our patients — the thousands who we will now be able to better care for and whose lives we will save. I am grateful to Providence and Swedish on behalf of these patients.” Dr. Mnenula is now the Associate Head of the Family Medicine Department at KUHeS.

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