ENT - September 2020 - 501

Editorial

The Creation of a Sustainable
Otolaryngology Department in Malawi

Ear, Nose & Throat Journal
2020, Vol. 99(8) 501-502
ª The Author(s) 2019
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DOI: 10.1177/0145561319855366
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Nathan Douglas Vandjelovic, DO1 , Eric Masao Sugihara, DO1,
Wakisa Mulwafu, MB, BCh, FCORL(SA)2, and David Nathan Madgy, DO3,4

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.
Keywords
Malawi, Africa, sustainability, humanitarian outreach, otolaryngology

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
1

Department of Otolaryngology, Head and Neck Surgery, Detroit Medical
Center, Detroit, MI, USA
2
Department of Otolaryngology, Head and Neck Surgery, University of Malawi
College of Medicine, Blantyre, Malawi
3
Department of Pediatric Otolaryngology, William Beaumont Hospital, Royal
Oak, MI, USA
4
Pediatric Otolaryngology, Michigan Pediatric Ear, Nose & Throat Associates,
West Bloomfield, MI, USA
Received: May 10, 2019; accepted: May 15, 2019
Corresponding Author:
Nathan Douglas Vandjelovic, DO, 3901 Beaubien St, Detroit, MI 48201, USA.
Email: nathanvandjelovic@gmail.com
https://www.sagepub.com/journals-permissions https://www.doi.org/10.1177/0145561319855366 http://journals.sagepub.com/home/ear https://www.orcid.org/0000-0001-5509-7995 https://www.orcid.org/0000-0001-5509-7995
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